Laura Dorr is the former executive editor of DPR's Modern Dental Network and a regular contributing author.

Laura Dorr

Getting patients into the office can be, well, a bit like pulling teeth. And if such is the case, how can dentists expect patients to follow through with additional treatment, like orthodontic care?

The answer is that they can’t—to the detriment not only of the patient but of the dentist as well. If a practitioner can’t offer the care a patient needs, the odds are the patient isn’t going to return. The idea of orthodonture is already daunting enough, so how can we make the procedures themselves less so?

The answer—bringing orthodontics into the general practice. Although this may not have been practical 20 years ago, the advent of clear aligners and the emergence of numerous aligner support companies have made it much easier for general practitioners to integrate services.

“General practitioners are great caretakers of their patients,” says Alyssa Emory-Carter, DDS. “Their patients trust them. Many…want to treat their patients orthodontically…to ensure…[they] are following recommendations, but [they] have run into obstacles with workflow or the ability to provide the quality of care they…[offer with]…other dental procedures. Now, there are options.”

And patients are looking for these one-stop-shop options among those clinicians with whom they already have a rapport, which takes a lot of the anxiety—and legwork—out of the process. “It really starts with the dental consumer, and the dental consumer is really looking for comprehensive care,” says Jody Rodney, senior vice president of marketing and education at orthobrain. “They want to be able to see the dentist and…the dental team…they know and trust. What’s happening is [that] dental consumers are going into the general practitioner who can…provide full orthodontic treatment.”

The benefits for practitioners are numerous. They can add a revenue stream and attract patients interested in comprehensive care. Precedence Research forecasts that the global orthodontics market, which is growing at a rate of 15.3% a year, will exceed US$ 21.5 billion by 2030 and the US market, whose annual growth is 14.3%, will reach US$ 9.6 billion in 2029.

Therefore, it makes a great deal of sense for those dentists who are considering specialty work to look at orthodontia.

“Offering in-house orthodontics expands…[the] general practitioner-patient relationship and allows the general practitioner to own the patient, versus sending them out to a specialist,” Rodney says, “So, it’s helping the dental consumer, and it’s also helping practice profitability.”

Given that most dentists leave dental school with little orthodontic training, many general practitioners haven’t given it any thought since graduating. Now, however, continuing education, rapidly advancing technology, and clear aligner companies are making the field accessible to the general practitioner.

Since 2020, when technology became critical to weathering the pandemic, digital systems and workflows have increased, and products and software options have improved. Braces systems offered by such companies as LightForce, KLOwen Orthodontics, and Digital IDB, and the advances in clear aligners from Spark and SoftSmile are pushing the industry forward.

“Digital scanning and AI have allowed orthodontists to treat patients with an increased quality of care, as well as from a wider demographic region,” Rodney says. “It has allowed us to create systems,…change our treatment philosophies and sequences, and customize for every single patient in real-time. This should have our dental community excited because it 

allows for better, more customized care for our patients.”

Although the new options are fantastic, practitioners must nevertheless understand what the design software is doing. “Education is essential,” Rodney says. “Education will drive a 15% growth for a practitioner who engages on at least 2 education modalities with us. Education drives the comfort level and the knowledge level when it comes to clear aligner program implementation, so education is absolutely essential in all that we do.”

Dr Emory-Carter agrees. “I would encourage any general practitioner who wants to begin offering orthodontic services to take courses…especially on growth and development, diagnosis, [and] treatment planning. And then find an orthodontist who is willing to be…[a] mentor…and…assist with case selection,” she says. “Every orthodontist I know has a mentor orthodontist.”

Despite advances in treatment-planning software and aligner design, technology is no substitute for a specialty in orthodontics. Partnering with an orthodontist or an organization that specializes in treatment planning and can provide case support can be extremely beneficial.

“Partnering with a company to help them with case management treatment planning from A to Z can be really essential for a general practitioner,” Rodney says, “because they aren’t specialists. They didn’t go for an orthodontic residency and may not be as confident with the mechanics involved in moving teeth. So, they really need to partner with an organization that can help support them with a full, 360-degree approach.”

Once general practitioners are treating patients with malocclusion, it’s important for them to remember that some cases will be beyond their ability and best left to a specialist. Luckily, there are companies that provide direct support to general practitioners who may not have the necessary skill set. One such entity is orthobrain which helps dentists integrate orthodontics into their practice and provides education, support, and comprehensive case management.

Dentists register with the company online, complete an initial patient assessment, and submit patient records to the platform. An orthobrain orthodontist reviews the files and creates a treatment plan.

“orthobrain offers a total solution; we do all the treatment planning, so we remove many of the barriers and increase the confidence of the general practitioner that is incorporating clear aligner therapy for their patients,” Rodney says. “After the dentist has approved the treatment plan, we take it from there as far as manufacturing the plastic, making sure that there’s full support and 360 engagement, from our clinical team.…Then, aligners are delivered within 12 to 14 days.”

Orthobrain’s SimplyClear aligners are manufactured with a softer, more pliable material, making them more comfortable for patients.

Even after the aligners are in hand (or in mouth, so to speak), orthobrain continues to support the clinician.

“orthobrain isn’t just about the plastic,” Rodney says. “We say, ‘go beyond the plastic’; it’s being able to support a general practitioner through full case management, treatment planning, and all of the essential business components. We give absolute, 100% guidance to the general practitioner to help them through the entire process, and this support is something that we feel that they should be confident in,” Rodney says. “Because of the concierge-style way that we interact with our general practitioners, we get to know them individually, and we understand where they are clinically.”

This understanding of clinical capabilities is particularly important when it comes to deciding which cases can be treated by the general practitioner and which should be referred out.

