Unlocking Airway Health: How Dentists Are Shaping Sleep Medicine

I think the key thing, Phil, is don't walk in there trying to sell the physician something. Walk in there with your genuine desire to help your and their patients. Sometimes you want to refer to them to get them sleep tested and say, how can we collaborate? We're working together to help our patients sleep better, live longer, not snore, all these things that we're talking about. If you have a bad attitude, it will pay off. Welcome to the Phil Klein Dental Podcast. Obstructive sleep apnea, commonly referred to as OSA, affects 25% of adults, yet 80% of cases go undiagnosed. And we know that sleep-related breathing disorders can cause havoc on a patient's oral and systemic health. And with so many patients having OSA, dentists have an amazing opportunity to treat these patients that are already patients of record. They should be screened and tested for OSA. And doing so will not only help the patient, but it can bring a whole... revenue stream into your practice. And as you progress with this and get the proper training, you can begin treating these cases, offering your patients an invaluable service. And according to our guest today, Dr. Gy Yatros, treating patients with OSA can become the most profitable part of your practice. But there are some caveats you need to know before starting your journey into dental sleep medicine. One important bit of advice is that it's difficult to do it alone. In other words, you should consider working with a third party that can help you with everything you need to make the dental sleep medicine part of your practice run smoothly. And that involves training, a variety of testing tools, and of course, technology to help you bill and collect for OSA services. So let's get started with our guest, Dr. Gy Yatros, a general dentist with decades of experience with dental sleep medicine, and Lisa Fisher Hurt, an industry veteran with 25 plus years of medical billing experience. Both Dr. Yatros and Lisa are affiliated with Dental Sleep Solutions. Dr. Yatros, Lisa, thanks for joining our show. Well, Phil, it's a pleasure to be here too. Yes, Phil, thanks very much for having us. Yes, our pleasure, our pleasure. It's an interesting topic and I think it's important. I'm doing a lot of podcasts with KOLs, Key Opinion Leaders, that are... to have a airway-centric practice. So this is actually very appropriate that we're talking to you guys. So just to make it clear to our audience from the get-go, this episode will not only focus on obstructive sleep apnea and other airway conditions that affect oral and systemic health, but we'll also address the business end of the airway-centric practice. In other words, there's more to billing and collection when it comes to sleep medicine services than, for instance, a three-surface composite resin. So it's a little bit more complicated than that. And it's a great thing to get into airway services for your patients for many, many reasons. But you really need to have an understanding of the business end. So we're going to be covering that in today's episode. But before we do that, I want to ask Dr. Yatros. Why are sleep-related breathing disorders such an important issue for the dental profession? And what can dentists and hygienists do to identify those patients and treat them in the best possible way? And I do want to mention that we're not limiting ourselves to obstructive sleep apnea. We also would be on the lookout for other sleep-related breathing disorders like typical mouth breathing and upper airway resistance syndrome. First of all, 54 million Americans. suffer from obstructive sleep apnea. That's about one in four adults we're talking about. And we could talk about the children for hours as well. So it's a huge, huge problem, Phil. And, you know, the dentists are in the best position to not only help with many of these patients, but also help identify the ones that are at risk because probably less than 10%. 15 % at the most of people who have sleep apnea, even though they have it. So the dentists are there. They can help with screening. They can help this problem. And the problem's a big issue because it has a lot of symptoms that the patients have to deal with. And also has a lot of health ramifications that are just tons of health ramifications, such as heart problems and so forth. And so the dentist can help with this. And at the same time, it's really, really rewarding. I've been doing this 23 years. And you can help patients live better, feel better, sleep better, live longer. And at the same time, you can make more revenue in your office because medical insurances cover this a lot. It's a whole new revenue stream once you get the systems in place to do this. So it's rewarding for many reasons, helping the patients as well as financially helping your practice. Right. Now, when you first started treating patients, did you just focus on the screening and refer them out? Or did it take you some time to ramp up and start getting into oral devices, physical therapy, breathing exercises, some ortho? How did that whole thing evolve? Well, it took a long time to ramp up, Phil. I mean, one of the things I say when I talk to new dentists doing this is, you know, I talk to my dad. You don't know