E1.13 | Effective Patient and Team Communication During and After COVID-19

Richie Guerzon: Hi everyone. We have a great guest today. Dr. Dressler. Dr. Dressler has over 35 years experience in private orthodontic practice. He currently serves on The Advisory Board of the American Teledentistry Association. He's also an avid entrepreneur in 2000. Dr. Dressler co-founded OrthoBanc LLC, a cloud-based automated accounts receivable platform that is currently serving over 4,000 Healthcare Providers and is doing over 450 million in sales annually.

OrthoBanc has made the Inc 500 5000 list five years in a row for being among the fastest-growing private companies in the U.S. In 1998. Dr. Dressler co-founded Elite Physician Services, a national health care patient finance company as CEO and chairman Dr. Dresser grew the business to 200 million in sales before it became the city health card in 2003. Welcome to the program. Dr. Dressler.

Dr. Keith Dressler: Thank you so much for having me, Richie. Glad to be here. And hey, for everybody out there, so I don't forget- Good Friday to everyone and happy Easter on Sunday. And for the Jewish audience, Happy Passover this past Wednesday. I hope everybody is healthy and safe and my blessings to you all.

Richie Guerzon: So I thought we'd start by talking about how Rhinogram came to be. Could you tell us that story, because I think it's a pretty interesting story.

Dr. Keith Dressler: It is a pretty interesting story. So back in 2013, and I want to sort of walk everybody back to that time frame. It was probably the first wave of millennial moms. Okay, and what I began to notice in my practice was that my employees, no matter if they were front desk or clinical, were getting texted by patients that knew them to do everything. My patients were no longer using the phone to call us to change an appointment. They would simply text whoever they knew within my practice and get them to do whatever it was and that included some really clinical Dentistry stuff. That's like a patient would be at the family dentist. They would see a panorex with wisdom teeth that might or might not be impacted and they would snap a quick picture send it to my staff because the dentist said hey, you ask the orthodontist that these need to come in or out and that patients simply wanted to do it instantly and to my knowledge, which, or my lack of knowledge it was going on and my staff were given recommendations. Like yeah, they need to come out. I wasn't seeing the x-ray they all of a sudden had their DDS degree, I guess. I wasn't seeing it. Yeah, they were just you know doing what they normally were doing. And for those that did not have contact to any of my staff members with their cells. They were getting on my Facebook business page under messenger and sending in all kinds of questions and things and again in those days messenger did not come with notification. So unless somebody was manning the page, then nobody knew that it was in and literally it was days, weeks, months before we would get back to him before we were delivering.

Richie Guerzon: and they're just going to a black hole and then we never hear from you again.

Dr. Keith Dressler: They weren't hearing from me. So it was horrible customer service things that I really didn't want and there were two other things that were occurring then. The other thing was we had sent out automated appointment reminders, which were just that up reminders. They were not bi-directional communication, but again as these Millennials began to enter our Market they began to text back and so and it went to lala land, and so when we would call them they're very upset with us. Like hey, I texted you back that I was going to be a little- it was horrible. I had people literally screaming at my front desk. And so and then last but not least, what was beginning to occur as well as my staff who had personal cell phones and let's say I was off of work it's weekend or at a CE course or something like that and there was an emergency that came through. They would text me the whole entire emergency situation from their personal cell phone to mine exposing PHI and everything else. And we're you know, we weren't allowed to store it. So all of a sudden in 2013, I began to realize there is a major problem, and the major problem is now Communications, and no longer is voice the preferred method of communication. The preferred method is text, social media messaging, and the like. So I began to look everywhere to see if there was a solution being an entrepreneur as you have described me and I am. It was what I decided Hey Nobody's doing this nobody's even looking at it. I'd like to create a HIPAA compliant modernized communication platform that would encompass telehealth as well. So hence Rhinogram was formed and it basically gave the patients what they wanted, which was convenience. Why would they text versus voice call? Well, there's just one answer. It's more convenient to do so. And that’s why they did. So I would tell any practice listening that you definitely want to modernize your communication systems to give patients what they want because they're going to figure a way to do what they want anyway, which is what was happening in 2013. Okay. So Rhinogram was created to give patients convenience, and to give providers the compliance that they need through everything that we're required to do by the by law. So the Rhinogram platform brings in Facebook business messenger into one place. It basically will take your phone line and create a HIPPA compliant textable port so to speak, meaning we're not going to change your phone system at all. We're just going to take over the texting port to that number so that you keeping the-

Richie Guerzon: You're keeping the same number, right?

Dr. Keith Dressler: Their number. the practice keeps the same number they've had so it's really simple to begin getting patients educated to begin communicating with you by text because they- the existing patients should already have your phone number. In their phone that they would have voice called but now you can begin to educate them. You can actually text that bi-directionally. You can initiate a conversation by text because again, back in 2013, the way we viewed things it was doctor only initiation of communication. Right! Meaning it was I'm sending them appointment reminders. I'm sending them birthday. I'm sending him. I'm sending him. So, the shift in thinking is oh, the phone's not going to ring anymore because we're substituting voice communications with text communications. And part of the beauty of the platform is that you can move those Communications to the right people, at the right time, and because its cloud-based nobody has to be even in the office so they can all be at home like the COVID situation. I'm going to talk a little more about that later, but I'm trying to give everyone sort of because I'm not going to go into the fact that this is what I'm using. I'm going to show you how we're doing things and just know that it's through the Rhinogram platform that everything is occurring and it's all permanent record non editable. So you have got a basically a log of everything that has occurred with you and your patient throughout time.

