Too many people have sleep apnea — and too many people go undiagnosed and untreated! There is a way to help these patients, and that is to include dental sleep medicine in your practice. To help you do it effectively, Kirk Behrendt brings back Dr. Mark Murphy, executive director of the International Academy of Sleep, with advice for helping sleep-disordered patients while still being profitable. Now is the best time for DSM! To get started today, listen to Episode 780 of The Best Practices Show!
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Main Takeaways:
Quotes:
“When you think about the business of sleep, what I want you to think about is, what do you want sleep to be in your practice? Or do you want it to become your practice? What we see is people that are successful in sleep and get up to 15, 20, 30 devices a month — which is lucrative. Twenty devices a month could be $720,000 a year with a very low overhead, less than 50% overhead. You're keeping more than half of that, so the economics is crazy.” (8:52—9:16) -Dr. Murphy
“The American College of Prosthodontists wrote a white paper in 2017 — 2017. That is seven years ago, this October. Seven years ago, they said we should be screening. I'm willing to bet that way less than half of the [200,000] dentists in this country are actually screening their patients for sleep, because if they were the number of patients being treated would be blowing up. Twenty-five percent of the adult population — probably 50 million or 55 million people in the United States — have obstructive sleep apnea and 80% or 85% of them are undiagnosed and untreated. So, in a practice of 2,000 patients, if they've got 500 sleep apnea patients and 400 of them are undiagnosed and untreated, if you screen those patients, even if just 10% of them in every practice sought treatment, CPAPs would be flying off the shelves, oral appliances would be flying off the shelves, and hypoglossal nerve stimulation surgeries would be going crazy in the OR. Instead, those numbers are growing at 10% to 15% compound annual growth rate. Which is, don't get me wrong — 10% to 15% CAGR is still attractive to most people, from an investment standpoint. But it's not what it should be.” (14:45—15:53) -Dr. Murphy
“[Dental sleep medicine] still doesn't have the adoption that I would have expected. I would have expected more dentists to be into sleep. I think it's this fear of medical billing. Maybe there's some fear — I love the Pankey Institute, but I think there was even a cautious movement there to say, ‘Maybe when we were making devices in centric relation, making bite guards in centric relation for clenching and grinding and TMD — sorry. We didn't realize that we were opening the VOD to do that.’ I mean, we did realize we were opening the VOD, but we were autorotating the mandible and maybe compromising the airway. That's what we know today, and I think it's hard for these large, somewhat dogmatic entities to say, ‘Yeah, we were probably doing it wrong, and we should first think about the airway every time we make a bite guard,’ and I don't think that's happening at the level It should be. It should be happening across the board.” (16:10—17:03) -Dr. Murphy
“There are 200,000 dentists in the country. We think maybe as many as 100,000 have taken a sleep course. That's pretty impressive. We know that somewhere between one and 2,000 — let's say 1,500 to pick a number. But I don't care if you choose 17 or 1,200. It's not 2,000 — have ever billed medical insurance for an oral appliance. And maybe 200, maybe 250, not 300, are doing a lot of sleep. So, is it a disruption? Hell yes. Is it innovative? Hell yes. Are there different schools of thought? Hell yes. But I'm not going to spend a lot of time fighting with the Vivos people or fighting with these other schools of thought. I'm glad that there are maybe 1,000 or 1,500 people that are paying enough attention that they figured out a way to bill medical insurance and help people sleep better at night and manage some of these comorbidities.” (19:00—19:56) -Dr. Murphy
“Every dentist who says sleep is hard means working with physicians is hard. They mean billing medical insurance is hard. They mean getting people to say yes to a $2,000, $3,000, or $4,000 device because they're not using medical insurance, that's hard. The doing [and making the oral appliance] is super, super, smoking easy.” (20:05—20:21) -Dr. Murphy
“You can't learn how to swim without getting wet. So, we tell [students] in the first month [of the IAOS program] — in the first month — we want you to treat three, four, or five patients. They're like, ‘How the hell do I do that?’ Well, you treat yourself, your wife, your friends, your neighbors, your staff. You treat people you know, and you don't worry about getting paid. You eat the cost of that device — $500, $600, $700, who cares? Manufacturers will give you some break on those first devices you do, so they'll help you out with that. ProSomnus does that. Everybody does that. So, make your first devices the first month on people you know. Get your fingers and hands wet, deliver a device, and find out what was hard, find out what was easy. ‘I couldn't figure out this part with the bite.’ Watch another video, smooth those wrinkles out, and then start screening your patients and start treating them for real. Then, maybe in the beginning, you do that for cash the first month or two. So, you're doing another three or four devices the second or third month, and you're getting paid cash by those patients. Then, start to figure out how you're going to go talk to physicians, and figure out how you're going to do medical billing. That next piece of time could be two, three, five, six, eight, or nine months. It doesn't matter. Sometimes, it depends on how busy you are when you practice, and how excited you are about doing sleep.” (21:45—22:47) -Dr. Murphy
