Dave Monahan is the CEO of Kleer, is an advanced, cloud-based platform that enables dentists to easily design and manage their own Membership Plan and offer it directly to their patients. Kleer is turn-key and free to implement. Kleer’s mission is simple: partner with dentists to increase the value of their practices by making dental care accessible and affordable to everyone.
Dave has a passion for creating technology-enabled businesses that improve people’s lives. Prior to joining Kleer, Dave served as the President and CEO of FitLinxx, a leader in the wearables market, where he created simple, affordable and connected wearable devices for the medical and sports markets. FitLinxx devices enabled patients to monitor and manage chronic conditions and athletes to monitor and improve their performance.
Dave is a graduate of the Pennsylvania State University and Loyola University, and resides in the Greater Philadelphia area. Dave is married and has 3 children, ages 12, 14 and 16. When Dave is not coaching his kids’ teams, he finds time to exercise, travel and play any sport or competitive activity that he or his friends can dream up.
VIDEO - DUwHF #1015 - Dave Monahan
AUDIO - DUwHF #1015 - Dave Monahan
Listen on iTunes
Howard: It's just a huge honor for me today to bring back Dave Monahan of Kleer. Kleer is an advanced cloud-based platform that enables dentistry to easily design and manage their own membership plan and offer it directly to their patients. Kleer is turnkey and free to implement. Kleer's mission is simple. Partner with dentists, increase the value of their practices by making dental care accessible and affordable to everyone. Dave has a passion for creating technology-enabled businesses that improve people's lives. Prior to joining Kleer, Dave served as the President and CEO of FitLinxx, a leader in the wearables market, where he created simple, affordable and connected wearable devices for the medical and sports market. FitLinxx devices enabled patients to monitor and manage chronic conditions, and athletes to monitor and improve their performances. Dave is a graduate of the Pennsylvania State University and Loyola University and resides in the Greater Philadelphia area in Wayne, Pennsylvania. David is married and has three children, ages twelve, fourteen and sixteen. When Dave is not coaching his kids' teams, he finds time to exercise, travel, and play any sport or competitive activity that he or his friends can dream up. Guess what the new sport is in Ahwatukee that's going crazy?
Dave: I don't know.
Howard: What do they call it? Pickleball?
Dave: Pickleball. I've heard of it. I don't know it.
Howard: Oh my God. They, I mean, it's just gone from nothing to everything in Ahwatukee. You know how crazy it is. It’s hard to get anything done with the government. They just announced they're going to build like a $100,000s of pickle courts at our local city park here in Ahwatukee.
Dave: Is that like tennis?
Ryan: It's like tennis for old people. The courts are smaller.
Howard: Oh, don't say tennis for old people, Ryan. Come on Ryan, just because I'm fifty-five. So Dave, I brought you back because my buddy who wrote the book, ‘The Four Horsemen of Dentistry’, he's talking about that. It's kind of a perfect storm. You have a huge increase in the number of dental graduates. Indemnity insurance has gone. It's all gone to PPO and the average fee is about 42% lower than their fee schedule. And then, inflation every year, a solid 2%, and that's just according to the Fed. And the Fed is, in my opinion, notoriously fudges their numbers. For instance, I'll give you some examples they do. Dwellings. There's three hundred and twenty five million Americans, they live in about a hundred and fifty million dwellings. As apartment prices went up, they kept them stable, showing no inflation because they factored in that the apartment was bigger. And when you look to that bigger, they didn't go with square footage. They went with volume because the ceilings, when we were little, all those ceilings were eight-foot-high, nine foot high. Now those apartments ceilings can be vaulted ceilings and it's like, really, dude, you're increasing the volume metric of an apartment. So the Fed, in my opinion, has notoriously done every accounting trick known to man to do their job, which is to counterfeit money while holding inflation stable. I'll give you another example. You know, right now the average new car in the United States is thirty-three thousand. Well shit, when I got out of high school in 1980, the average new car was ten thousand. But you look at the Fed number, there hasn't been a 300% increase in autos from 1980 to 2018, but there has been a 300% cooking of the numbers, so they massage the numbers. I have so many friends that are doing what you're doing and they swear by it. Some of them are my classmates from Casey Dental School, class 87, where they're just saying that this is the bomb. So what's up? What's changed since the last time you came on the show?
Dave: It did. Just to emphasize first, thanks for having me on the show. Just to emphasize your numbers, I'm not sure if you've seen the Breece Report, basically the ADA showed that average dentist earnings have not changed since 1997. That's over twenty years. So without all that inflation happening, the earnings have remained flat.
Howard: Where did you get that number?
Dave: It was from the ADA.
Howard: Did you have a link to it or anything?
Dave: I can send it to you after the broadcast.
Howard: Send me the link, howard@Dentaltown.com. And if you're listening to show, send me an email telling me who you are, where you live, how old you are. I like to know who my homies are.
Dave: The market itself, the dental market is growing 70% in that timeframe. So the market's growing but dental earnings have remained flat, which is pretty amazing. I've never seen it in and out of the market. So to come into your question about, you know, what will be an uptake. So the last time I was on, it was back in, I think, the beginning of January and we had just launched our program, Kleer ,and we had just gotten to what we're calling our pilot phase, and we had about thirty, forty dentists on the platform at the end of last year and we were just basically testing the system, making sure it worked well, it provided the value the dentists were looking for and the pilot went very, very well. So, we released it to the public just as we were broadcasting in January, and since then, just to show you the enthusiasm, we have about five hundred practices on the platform right now, about five hundred and a quarter, in basically 90 days. And the feedback we're getting is very positive both from the dentists and from the patients by the way. The patients love it. We just did a net promoter score, a rating system into the members and they've rated it a nine out of a ten-point scale. What they like about it is it's simple, it's easy to understand, it's affordable. There's no middleman, there's no complexity. Before I get to the dentist side, I just wanted to let everybody know the patients loved the program as much as the dentists. And then on the dentist's side, what we're seeing is they are on average across the country right now charging over $300 for the subscription for the membership and what that gets the patient is their two cleanings a year, their exams, their X Rays, there's an emergency exam thrown in there, so everything the patient needs in order to keep up with their hygiene twice a year. And then in addition, the dentists are offering discounts off of their normal fees for fillings and crowns and so on. And those typical discounts range from about 15% up to 30 % off of their typical fees. And again, it'll depend on which practice you talk about, but they all customize it based on their needs. So, the feedback from the dentist, they're keeping that subscription. That's not going to an insurer. They keep that subscription, and then they just charge the patient directly for those fillings and crowns. There's no paperwork, there's no pre approvals, there's nothing from a middleman-hassle perspective. So what dentists are getting is a nice profitable patient and to get rid of all the overhead and the admin needed to manage a plan. They're getting you more satisfied patients. The net is we're seeing them increase revenue and profitability and it eventually, as part of that, building a subscription business which is increasing the value of their practice. So that was a lot to throw in there. But that's what we've seen in the short time since we've launched the program.