Richie Guerzon: Yeah, and that's critical. You want to keep all that in your records not editable. So what's going on in your neighborhood out in Tennessee right now?

Dr. Keith Dressler: Well, yeah, and it's wild like everywhere else Tennessee- the governor- I don't know three weeks ago said, four weeks ago, said we're closed and except for emergencies until the 15th of this month yesterday, which the 15th by the way is Wednesday of next week. And so we had scheduled patients because he hadn't changed his mind yet, even though the federal government had changed theirs, and then all of a sudden yesterday we get notification that we're closed to the end of the month. So all the people that we had thought we might see next week, we’re again rescheduling them out due to the governor's notice. So in Tennessee, that's what's going on. I'm sure it's going on in a lot of states. There are some states by the way, that really don't have lockdown requirements still, and I have talked to a few orthodontist that reached out to me and said, there's still practicing they've never shut down. Yeah, but that's the exception that's not the rule most most all orthodontist across United States or shut down and seeing emergency only types of patients.

Richie Guerzon: So for those few practices that can still see patients, what's your advice for them?

Dr. Keith Dressler: Well again, the first and foremost thing if they're seeing patients is I know when I was seeing patients before I was shut down and how I'm seeing them in emergency only situation is we've changed Protocols of how they actually come into my office and for the most part I’ll liken it to I've substituted my parking lot becomes my waiting room, not my waiting room. And so what we have done is we text everybody that would be seen on that day, text the night before basically informing them that when they arrived in our parking lot on the day of their appointment to please text as you're here, but we will text them back when they're allowed to come in. So we're keeping them isolated in their car. We have our door if you will, from our reception room all the way back to the open bay area, open. We propped it open, and we text them back you're ready to come in. I'm sending an assistant out to get you the assistant holds the door open. And by the way, we ask that only the patient come back type of thing. If it was a new patient and a parent was going to be with them then yes, we do say the parent can come with new patient. Meaning for those offices that are really open. Yeah, and then you bring them back to whatever. But we would let's say bring an existing patient all the way back to a sterilized chair even though I have six chairs and when I was going I had six people scheduled every 15 minutes, we did not bring six back. We did not put them side by side. We put every other chair. We brought back three at a time, get our work, escorted them back out. They touch nothing and we told them that we're going to be making their appointment before they leave our parking lot. Yeah from their car and they're texting with our office to make their next appointment, whatever whatever time. If they had bills to pay, Mom's in the car. She says hey, I've got a bill I'd like to pay, we send them a link to pay, we have text to link. I'm gonna text to pay link and and that's part of the platform as well. So it's really nice mom’s out the car. She's paying a payment of some sort, and she might be behind on or whatever and then and then we're texting her when the next appointment is. So again, and then re-sterilizing chairs. Nobody's done anything and by the way, I forgot to tell you we do also give them the warning to say please reschedule if you had a fever within the last 72 hours, or are coughing. We would prefer not to see you and we'll reschedule you when we send to stay in the car in the parking lot that is all sent to them the night-

Richie Guerzon: So you have like a template maybe that you're sending them. So, you know, you're saying the exact right thing every single time, never getting lazy.

Dr. Keith Dressler: Yeah, I'm glad you brought that up. It is a template so it's very, very simple. So you take a template you blast 50, 60 people at that’s how many you're seeing now. We don't even have to do that. You know, we've got two, three people once a week, or emergencies there. So at any rate, that's how we handled- and believe this or not, we ran more on time doing it this way when we were seeing a full schedule. Than we did when we were seeing six at a time, and I would almost tell you that again, you can only imagine because I being the doc I'm in the back and I don't see really what goes on in the front, but I can just imagine people come in they go to our drink area with juice bar, coffee, and we've got games that they start playing, and they go to the bathroom then they come back. We have a brushing station. So all of that is no longer happening. And so again, they're coming from their car all the way back, you treat them, you move them out. There's none of this other stuff that's going on. And even though we were seeing them three at a time versus six at a time, we were actually more efficient and more effective because of the process, and we ran right on time. It was amazing and my staff said even when this is over potentially, we would love to make that the protocol because it helps in all kinds of ways. And again templated, and I also want to tell folks out there. You know what- what are we doing now type of thing, and this should be applicable to everybody whether your quote-unquote closing emergencies only, or whether you're truly open, but if you're truly open, that's how I would work the patients in and out of your place.

Richie Guerzon: So if you’re not open, what are your suggestions?

Dr. Keith Dressler: Well if you're not open, I would definitely market yourself to your market that you are open, but your open virtually okay. Meaning, I think they need to know that they can get you virtually about anything because if you say you're closed, and to certain people that means you're not available. Okay, and I truly don't believe you should say that if you say you're open virtually then oh cool then how do I get a hold of them, or in my case, my patients know they can text and send me photos and different things to my practice. But that's what you want to be able to let them know out in the marketplace there. You also have the great ability to prescreen and again we screen.

Richie Guerzon: Prescreen? What do you mean by that?