“If we have a case that is submitted or comes through that we feel is beyond the general practitioner’s clinical level, we will either recommend that they send it out to a specialist or suggest a different process in order to make sure that the patient is well situated and gets the outcome that they’re looking for,” Rodney says.

In the end, a positive outcome for everyone is the goal. In addition to owning her own orthodontic practice in Sherman, Texas, Dr Emory-Carter serves as a clinical advisor for On Demand Orthodontist, a company whose “bottom line is [that] we want what is best for the patient in their orthodontic needs, regardless of where the patient is treated,” she says. “We want to bridge the gap as general practitioners begin to explore the field of orthodontics.”

On Demand Orthodontist offers a variety of services based on each of their general practitioner’s needs. This support includes diagnosis and treatment planning, orthodontic monitoring, refinements, and direction on patient care. It also provides materials, including aligners, scan boxes, and retainers. Essentially, Dr Emory-Carter says, the company is a “virtual orthodontic associate” for general practitioners, allowing them to keep the patient in their practice while a partner orthodontist helps oversee the patient’s care. This collaboration allows for optimal care, benefiting patients as well as dental and orthodontic professionals.

“On Demand Orthodontist takes the obstacles out of the way and provides the general practitioner… [with] a way to…[give] patients…the highest quality of care…with the knowledge, systems, guidance, and care of an orthodontist,” Dr Emory-Carter explains. “The clinician’s experience is smooth from beginning to end. Essentially, On Demand Orthodontist wants to ensure the care of the patient comes first, regardless [of] who is treating the patient, as well as promote collaboration between the general practitioner and specialists, which is something we as a profession have room to grow upon.”

Although orthodontic tools for general practitioners are available and advancing quickly, the most important factor is to successfully execute a treatment plan, and at this point, that’s up to the clinician, not the technology. Emerging tech is undeniably changing the playing field, and artificial intelligence is streamlining treatment planning and helping practitioners make informed decisions based on large sets of data, but the human component remains critical.

“The No. 1 thing to keep in mind is that the aligner is just a tool,” Dr Emory-Carter says. “And the tool will only be as successful as an accurate diagnosis and treatment plan. An author doesn’t have a best-selling book because of the pen they used.…And we shouldn’t expect a good result if we do not have a plan in place.”

This plan becomes increasingly important as the general practitioner orthodontic field continues to expand, particularly with the growth of the clear aligner industry. Ultimately, however, despite all the new bells and whistles, if a general practitioner is thinking about adding orthodontics, they need to be committed to quality care.

“Clear aligner therapy will undoubtedly take up more share of chair,” Dr Emory-Carter predicts. “As the product improves and our knowledge of plastic biomechanics continues to improve for predictability, the ability to treat advanced cases improves. There will be added features to the aligners that change the way we practice with aligners and additional considerations with surgery and sleep and breathing disorder treatments. This will allow clinicians more flexibility in honoring the patient’s preference on which tool to use to treat them.”

At 14.3 percent CAGR, US orthodontics market size to hit USD 9.60 billion by 2029. Globe Newswire; September 20, 2022. Accessed October 2, 2022. https://www.globenewswire.com/news-release/2022/09/20/2518999/0/en/At-14-3-CAGR-US-Orthodontics-Market-Size-to-Hit-USD-9-60-billion-by-2029.html#:~:text=Pune%2C%20India%2C%20Sept.,Market%2C%202022%2D2029%22.

Orthodontics market size to surpass US$ 21.5 billion by 2030. Globe Newswire; January 28, 2022. Accessed October 3, 2022. https://www.globenewswire.com/en/news-release/2022/01/28/2375147/0/en/Orthodontics-Market-Size-to-Surpass-US-21-5-Billion-by-2030.html

Articles

Aligner support companies and the variety of clear aligner options allow clinicians to bring orthodontics into the practice, making ortho care more accessible. 

Orthodontic Options  in GP Settings

Picture this: A patient comes into the practice for the first time in years and presents with numerous dental issues. The treatment plan involves 5 different procedures, totaling $5000. The first few steps are the cheapest, and the patient (who doesn’t have insurance) only accepts the first 2 recommendations because they cannot afford the entire treatment plan, then you never hear from them again.

This scenario happens in dental practices every day. The biggest barrier to treatment acceptance is cost, particularly for uninsured and fee-for-service patients. In 2021, approximately 74 million Americans did not have dental coverage.

Not having dental coverage means paying out of pocket, which many people are unable to do. In 2015, a study by ORC International found that 39% of patients had delayed or limited dental care because of finances.

 These rates are expected to continue to climb, as an estimated 6 million Americans lost dental coverage in the past 2 years because of a lost job from the COVID-19 pandemic.

“Nearly 6 of 10 Americans do not have enough savings to cover an unplanned expense of $1000,” Jay Letwat, vice president of dental at Sunbit, says. “The average dental treatment is [approximately] $1200, so there’s obviously a disconnect.”

Sunbit’s Smile Now, Pay Over Time solution for the dental market offers patients the flexibility to pay for dental services over periods of 6, 12, 18, 24, and even up to 72 months. This program is able to approve 85% of patients who apply. It offers access to financing for procedures between $60 and $20,000, and all qualified patients get access to 0% interest payment plan options. Sunbit manages the application and collections processes, and the dental office gets paid right away, increasing cash flow to the business without the risk of a patient defaulting on the loan.

What patients unfortunately do, Letwat says, is deny treatment. “[Patients typically] approach it like a fancy French restaurant. They say, ‘OK, I’ll get the first couple things on the list, but the rest is out of reach. I’m going to hold off until it’s really painful, then I’ll somehow come up with the money.’ But then they don’t have the money, so they skip the last few items on the treatment plan and don’t get the full care they need.”