Howard: The millennials are burdened with about 1.3 trillion dollars in student loans. Thirty percent of them are living with their parents and they say another 50% would live with their parents, if they could, but their parents are divorced, there's no room, et cetera. And we're seeing the death of brands. When these millennials go to Amazon and they see the big Duracell batteries and they're high price and they see these generic batteries, they're just buying generics all day long. And another heads up to you dentists out there. Millennials, not only are they the biggest segment of the population, now, they're also the biggest coupon clippers. They're using coupons more than my generation and the one before us, ever. And so they shop on price. And Delta Dental says 95% of the dentists take their insurance. And so that is a PPO. You can say 95% of dentists take PPOs, we think two thirds take three or more. And so when these price shoppers call the office, the dentist always quotes their cash fee. They'll say, well, how much is the crown? And they'll say, oh, a thousand dollars. They'll say thank you very much. And they hang up. And then I go and look at that. It's crown deals. And 90% of his crowns are done with Delta, like $650 a crown. So why are you telling everyone on the phone a crown's a thousand when 95% of your crowns are $650. So, the average reduction from fee to PPO is 42% and you're saying your members are discounting somewhere between 15 to 30%. They don't have insurance. You want to build up cash patients, yet you say you want to build up cash patients, but you're giving them your highest fee possible. A thousand dollars. So, do you think there's any benefit towards more a 15% versus the 30%? Because that's a 100% variance?
Dave: I think it just depends on the practice and what their philosophy is and how they position themselves. I was at the townie meeting last week with Chris Moriarty, who had a great presentation on behavioral economics and how you price and position products to the patient. And by the way, he told me to tell you that he needs more time at the next townie meeting. Looks like he wants two hours or three hours or so on the first presentation.
Howard: Just for the townie meeting. I mean, it was a whole new presentation.
Dave: And I just got to recommend everybody to go watch his stuff and talk to him. He knows this whole area. The net is practices that position on value and not just on price, we're actually seeing them towards 10% or 15%. We actually have one practice that’s given a 0% discount in their membership plan and they're not positioning this as a way to get bargain procedures. It's a way to get great value from the practice. And then we have other practices at the other end of the scale who are more about trying to get volume and lots of patients and they're willing to take lower margins for the patient. So what I tell the practices is, I think it can go either way. You can play either side of that spectrum, but know your patient base, know how you're branding your practice back to your patient base and into your local market, and then price your membership plan accordingly. It can be applied across different, what I would consider, brands and pricing strategies.
Howard: I feel like we're going way too philosophical and a lot of my homies listening to this might not even know what, what it is that you're doing. Can you backup a little bit and start with, how did you go from wearables to in-house dental insurance, and exactly what is your passion? What are the details of what you're doing?
Dave: I spent about ten years at Microsoft. Then I left there and started a wearables device company. And what we did was we were creating wearables that made it real easy for either a patient, like a heart patient, or somebody with congestive heart failure, who still want to monitor their body and do it in an easy way. So, we created a stick-on: basically, you put it onto your chest and would monitor your cardiovascular system and we also did the same product, but into the athletic space for people who are really trying to push their bodies and get a sort of elite-level athlete and monitor their bodies, understand how it's recovering after exercise, how they can push or pull back day in and day out. What that became, for me, it tied two of my key passions together. One is, I love technology. The other is, I love to help people understand themselves and improve their health. We sold that company back in March of 2016. We actually sold it to a medical diagnostics company and I was looking for my next thing to do and I ran into somebody who actually owned dental practices and I didn't know really anything about the dental market, besides I went every six months and got my cleanings, X-Rays, exams, and so on. But I started talking about the business side and he said it was really difficult to make a living. It was very difficult from a profitability standpoint and attracting new patients and locking in existing patients. He was basically blaming the insurers for a lot of it. I thought that was interesting. He also said he knew about half of consumers in the US never went to the dentist or go to the dentist on an annual basis. And that made no sense to me. I just assumed people were going. And so, I spent about nine months doing market research and we did focus groups, we did interviews, we did a national survey, both of patients without insurance and also of dentists. And what we learned on the dentist side, was that everything I had heard from that person was true, and they were struggling to figure out how you sort of reposition the practices to make a profit and grow and get away from the dependence on insurance. And then on the patient side, what we heard loud and clear was they wanted more dental care, and they also wanted a dental care plan, but they looked at insurance, and realized it's too complex, it's too costly. And if their employer wasn't subsidizing, they weren't going to buy it on their own. As I came out of that market research, I realized that tied back to my passion around one, applying technology into the healthcare space, and then improving and helping people get access to the care they want to improve their health. So that's where we created Kleer from. As far as Kleer is concerned, what we've created is a platform that makes it very, very easy for a dentist to create their own membership plan and offer it directly to their patients, getting rid of the middleman. Once a dentist will come on board, it takes about 15 minutes to set up a plan. We basically have a six step process. They walk through. It's all online. They pick and choose the options, they set their subscription rates. They create an office fee schedule. They can do things that exclude certain procedures. If they don't offer orthodontics, they can exclude that. They can do things like pick and choose between, do they offer monthly payments versus annual payments, or both. So on and so forth. There's lots of little options they can choose from. But it's very easy to set up to the plan. And then once they set it up, they have access to a portal and the portal basically enables them to invite patients into the plan. They can see what members have joined, what care plan they've bought, what has been deposited, the payments made by the patient, what's been deposited into their bank account, and there's all kinds of things they can do, but it allows them to manage the overall plan. And then on the patient side, what we have is a whole other application the patient uses so they can be invited to the plan by the dental practice. We also give the dental practice a little piece of code to put onto their website where a patient can click in and purchase the plan, but they can get access to the plan in multiple ways. The patient can purchase the membership plans straight from any device: their mobile phone, their tablet, or their PC. We make that a very easy process. It's very classic, what a consumer would expect when they go to purchase something, very simple, very nice UI, three step process to purchase the plan and they move on. Once they make the purchase, they have access to a portal as well where they can see the benefits that are part of their plan. They can add new members. Let’s say they bought it for themselves and they want to add a spouse. They can add a new member to their plan. They can invite friends and family. There's some incentives to do that. They can also print out a membership card and planning documents, everything they need. We have basically taken everything a dental practice needs to launch a plan, a membership plan, and basically made it very easy both for the dentist to implement and manage and for the patient to purchase and manage. And so the net of all of that from a financial standpoint is the patient is paying a monthly or annual subscription. If the dentist wants to, we collect the money all upfront if they want the patient to pay up front, or we collect it on a monthly basis, if they allow a monthly payment. That money is basically transferred to the dentist's bank account, all electronically fast. We have a backend merchant bank processing system that takes care of all that. The net is the dentist needs to do very little to manage the plan. It's all automatic and independent in the background.