Dr. Keith Dressler: Well, if somebody thinks they're in emergency and they text in hey, I've got a problem. You basically can say, can you selfie me that problem, and you triage it? Okay. So again, if you think of me, it's I'm at home. Each of my staff is at home. Everyone is logged in to run aground. So everyone is actually seeing this text come in, and as soon as it comes in, everybody knows whoever gets it first, I'm not sitting there watching run a gram every second of every day, but we have notifications and so I wear an Apple Watch and a notification will come across my watch that says hey you have got something to look at in Rhinogram because they will route that message to me to prescreen them. And I basically look, and I'll make a decision. Is this something that we need to set them up a time to come in or not? If we do make that decision to come in, the other beautiful thing is we have internal Communications built within the platform much like slack where you can add somebody, so what I would do is add a couple of people, let's say a front desk person and an assistant. It's a tomorrow, we're seeing an emergency. You may have seen this come across. I do need you to come in at this time. We're only going to be there short period of time we'll get ready for this as you can see. They either had a bracket off that had a chain that was pushing a tooth out of place that we're going to have to put on, or they've got multiple things off, and teeth going everywhere or a steel wire that it's bent the kingdom come, and we need to replace it because teeth will go everywhere. And they're in a lot of pain because they spent that wire in some shape or form.

Richie Guerzon: So all of this is just the attacks. So your amount of time actually getting this all organized is various, it's limited, and it's not taking a lot of time out of your day, but you're making sure it happens tomorrow, and it happens properly. Everyone comes in and does what they need to do.

Dr. Keith Dressler: No, that's right and our existing patients. Let's say existing braces patients. We're still engaged with them. I think it's very important, and we would send out if they were quote scheduled that week. We send them out, again a templated text saying hey this visit is going to be virtual. We would like for you to send us these three pictures of your teeth. Dr. Dressler is going to evaluate you, and then we won't make you set you up an appointment for an in-office visit. Now, once I do that, I'm actually quote giving them telling them you're doing fantastic my receptionist is going to be reaching back out to you to schedule you your next in-office visit in 10 to 12 weeks. If you've got any problems, please selfie it to us. Please stay safe, thank you for flattening the curve, all of those types of things. So they really feel connected. Now you talk about saving time, I'm doing these in 45 seconds or less. It's a template. And then I am rowdy that patient after I've given him thoughts. Some of them are emergencies. Like I said, hey, you've got a bracket off in a changing and a tooth is squirting out, and it's going up, and in all of that. I need to see you tomorrow, you know, but then some of them, most of them are not. In most of them, again, are again 45 second type of communications for it.

Richie Guerzon: But even the ones that do end up becoming a necessary appointment, you can just add everyone that needs to be in the conversation and get it.

Dr. Keith Dressler: That that's exactly right, which is what's really cool about about the platform. Yeah.

Richie Guerzon: So what do you think the new normal is for practices right now? I mean, Telehealth is already starting to come down the pipeline, but now it's kind of been a catalyst felt, just going up to speed. Everyone's got to get up to speed now, or they are just going to get left behind.

Dr. Keith Dressler: Well again, I think we even when we come back, I mean the new normal right this second is how do doctors, you know communicate with their patient base. And by the way, I think that's the number one area that you need to communicate with because they're still paying you monthly. You know, that can be your revenue stream that stays alive. What you don't want to appear to that patient base, is that you're ignoring them and whether you text with them, or whether you're making voice calls, whether you're sending them notes, I don't think it matters but it is engagement. But the reason I like the text and the pictures is they feel they're still being treated. Okay, and so if I'm being treated, I don't feel as bad about having that monthly payment each month coming out of my account.

Richie Guerzon: No absolutely, you're giving them very obvious value for the service.

Dr. Keith Dressler: So new normal now is how do I virtually treat, or see, or check in on my existing patient base? And then how do I keep my entire staff involved and understanding, assuming that you're still employing them. I have chosen to employ my staff. Again, this is a personal decision for each individual doctor. I'm not here to say what any one person should do. It's whatever best for your situation to me. That's what you should do, you know, so whatever is best for your practice is what you should do, but if you have chosen to quote furlough them or keep a one or two of them. It doesn't take many people to handle what I'm just describing they can handle it all very, very easily and can be again, informed of what to do because I would assume if everybody is at home and you have a phone line you are going to be transferring that phone number to be answered somewhere else there and they could be overwhelmed with with phone calls.

Richie Guerzon: And I know a lot of you can keep a lot of the staff on unemployment if they're getting it now if you they work for you for every state is different, but they can be a very short amount of time per week they can work with you. But if you have a really efficient process like this, you can schedule that out for the team throughout the week, and they could be getting the unemployment but also still getting some work done. It's really valuable.

Dr. Keith Dressler: Yeah, and to me the biggest problem or I won’t say a problem, but the challenge that we're going to face and I'm beginning to realize it more and more as time goes on, is how do we handle the first day that we open back after being off all this time? And I think it's very, very easy for us to be able to schedule regular visits and scatter them out. That's not who I worry about, but if you're a practice like mine, who's been around for a long time, you know, we're doing debondings virtually every day. Okay, and these people when I look at a month backlog, or two months back log, of D bands every one of these want to come in tomorrow, you know the first day you're open, they want them off and how do I handle, and how do we handle the backlog of the patients wanting them off? And then how do we handle the potential new patients that you might have been able to put on your schedule that you said you would see when you re opened and I'm beginning to think that my first two weeks or three, might be only D bands and new patients. And I might see regulars on out. Now, I'm giving you top of my thoughts, I haven't decided- I'm just I'm having to think about it now because it's more, and more, and more, and more, and who do I need to service, who can I put out longer? I've been able to triage, if you will, the braces cases to see where they are in treatment. Who can I push out further to open up my schedule for who wants to see me the most now. Because I've got a feeling, you know, we did, and do, a minimum of two debondings a day. And sometimes four. And so when I think about how am I going to put all of these folks in as fast as possible, then this is how I'm thinking about potentially doing it.