Treatment should be more accessible to all patients, regardless of insurance status or income. But historically, this hasn’t been the case. Options have been limited to insurance, out-of-pocket, or financing solutions that are often intimidating or even unobtainable. “We’ve found that there hasn’t been any innovation in the past 30 years—literally the same solutions that were available then are the ones that are out there today,” Letwat says.

The programs today often exclude a large portion of the population, according to Letwat. In traditional dental financing models, only 35% to 40% of patients are approved for financing, he says. “Many of the players in the financing field are only approving patients with prime credit,” Letwat says. “But only [approximately] 40% of people in the US fall into that category. The problem is that 60% of people are considered subprime, and they aren’t getting approved, so those 60% aren’t getting the treatment they need.”

Money can be a taboo topic, and these low approval ratings make offering financing solutions to patients an uncomfortable process for the dental team, as they don’t know whether the patient will even be approved. “It’s an incredibly awkward conversation,” Letwat says. “Even outside the dental office setting, it’s very uncomfortable to talk about finances to anyone. If there’s a $1200 procedure, the treatment coordinator doesn’t want to ask you [whether] you need help because it’s uncomfortable. It’s uncomfortable to ask because you’re not sure what the answer is going to be or even [whether] financing can help.”

Letwat believes the key to success with financing is a transparent, respectful solution with competitive rates that makes both the patient and the office team comfortable. “More and more practices are seeking out easy, transparent, pay-over-time solutions,” Letwat says. “They know it’s critical to offer this type of solution to their patients so the patients [can] receive the care they need. The whole concept of buying something now and paying over time is catching fire. [However], on the dental side, they’ve been slow to adopt technology…”

Three years ago, Sunbit, a financial technology company, entered the dental field. Using artificial intelligence (AI) and machine learning (ML) technology, Sunbit can offer more patients financing for their dental treatment. Sunbit’s AI/ML approach streamlines the approval process so it’s quick, simple, and most importantly, accessible to most patients. On average, Sunbit approves over 85% of patients for financing, which is double the traditional average. “With the advanced machine learning and other technologies we’re using, Sunbit is reducing the barriers for everyday [patients] to get the financing they need,” Letwat says. “That’s the mission of the company.”

Applying for other financing options can be a cumbersome process, much like a credit card application that asks invasive questions and requires a hard credit check. “The same questions on that 1968 credit card application are the same ones on the dental application today,” Letwat says. “[Patients] are very much unsatisfied with the product, [which is] something we can disrupt with our technology. The process is incredibly quick and easy—it takes 30 seconds.”

Sunbit can expedite the application process because it doesn’t require a hard credit check to apply. Instead, they implement a soft inquiry, even if the patient decides to take the loan. This puts patients at ease because it prevents hard credit checks, even if they aren’t approved.

“We don’t want this to feel like an intimidating financing transaction,” Letwat says. “It doesn’t feel like an overwhelming commitment, like a typical financing transaction, [which] is what we want for the patient.”

Participating practices are provided with an iPad, which they can hand directly to the patient to complete the process themselves. Patients scan the barcode on the back of their driver’s license, and the software automatically pulls the patient’s information from the patient’s state issued ID. Patients are then presented with 3 to 6 different payment plan options.

“Ultimately, we want the patient to select the option that’s best for them,” Letwat says. “With us, treatment coordinators can say, ‘You don’t have to pay everything today. We have a payment plan so you can pay over time. Let’s get you qualified in 30 seconds and find a monthly payment you’re comfortable with.’”

For example, say a patient is presented with a $2100 treatment plan. The patient doesn’t need to panic; they’ll see multiple options for payment plans, even as low as $56 a month over 48 months to finish treatment. Payment schedules are clearly spelled out and illustrate that the same amount will be auto-debited monthly, because Sunbit doesn’t apply deferred interest.

In addition, Sunbit doesn’t charge any extraneous fees. The plan the patient sees is what they get. “Because there aren’t any other penalties or origination or maintenance fees, the patient feels like they understand what they’re signing on for and they end up opting for much more treatment than they typically would,” Letwat says. “So, we’re seeing much higher treatment acceptance and much higher-dollar treatments being accepted.”

While the main goal is always to provide accessible financing options to patients, these benefits of successful financing for practices—higher treatment and higher-dollar treatment acceptance—are added perks. The application process can be easily integrated into the practice. Sunbit can be added to the practice management software as a tender type—no extra software is needed. “It’s a form of payment that essentially becomes a receivable,” Letwat says. “When a practice closes out their books at the end of the day, they know they can expect a payment from us within 2 business days. We provide real-time reports, so everything is at their fingertips in real time.”

To expedite the onboarding process for staff, Sunbit provides full training for every new practice offering the service. “We have a full onboarding and logistics team, with [staff] all over the country,” Letwat says.

In 2½ years, Sunbit has staggeringly not had a single practice cancellation. They’re now in approximately 6500 to 7000 dental locations nationwide (in DSOs, multilocation practices and single private practices).

“[Ultimately], we want to help everyday patients get the dentistry they need. That’s the bottom line,” Letwat says. “We always say, ‘Be good to the patient, be good to the practice.’ That is how we operate.” 

1. Major national survey reveals impending spike in oral health needs. GlobeNewswire. April 8, 2021. Accessed August 13, 2022.

https://www.globenewswire.com/news-release/2021/04/08/2206983/0/en/Major-National-Survey-Reveals-Impending-Spike-in-Oral-Health-Needs.html

2. Americans limit or delay dental care due to financial concerns, survey finds. 

®. May 11, 2015. Accessed August 17, 2022. 

https://www.dentalproductsreport.com/view/americans-limit-or-delay-dental-care-due-financial-concerns-survey-finds

3. Carter SM. Over half of Americans delay or don’t get health care because they can’t afford it—these 3 treatments get put off most. 