Howard: What is the business model called, like Netify and Spotify used where they just ding your credit card every month or your life or your gym membership and what does that?
Dave: It is called a subscription business model.
Howard: When they do a subscription, what percent sign up for this subscription? The monthly, I mean. You earn your money monthly, you pay your bills monthly, it's hard to pay for a whole year up front. What percent go on the monthly subscription?
Dave: It’s interesting. We assume that most are going to select the monthly option. Just to give you the practice side, 75% of our practices offer the monthly option, but only 25% of patients actually select it. So, 75% of the patients are paying on an annual basis upfront, which really surprises, and it changes by demographics. So we looked at age groups and what they're doing. So about 80% of fifty-five plus pay upfront. They paid annual, about 20% of them select the monthly option. And then in the millennial space, almost 50% of millennials select the monthly option because they're on a tighter budget.
Howard: You said when they're fifteen and above or fifty-five and above?
Dave: Fifty and above.
Dave: Yeah, I'm fifty-five and I always thought it was crazy because that gives us senior citizens a 10% discount. Senior citizens are the only group that buys our houses and cars in cash. Their kids are gone. They paid off all their bills and these are the people you give a discount. You should give the stay-at-home mom with four kids the discount, not grandma and grandpa who will withdraw all the money they put into social security if it would have been invested in the S&P 500 index fund in three and a half years. And then they're going to go live the next 10, 15 years on borrowed money from their grandchildren. I think it's so funny when a grandparent comes and gives a newborn baby a little gift. It's like, dude, you should give her $60,000 of your debt that she's going to have to pay off in her lifetime, plus interest. So, now when they do the subscription revenue model, is that something that's terminated in 12 months, or is that in perpetuity?
Dave: They sign up for a twelve-month program. When we do the monthly payment by the way, we collect the first three months upfront just to make sure they're serious and they're not trying to game the system. The first three months comes up front and then the fourth month gets charged. When the fourth month comes around, they sign up for an auto renewal function just like Netflix and Amazon and the rest of them. So, they basically say, yes, I'm going to renew after 12 months unless I take the action to basically uncheck the auto renewal feature in the platform. And what we've learned is super protective. They're fine with that. They're used to that. They just want the ability to uncheck it if they decide not to renew it, but it makes renewal, when you think about it, a lot of practices out there right now have manual membership plans and what we've heard from them over and over again is the renewal is really painful. They had to go back out and they have to call the customer and the patient, they got to talk to them. They got to resell them, they got to get their credit card again. And the renewal rates when you do manual membership plans is very, very low. We actually had one come into our platform whose renewal rate was 20%. So, you're losing 80% of their memberships on an annual basis.
Howard: Did you ever talk to my Office Manager, Dawn? I know there were some emails after your last podcast. Did you ever call her?
Dave: I did not. We haven't connected.
Howard: Dawn just celebrated her 17th anniversary with me yesterday. I took her flowers and gave her a gift card. But email her Dawn@today'sdental.com, and cc me Howard@Dentaltown.com. And then, also, give her your phone number because I know she's swamped, she's always busy, but we never got around to the final details on that, and I want to see what she thinks of all that. America has got $323 million people. What percent of them do you think have dental insurance and what percent of them have to do cash?
Dave: The stats are about 60% of US consumers have dental insurance and 40% do not. Of that 40% that do not have dental insurance, roughly 40 to 50% of them actually go to the dentist. If you do the math, the typical practice has about 30%, 25 to 30% of their patients coming in and paying cash.
Howard: And it's a cultural thing. There's no dental insurance in South America. There's a new one starting in Brazil. But Asia, Africa, there's no dental insurance and in fact, when you're in China, it really hurts the dentist's brain to wrap his head around dental insurance. She's like, okay, so you eat chocolate and Coca Cola and then your boss subsidizes your fillings and the government pays for it. They think it's reversed incentives. A Chinese doctor had told me they think it's insane that insurance paid by your employer or your government treats the lung cancer that you got from smoking two packs a day for forty years. They call it perverted incentives, moral hazards. But when you're in the United States and the Western world, so many people who pay 100% for their house and their car and their iPhone just have a mind-block that you just can't pay for your own body. Someone else has to pay for your body. I'll pay for my Ford 150 and my ranch, but I ain't paying for my ten organ systems. That’s not my responsibility. It's a psychological thing when they call your office and then you offer them insurance and now that they have insurance and now they feel like they can go.
Dave: You’re absolutely right. And I could actually argue that the US does not have dental insurance because it's not really insurance. It just covers your cleanings and exams and x rays. You basically get discounts off of other procedures at the end of the day when you net out what insurance is.
Howard: Well, let's clarify that for the young kids because about 25% of the people sending me an email at Howard@Dentaltown.com are actually still in dental school. Insurance is an actuarial risk analysis versus the moral hazard of gaming the system. Everybody has fire insurance on their house and all what took either is eighty-five thousand people here. There's only been three houses that I'm aware of that burned down in my thirty years. So everybody pays a little, spreads the risk, three burned down. Same with car insurance. Everybody has car insurance pretty much. But how many people do you know sacked their car last year? In dentistry, there couldn't be any insurance because how do you spread the risk around when 100% need cleanings, exams and x rays and a cleaning twice a year? And they all eat sugar. No one flosses. There's no way to spread the risk around. So there's no such thing as dental insurance. There's only dental benefits and in the United States, about 92% of those benefits are paid employer-based and about 8% are paid government-based, no federal level. Medicare is at the state level. Medicaid. It’s only a dental benefit if you can get someone else to pay for it. So, what will you call this, because the government, your employer's not paying for this, the government's not paying for this? You're buying this, you're paying a set fee, $300 a year, and you're getting your cleanings, exams, and extra is free. And then the dentist is offering a 15 to 30% discount. So what do you call it? A discount plan?
Dave: I don't like to call it discount plan because there's discount plans out there and they act just like insurance. They negotiate fees with the dentist or they don't negotiate. They tell the dentist what fees to accept. And it could be a $39 cleaning, but you have to accept from a discount dental plan. And also discount dental plans take a fee up front from the patient so they'll take it, say $99 all the way at $199 in order for a patient to join, while the discount dental plan keeps that. We're way different than that and that subscription goes to the dentist. We don't keep that. I just like to think of it as a dental care plan that you offer directly to your patients.