how good you've got it. Because it was a lot harder then. We didn't have the systems in place that we have now. Testing was much more difficult. You had to go to sleep lab. You can't do it at home as you can now. Dennis really couldn't be as involved. We didn't know as much as we know now. So, yes, it took a long time for me to ramp it up because we were kind of some of the pioneers. But it doesn't have to be that way now. You can ramp it up fairly quickly as long as you get the proper training and understand, you know, there's no, you know, quick fix here. You do have to put some time in to learn how to do this. But if you put the time in, get the right training, the systems in place, you can. really start helping a lot of people very quickly. So you're a GP, you're a general dentist, Dr. Yatros, correct? Correct, but I haven't done... dentistry in about 15 years. I focused solely on treating sleep apnea and snoring and sleep disorder breathing with oral appliances. But most dentists involved in this, that's not what you have to be. You can do both. And I did do both for quite some time. I just became passionate about this and wanted to focus my time on what I was passionate about. Yeah, that exactly was my point. Yeah. So I was just curious to know what part of your practice continues to be. general dentistry and the restorative side. And obviously, you just told us that you're 100 % airway centric right now. So let me ask you this, Lisa. Let's get more to the business end of treating patients. And I know you have a tremendous amount of experience with billing. When you talk about sleep-related breathing disorders, you often talk about four pillars of running a sleep practice. Tell us about those four pillars. Of course. So we feel like there are four pillars of dental sleep medicine, and that is screening, testing. treating, and billing. And you need to have those four items in place in order to have a successful dental sleep medicine practice. So for example, screening, most people are familiar with the Epworth sleepiness scale, stop bang, things like that. They're familiar with that. So that's one way to screen the patient's testing. You need to be connected with HST companies. You need to have relationships with doctors in your area that may send you pre- diagnosed patients. So there's a lot of things that go into that, but the screening, the testing, and the dentist are the key component to treating. That's where they really fit in extremely well into this whole program, and they're the subject matter experts over that. And the billing is probably the biggest hurdle that people encounter, but it is very rewarding for me to be able to tap into somebody's benefits that they're paying an insurance premium. for to make sure that they are obtaining this service that they deserve and they pay for. So, but it's completely covered by medical insurances in most instances, including Medicare. So that's great. If you live in a populous area that has Medicare patients, it's absolutely covered by Medicare. Most of your Medicare Advantage plans cover the sleep appliance and all of your commercial policies do too. So you have to focus on getting credentialed or recognized by the insurance companies, which our company, Dental Sleep Solutions, can help with that as well. So there's a lot of opportunities to tap into benefits that are available for the patients. So we all know, especially the dentists know, Dr. Yatros and I, who went to dental school, there's only so much you can learn in the curriculum that's so... heavily packed and condensed during that four-year period and some of us go on to a residency and they do some specialty work and so forth but when it comes to airway issues that affect breathing during your sleep that's kind of a thing you have to learn about in continuing education I mean there's some training that has to go behind really understanding that thoroughly before you can go out and claim to be a dentist that treats these kind of problems and as you mentioned there's four pillars Lisa so it's apparent that with All there is to learn. I would think that a dentist needs a partner in this. Some company, some third party that helps them through the process and makes this whole thing more efficient and more enjoyable to sustain a practice focusing on treating patients that have obstructive sleep apnea and other breathing problems. Do you agree? Yeah, so I'll start off and I'll let Dr. Yatros chime in a little bit with this as well. But I think it's really important to have a really strong partner that provides an education arm, training your staff, getting them involved in the process. Because even in medical offices, your staff sort of leads the way. So they need to understand the importance of why they need to do it. It's within the scope of the dental license. Hygienists and dentists should be doing this. because the ADA says that you should be at least screening at a minimum. And so it's really good to find somebody that can help you navigate through all of the hurdles because we've learned all of those lives of hard knocks. You know, we've learned along the way and have some tools that are in our back pocket that we love to be able to share with people and provide the education. So Dr. Yatros, tell us how things