. Updated April 3, 2019. Accessed August 17, 2022. 

https://www.cnbc.com/2018/11/29/over-half-of-americans-delay-health-care-becasue-they-cant-afford-it.html

Sunbit can offer more patients financing for their dental treatment by using artificial intelligence and machine learning technology.

Deep Dive: Financing That’s Good for the Patient and Practice

To become a dentist, you’ve invested heavily in your education—very heavily. The American Dental Education Association reported that the average debt for 2021 dental-school graduates was $301,583, with only 17% of graduates reporting no student-loan debt.

You’ve made a hefty investment to make this career a reality. But it’s not a one-and-done deal: To pay off that investment, you’ll need to invest even more.

From the day you start practicing, to the day you open a practice, to the day you retire, you should be thinking about investment strategies that can benefit your practice and yourself. By making sustainable, calculated investments, you can increase your revenue, practice value, your retirement nest egg, and more. It’s important to make investments that will retain value and continue to power practice and wealth growth over the years so you aren’t left with money wasted on stagnant investments without long-term benefits.

“Once you transition to owning a practice, you can’t ignore the numbers anymore,” says Matthew White, cofounder of White & McGowan, a financial firm in Little Rock, Arkansas, that specializes in strategies for dentists and physicians. “You can’t ignore planning. You can’t ignore organization, risk management, or finances. Those all become a part of your life, and when that starts to happen, you need to take more interest in financial planning. This shift happens when you become a business owner.”

The American Dental Association reports that practice owners can expect to make an initial investment of approximately $500,000 to start a dental practice from scratch. These costs include construction and renovation of the building ($240,000); acquiring tools, equipment, technology, and supplies ($190,000-$200,000); and back-end expenses like marketing materials, information technology (IT) support, legal representation, and start-up employee salaries ($70,000).

But these costs only represent the start-up. To remain profitable, you need to continually invest in smart strategies that will grow your practice and keep it appealing for sale when the time comes to sell out or retire. What follows are several areas that practice owners should keep in mind.

Owning your practice’s physical space instead of leasing can be a very good investment. Having real estate helps you build equity in your practice, which appreciates over time and gives you the option to borrow against the property if you need to in the future. Plus, there are big tax breaks: Property owners can deduct interest, non–mortgage-related experiences, and depreciation. In fact, you may be able to accelerate deductions on your income taxes by applying Section 168 of the tax code. This section allows practices that have undergone a cost segregation study to break the building down into Internal Revenue Service (IRS)–sanctioned asset classes instead of sticking to the standard 39-year depreciation schedule that would apply to the whole property.

Under Section 168, different aspects of the practice are assigned different useful lives, which can open the door to accelerated depreciation for shorter components. Aldrich Advisors, an accounting, wealth, and consulting firm, reported that ground-up practices that switched to Section 168 had 24% to 65% of total building costs reallocated from the 39-year schedule to much shorter ones, which could have a major effect on your tax liability.

The best way to ensure continued revenue growth is to have an established and growing patient base. After all, your patients are what brings in the money. In addition to generating revenue for you now, it also makes the practice more attractive to potential buyers down the road that are going to look for a stable, sustainable patient base. This means you must be able to reach prospective patients.

One way to do this is to invest in a web designer and IT support system to ensure you have a user-friendly, attractive, modern website. Although a website may seem like a low priority, it’s the first impression prospective patients get of your practice. In the digital age, it’s critical that your website be up-to-date and tech-savvy and promote a positive image of your practice. You also want to ensure this presence carries over to your social media accounts, which should always be active. Posting a few times per week boosts your internet presence and makes you more accessible to patients.

Although the first inclination may be to invest in technology for the operatory, this digital technology is critical in getting new patients in the door—so that you have someone to use all that exciting new clinical technology on. If you don’t have someone in-house to run your website or social media, consider bringing on a contractor or partnering with an agency to maintain your digital presence.

This brings us to clinical technology, such as 3D printing, imaging, CAD/CAM—whatever latest emerging tech appears on the market. Investing in new technology for your practice allows you to treat more effectively and efficiently while also showing your patients that you are providing the most modern and best-on-the-market care.

Although the up-front cost of purchasing the latest digital scanner or 3D printer may be steep, the dividends it can bring make it worth it. Convenience is one major benefit. For example, if a dentist invests in a CAD/CAM solution that allows them to design and produce crowns, they could offer ceramic restorations in a single appointment—reducing the number of patient visits and increasing the ease of accepting care. This CAD/CAM solution could also save you on lab costs and costly production delays. Essentially, the benefits it provides now in saving you money, attracting new patients, or increasing case acceptance can more than cover the initial costs or the cost of investing in newer emerging technology down the road.

And if the cost seems insurmountable, there’s good news. Practices can claim a bonus depreciation tax deduction under IRS tax code Section 179 for 50% of the cost (or up to $500,000) of equipment purchased and put into use in a year.

It may seem superficial, but the look of your office can have a big impact on whether patients return. Your waiting room should be comfortable and comforting; many patients experience anxiety at the dentist’s office so providing them with a low-stress experience can keep them coming back.

In addition to considering aesthetics, investing in a layout that maximizes efficiency is something to consider seriously because it can save your practice time and money. If you’re struggling in your existing exam space, invest in renovations to add another operatory. If the cabinets in an operatory are inconveniently located and causing your hygienists to spend time getting up and down to get tools, redesign and reequip the rooms.