Richie Guerzon: So we could go into the patient management system to kind of analyze that data now to really work it out, and do some sort of scenarios. You need to get a grip on the schedule, that makes a lot of sense. So when we're talking about this modernizing communication with patients, how do you think that can help combat the direct to consumer services?

Dr. Keith Dressler: Yeah. One, I think orthodontist or non direct-to-consumer practices like DSO’s. It can be whatever. It can be individual practitioners. You must understand what direct to consumer marketing is doing to you. It's trying to define you, it's trying to define me, the individual practitioner. And it is defining me, and I can't, me personally, I don't like that at all. I don't think anybody else should define who I have in the services I provide. Yes, and that's what they're doing, and for you out there who don't may not understand what I'm talking about, every message is saying to you no matter who the director consumer company is that's doing it, the message to the consumer to the public to see an orthodontist, it is very inconvenient. It’s monthly visits, it's a lot of your time, and it's extremely expensive. So they're pushing convenience and cost and they're basically defining all orthodontists as this way. I will not allow them to define me this way. So that's why I think digital marketing allows, you, the individual practitioner or you, the DSO group, to go out there and market directive to consumer as well in your local market, and be able to say I miss convenient. I'm as affordable on certain case types, but because they're going to be able to send you pictures, you understand if it's an orthodontic retreat, one or two teeth, you can do it six months or less, you can do it for a competitive price. And if enough orthodontists are out there defining themselves in the market, and especially somebody like myself that has a brand name, and has been in the market for a long time, they have more power than anybody else. So their name is known in the market, they need to be out there defining themselves in a different light than what's being defined by someone else, and that's what it gives you an opportunity to do just that.

Richie Guerzon: Yeah, so you can, and you can use these digital platforms like Facebook, Google ads, Pinterest, whatever, and they're really not that expensive as long as you have the ads and the campaigns to run them, and can get to you can get your message that thousands and thousands of people are very low price. So I think that's great. And if you have these modern communication channels like Rhinogram, you're doing virtual consultations, you're doing things that truly differentiate your practice, and you're showing that added value when you're communicating with these customers. You’re showing why you have more value than these other direct consumer services. So it helps justify. If there is a bigger cost, and you need to kind of justify that we can't let the practices be viewed as commodities right now. We can't let the commoditization really threaten us.

Dr. Keith Dressler: Right, and actually consumerism is what the biggest disruptor is because understand that the population of people that we're dealing with today, and it's only going to get larger, are Millennials, Gen Z’s, and these people through texting. They did not grow up speaking on the phones, as a matter of fact, a lot of them have difficulties speaking to you. And yeah I have a daughter 23 years old, and it's amazing to me that I tried to voice call her, and she'll never answer and when I text her she answers immediately, and when I confront her with it, she says, dad you don't understand, I'm actually in conversation with five other people with you. And so if I don't answer a phone, I can't stay in conversation with those five people. So I'm basically interrupting her line of communication by calling, where I'm just a part of her communication by texting and I would tell you that it occurs in your practice the same exact way you're going to be able to to communicate with 7 to 10 different people in the same amount of time as one voice call or one video call. So again, I want to think about whether you do virtual this, or virtual that, it doesn't matter. What is important if you choose to embrace it, fantastic, if you choose not to embrace it that's okay too, but I would embrace modernizing your communications meaning embrace technology. Meaning communications over voice because that's equally as important when it comes to convenience because patients will want that convenience, over somebody who doesn't provide that convenience.

Richie Guerzon: I think even people older generations are using text more. I know my own dad when he discovered you can speak to the phone and it types text, and then texts you. All of a sudden he started texting me because it was easy for him, and he didn't have to pick up the phone. Yeah, so we know Millennials love to be online, but with COVID do you think now older generations are going to be more comfortable with this type of communication, where maybe a few months ago they weren't. It wasn't really in their comfort zone, but they’re kind of being forced to- do you think we can help attract more of those type of patients for look for older of new patients?

Dr. Keith Dressler: Yes. Yeah, of course all of everybody's forced to do virtually everything. There are more virtual doctor visits going on. There's more virtual- I'm talking about physician follow-ups, and with the older generation. I know my father who's 87, maybe 88. Yes. He will be 88 May 7th, and my mom is in her 80s as well. They've both had telehealth visits for the first time. They actually loved it. They did it from a desktop, you know, where they were able to go to a link and click the link in the doctor. They were in a waiting room, a virtual waiting room and then the doctor came on and talked to them. My wife, I did hers and for whatever reason the internet wasn't working well, so the video kept hanging up. I mean, yeah Frozen and so she ended up doing hers without video and it was with voice, and text, and pictures and they were able to do the same thing, and in today's world, the doctors are getting reimbursed the exact same amount of money by the insurance company. This is medical providers, as if it were an in office visit. And so what I think is happening you ask about the older folks. Yes, they're engaged, but they're also engaged and had started getting engaged because the only way they can speak to their grandkids is through social media. And so they had to get used to you know, the Facebook, the Instagram, Snapchat.