Howard: A dental care plan. Now is it technically illegal to call this dental insurance?
Dave: It is officially illegal. So we actually went through a full legal review and one thing we have to do is state very clearly to the patient that this is not insurance. And we say that in everything that they get on and read. It says this is not insurance. Insurance, dental insurance, quote unquote is not insurance either. So, think about this for a second. What dental insurance does is it covers your cleaning, your X-Rays, your exams, and then you basically get a discount if you need major treatment or minor treatment, like a filling. You still pay. With most of these plans, 50% of that fee for a crown you pay whatever the number might be, maybe 60%. They all change, they're different, but it's not covering your catastrophic issues. It covers your needs day in and day out, which is your cleaning. So, it would be the equivalent of getting car insurance that covers your gas, or covers your wiper blades, sort of the standard maintenance. It doesn't make any sense. In a way dental insurance is saying I have a quote unquote catastrophic issue every six months, which is a cleaning that the insurance is going to cover. So, what's that done though is when you think about what you actually get out of these plans is your claims. You're actually using discounts, lots of other things, but you get this huge middleman in a way who's creating an amazing amount of paperwork and hassle when denying claims. They average about 20% of all claims are denied and they keep the premium. They don't pass that on to the dentist. If the patient happens to come in, then the dentist might get paid, but they get paid at a very discounted rate, like you mentioned, forty-some percent discount to their normal rate. We had this whole complexity in the middle between the dentist and the patient that is not needed. There's no insurance. And they're all capped. They cap your benefit at a thousand dollars and Fifteen hundred. Well just think if your home insurance kept the value of your home at $10,000. It doesn't make any sense, but they never changed it over twenty or thirty years. So, what we ended up having, in my opinion, is we have a system that just doesn't work. It doesn't work for the dentist or for the patient and it's not what it says it is. It's not insurance. It’s just cleanings and some discounts.
Howard: And that's why I was so disappointed with Obamacare. I love the good stuff from the heart, like no preexisting conditions, you can cover your kids on your own insurance to 26. I loved all that big-heart stuff, but, typical government, they never ever tried to figure out how to cut costs. And every expert I've ever read says that 30% of our healthcare cost is just shuffling paper. Look at Delta Dental. Steve Jobs came out with the smartphone in 2007. You would think Delta would have a damn app on their phone and when they come in I just pull up my app and the scanner and that updates all my information, all my plan. But no, I have to have a human call your human at the dental insurance company and sit on hold and listen to elevator music for thirty minutes. They're lowering our prices, but they're not lowering our overhead.
Dave: It's crazy.
Howard: I mean, if you would've just taken half the paper out of the healthcare system, the cost would have gone down 15%. But what he did got rid of no preexisting conditions. Great, love it. But the costs just went out of control.
Dave: Howard, we did a study of insurers. They keep about 40% of all payments made by you as the employer or the patient. So think about that. Forty percent goes to them.
Howard: Medical or dental?
Dave: Dental, dental.
Howard: So, insurance companies are keeping 40%? Forty percent gross revenue?
Dave: Let’s say the employer is paying half the premium and the employee pays the other half, or whatever the split is. That obviously all goes to the insurer. About 33 percent of patients with insurance never go to the dentist. They keep all of that premium and don't deliver anything. And then, on average, people with dental benefits come into the dentist one time a year. When you think about how the employer and the employee paid for two right into the insurance, they only came in once, the dentist gets one cleaning exam, X-ray, and maybe some other treatment. They provided that point, but that other half that was paid into the insurer for the next visit stays with the insurer. That never gets to the dentist. So, if you do all the math, and by the way, I can send you a link to this, the California Dental Association did a study of something called Dental Loss Ratio. And there's a thing in medical called Medical Loss Ratio. Medical Loss Ratio is a way for the government to control how much of medical insurance goes to care. And typically, what that metric said is anywhere between 80 and 90% of anything you put into a medical insurance plan needs to go to care. If it doesn't go to care, then the insurance company has to refund that money back to the whoever paid the premium. Dental insurance doesn't have that. But California actually did a study. They collected what they call the Dentist’s Loss Ratio for dental insurance. So they forced the dental insurance companies to actually report back to the association. And what they found was the range of funds getting to dental care varied from about 40% up to about 60% of actual money paid into the dental insurance actually went to care. They actually had a plan. They found one plan where 5% went to dental care. Now they're not giving the names of the different groups that…, what the percentage is by insurer. But it was pretty amazing. It actually validated our market research. If you average all that, it says about 50% of money paid into dental insurance goes to care.
Howard: And again, not only has Delta not done one thing with a smartphone, you know, it's really gross. Last week, did you hear about 911?
Howard: They just added the texting capability to 911. I've called 911 a few times over the last ten, twenty years, car wreck or something. And they're saying, well, can you give me a description of the car? I can Facetime my 80-year old mother, why can't I just Facetime you and show you the damn car, why am I describing it? And then if your house is broken in and you heard robbers downstairs, wouldn't you rather just be texting 911 than calling and having a ringtone and noise and all that, and then I'll be able to listen to what's going on. I mean the government is so incompetent and then they wonder why they've had an 11 % approval rating for two decades.
Dave: They're spending all their time arguing back and forth and you know, tweeting about things.
Howard: The only secret to lower prices is to lower cost. It's a four-finger rule. On every person that pitches me a dental idea, I always say: is it faster? Is it easier? Is it higher in quality? And is it lowering cost? And sometimes they only get one of those.
Dave: Chris Moriarty showed that in his presentation at the townie meeting. He had that slide.
Howard: They taught us at MBA school back in 1998. It's the four-finger rule. It's just got to do those things. So then how do you get paid? How do you make money?
Dave: We basically just take a piece of that subscription that's paid into the dentist. So, what happens when a dental practice sets themselves up on our platform is we actually create a merchant bank account for them. And that merchant bank account is with a company called Stripe and you can look them up there. They do the back end of Amazon and I think they’re eBay and a number of other technology companies use them. They've actually gotten very large, but they're an electronic merchant bank. We set up a virtual bank account for the dentist. When a patient makes a purchase, the money goes into that merchant bank account and it takes about 24 hours for it to clear and then it's transferred electronically over to the dentist's bank account, whatever practice account they want it sent to. We take a fee from that subscription and it averages. I won't get into all the details. The average is about $4 per patient per month on the platform. So we don't get paid unless the dentist gets paid and that subscription is active and being paid.