Although the investment cost of renovations may seem daunting, the long-term benefits can outweigh the price tag. Plus, there are other tax breaks for building improvements, which qualify for the leasehold improvement deduction under Section 168 of the IRS tax code. Leasehold improvements are depreciated over 39 years, allowing you to spread the cost of upgrades across a longer period.

Your practice is only as good as its people. Investing in your staff—whether that be through offering continuing education credits, competitive salaries, practice-performance bonuses, or other benefits—rewards hard workers and helps retain personnel. You may face more up-front costs by paying higher salaries or offering benefits or competitive retirement plans, but you’ll be able to retain talent. Not only do you get to keep the people that keep your practice running smoothly, but you avoid the cumbersome, time-consuming process of having to train a new front-office member or hygienist on a regular basis.

Additionally, patients appreciate staffing consistency. Having long-term staff reflects well on the practice owner and helps build relationships with patients that will keep them coming back. If they receive oral-health or treatment advice from a trusted hygienist that they’ve been seeing for years, they are more likely to accept treatment than if they didn’t have a relationship with the dental professional. Higher patient return rates and higher treatment acceptance mean more revenue for the practice, which can easily offset the cost of compensation.

You’ve already invested so much money in your education and your practice, but you also need to remember to continue to invest in yourself. Dentists should continue to pursue opportunities to grow to provide the best care for their patients. Continuing education courses, lecture circuits, publications, and research are all great ways to stay on the cutting edge of the industry while also establishing yourself as an educated and forward-thinking clinician. Doing this can result in an increase in revenue. If dentists position themselves as always learning and improving, it can become a great marketing tool.

Social media and the practice’s website are great places to let patients and potential patients know that you’re consistently invested in improving the care you provide by participating in continuing education. If you learn a new technique with new technology, promote it on your page to explain how this new technology can provide better care for them and that you are equipped to handle this technique or type of case. This can help drive more patients who see that you are experienced in treating their problems in the most up-to-date manner.

Continuing education also gives you the opportunity to create blog posts or educational materials. You can present the information you learned and how it will help you provide better care to your patients, which positions you as a knowledgeable professional there to educate as well as treat. By enhancing your own continuing education, you are also enhancing your public image and thus growing—and maintaining—your patient base over time.

Financial Investment Strategies That Pay Off

Smart savings go beyond just investing in the practice itself. Doctors should always be thinking about the value of their investments when it comes time for a practice sale or retirement. Getting started with these investments early can pay big dividends in the long run. But where should practitioners be putting their money?

The smartest investments you can make are varied. White says that diversifying your investments is the best way to plan for the future. Doctors can diversify by investing in a variety of plans for themselves and their employees to maximize their pretax contributions and pay less in taxes.

“Having multiple types of retirement plans gives the owner the ability to make greater pretax contributions,” White says. “You do you have to make 401(k) contributions to those employees, which is a cost and is overhead, but assuming the tax savings for the owner is greater than the overhead cost of making matching contributions to employees—which it typically is—then it makes sense for them to implement plans like a 401(k), and a profit-sharing plan, and a cash-balance plan.”

White believes that retirement contributions can start early and may even be an option for younger dentists who may not be in a position to contribute much at this stage in their career. For instance, cash-balance plans are age-weighted in the way the contributions are calculated, so the older you are, the larger those pretax contributions will be.

“If you start when you’re really young, your contribution on top of…a 401K and profit-sharing plan will be much smaller, but if you are age 55 and starting a cash-balance plan, your contribution may be $250,000 a year that you can contribute to this account pretax,” White says. “The deductions can be significant and can help a dentist save a significant amount in taxes.”

These deductions add up quickly. In 2022, White says people younger than 50 years can contribute up to $20,500 with a 401(k), and those 50 years and older can add another $6500 to that total as a catch-up contribution.

If you’re younger than 50 years and add a profit-sharing portion, you can set aside $61,000 per year pre-tax. And, depending on your age, if you do a cash-balance plan on top of that, your contribution could amount to an extra $50,000 on top of the $61,000 for those younger than 50 years and the $67,500 for those 50 years and older.

When it comes to investing in retirement, understanding the different options for savings can help dentists save more and pay less. Aldrich Advisors recommends that business owners invest in the following 3 types of retirement plans:

Making contributions to a tax-qualified retirement plan is a great way to start saving. An annual investment in an IRA can grow to a substantial amount by retirement time. As a bonus, contributions to IRAs can often reduce the amount you’ll owe at tax time because it affects your adjusted gross income. Practitioners should begin making contributions to one of these tax-qualified plans as early as possible.

Contributions to 401(k) plans are another way to set aside savings. These contributions are deducted from gross income before income taxes have been deducted. The money contributed—and any investment earnings—aren’t taxed until withdrawal. Although the downside is paying taxes on your withdrawal, you may be in a lower tax bracket by that time, which will save money overall.



A Roth IRA differs from a traditional IRA in a few key ways. With a Roth account, you’re able to contribute after-tax dollars, your money grows tax-free, and you can generally make tax- and penalty-free withdrawals after the age of 59½.

According to Charles Schwab, Roth IRAs are best suited for individuals who expect to be in a higher tax bracket when they start making withdrawals.

“Let’s say we convert a million dollars over 5 years,” White says. “By going ahead and paying taxes on that before the required minimum distributions hit and getting it into the Roth IRA, it’s able to grow tax-free from that point forward. Since there is no required minimum distribution on a Roth IRA, it allows this money—that you may not need for a long time—to grow tax-free.”

In the end, being left with more money is the goal of all investment strategies. By investing in your practice and planning for your future, you can ensure that down the road, you will see the results in increased practice value—and its subsequent revenue.