Tik-Tok, you name whatever it might be. Yeah, those types of services are where the grandparents are on really the generation believe this or not, that is the least technical is going to be really your 55 to 65 year olds, meaning the grandparents. These grandparents have gotten on board because of the grandchildren. They revoke the 55 to 65, 70, or maybe 50 to 65. Their emails are their preferred medium, if you will, now not me. I'm in that category. I'm a text or social media messenger myself. That's why I said I think modernizing your communication should be something that you would want to do so that again, you can easily communicate with patients and you can do virtual check-ins. It's not a virtual console if again, for those doctors that and when I use the word consult, I'm thinking new patient exam. It's not a new patient exam per se but it is a follow-up to an existing patient where you have x-rays, you know what's going on. You see pictures you can make determination and you can triage it to the extent that if you need live video you can have live video, and do live video exchange. But you'll find through triage, it's going to be like you use your cell phone today. Most of my communication is text. I have some voice, and some video. Less video than voice, and less voice for sure than text. So I see that's how this would evolve and again all of that capability is built into our platform.

Richie Guerzon: And would you- I mean- is it fair to say that the biggest efficiency gain is really through that monitoring phase with the patient journey, not really the initial consultations, far as time save energy save.

Dr. Keith Dressler: Yes, absolutely, because you decrease the number of in Office visits when you can monitor them from afar and in office visits are running approximately- I mean, this will vary the practice the practice but on average about a hundred bucks when somebody walks in your door, that's the cost. So why would it be then? Well, you know, you've got coffee station, juice bar, you've got video games, you've got front desk time, you know, they drink and eat you out of house and home when they are in a herd of kids with them, and a lot of times those kids, they'll go into the restroom, clog your commode the next thing, you know, you're calling down the plumber. You spent three hundred fifty bucks to do something that you might could have handled at from their home. If they were to have texted you a picture of what it was that they came in for a quote perceived emergency and then obviously you've got assistant time, doctor time, sterilization gloves. You name all the little things, it'll be a hundred bucks. I will tell you in 2019, I was able to decrease my expense structure sixteen overall percent so my expenses have decreased and the vast majority of that is keeping those people out of my practice that didn't need to be in the practice, and I see that as part of the evolution of change that's going to occur after COVID is people- are going to you're going to want to keep your chairs available for the meaningful appointments that you must see and begin to transition to what do I have to see when, versus how we're doing it today and whatever you can do from the patient's home or the comfort of their couch or wherever they might be. They can be on vacation for that matter, as long as you're able to monitor it you're in great shape and bring in what you need to bring in when you need to bring it, but let the wires work. I mean I was sharing with you before this podcast, there's not an orthodontist out there that either during residency or during practice that hasn't seen a patient that has disappeared from your practice for two years, goes up and lo and behold nothing broke the wires are still in perfect. And the teeth are as gorgeous as they've ever been in their lives. And we as orthodontist feel that we must tinker and do things, but maybe the reality is we don't need to be in there as much as we think we need to be in there. We're doing it to potentially create value of why patients are paying us what they're paying us to be treated, but though the new generation coming up I think will be more accepting toward less visits and more virtual visits because that is their world, and that is the world that they're in and as mentioned there's 80 million of those folks in the United States. They're the largest consumer population today.

Richie Guerzon: So it's fair to say if you're not- if you don't have some sort of Telehealth solution, you're really missing the boat on a lot of the Millennials out there and probably your competitions kind of taking a lot of that share.

Dr. Keith Dressler: Yeah. Absolutely. I mean, I really do think what the biggest thing that we’ll experience is how we acquire new patients more Acquisitions are going to occur online than ever before in my opinion, and especially five years from now. I still think we're in a hybrid state, and I think that we still have 40, 50 percent of our patients are traditional and the other 62, you know, 50 to 60 percent are your Millennials. But as time goes on, five, six, seven, eight, years from now, they're all going to be Millennials and that you're going to have acquired lots of them online. Again, 60 percent of my practice in 2019 was acquired online.

Richie Guerzon: And if you really can gain these efficiencies and you can get more available seats during the day for what- for someone who just wants to have one office. The doctor just wants have one doctor, one office, and they're fine with that. Just want to maximize the profit of their office. You can then fill those seats with more people as you grow and you’re not forced to open another office if you don't want to. I mean that’s really valuable.

Dr. Keith Dressler: Well, what happens is you see less patients per day. So, it doesn't require as many employees. You don't have to spend the money to have as many seats, meaning whatever your number is. Yeah is and to me, the overhead, it goes way, way, way down and to be quite honest I probably have got twice as big offices I need today with the modernized way of communicating and becoming more efficient and more effective. Even though I'm seeing the same or more patients than I would have seen traditionally.

Richie Guerzon: So you could see, you could keep your whole team see double the amount of patients or you could have a mix and have a little bit smaller team, but still see more patients. Maybe-

Dr. Keith Dressler: That's, that's correct. That is absolutely correct.

