7 Ways Dentists Fail Treating Sleep Apnea

Successfully treating sleep apnea in your dental practice?

You have taken classes, attended seminars, webinars and online courses, but still you struggle to implement a dental sleep medicine program at your practice. At Nexus, we speak with dentists across the country every day and we see them failing at treating sleep apnea, usually for one of the 7 reasons listed below:

No Sleep Coordinator

What this means for your team:

No one onsite to ask questions about sleep or protocol
No one onsite to enforce protocol & screening
Who is tracking patient progress through sleep protocol?
Who is managing the HST’s?
Who is scheduling patients for consults?
Who is overseeing paperwork & records specific to sleep/medical billing?
Who is doing peer to peer review with insurance companies?
Who is entering all charges and collections into the software?

The Sleep coordinator a is a key position in any dental sleep practice, most of all for a general dentist who also treats sleep.

Oversees progress of each patient through sleep protocol
Ensuring that all patients are screened by keeping the team engaged
Monitors HST units and ensures testing is completed in timely manner
Ensures all paperwork and records are complete
Calling patients to schedule their sleep appointments
Coordinate a peer to peer review with insurance companies when required
Entering all charges and collections into the software

Lack of Team Training

What this means for your team:

Your team is: nervous, self-conscious, uncomfortable screening patients
Creates fight or flight behavior & they stick to what they know
Resulting in errors on: records, paperwork, insurance, billing, HST’s

Treating sleep cannot fall on the dentist alone. Each member of the team must know their part in treating sleep.

Hygienists must understand their part in the screening process
Office team must understand the records and billing requirements for treating sleep
The Sleep coordinator must understand the HST referral protocol, proper records management and the appropriate timeline for treatment

Lack of Team Buy-in

What this means for your team:

“This is just another project the dentist will forget about in a few weeks”
“Now I have to do this too?”
“Just another way for the dentist to make money – I don’t get anything”
“It probably doesn’t even work”
“Just mark that they didn’t have any symptoms”
“This is not my job”
“Oh here we go again…. WHAT did the dentist do this weekend at that seminar?”

Each member of the team must be invested in treating OSA. If the team does not see the benefits, they will not consistently perform their jobs, resulting in fewer patients being treated.

Each team member must understand how serious the OSA epidemic is
Screening and treating patients for OSA saves lives and can stop snoring
Just as critical as screening for oral cancer, but OSA is a far more common condition
Treating sleep apnea (especially when caught early) can add YEARS to a person’s life
Monetary or performance-based incentives are not as effective as the feeling they get from helping people
Treat a team member or their family to create a personal anecdote

Inconsistent Screening

What this means for your team:

Not always taking note of physical signs like neck size and obesity
Not always asking about symptoms
Some team members not asking at all
Different verbiage with each patient
Nervous and unsure when screening
Not motivated to help people

Instituting a Comprehensive Screening protocol is key to success in Dental Sleep Medicine.

1 in 5 adults have mild to moderate OSA = 20% of your existing patients
Most are unaware their symptoms are caused by OSA or that a non-CPAP treatment is available.
Teams need to have skills and techniques to effectively screen each patient that passes through the office
Screening needs to be seamlessly integrated into the daily patient routines
Screening needs to be practiced
Screen for OSA and CPAP non-compliance

Ineffective Case Presentation

What this means for your patient:

“I’ll think about it”
“No thanks, not today”
“I’ll show it to my spouse”
“I’m not sure if I can afford this”
“This sounds like everything else that gets presented here”

What this means for the dentist:

“I’ll think about it” or “Not today” means they do not take the risks of untreated OSA seriously
They may feel you are trying to “sell” them instead of help them
The risks of untreated OSA have not been made clear
The benefits of treating OSA have not been made clear
Inability to deal with high deductibles and out-of-network costs

Effective case presentation:

“I’ll think about it.”

“No thanks, not today.”

If your patient says something like this after you present test results indicating they have OSA – you haven’t done your job. Being able to help people requires effective communication skills. It all comes down to case presentation.

Medical Billing Problems

What this means for the patients:

Delays in treatment
High out of pocket expense
Insurance company may direct patient to IN-Network provider
“Why is a dentist billing medical insurance?”