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https://www.adea.org/godental/money_matters/educational_debt.aspx

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https://marketplace.ada.org/blog/dental-business/the-real-cost-of-owning-a-dental-practice/

What do you do with extra cash in your dental practice? Aldrich Advisors. March 17, 2017. Accessed August 24, 2022. 

https://aldrichadvisors.com/dental/managing-cash-flow/

IRS issues guidance on Section 179 expenses and Section 168(g) depreciation under Tax Cuts and Jobs Act. News release. Internal Revenue Service. December 21, 2018. Accessed August 22, 2022. 

https://www.irs.gov/newsroom/irs-issues-guidance-on-section-179-expenses-and-section-168g-depreciation-under-tax-cuts-and-jobs-act

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https://www.law.cornell.edu/uscode/text/26/168

Waggoner J. How much can you contribute to your 401k in 2022? AARP. November 10, 2021. Accessed August 23, 2022. 

https://www.aarp.org/retirement/planning-for-retirement/info-2021/401k-contribution-limits.html

Roth IRA vs traditional IRA. Charles Schwab. Published 2016. Accessed August 23, 2022. 

https://www.schwab.com/ira/understand-iras/roth-vs-trad-ira#:~:text=With%20a%20Roth%20IRA%2C%20you,current%20income%20after%20age%2059%C2%BD

By making sustainable, calculated investments, you can increase your revenue, practice value, your retirement nest egg, and more.

Smart Savings: Practice Investment Strategies That Retain the Most Value

Dormant patients. Declining revenue. Lagging production. These challenges are ones that every dental practice faces. How do you retain patients and keep them from going elsewhere? How do you build patient loyalty and increase treatment acceptance? How can you best support your fee-for-service patients and drive results?

One approach is to implement a membership plan. Membership plans can expand patients' faith in a practice, make treatment affordable and accessible, and increase patient retention—all of which benefit your bottom line. These results are compounding and make your practice stand out, giving you a competitive edge.

But how exactly does it work, and what gives you the advantage?

According to Dave Monahan, CEO and founder of Kleer, a subscription-based dental membership platform, fee-for-service patients visit the dentist 50% less when compared to insured or membership-plan patients.

Once a patient is enrolled in a membership plan, there is a behavioral change that occurs. By 

 and alleviating the fear of cost, patient satisfaction increases, and patient loyalty is created. Access to necessary dental care, without all the stress, increases patient confidence in the oral health decisions they make for themselves and their families.

"For the fee-for-service patients, membership plans get them to engage more deeply with the practice. Many fee-for-service patients feel like they're on the outside looking in. So by offering a membership plan, what you're saying is, 'We value our fee-for-service patients and provide a way for you to get the care you need.'"

According to Kleer's platform data, once enrolled in a membership plan, patients visit 2 to 3 times more often. Plus, most treatment is diagnosed in the hygiene chair. As patients visit more often and maintain routine visits, the rate of 

"Treatment acceptance increases 2 to 3 times more because patients are coming in, they're seeing what they need, and then they accept the treatment during their hygiene visit," Monahan says.

Membership plans are also a great way to reach out to dormant patients who haven't been to the practice for 18 months or more. Membership plans help to convert a dormant patient into a compliant one, which means less time spent chasing down new patients and more time focusing on the ones already in your database.

"On average, a practice has about 3000 dormant patients," Monahan says. "So practices can reach out to those dormant patients with a membership plan and get them to return to their practice and commit to care."

A membership plan provides an incentive that brings fee-for-service patients closer to your practice, solidifies their commitment to care and your practice.

Auto-renewals solidify patient loyalty and make renewing a plan simple.

"The ROI [return on investment] on auto-renewals makes up for fees associated with membership plans," Monahan says. "Having something as simple as auto-renewal versus somebody in the practice trying to call a patient and get them to renew makes a big difference. I don't know any businesses that do subscriptions manually because it's not practical. Dental subscriptions can renew the same way with a membership platform."

Regardless of industry, once someone is on a subscription plan with auto-renewal, research says they're likely to continue. According to Truebill, subscription services for platforms like Audible, Amazon Kindle, and Time have retention rates ranging from 82% to 85% yearly.

 For Kleer, the annual membership renewal rate is 75%.

"Wherever there is recurring need, people want a subscription model," Monahan says. "Dentistry aligns perfectly with a subscription model because you have a recurring need for dental care, since you know you need to get into the dentist every six months."

These benefits flow directly to the practice. Monahan says research has shown that when someone commits to a subscription model in any industry, they purchase twice as much.

"We're seeing this same thing in dental as in other industries," Monahan says. "When a patient commits to the membership, they're doubling the amount they purchase from the dentist."

Strengthening the value of your patients, especially fee-for-service patients, is critical to a practice's success, but attracting new patients—and subsequently retaining them—in a saturated dental market wastes a lot of a practice's time and money.

"Practices spend a lot of money bringing new patients into their practice," Monahan says. "On average, practices spend $100 per patient to get them into the practice for their first visit. The issue is that only about 40% of those new patients ever come back to the practice."

Many practices write off these marketing losses as the cost of doing business, but it doesn't need to be that way. Membership plans can help retain these first-time patients and keep them returning for more.

"When a patient is offered a membership plan, and they accept it, the reappointment rate goes from 40% to 100%," Monahan says. "It keeps them coming back to the practice, and it increases the amount of care they accept."

Marketing these membership plans is easy when targeting both existing and first-time patients.

"Patients feel sort of exposed when they enter the dental practice, especially when they don't have any coverage," Monahan says. "If you train your team to talk about these membership plans and explain them to patients, the plans will market themselves because it reduces that layer of anxiety for the patient."