Howard: So what are my homies going to find if they go to your website? Kleer.com. By the way, explain the name, it's K-L-E-E-R, but it sounds like CLEAR. What is Kleer? Where'd that come from?
Dave: So Kleer came actually from our market research. What we heard both from the dentist side and the patient side was things are just too complicated and too complex, too many hassles, lots of exclusions and things like you can't get with a cap and you can only get so much treatment over a certain period of time. And so, we just said the major thing here is making very clear what is being offered by the dentist and what the patient is signing up for. So just get rid of all the mess, all the hassle and how opaque it is. It also had to do with pricing as well. One of the things that came back from the market research is that patients were typically overestimating dental costs by two to four times. If we asked them how much a cleaning is, the response would range from $100 to $500. We had patients actually quoting crowns at $4,000 and it was very consistent. They were way overestimated the cost, and so price transparencies are a really important thing to the consumer and actually it's a very positive thing for dentists. A lot of dentists don't want to show pricing to the patient. And actually, I encourage them to do it because 80% of the time they're going to ask you, you realize it's less than what they expected it to be. So Kleer actually has to do also with price transparency on the platform.
Howard: You have three kids?
Dave: I do.
Howard: You might know the answer to this question. Maybe you've already had a vasectomy. That's the only surgery I've had. Have you had a vasectomy?
Dave: A while ago.
Howard: So do you remember how much was my vasectomy?
Dave: I can't. I can't even guess. Five hundred dollars.
Howard: That's exactly what it was. But when you ask a woman that at a dental convention who does financial arrangements, to make your point that the patient over guesstimates the price two to four times, I say, how much was my vasectomy and there'll be like six women in the front row and the entry price will be two grand and one of the women will go all the way up to like eight grand. One thing that's really blown my mind is we were at the Sun's game, us four dentists and we drank too much and I was trying to make a point. So, we walked around the R aisle all the way around the Sun Stadium backdoor seats, and said, hey, we're dentists, we're just curious if you know, pointed to my front tooth number eight, I said, how much do you think a root canal cost on your very front tooth? The lowest price was $2000. And they’re routinely saying five, six, seven, eight. And then I was telling these dentists, what's even more strange is that in every zip code, say the dentist said they charge $1000 for a molar, but Delta is only paying them, you know, $650 or $700, but they're next door to a endodontist and the endodontist is charging $1,500 for a root canal. And of course, all the insurance companies will pay the specialists far more money, which is why you're seeing the business model changing these DSOs. They really need to have the general dentist just do general dentistry because they make so much more money. Having specialists rotate through the DSO because the general dentist does a root canal. They might only get $650 from an insurance company. But if they have a specialist come in and do it, they might be able to bill $1250 for it which is another thing - insurance is just throwing us under a bus. When we go to court or we go to the State Board of Dental Examiners and your root canal's four millimeters short, the endodontist grades it and says that is not acceptable and you can't say, well dude, you got $1,200 so you had the money to keep drilling all the way down the bottom. But I was drilling for oil and ran out of cash and stopped five millimeters short of the apex. Imagine cars. Imagine insurance only gives me ten thousand for a car, but they give the specialist twenty thousand for a car and then they're comparing my Ford Escort to the specialist's Ford Taurus. But when you get to court or the board, there's no market differentiation based on price. It's just standard of care. Which, by the way, every single malpractice attorney I've ever podcast gives a slightly different version of what even is standard of care. I don't think anybody really knows what it is, but I'll tell you at the bottom line what it is. When you go to court, the specialists are going to grade your work and they're getting paid 30% more revenue to do that damn same work. They could have all the latest, greatest equipment they can buy, more training. They only do one thing and you have to compete with that. So, the game just seems to be digressing. And I like what you're doing. You're trying to take back some ground. By the way, on your Kleer.com, your Facebook link works, your YouTube link works, your Instagram works, but your Twitter link does not work. I take that back. It just came on. The first time I didn't connect. The president of the United States! CNN praying times, only a million viewers out of now you can't say that a million people because it's a million homes, right? And then Fox News is three billion. Well Trump bypassed all of that because he had five million Twitter followers and that grew to ten, twenty, thirty, forty, fifty. So, he could send a tweet. On Facebook, when you make a post, it doesn't go to all your followers unless you boost the posts for money, but when you make your posts on Twitter, Instagram, or LinkedIn, it goes to all your followers instantly. So, the only secret to lower price is to lower costs. If you’re going to lower your social media costs, you get in bed with Twitter, Instagram, and LinkedIn because all of Facebook is pay to play. And that's also the reverse of who do you invest in? I've never given Twitter or LinkedIn or Pinterest a dollar. So I sure as hell wouldn't buy their stock. But you've given Facebook a lot of money and that stock’s done really, really well.
Dave: Until recently right?
Howard: I always liked to listen to people and when I was at a townie meeting I was asking not just dentists, but staff, all this stuff. And you know what the consensus is about all that stuff? They assumed ten years ago that transparency was dead. They already knew that now everybody has your name, your birthdate. You put your birthdate on Facebook and twenty people tell you happy birthday on your board. I said what do you think about that? You know what dentists were telling me? They say, when I'm doing a google search, if they have my history, they know what I'm looking for, it's better searches and if they take my data and serve me up an ad because they know that I'm… Say you're an avid elk hunter and you're always watching elk hunting videos on YouTube and there's some really cool ad about some new elk urine spray. You can spray all over. The bottom line is I don't think there's going to be any pushback from Facebook because its privacy died years ago.
Dave: I agree. I agree. People were sort of complacent to it and don't worry about it. But the issue I have with those business models, and Facebook's just one example of many, I think Google is similar. They have to make it much easier for somebody to understand what they're doing with that data and opt out and then change the services based on that. What I really don't like about those services right now, and this, by the way, long-term, will hurt them severely. If you look in a lot of different markets, if you're not honest and open and give people the ability to control what's happening to them, eventually somebody comes along and does that, and you know, upends your business model. I was surprised. I watched some of the Zuckerberg testimonial. I was shocked at how much he didn't know about what's happening with the data. He couldn't even explain where your data was going and who was using it. And here's one example that really scared me. One explaination was, if I never used Facebook before, but I'm in the contact list of somebody who is using Facebook, and they add me to Facebook, then Facebook now advertises to me. So, think about that right. Now hey've opened up the net to include people who opted out of Facebook and now I'm in their database and there should be some regulation around that. That if somebody hasn't opted in to be part of your platform, you shouldn't be able to store their data and use it as you wish. So that was a big issue for me - is how opaque it is. And even they don't understand, their CEO doesn't understand where the data's going.