Richie Guerzon: So, how do you feel the future? What do you think the future of oral care is going to be, the future Telehealth in your-

Dr. Keith Dressler: I think it's gonna be all of medicine, and not just, just dentistry or oral health, and in that is again what I just described, in that it's- we're going to learn better when people need to come in, and when they should come in, and when they shouldn't and the things that you can accomplish by keeping the patients at home, you'll be able to accomplish, and technology will advance as well. I mean, there are- I truly believe that, and I know I've talked with some of these folks like- mouth watch mouth watch initially came out as going to be a home device home camera intraoral camera for the patient's it was going to be yeah really inexpensive, and it was going to be Bluetooth to whatever technology. Well like, you know, no patience. I mean they didn't have a market at that time for that. So they began to use it attached to the computer, the actual camera, and their cameras are inexpensive. I believe that are between 200 and 300 bucks for their system. I mean, it's a nice intraoral system, but it's used in teledentistry to go out to the rural areas with a let's say a hygienist, or licensed assistant who can do things they then, if you will, scan with their mouth watch camera, but it's being video broadcasted back to a pedadontist or a dentist in the the Suburban areas and they're telling the assistants what to do now. They're not filling a cavity but they're saying yes, you can seal these teeth here. And then once they've sealed it, they'll go back over the sealant and the doctor in a remote location looks at it, and verifies that yes, those sealants are good. And now we're delivering care out to rural areas and protecting teeth of youth. And again, it's a pretty cool cool system, but I do feel, in again, the next 5-10 years these cameras will go back out somebody like Mouth Watch, who thought about this really before its time. We’ll have Bluetooth to the consumer and maybe it'll be in the 50 bucks or less range, and it'll be just something they have like a thermometer, and they'll be able they'll be able to use it and have sterilization. It's not disposable, you know, they'll have sterilization sleeves or whatnot and then they can Bluetooth their teeth to you and you're going to be able to have a much more accurate, better record of what you're looking at. And I think for those orthodontists who aren't quite as comfortable looking at still pictures, or even on live feed with Skype, or Zoom, or whatever. They can't really get to see what they want to see, then this is going to really blow it up, and you're going to be able to- it's almost like they've got a scan in there that you're looking at, so it's going to be pretty cool. You know.

Richie Guerzon: Yeah, I think the self diagnostic tools, self monitoring tools, in general become something that is in a lot of homes. I mean, imagine if we could- imagine if we could have just diagnosed everyone with COVID from home in a few days. How much different this would look right now?

Dr. Keith Dressler: Yeah. As a matter of fact Richie, I don't want to- I want to share with you that I did talk to the government about doing just that. With our platform because we could have- this was my big vision of COVID because of how our platform was done when the first case got diagnosed. We have a lobbying group that we contract with, and they went up there and I basically described through the emergency broadcast system that they could beep everybody’s cell phone, give them a 1-800 COVID number and say hey, we've got a health care crisis on their hand. We would have pre-built a team that can log into the platform because again, it's cloud-based. So-

Richie Guerzon: Oh so they could just be at home ready to go with like a National Guard situation.

Dr. Keith Dressler: That- that's exactly right. You would have that and then you would have your initial triage team that could be set up all across the country, then you would set up State teams that were- that you would have, and then it would go down to the local teams where every county you know, where city would have their local team, and you could build that, and you route the message to the right team after its triage. You've got a record of who it is, and it had gone to the extent that I had a guy that was going to be able to deliver 250,000 couriers. So, why would we need those people? Well, when you when you could diagnose those that could be quarantined. They didn't need to be in a hospital, they’re at home, you then have your local person communicating with them on a daily basis to make sure they're not getting worse and again through text and then you would you would say if they needed anything you'd say, hey, we've got a courier service, the government would protect those people and you'd have them as young people, you know, so if they got it, they may not they're not risking their lives most of them, and they would be your Courier but even better yet, you now have these couriers that can go when these people are healed, and go I collect plasma and then you can inject that plasma into folks who are getting sick to get them well quicker and these couriers would be trained to do all of that and to me we could now contain something like this and guess what? We've got a record of every single person that would have texted in with symptoms. You're not going to get what happened today. You wouldn't get where they get busy signals, they go to emergency rooms, and oh you can't have that test even though you're having symptoms because you don't have anybody who's written it out for us and we just have a case in Chattanooga that was written up about where a guy actually had it was told he had it by his doctor virtually through video, but couldn't get a handwritten prescription from him because- and so subsequently, he went to get his test and they wouldn't give it to him. And I mean that's ridiculous. So I had to go to the emergency room infect everybody in there and to get his damn test. I mean it's you know, it's ridiculous. But anyway, I didn't mean to get off tangent.

Richie Guerzon: No I think that was great what you're saying. I believe what you're saying is going to be the future because it's just it seems so obvious. In the days of Amazon, and all these amazing supply chains and all the capability until health and technology, we have, there's just no reason not to have a system like that. And it requires that exponential amount of people to reach everyone at the same time. You have to have these systems in place. We do have one question from Hilton, and they just wanted to know if Rhinogram will be coming out with video capability.