Monahan recommends ensuring that your team 

 and how to discuss them to encourage patient sign-ups.

"When patients understand that this is an offering, you differentiate yourself from other practices, and you show your commitment to your fee-for-service patients," Monahan says. "Make sure you're presenting this clearly to new patients on your website, social media, or direct mail. However you're marketing it, make sure anybody from a new patient perspective understands that you value them and are offering ways for them to access care."

It's no secret that collaborating with insurance companies or tracking payments can be tedious and time-consuming. Membership platforms deposit patient dues directly into the practice's bank account. The increase in innovation also means new features and automations to make your life easier.

Kleer will soon launch practice management system [PMS] integration so that payments post directly to practice management systems.

"The benefit is that no one in the practice needs to manage that or do it manually," Monahan says. "Practices will be able to pull up patient information and autofill the membership information when patients sign up. There will be automated marketing to patients to promote the plans. That integration will open all kinds of opportunities, automating the majority of steps to get better results for the practice."

 or manually documenting payments is a thing of the past. Simplifying collections with a membership platform empowers practices to focus on what they do best—treating patients.

Kleer combines an advanced, cloud-based platform with dedicated and personalized support to ensure your practice has everything you need to easily and quickly design, implement, and professionally manage a successful membership plan. Kleer has implemented membership plans for 7,000+ dentists, including over 300 groups and DSOs. Learn more about improving patient access to care and building a better, more profitable practice by visiting 

1. Roach S. The most popular — and most canceled — subscriptions will surprise you. 

. April 29, 2022. Accessed August 10, 2022. 

https://www.protocol.com/best-worst-weirdest-subscriptions

(Sponsored) Learn how to leverage your practice's membership plan to stay ahead of the competition.

More Than a Membership Platform: 4 Ways to Gain a Competitive Advantage

A typical practice population generally consists of patients with varying coverage types: preferred provider organizations (PPOs), health maintenance organizations (HMOs), dental discount plans, and those who pay cash. Typically, patients with insurance are more likely to return regularly for care, whereas cash-paying patients may be less consistent. This demographic—patients who pay cash—is often overlooked and relegated to languishing in a practice's dormant patient list, producing little to no revenue.

"If I'm a cash patient who doesn't have coverage, more often than not, I'm not coming into the office for regular hygiene," says Dan Crawford, enterprise sales manager at Kleer. Kleer's powerful cloud-based platform lets dentists offer their own customizable dental membership plans directly to their patients. "I'm much less likely to accept treatment because of that financial barrier, and if I do accept treatment, I probably won't return until I have a dental emergency. And all of this stems from not having coverage."

. Membership plans allow patients to subscribe to a practice for their preventative care. A significant benefit of these plans is that it increases access to care for fee-for-service patients who typically avoid the dentist due to the fear of high out-of-pocket dental expenses.

"We tend to see patients that join the membership plan behave similarly to patients covered by insurance: They're visiting more, much more loyal, and they're accepting 2 to 3 times more treatment," Crawford says. "Giving patients access to the care they need becomes an enormous asset for your business because suddenly that patient's generating production similar to that of an insured patient."

, putting the practice firmly in charge of their revenue. "The age-old problem with groups and practices is that they have no control over insurance reimbursements," says Crawford. "Reimbursement rates have continued to drop. And now these offices need to work more and see more patients to be profitable given how these insurance plans are structured." That's how a membership plan can help. By having a consistent stream of recurring revenue, you're no longer beholden to the whims of insurance companies.

Many practices and groups try to implement membership plans on their own. However, because this is new and unexplored territory for many, once they gain members and momentum, the payment and reporting aspects become more complex, leaving greater room for error and adding more work to an already busy team.

"There are practices using Excel spreadsheets, which becomes a big problem when you start to add 20, 30, 50 patients," says Dave Monahan, CEO and founder of Kleer. "Who's paying what? Have they made their payment? You don't have any way of managing renewals. You have no way of managing what benefits somebody has used or not used. We tell practices that platforms may have fees associated with using them, but we will more than make that up and produce ROI [return on investment] by having something as simple as auto-renewal."

In addition, "Multi-location practices are much more complex operations than, say, a single office, so your platform has to be reliable," Crawford says. "It has to be fast, and it has to be compliant in terms of things like HIPAA [Health Insurance Portability and Accountability Act], fee-splitting laws, etc. But it's really going to be critical to partner with someone with an infrastructure to handle these complexities."

Many underestimate the simplicity and security a platform can provide for the patient and your front office team. It's an asset to be able to leverage a platform that will take on these responsibilities for you.

Suppose a practice has offices in 10 different states, and each location has different fees and demographics. In that case, the practice needs a platform to handle that kind of data to deliver value at scale.

"If you have multiple offices in multiple states, it's essentially several entirely different operations because South Carolina is not New Jersey and is not New York," Crawford says. "They're very different places. So the pricing of a plan will be important, but the other challenge is ensuring uniformity. Do you have 

 between these very different markets under the same umbrella as your group or DSO? You need a reliable system to keep this dynamic group space on the straight and narrow."

Monahan agrees. "Customization of the plan is huge," he says. "These plans need to be thought through. What do your patient demographics look like? How many care plans do we need to offer, and what treatment options should they entail? Practices need to make sure that they customize their membership plan based on a patient's demographics—and they also need to price them properly."

It would be impractical to log in to 10 different dashboards to try consolidating the data to determine if a membership plan is getting results. Single-enterprise platforms allow everyone from the accounting team and the chief financial officer to the office and regional leads to log in to one place and see the data and performance metrics at varying levels in real-time.