have changed for the better for dentists who are interested in doing this kind of service, just in terms of how systems are now available to streamline record keeping and billing in the OSA space. You don't know how good you have it now because we have good systems in place. Yes, there's work that's involved in this, but things have come so much further for the dentists. that if you tap into the resources that we have available, you can certainly do this in your practice and help a lot of patients while helping the financial aspects of your practice as well. So Lisa, let's touch on that for a second about increasing revenue to the practice. We know these patients are out there. They need the treatment. How do we get the patients to know that you as a dentist have that ability, have that knowledge, and are set up to treat patients that are suffering from obstructive sleep apnea. Well, like Dr. Yatros said, you know, there's one in four adults that are undiagnosed with sleep apnea. So if you look just at your patient base in your general dentistry practice, you probably have a lot of people to start with right there. So that's a good place to start. We recommend starting out with either treating family or friends. There's no bigger advocate than you treat the spouse of one of your hygienists and she's getting better sleep or he's getting better sleep. The spouse feels better. Trust me, they're going to want to start screening. So that's important to get your staff on board, but also start networking with the medical community because you are a subject matter expert and you need to network with the medical community a lot as well and figure out ways to communicate with them, keep them in the loop with your mutual patient because you're providing a really good source or resource for that dental. not the dental sleep practice, but for the actual medical doctor that sometimes doesn't have the bandwidth to see some of the patients and to get them tested. networking with the medical community and start with your actual patient base, you're already sitting on a pretty good amount of patients already just in your general dentistry practice. Dr. Yatros, could you give us an example of what a dentist would do with the medical community? Do they make an appointment to have lunch with the physician? Do they go to their practice and give a talk? to four of their associates, you know, like a lunch and learn. What are some of the things a GP, a general dentist can do to get into the medical community and what should they expect from that doctor regarding referrals? Yes and yes on both what you said there, but I want to emphasize starting with your patients. of record and your friends and family, do that first. Get comfortable doing what you're doing. Don't make your first appointment to run out to a doctor's office when you don't really know what you're doing. Take the training that we can help provide. Once you get your confidence level and you've done a few dozen of your friends and family, then, yes, you want to go approach your physicians. You want to talk to any physician, really, primary care, sleep doctors. Just have a phone call with them. Drop by their office. Take them donuts. See if they are amenable to you bringing lunch by. And what to expect, Phil, anywhere from thank you for coming here. You don't know how much you're going to help our patients. We've been looking for someone like you to come walk them through our office to help with these patients who can't wear CPAP to we're not interested and they shut the door on you. OK, so you've got to be prepared for both. But that's how I built my practice, starting with the screening, then moving to physicians. You certainly can do external marketing. pay-per-click and things like that are less expensive for dental sleep than they are for other things, but do it in that order. And then, you know, stay with it. The physicians, they want to help their patients too. And you're not really, I think the key thing, Phil, is don't walk in there trying to sell the physician something. Walk in there with your genuine desire to help your and their patients. Sometimes you want to refer to them to get them sleep tested and say, how can we collaborate? We're working together. to help our patients sleep better, live longer, not snore, all these things that we're talking about. If you go into that attitude, you're going to find a lot of physicians who are very open to working with you, but don't get upset if some of them aren't. Keep knocking on the doors. It will pay off. That's how we run my three offices in the Tampa Bay area here. So just curious, Dr. Yatros, what do you attribute the increased interest and demand for services? related to sleep-related breathing disorders. And I know how important it is for a patient to breathe comfortably and normally during the sleeping hours. There's a lot of oral health ramifications to poor breathing habits during the sleeping hours. There's no question about it. It's related to the entire systemic health system. And we're learning that more and more as time goes on. But there seems to be more GPs entering this area of dental medicine. and becoming in their community the airway-centric dentist. What's driving that the most in your mind? Well, patient awareness