Dr. Keith Dressler: And yeah, absolutely. You heard me say that and it's going to be do- it should be to everybody by June first it is in Alpha right now. It’s going to be really, really cool. By the way, patient doesn't have to log into anything. What's going to happen is the doctor or staff, whoever is going to send the patient a link that all they have to do and say that this is their appointment time. They click on the link, the link then notifies the practice that somebody's in the waiting room waiting on them, and the doc can then just boom, log right in from Rhinogram and be with that patient for that period of time. So it's going to be real simple and easy. Again, Rhinogram’s belief system is zero barriers between patients and in there in the provider. That's why there's no app to download for the patient, there's no portal to login, they simply do what they already know to do, and that's why we didn't want to we didn't want to create another barrier to adoption because what people don't realize- they- to log into a portal or to download an app, that's a huge barrier for people to do, and I hate to tell you, it's not as much orthodontist, but because we don't deal with the lower socioeconomic as frequent, but the lower socioeconomic which is 30 to 35% of the United States population has no internet access so they can't log in to the portal.

Richie Guerzon: That is such a huge point. I always forget that's true.

Dr. Keith Dressler: You know, we live in this world thinking that that everybody's got the same technology we do, the reality is they don't. So being able to text with them is phenomenal. We have a pediatric practice the largest Medicare practice in the state of South Carolina that quadrupled their engagement with the lower socioeconomic by texting versus trying to get them through voice. It- It was amazing for their costs have gone down because of the enormous time spent trying to just call them, and them not answer. And of course, if it's coming from a back number, not a number that's in their phone, they're going to think it's a robocall. They're not going to answer.

Richie Guerzon: Of course, I do that all the time. So Hilton had another question. What are the groups that you use in-patient messages and in team messages.

Dr. Keith Dressler: Oh god, I've got you- I've got it, you name the group. I've got it. But let's just start with with basic groups of- that I use with my patients texting in, and then I'll tell you about team as well. But patients are going to have the obvious groups. I'm going to have an appointment team- a group. Okay. I'm going to have a insurance financial team because my insurance coordinator and financial coordinator are the same person. Now, if you have multiple, you just put them in a team and you route the message to the team and whoever's available can begin to answer. I have a Rhinopay team, I guess. Well, I guess if you've got Rhinopay it's automatically on there. I have a clinical team that will triage some of the clinical questions that's made up of license personnel that could actually tell and make the determination. Is it something that Dr. Dressler needs to see or not? And then, we see in bigger groups, not just one doctor but, you've got a doctor team and in my practice that team is just me, so they know to send me those types of things that need to be handled legally by the doctor. I do have a- I guess this will move down in- those would be the main things that I have. I have groups. Let me, let me go back to the patient because I do have group patient groups, and those patient groups consist of these. I've got an aligner check group. Meaning these are all that I'm treating for aligners in every two weeks. This is just me. You can set your protocols how you want to set them. We ask them to send pictures of their aligners in and aligners out every two weeks. I evaluate those aligners and I tell them yes, you can move to the next aligner. My protocol is this- I have them in for the exam in scan, I have them in for the first visit, which I try to put all the attachments in slenderization, I give them their first two aligners, and every two weeks I have them text me pictures if they have done well after four weeks. Both the aligner one and aligner two, we Fed Ex them four aligners, and we still see them every two weeks. Okay, if they did well with four, I Then I then FedEx and eight and keep going until I'm done.

Richie Guerzon: So you’re slowly building trust.

Dr. Keith Dressler: That's right. And if they get off, I then- and if they're there and I don't go past eight. I don't ship them any more than eight. And again, I tell them how good they're doing and it takes me literally 45 seconds to know and- but when they're in for that first placement, this is critical we spend time teaching them how to selfie with the aligner in and the aligner out, and what we want. Okay, because if you train them is sort of like how you spend time with toothbrushing, you know, here's how you're supposed to brush. Here's how we want you to take these pictures. This is going to give us the best. We let them practice they show us on their phone what they did, and we say yes or no or whatever. So again, we're training what we're wanting to keep as many people out as possible. So aligner checks, we have retainer checks out of braces now, and I will physically see the patient the first time, let's say six weeks, eight weeks, whatever it is. You have to retake in the braces off will do the final records. Then I'll check the retainer. And at that time we asked them and the family, would you like your next visit to be a virtual visit, or would you want to come see me? Yeah, because again, I don't know if they're one that value coming in, or one that doesn't value. So again, to be able to separate without forcing everyone into one category or the other, we’re giving them the choice. So that's what we're doing with them. I've got it now because of COVID, I've got braces checks. That's another group that we are putting all of the people that we’re doing braces checks into that group-

Richie Guerzon: But you already had these other processes. So it's sort of a template you just had to apply at the braces.

Dr. Keith Dressler: That's right. Now then those would be, again, my main ones that I would have for patients. Okay? Oh, oh wait, wait, wait, two very important ones that would be new patients okay, or we call it potential new patients. We have a category for them, so somebody's texted in brand-new, send us pictures. We've- they've asked a lot of questions. They still haven't made up their mind, or they have told us that it may be until they get their insurance check, or when it'll be six months until I say where I'm getting orthodontic Insurance. Some obstacle in the way, and we put them in that category, so that we know to go back and we'll time- put a time note on it. Yeah and go back and send them a just a hello again text. Hey, it's Dr. Dressler's office. We know you were waiting on your insurance. Is it taking effect? We want to know we're here for you. We don’t bug them, we don't- but we will follow up with that group just to try to see who of those might we get to start. Via text. Yeah, and you can attach a link to a YouTube video or whatever you want to do. You can do any of that. I mean you can become as creative as you want from that perspective, but I think that's a good one. And then the other good one were what we have delayed starts. Okay, meaning these people said they were going to do it, they want to do it, they know their pay arrangements. They've accepted their pay arrangements. But for whatever reason they haven't paid me yet, but they agree. They've done everything up to just up to actually starting and this could be something like we've had an unexpected death in the family. My husband was laid off. Those types of things, and we put them in the future starts column meaning the we know they're going to when they overcome whatever obstacle there got in their way here further down the road and the potential new ones, you know.