Automations to Make Your Lives Easier and Your Patient's Lives Better

When establishing processes that work, it's essential to have the appropriate support in your corner. "When [you're thinking] about implementing a membership plan or perhaps elevating a current membership plan, you need to think about, What is the time commitment going to be for my team, and what costs are associated with that?" says Crawford.

Much of this depends on partnering with a platform that can help automate membership management. Front offices no longer have to track down payments, and patients have the peace of mind that their coverage is up to date.

"Subscription models streamline payments and save time," says Monahan. "When we get payments, we deposit them directly to the practice's bank account. There's nothing the practice needs to do. It's all done in the background. It's really, really simple."

But perhaps the most essential feature is auto-renewal. "That renewal at the end of the year is critical so that the patient can continue to be a part of the practice," Crawford says. "More often than not, the patients appreciate that automated renewal because when they sign up for the plans, they want the security of having coverage and staying with the practice. But a year is a long time, and sometimes these patients slip through the cracks and forget to renew, so having a platform that can take care of that for you is going to be important."

Automation features, in addition to patient self-service tools, are a great asset to the administrative team by allowing patients to manage their accounts. Many times, patients will have questions or need to update their payment method, and they should be able to log into a portal and get the answers they need without assistance.

As the market reflects, "Practices are having trouble hiring people right now, and team members are busy," Monahan says. Therefore, implementing efficiencies via software and automation is more important than ever.

"Your practice management software [PMS] is kind of the mother ship for the practice; that's where everything lives," Crawford says. "So now many dental membership companies are looking to integrate into practice management software. But it has to be executed successfully."

, practices should look for ones that showcase innovation and are transparent about their product roadmap. A platform with Integration capabilities will enable practices to harness the data between their membership platform and practice management software [PMS] to help make more informed business decisions and save their team valuable time. These integrations are critical in providing additional value to your business, from auto-filling forms to PMS payment posting to benchmarking coverage performance.

Kleer is one company making waves in this space. The platform offers an end-to-end solution quickly becoming the industry standard for dental membership plans. Their ability to innovate and integrate has allowed them to become one of the industry's most trusted, most powerful membership platforms.

(Sponsored) Understanding the types of technology and services that can help growing dental practice groups continue to thrive.

Tech to Grow and Manage Your Multi-Location Membership Plan

Dental and medical care have long been siloed, with dentists addressing only oral health and all other doctors handling every part of the body except the mouth as if it were not a vital organ. More recently, however, dental and medical practitioners have begun to think about total—oral-systemic—health.

“Total health has been a term used by many over the last decade, but its meaning can . . . [vary depending on the] individual,” says Bobbie DelSasso, RDH, BS, executive director of the American Academy of Oral Systemic Health (AAOSH), adding that the Academy’s focus “is on…collaboration between health care professionals to bring awareness to how systemic diseases can affect the mouth and vice versa.”

Some clinicians are tearing down the siloes, collaborating on cases or partnering to offer comprehensive care. And medical doctors are finally learning about the inner workings of the mouth—or at least taking the dentists’ word for it. As medical and dental care become more integrated, overall patient health is sure to improve. But what exactly does this medical-dental consolidation look like? And what does it mean for the future of dentistry?

Because poor oral health is linked to many chronic diseases, like diabetes, Alzheimer, and cardiovascular disease,

 an integrated approach can be very beneficial. A 2021 study

 looked at 6 state health departments that conducted 2-year pilot programs to promote collaboration between oral and medical health practitioners and found that the departments were able to increase collaboration, deliver preventive education to patients, and implement better organized referral systems.

“Quite simply, focusing on oral-systemic health improves patient outcomes,” says Eric Giesecke, MBA, chief executive officer of Planet DDS. “And eventually, things like AI machine learning and predictive analytics will . . . help providers suggest treatment based on a holistic picture of . . . [the] patient’s health.”

With such obvious benefits, it comes as no surprise that medical-dental integrations are growing. And the precedent is there; along with the rise of DSOs and dental groups, specialists like orthodontists and oral surgeons have been joining general practitioners more and more frequently to form multispecialty practices. Giesecke thinks the transition could mimic the inclusion of in-house specialists by DSOs.

“A lot of DSOs are starting to bring specialties in-house, and so they need to be able to communicate across providers. And being on a single platform like Denticon allows you to do that more effectively,” he says. “Patient care is [also] improved when there’s more choice to be able to refer out to specific specialists. . . . If it’s not easy to do, people won’t do it as much and won’t be able to pick the best specialist for . . . [an] individual patient. But . . . we’re going to see more consolidation with dental specialties, and that might extend to medical as well.”

For her part, DelSasso is beginning to see more of these collaborations, primarily in the form of referrals, from dentists to doctors and vice versa. Dentists interested in establishing a relationship with an MD should start with mutual patients.

“Ask them who their cardiologist is,” she says, and then talk “with the cardiologist about . . . [patient] needs . . . perhaps [a] concern for heart issues before implant surgery or lung issues prior to general anesthesia. Many doctors . . . welcome conversations about mutual patients and . . . it’s a great place to begin . . . [to] grow each other’s practices too.”

In a perfect world, DelSasso would love to see practices that include doctors, nurse practitioners, nutritionists, myofunctional therapists, or other allied health care professionals collaborating with a dental practice in one location. She sees this trend growing steadily, although slowly, every year.

“The thing about integration is that it takes many dentists and doctors out of the[ir] traditional comfort box,” DelSasso explains, so change will take time. “But the more they hear [about] and work with other professionals who have moved to this type of practice,” the more interested they will be in making patients healthier while using fewer pharmaceuticals. 

The dental and medical professions have been disconnected for years. But the secret to truly comprehensive patient care may lie in a partnership between these practices.