What this means for the dentist:

Longer waits to get paid
Lower reimbursements
Higher out of pocket cost for patients
Patients refuse treatment
Patients go to IN-Network providers
3rd party billers reduce profits

Many dentists become frustrated with medical billing: it can be confusing, complicated and infuriatingly inconsistent.

With proper training your business team can become experts at medical billing
Your team needs to understand how medical insurance works and why you should be credentialed
Your team needs to be prepared to submit and appeal claims (which is common with medical insurance)
You must also be prepared to discuss out-of-pocket expenses when insurance does not cover treatment
3rd party billing is an option for busy practices that don’t want to invest in training, but can eat into profitability

No Physician Relationships

What this means for your patients:

You refer out but they don’t come back
Physician may tell the patient different information: Oral appliance is not as effective as CPAP, CPAP is only option, Sleep lab is needed
Physician may refer patient to different provider
Dentist and physician are not working together on treatment

Physician referrals are key to every dental sleep practice. But building a solid referral network takes both time and effort. It’s not something that is taught in dental school.

Building relationships with physicians is crucial to expanding beyond your existing patient base
Document your experience so physicians know they can trust you
Refer your severe OSA cases to them
They refer mild to moderate and non-compliant cases to you
General Practitioners and Sleep Physicians need education about Oral Appliance Therapy: better tolerated and higher compliance rate compared to CPAP, comparable efficacy to CPAP because of higher compliance, a good option for CPAP non-compliant patients

What To Do

No Sleep Coordinator
Lack of Team Training
Lack of Team Buy-In
Inconsistent Screening
Poor Case Presentation
Medical Billing Problems
No Physician Relationships

● Designate or hire a team member to “own” sleep and guide patients through● Train the whole team so they have the skills and confidence to treat sleep apnea● Educate your team about the effects and prevalence of sleep apnea● Train your team to screen as part of their normal daily routine● Use proven communication techniques to effectively reach your patients● Train or hire experts to navigate the world of medical insurance● Document your expertise to confidently approach physicians

Find Your First 300 Patients

1 in 5 American adults have mild OSA¹

1 in 15 have moderate to severe OSA¹

1
% of these patients are undiagnosed / unaware of their condition²1. Young et al. J Am Med Assoc 20042. Young et al. Sleep 2008

Risk is Elevated in Those Who Are:

Male
with BMI >35
Neck size >17”

Age >50
High blood pressure

Typical American Dental Practice

An average, well-run, solo general dental practice with two restorative rooms and two hygiene rooms should produce about $1,125,000 per year, and with $750 per year average patient billings = 1500 patients¹.

1 in 5 American adults have mild OSA²
1500 patients / 5 = 300 sleep patients already in your typical solo dental practices MORE if you are part of a group practice!

1. http://www.aftco.net
2. Young et al. J Am Med Assoc 2004

So Why Are You Not Treating Those 300 Patients?

Inconsistent Screening
No Sleep coordinator
Lack of Team Training
Lack of Team Buy-In
Poor Case Presentation
Medical Billing Problems
No Physician Relationships

● Your team is not screening every patient, usually because…● There is no one in charge of the process, ensuring they follow protocol● No sleep coordinator = no ongoing coaching; team doesn’t know what to do● The team doesn’t believe in sleep medicine – again, lack of coaching● Once the patient is screened, they don’t agree to treatment● Problems with billing are another barrier to treatment● A solid physician network will support every stage of treatment

The Secret

There you have it. You have patients already, but if you don’t commit to sleep medicine, and get your team committed to sleep medicine, you will lose out on the patients you already have.

These patients are the beginning of your future in sleep. These patients you already have a relationship with, you can hone your craft, train your team and iron out your billing problems.

7 Ways Dentists Fail Treating Sleep Apnea

Successfully treating sleep apnea in your dental practice?

No Sleep Coordinator

Lack of Team Training

Lack of Team Buy-in

Inconsistent Screening

Ineffective Case Presentation

Medical Billing Problems

No Physician Relationships

What To Do

Find Your First 300 Patients

Risk is Elevated in Those Who Are:

Typical American Dental Practice

So Why Are You Not Treating Those 300 Patients?

The Secret

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