Richie Guerzon: You made a very sophisticated sales pipeline for it worth of practice.

Dr. Keith Dressler: That's what we've done and there. Now let me move to team. Okay? Sorry are about that, but I thought that was important to hear. So in the team I've got it's going to come on automatically with every direct team member there. So it's going to have direct ever that's an individual communication with everybody that you have entered into the system as a team member of yours doctors and staff. Yeah, and I have an all, all staff and doctor communication channel I have, if you will, a you can create a doctor only Communication channel, then you can create- I have other things like supplies. All of my staff who are involved in ordering, but everything they order in that slot with how much we're paying because if I'm at a trade show and they go, hey, I've got a special on gloves, you can- and I would say, well I have no idea. I've got somebody who orders what gloves are. I now, for my phone can log into Rhinogram, look up supplies, look up gloves, and go oh I'm paying this. How much is your discount? Oh, so it's really good to understand, am I getting a deal, am I not getting a deal, and I've got it at my fingertips what we're actually paying for everything. Likewise, what I have done my insurance person handles all my credentialing and certifications. So I have her and I on a team and each individual staff and her, on a team and we require everyone to take a picture and add it to their Rhinogram account of their continuing certificates and licenses, so she goes in and can just look and when she’s spilling out renewal paperwork, everything's at her fingertips. She can drag and drop those licenses wherever digitally, and it's a lot of help there.

Richie Guerzon: Well thanks for sharing that, I'm sure a lot of doctors are thinking about how they have all these processes set up in their own practice and you've got it down to a science. I think obvious you've been doing it for a while.

Dr. Keith Dressler: Yeah, well yeah for years and we keep adding new things and I think the Rhinogram doctor community and I use that word because we're in all of healthcare because what happens is we do have a super user page, and docs of- you can be a pediatrician and can be an OBGYN there's they're sharing best practices with this colleagues group, you know, our Rhinogram super user group, which everybody can be a part of if you're a Rhinogram customer, and they're beginning to see, and I've learned so much from others, and we put that into our platform or suggest it to our client base of how we can save you even more time and it become more efficient, you know.

Richie Guerzon: Well, that sounds great. It sounds like a great program. It really focuses on getting this efficiency up and saving time and money, so thank you so much for your time. Is there anything else you want to add before we wrap up?

Dr. Keith Dressler: If you would like, I mean, I know your marketing I would like to just quickly, very briefly, share within the two minutes some of the ads because I will yeah you want to do that for sure. Yeah, I would tell you that digital marketing is a must and whoever you guys out there want to use I know Orthosales here is a great, great company and I really appreciate Richie having me on their marketing, and they can help you with these ads. But we also make them available. So you can hand over to Richie what it is that our most successful. So let me show you very very quickly what we're doing during COVID. And again, it's just suggestions, but it's also things that actually work and I need to be able to share my screen.Oh here it is. This is one of our ads currently, you'll see it has the dates. These are Facebook and Instagram ads that are already scheduled here, and these will be the dates that they run, and what we're doing for COVID people is basically we're giving 20% off any treatment. Normally. I don't do much of this at all but because of COVID I do know coming out of COVID, people are going to be hurting financially. So I wanted to be able to offer something to these folks, but it's up to a thousand dollars and they must start treatment within two months of us reopening. This is a way that I can drive folks to us, and set them up a time in the future.

Richie Guerzon: You have that sense of urgency. You have a good deal to kind of get people off the fence and you're at being empathetic to the situation. So that ad covers all those things.

Dr. Keith Dressler: Yeah this ad here basically saying hey, we are open virtually to you. We provide virtual exams and check ups with a- we highlighted free quote. This is really important because it will differentiate you because at the end of the day the most common question you're going to get is how much is it going to cost?

Richie Guerzon: Yes, of course. That's what's on everyone's mind. That's why we make sure all the websites we build address cost because people really care about that.

Dr. Keith Dressler: Yeah, and so we're out there and people are beginning to see all this. Here's another one, fit treatment into your life, virtual orthodontics checkups creates fewer in office visits again, I'm sharing with the world that I'm convenient and I'm saying that hey, why wait to get a virtual exam with a again, free quote today because if you say free orthodontic exam, well every ad says that, I mean you've got to have an ad that differentiates you a little bit and that's why these work so well and have been proven, I will tell you. I don't know if the 20% off if we haven't started in its April 13th Monday. I don't know if that's going to do anything different or not, but these definitely drive value here again, the another 20% and this is selfie in your smile. You can see so these are what's coming in April to all of my social media. And as you pointed out Richie it is not that expensive to do this at all. Thanks so much for having me.

Richie Guerzon: Yeah, thank you for being on. I really appreciate it. You shared some great insight for everyone.

Dr. Keith Dressler: Yeah, and thank you for having me.

Richie Guerzon: Absolutely, well take it easy and stay safe out there and have a great weekend.

Dr. Keith Dressler: All right. Bye!