has gone way up, is part of it. The predictability of oral appliances for treating sleep apnea has gotten much better. If we have a moment, we can maybe talk about the technology that's helped that. And as patient awareness goes up, there's a new thing called Inspire out there. You see the commercials all over the country. Well, most patients aren't candidates for that. So they go to their doctors. They're looking for solutions. And we've gotten a whole lot better, Phil. at doing this. We do a really good job of helping most people's airways. And so it's becoming more predictable. So physicians are becoming more acceptance of it. Insurances are covering it. And then practice parameters set by the American Academy of Sleep Medicine have changed where they endorse, accept dental devices for mild to moderate. That is the first line. therapy. That wasn't true when I first started it. So all these things are coming together. I think more dentists are looking at it as a revenue thing as well. But, you know, let's start with doing it for the right reason. It's fun. It's enjoyable. And man, the revenues can certainly come because it's one of the most profitable things you can do as a dentist. It's interesting that you say it could be the most profitable part of a dental practice. I wasn't aware of that, but I do feel that the services are so important. They're so necessary. Poor sleep can affect so many things in your life. notwithstanding the obvious, which is the deterioration of your oral health. It has an effect on your emotional health. It could have a negative effect on your family, your marriage, your relationship with your children. You may have trouble at work, holding a job. It could lead to diabetic issues. It could even lead to dementia. So there's so many aspects to this when your body is not getting enough sleep and if the culprit is poor breathing. It's fantastic that dentists could be on the front line on this and actually helping with the whole process of the obstructive sleep apnea that they're experiencing. Let's talk a little bit about the advanced technologies that are available that can contribute to the success of a dental sleep medicine practice. I know you mentioned there's new things that have come out that are very effective. What are some examples of tools or techniques that we as dental clinicians who are focusing on this in our practice can improve patient outcomes? Well, Phil, the first thing, of course, is, you know, digital scans. I mean, the same things that are helping dental practices. CVCT helps to some degree. The devices themselves have gotten much better. A lot of them are 3D printed or milled. They fit better. They're more comfortable, so the patients are more compliant. I'll talk in a moment about some of our EMR and things that we've developed to help dentists do this. But probably the biggest one is sleep testing. Not only is sleep testing better for diagnosis, We now have the ability through very convenient and comfortable level four sleep recorders that we supply to our patients, most of them in the form of just a ring, that once we start their device and they're wearing it for a while, we can calibrate. We call it calibrate or titrate the devices very quickly, something I coined called fast track calibrations, where they'll wear this monitor at night for a week every night. move their device to various positions, and we'll be able to more actively find where the best jaw position that opens up their airway comfortably that gives us a better result. Before, we were kind of just, you know, stabbing in the wind. Where do we put the jaw? And we went by symptoms. And now when we send our patients back to physicians, we're getting much better results. They're going, yes, this thing is really working, which kind of goes back to one of your previous questions. Why is it becoming more popular? Because we're doing a better job. Because we have better technology, and the technology is less expensive. It's affordable so that we can supply these to our patients. And, you know, if we're going to do this, you need to learn how to use this technology to better treat your patients with that. The last thing I'll say on that subject is, of course, having a predictable system, electronic medical record. If you're using something like one of the dental softwares out there, they just don't manage the patient flow for this. One of the reasons, I don't know if you've mentioned, but I'm one of the founders of Dental Sleep Solutions, and I helped develop this system, which helps dentists go from not knowing what to do to each step along the way and have an electronic medical record that helps them coordinate all these appointments and the training. And so that's what Dental Sleep Solutions DS3 did or does for dentists. When you started with doing this kind of treatment, you were using the typical electronic? medical record systems that are available, like Dentrix. Patterson has one. I forgot the name of the popular one. Patterson has. Eaglesoft. Eaglesoft, yeah. And there were so many of them out there for a while. Some of them have consolidated. So you saw the deficiencies of these systems and basically it was slowing you down. You were becoming frustrated with trying to use the tools that were not really