Howard: Did you know his dad was a dentist?
Dave: I did, yes.
Howard: His mom's an MD. His dad's a dentist. They're just the greatest people. He comes from an amazing family. So I assume he's a really, really good guy. His dad tells me he’s a really good guy, but what I always think of, what I always feel sorry for Ed about is, I got four boys. Mark's only thirty-three years old. Could you imagine sitting there watching your thirty-three-year-old son getting grilled by congress. I bet Zuckerberg's heart is worse than mine at fifty-five. I bet he's eaten more stress in the last ten years. I bet when his alarm clock goes off in the morning he just wants to throw it through the window and go back to bed.
Dave: He showed amazing restraint in those hearings because they were asking him questions - the one question I thought was really funny was, they would go down a line of questioning of email being used on WhatsApp. There is no email on WhatsApp. It's just a messaging system. And he was constraining himself. Mark was constraining himself. He could have easily torn that person down and he let them continue with their discussion and he answered in a very polite way. The people asking the questions don't even understand what the products do. And that's what frustrates me as a parent. If my child was up there, I'd want to just tear into the people asking the questions. I'd say ask your question if you know what you're talking about. If you don't know what you're talking about, get somebody else. Don't ask it acting like you know what you're talking about.
Howard: The other thing I think is adoring about Mark Zuckerberg is his dad's a dentist who married an MD, and he married an MD. His wife Priscilla is an MD, he met her at Harvard. But I just think he's just in the fast lane. I just retweeted your last tweet, your, twitter is @Kleer_ llc. I just retweeted your last tweet to my twenty-five thousand homies. Thank you so much for following me on Twitter. Thanks so much for following me, for subscribing on YouTube, or youtube.com/dentaltownmagazine. I just retweeted your last tweet. Kleer comes with full version control that makes it easy to edit your membership plan and track changes, design your plan. And then there's the link. And the reason I'm telling this because they're driving the car. Eighty-five percent of the people listening right now are driving to work so they can't take notes. And by the way, we always make a transcript of this, so it's posted on dentaltown, because some people say they can read a one-hour podcast in twenty minutes. In fact, a lot of people are telling me they always listen to this at one point five. So right now, you and I probably sound like Mickey Mouse. With Kleer you can completely customize your membership plan. It's your plan after all, design your plan. But my next question is - is this available on an app? Do you use any app technology on the smartphone?
Dave: So, we actually have an app in development, but so far it hasn't been needed because we actually created the whole application to be mobile friendly, so you can pull up the app and it works just like a mobile app, you just don't have to download it. Once you join, you get a link to the portal and you can manage and use that from any phone, any tablet, any PC. It's a dynamic app that scales to whatever device you're using.
Howard: Well, you know, explain that because, it took us a year and we did it last year, making Dentaltown mobile friendly for the deal. And when you go to any of your homie's websites in dentistry, their app is not mobile friendly. In fact, I can't believe how many of them still have flash images. So, it just like a black hole on iPhone, but explain mobile-friendly and why a dentist should do that for their own dental website.
Dave: The answer to the question of why they should do it is about 80% of all traffic is going to come through mobile devices. So if you haven't optimized your app or your website for mobile, you're missing the majority of the market and it's actually very easy to do. There's some investment up front, but there's now technologies out there that we used to have to develop different applications for different use cases, so one app for a PC, another app for a mobile device and so on, and they weren't compatible. You doubled the price of your app development. Now there's technologies out there that are dynamic, so they understand what device they're being viewed on and they change their behavior based on that. So we have, we're a great example. We have one application and if somebody wants to try this and pull up our website, Kleer.com, they can pull it up on a PC, pull it up on a tablet and pull it up on a mobile device on their phone and you'll see it scales to that device and you get a good experience on the device you're using. It's one set of code so you don't have to do multiple coding. You do one coding and then, it scales to whatever device it's on.
Howard: Mobile is taking over everything. It's just amazing. When I was in high school, it was IBM and Mainframes. Even when I got out of dental school in '87, whenever you heard a conversation about a computer, it was IBM. And then about 85, the Microcomputer came out. Bill Gates wrote the software for the Microcomputer called a Microsoft and then it was that PC revolution. I can't even believe Dell is no longer even listed. I mean that was like one of the biggest stocks from '94 to March of 2000. It was Dell, Cisco, Microsoft and Intel. And now it's all smartphone. But I think what's also interesting about a smartphone is you can buy an IP address. When you log onto Dental Town, we know if you're on an iPhone or an android and, when you go above a city, they have aerial data maps. You look above LA, Beverly Hills, all iPhone. Then, the poorer areas are all android. At New York, lower Manhattan, all iPhone, and then upper Manhattan, all android. Dentists are pretty much all iPhone. They must be doing well.
Dave: We've seen our traffic as well. It's about 85% are iPhone and about 50% are android.
Howard: Say those numbers again.
Dave: It's about 85% are iPhone from the practice on the practice side and about 15% or something else. On the patient side it's about 50/50. And just real quick on the platform itself, we were surprised - we were thinking 75% of the patients would go to the front desk of the dentist and buy the membership plan and so there's an app, there's a little link inside the patient or the dentist portal where the front desk can add a patient and basically do the purchase process for the patient. So, we're expecting about 75% of patients to come through that way. What actually happened is 75% of patients are buying it off of their mobile device, which is great. So, the front desk sends them a link, they hit the link and they purchase it on their own or some practices actually have tablets in their office and they hand a tablet to the patient and the patient makes the purchase on their own or they go up to the website of the practice and there's a link there to buy the plan. What's great about that is it takes that burden away from the front desk. They don't have to enter those patients, but to your point, what really surprises is that's actually what the patients prefer. They actually - we talked to them - and they basically said, if I'm buying something, I like to keep it private. I'm used to doing it on my phone. I have no issue with that. They just follow through and get it done on their own. The power of the mobile device is you can actually offload some admin to your consumers.
Howard: Another thing that's frightening to me is all these DSOs cannot go public because all they're doing is a roll up. They'll go get a $100,000,000 line of credit and then they'll go buy one hundred offices doing a million dollars apiece. I go, look man, we went from zero to $100 million in sales. You also have $100,000,000 in debt and then you come back 10 years later, now they're $200 million in debt at two hundred million sales. So there's only three publicly traded dental offices that are actually profitable and none of them have a hygiene department. It's Three Hundred Smiles, and Pacific Smiles in Australia, and Q and M in Singapore. And I've done podcasts at all three of those owners. They said, I don't know how these American dentists do it. How do you pay a hygienist $40 to do a $55 cleaning when the ADA says your average overhead is 65%, but you say on your website that your membership plan can turn your hygiene department into a profitable subscription business? How's that?