“This idea of getting in and getting started — I just had a call yesterday with a dentist who said he took his sleep course with another group over a year ago, bought a piece of equipment that he would be using, and he's finally made seven devices. I told him, ‘Seven devices is great!’ He says, ‘Yeah, but they're all in the last six weeks.’ So, he was a year before — he just kept reading about how to go swimming. He wouldn't jump in the pool. And when he finally jumped in the pool, now he's having some problems. I'm like, ‘This is great!’ He goes, ‘What do you mean it's great?’ ‘This is great because you can't fix those problems until you make a device.’ So, if we stand around waiting for our first device to be perfect, we're never going to get started.” (22:48—23:29) -Dr. Murphy
“Even identifying the people that are at-risk and pushing those people in the right direction — first off, you get to write down in your chart that you told them that they're at high risk for sleep apnea and they should get tested. If they don't want to, you can wipe yourself off any guilt you're going to have if they don't get treated. But second off, when you see these people get treated, even if you're not the one treating them, and they come back and say, Thank you ever so much. My husband and I are back in bed together,’ or, ‘My medications are working,’ or, ‘I'm finally starting to lose weight,’ or, ‘I sleep so much better. I have so much more energy,’ whatever it might be, whatever the positive symptom management that you see from that activity, is highly rewarding and very motivational to the dental team.” (24:22—25:07) -Dr. Murphy
“There's nothing wrong with CPAP. CPAP is a great treatment. It's just hard for most people to get used to. Oral appliances are much easier for people to wear, so the adherence or compliance rate for that is much higher than it is for CPAP. CPAP, about half the people wear that. With oral appliances, about 90% actually wear it. So, it wins on adherence. It isn't quite as efficacious as CPAP. But the math, when you multiply it by two, it comes out it's not inferior to CPAP, which is kind of cool.” (25:17—25:43) -Dr. Murphy
“You can have any kind of practice you want. It's about your vision. It's about Alice in Wonderland coming to the fork in the road and asking the Cheshire Cat which one to take, and the cat says, ‘Well, it depends, Alice. Where are you going?’ She said, ‘I don't know.’ He said, ‘Well, then it doesn't matter which road you take.’ So, it's about making it matter which road you want to take. If somebody commits to wanting to do dental sleep medicine, then there's a support structure out there for you that can help you get there. If you say, ‘I want to do that. I want to be involved. It sounds exciting and I want it to be successful,’ but I'm not willing to commit to it, I'm not willing to put in four to six hours a week, I'm not willing to make an investment of time or money, then you're very likely not going to be successful. You'll be frustrated, and you'll be another one of the 100,000 dentists who've taken a sleep course and really aren't doing sleep. So, you have to make a decision to have that be a vision of what you want to do. And then, if you decide that's what you want and you really want to move into sleep, if you want to go fast, you go alone. But if you want to go far, you go together.” (32:56—33:57) -Dr. Murphy
“You could join the best gym in town, and you could hire the best trainers. But if you don't get up in the morning and go to the gym, nothing changes. So, it's about having a vision for what you really want to do — because sleep isn't everybody's cup of tea, but it's great. It’s super rewarding — and then, it's about making a commitment to that.” (34:16—34:32) -Dr. Murphy
Snippets:
0:00 Introduction.
2:00 Dr. Murphy’s background.
5:51 The evolution of sleep devices.
8:18 The business of sleep, explained.
13:28 The slow adoption of sleep.
17:05 It’s really not that hard.
21:06 You can't learn to swim without getting wet.
23:53 Screen every patient.
25:45 Dr. Murphy’s passion behind the International Academy of Sleep.
32:31 Final thoughts.
34:46 More about IAOS and upcoming courses.
Dr. Mark Murphy Bio:
With nearly 40 years of experience in the dental and dental laboratory professions — and recently in the dental manufacturing industries — Dr. Murphy has a gestalt perspective of the various functions and relationships. A long-standing role with the Pankey Institute in Key Biscayne has had significant influence on this point of view. After receiving various awards and honors within the dental profession and selling his very successful practice in 1998, he drifted toward a more global industry view and role, serving with Dental Technologies Inc. and as a consultant to several manufacturers and suppliers for dentistry and the laboratory profession.
Currently, Dr. Murphy is the chief learning officer for the International Academy of Sleep. He was the former lead faculty for ProSomnus Sleep Technologies, practiced dental sleep medicine part-time in Rochester Hills, Michigan, and was on the faculty at UDM School of Dentistry and the Pankey Institute.