set up. for this type of billing system and so forth. And then you develop this dental sleep solution. So tell us about that, because that's very important that dentists know that they need to be prepared for the whole process from the four pillars that Lisa talked about, but also the business end of the practice. Because if it becomes a frustrating situation, you're not getting collection, you're getting declined submissions of insurance, it becomes a nightmare and nobody wants to do it. So tell us about dental sleep solutions. Yeah, exactly right. I was doing this in my dental practice, trying to find an efficient way to do this. Tried to use, I was using, I think PracticeWorks was my software I was using. There were some dental sleep softwares out there that just didn't help the patient flow. They didn't help me figure out a screen and the workflow and the billing aspect. You know, you might as well go get a cardiologist software. and try to use it or podiatrist software to manage your sleep patients, they'll do as good a job as a dental software because it's not the same thing. And so we developed this to make the systems better. And then kind of did it for myself and Rich Drake did it for ourselves just to help our own practices. And then we realized this could really benefit other people. So about 15 years ago or more than that, I guess now, we decided to help let other people use the software we developed. And then everybody wanted training. So, well, here's great software, but I don't know how to use it. So we started making videos and manuals and what's evolving today to Dental Sleep Solutions DS3 system for successful dental sleeping practices so that really everything from the software to training to billing for your screening, testing, treating, and billing, we have a system of training that will help the dentist, you know, go from not really knowing much about it to being able to do this in a practice. If you want to recreate the wheel, Good luck. We spent 20 years between us and thousands and thousands of patients to be able to find a system that helps. And you can talk to any of our members. It's still one of the most gratifying things. I don't run the company anymore, by the way. I'm a consultant for the company now, and I still love being involved. But one of the things I just tell you that gets me out of bed in the mornings is quite often I have people come up to me and say, you know, you changed my life. You absolutely changed my life. I heard a webinar. blog or you know uh whatever we're doing or a podcast how about our podcast yeah i couldn't don't forget about a podcast yeah yeah sorry i was the word was on the tip of my podcast i don't do too many podcasts as you could tell so and uh and i said you know and then from there i joined ds3 i started using your system your software and you've changed my life you've changed my family's life uh you've helped all my patients and I mean, the hair on my arms are standing up. I'm not just making this up. It makes me feel good to know how many people we've reached, not only through our own patients, but through all the dentist offices that we've helped throughout the country bring the service to them and help their offices be profitable along the way. So it's very rewarding. What you're saying falls into line with everything I've talked to other people about. running a practice and it wasn't necessarily related to osa it's just having systems in place systems that create efficiency that create workflow so that you know when you're done with your day you feel really satisfied what you did the patient's taken care of the revenue starts coming in and you're just decreasing the hassles because when there's frustration and hassles nobody wants to get involved with it nobody enjoys it and it becomes real work But when something is really tailored to what you're doing, especially the software, there's so much that that technology could bring to the table as far as making things streamlined. Any comments, Lisa, on anything else you want to talk about as we wrap this up? The big thing is just get started. You know, it's part of your responsibility within the scope of your license. It's very rewarding, as Dr. Yatros pointed out. And we would love to be able to. provide additional information and to get that information you can visit dental sleep solutions website that's dentalsleepsolutions.com and i believe on that website you can schedule a demo to learn more about what Dental Sleep Solutions brings to the table to help you get started in your dental sleep medicine journey. So we really appreciate your time, Dr. Yatros and Lisa, and hats off to you, Dr. Yatros, for being an entrepreneur. You certainly can be considered a pioneer in dental sleep medicine, and you realized how difficult it was to get this all going, so you started your own operation, which now is available to all of us to benefit from. So thank you for that. And the bottom line is we're helping patients. with issues that for many, many years were unattended to, and now dentists are testing for it, and these patients hopefully will get the treatment they need to put them on a better course of health. Thank you very much, Dr. Yatros, and thank you, Lisa, for your time. Thanks for having us. Thank you very much.