Dave: The membership plan is a number of effects on the practice itself. I'll just go through these numbers and then get to that profitable subscription business. So, by charging on average on our platforms about $324 for a subscription, you're given two cleanings, two exams, two x rays, and an emergency exam. That's profitable business, right? That's a good profitable business. Much more so than an insurance plan or a discount, a dental plan. So, in addition to that, when a member signs up, they come in, a typical uninsured patient comes in once every two years. That's an average across the US. When he signed up for a membership plan, they come in about one point four times a year on average. So they increase their visitation by about three x. So, what you end up having is these members are coming in. They're getting their hygiene done, which is great. They're keeping that hygiene department moving and active and that subscription is profitable for the practice. But when they're in the chair, a member, somebody part of a membership plan will accept about 50 to 75% more treatment in addition to that hygiene when they're in that chair in a membership plan versus they’re uninsured and paying cash. And the reason is what we call the membership club effect. So, you know, I paid in - I'm committed to this. I'm sort of on the other side of the rope. I know I get discounts on all my other care. So I trust the practice more than if I'm an uninsured patient, paying cash and they're much easier. And this is not just true in the dental space, by the way, it's true across all industries. When you pay a subscription, you typically will purchase anywhere between two and four times more than somebody who's not paying into a subscription model. When you think about it, it's a double effect. One, you get that subscription, you create a profitable hygiene department, you get more treatment acceptance. You drive more revenue. The value of the practice from a profitability practice increases. And then one more kicker on top of that is when investors buy businesses, they will pay two to five times more for a subscription business over a non-subscription business because it takes the risk out of the cash flow of the business. So, we actually can show a practice, if they’re able to sign, and say they have 30% of their patients that are uninsured, let's say I can magically flip the switch and all 30% of those patients are now paying into a membership plan. And paying that subscription and coming in and getting that treatment and accepting more treatment, you would double the value of your practice fairly easily by just doing that. Not adding one new patient, just bringing these uninsured patients in, making a membership plan, having them come in for the visitations, have them accept treatment and care and paying that subscription. That would double the value of your practice.
Howard: Well, you know, on a large scale, the richest man in the world, Jeff Bezos, he says, his Amazon Prime members buy twice as much stuff as non-Prime members. It's why everybody thought Saul Price with Price Club was insane when he started his deal, he said, no, no, not anyone can just come shop here. You got to buy a membership and he's going to make it one hundred bucks because he didn't want all of the crazies coming in to buy one gallon of milk and one box of cereal...
Dave: It's a perfect example.
Howard: So, I would be like, come in, and get a big old cart and buy $400 for this stuff.
Dave: Howard, that's what we tell the practices. Don't give these free initial visitations. It's fine if you want to try to get some interest in from some people, but you're going to find the bargain hunters who are going to flip practices at a drop of a dime. Invest in a membership plan. You actually use it in a way as a filter for those who aren't going to commit to your practice. And what you're going to find is these patients that come in and buy the membership plan are the committed patients and they're the ones who want to basically get more treatment. They want to be part of the practice. They want to feel like they're being treated well. And it's a good way to create long-term value. We're not after short term value. We're not trying to flip a patient and try to get patients to come in and do one treatment and leave. We're trying to get them committed over many years to your practice.
Howard: I called it here first on the dentistry uncensored podcast a thousand days ago that groupon was a race to the bottom. Those people aren't loyal. You get a groupon deal, it says you go to this Mexican restaurant and you get all this stuff half off, and then they get the next coupon to go to the next Mexican restaurant. They're not loyal. It's a race to the bottom. And the thing that I'm trying to get dentists to quit talking about is the new patient experience. No, you should talk about everyone's patient experience and they're always trying to get new patients. But the mature fortune 500, they're all into loyalty programs. Chase credit card, Southwest Airlines, everybody who's the real deal like Costco and Sam’s Club and Price Club is trying to get you on a membership plan and they're trying to keep customers for life and the dentist is trying to burn and churn new patients and you say to this dentist, dude, you're in a town of 5,000. You got here when you were twenty-five, now you're sixty-five. Forty years later you still need new patients. Dude, you've gone through everyone in the county three times. Have you ever focused on quit burning and churning? If a hygienist works forty hours a week, fifty weeks a year, that's two thousand hours a year. That means she can see a thousand people for cleanings and exams twice a year. So, the average new dentist is getting twenty-five new patients a month. That means adding a hygienist every three and a half year, but that dentist has been practicing in there from age twenty-five to sixty-five. He only has one hygienist the whole time. If his hygiene capacity is not expanding, it's like it's like a cup of coffee. Could you imagine you're standing there for 40 years pouring coffee into the same damn cup, you know, every molecule going in is coming out, running down the side and I can't find a single dentist who does not accept new patients because it's a hard job to keep them in. You're not selling them chips and salsa and a couple of cheese enchiladas. You're giving them a shot, you're hurting them, you're drilling them. They might not like to way it feels. They might not like the way it looks. And that's not just you. They might not like you, your assistant, your hygienists, receptionist. There's so many emotional touch points. Plus my dad owned a Sonic drive-in. My God. Everybody that ever went to a Sonic drive-in you couldn't beat the smile off their face with a crowbar. They were about to eat a cheeseburger, a chili hot dog, onion rings, tater tots. I don't care what happened, they're just so happy. And then you go to a townie meeting. I was at a townie meeting, took my granddaughter to Magic Kingdom, everybody is so happy at Magic Kingdom and Sonic drive-in, and then why did we pick dentistry? They're all scared, they're all frightened. They're going to get a shot. They think it's going to cost two to four times more than it really is, and you need to switch from new patient marketing and the new patient experience to the overall total patient reality experience and you need to start doing membership programs and loyalty programs. I can't believe we're already past the hour. Hell, we're way past the hour, but would you consider this a loyalty program?
Dave: It is exactly what it is. That's exactly what it is. It's a loyalty program. It's basically inviting the patient into your practice and giving them what I consider extra care and you actually have them a lifetime. I look at it as a lifetime member of your practice. So there was a piece of this which is all the economic side and the procedure side, but there's another piece of this which is these are going to be your best patients. These are the ones you want to treat really well. We see this over time. We add things to this outside of just the procedures. They should be getting things like gifts from time to time. They should be getting extra treatment when they come in. People should be treating me special. When you think about airlines, when you walk up to get on board, they have one line for their loyal flyers and they have another line for the non-loyal flyers and I'm not saying we get that harsh about it, but the loyal patients should feel better about their experience and they should feel you care and there should be a flag in your system to say this person is committed to a subscription. These are the people we want to keep. And by the way, Howard, you said this, but, I can't find another industry that doesn't do this. Your current patients are by far the most valuable thing you have. They are by far your most valuable asset and especially the uninsured because they're willing to pay more than your insured, and you don't have all the hassle. The paperwork. Treat them like gold. Even if you don't do a membership plan, treat your uninsured and your cash-paying customers as gold. Do something extra for them. Make them feel good versus trying to go find a new patient that you know nothing about You're going to spend $500 trying to find that patient. And by the way, most of them come in and leave within a year. So stop throwing money into that whole. I'm not saying don't do it. You want to do it - you want to be smart about it. There are ways to do that that are more efficient. But, you have something right in front of you that's incredibly valuable. It could be worth two times what it currently is, which is your existing patients, including your dormant patients, by the way. Most of these dormant patients are staying away because of their fear of costs. A membership plan, by the way, is a good way to get them back into the practice. It’s amazing to me that the market, the dentist market, hasn't really focused on that and made that the number one priority to grow revenue.
Howard: And I'll just end on this note. For 30 years, I'll point to a patient's, maybe it's their only crown, maybe it's their only tooth, with a root canal and I'll say when, when did you have this root canal done? Who did it, was it here in Phoenix, back in Iowa? They never remember. Are you kidding me? Someone got in your mouth and did a root canal and you don't even know who it was, when it was? They never remember anything technical. They only remember if they liked you, how you made them feel. Blockbuster and the ATM machine are two classic business examples. Blockbuster had limited hours and it was replaced by Redbox. But the customer experience was different. There was no downgrade in the customer experience of going to a Blockbuster or a box, and that's what your team is doing. That's what your introvert receptionist, hygienist, assistant or dentistry dude. There is no difference between going into the bank teller or an ATM machine. You're just not connecting with them. You're not making them secrete Dopamine, Oxytocin, Serotonin. In every major business, the highest paid department is whoever answers the phone, inbound sales, whoever calls out outbound sales and dentists will get a cancellation and you know what he'll do? He'll go back in the office and surf Facebook for an hour instead of going up front, setting down on Dentrix, Eaglesoft, open that all and say give me a print out of names and numbers who fell off the recalls that aren’t coming in. Hey, Dave Monaghan, it's Howard Farran. I'm your dentist. You didn't even come in this year. What's going on, buddy? Because last time you were in you had mild to moderate periodontal disease, gingivitis. I don't want it to turn into something major. You know what's going on? They did do you, did you move? Did you know what's going on? You're like, I know, but your dentist is calling you, showing concern. But see the dentist is above outbound sales. So I'm not a salesman. I'm a dentist. That's what your hygienist says. She's back there with the cancellation back there, eating donuts for an hour and then your front office receptionist where they answer the phone. It sounds like a librarian and you just got to connect. And inbound sales is the most important person in that office is receptionist outbound sales. What I like to do before I go home or going to lunch or whatever, I'll go up there and say you need me to call anybody? And my Valerie might say, you know what? I talked to Dave Monahan for like 30 minutes and he didn't schedule and I'm not even sure why. So I'll call him back and Dave, hey, getting ready to go to lunch. Just talking to Valerie, she said she talked to you this morning for about twenty minutes when she feels like you still had more questions and she thought it was best that I actually talked to you. So what's going on buddy? And they're like, now the doctor's on the phone.
Dave: And he cares.
Howard: And he cares and he's connecting and then every single patient that leaves, I give them, I'll hold it up to you right now. This is my card that I give to every single patient I got. And you know what it's got on there. It's got my cell phone number, my dental office number, my personal email, @today'sdental.com. So, when some a number comes up on my iPhone and it's an area code for 800 number, I mean it's a 90% chance that it’s some patient and the dentists, when I tell them that they think that's a nightmare. They're like, I don't want anybody calling me. It's like, dude, get over it. You just want new patients for forty years because they can't call. I'm also very amazed that nobody ever calls and wastes your time. Every time they call you, I'm so glad they did because we're either having an emergency or they're upset or they think they're not coming back. And by the way, when they're upset and your dentistry failed and the crown you did fell off and every nightmare you can think of, it's never the tooth you worked on. You know, you'll go in there and do a filling on a tooth. It's brand-spanking new. Three months later a filling falls out. Well, I went to Howard three months ago, he did a filling. A filling fell out, that was your filling. Well dude, you got 32 teeth and you got 20 fillings in your mouth. So, I always take it with a grain of salt at and this is why my assistants hate me because they say, well, when can I come in? I always say whenever you want, what's a good time tomorrow? And I'm not, I don't know the schedule. They say, well how about 10:30? Perfect. I'll see you tomorrow at 10:30. And then of course I forget. So then at 10:30 though, they're all running back to me. Did you tell Mrs. Cranston she could just come down at 10:30? I’m like, yeah I probably did, I don’t know.
Dave: That's a good problem to have.
Howard: But Dave, seriously, I'm a big fan of yours. A lot of my classmates are big fans of yours. I think that we got to innovate our way out of where we're at. And I sure hope you can send me a link because when you started the program you said that general dentists' income has been flat from 1997 to 2018 yet dental revenues up 70%. I'd like to have the link to that. In fact, you should post that on Dentaltown and say, I just did a podcast with Howard and you should start a thread on that. I think that's amazing because that's what we're going to have to do that, that's what every great civilization society do. You can't get rid of your problems, you have to innovate and use technology and outsmart your problems. And the definition of success is that a year from now you have new problems. If you have the same problem a year from now, you're not working the problem. So, you know, my success of the President of United States, when he left eight years later, did we have a whole set of new problems or did we have the same damn problems that when he walked into office eight years ago, and I pretty much say that I probably have to live one hundred years before I ever get surprised by a president that actually leaves office, solving all their problems, now we're into a whole group of new problems. And it's the same thing in your dental office, man. Dude, if you got the same problem that you did last year and the year before and the year before, you're not working the problem, you know what you're doing. Read Tim Ferriss' book, the Four-Hour Workweek. You go in there and all you're doing is all your rituals and you're just working, working, working, working, working. You're never working on the business, you're just working in the business. And I know dentists have to wear so many hats, but dammit, you need to work on the business and I know what your problems are. We talk about them every day on my podcast, so just innovate your way out of your problems and Dave, I love your innovation. Thanks for coming back on the show.
Dave: Thanks for having me, Howard. I really enjoyed it.
Howard: All right buddy, have a rocking hot day. Thank you Ryan.