Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
How to perform dentistry faster, easier, higher in quality and lower in cost.
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1122 Kevin Rossen, Founder of Divergent Dental Resources : Dentistry Uncensored with Howard Farran

1122 Kevin Rossen, Founder of Divergent Dental Resources : Dentistry Uncensored with Howard Farran

1/10/2019 2:07:32 PM   |   Comments: 0   |   Views: 177
Kevin Rossen is the Founder & CEO of Divergent Dental, which provides dental practices with a focused, simple system to track their performance.  He comes from the front lines of dentistry, having worked alongside his father as the Office Manager of his established dental office in North Texas.  Kevin’s focus in dentistry is to equip dentist’s and their teams with tools that are easy to use and keep the team focused on the data that matters most.

VIDEO - DUwHF #1122 - Kevin Rossen

AUDIO - DUwHF #1122 - Kevin Rossen

Howard: It is just a huge honor for me today to be podcast interviewing Kevin Rossen, who is the founder and CEO of Divergent Dental which provides dental practices with a focused simple system to track your performance. He comes from the front lines of Dentistry having worked alongside his father who is David J Rossen as the office manager of his established dental office in North Texas. Kevin's focus in dentistry is to equip dentists and a team to tools that are easy to use and keep the team focused on data that matters. So you're in Lewisville Texas is that where you're at?

Kevin: That's where I live yeah, it's a just a little bit north of Dallas my dad's practice is in a town called The Colony.

Howard: So you're outside of Dallas that means you're one of those obnoxious Dallas Cowboys fan Americans are you a Cowboys fan?

Kevin: Yeah unfortunately I'm not a Cowboys fan and I say unfortunate because I'm a Chicago Bears fan and we just had a rough evening yesterday in the playoffs. Well I just it's something that I was born outside Chicago and I've tried to break the habit and I just really haven't been able to break it yet.

Howard: Well you know what I thought last night okay so if you're not a football fan hang with me because it's still a great lesson I still think the NFL is probably the most competitive business in the world. I mean their's only 38 franchise they do over 10, 12 billion a year in sales but they got a hundred million Americans looking at them under a microscope. So they're the most analyzed business on the world so you draw a lot of great analogies but I love this one so last night if you're not a football fan the Bears should have won. They were on like the 20, 30 yard line all I had to do is to chip shot field goal and the field goal guy hit the uprights and I love this guy posted this on ESPN this morning bear with me whether your a football lesson time, whether you are a football fan or not their's a good chance you have heard by now that the Bears, Eagles game from last night in case you did not the short version is the Bears kicker Cody Park, he had a chance to win the game on the final play a field goal kick. When he first made the kick Eagles called a strategic time out just before the play to serve as the distraction to the kicker who has had some trouble all year was successfully making his kicks in such a high-pressure situation, last thing you want to do is overthink, well the Eagles do this and that's why they call the timeout on the second attempt Cody hit the uprights and was unsuccessful on his attempt therefore costing the Bears the game. Here's the point all of us to step out in the name of accomplishing our goals and playing at the highest level subject ourselves to moments like this and allow me to remind all of you when you do so it is inevitable that you'll have days where you hit the uprights and take a loss what I am impressed by is this kids perspective after this huge moment he said this is what he said to the reporters, he didn't even hide her duck out he said this is going to sting for a couple of days. I was prepared and did everything I could, the Sun will come out tomorrow these were the comments coming out of his mouth postgame as he didn't hide from the media but instead face them head-on. Today their are going to be a million memes and jokes flying around you know how I've posted three today. I'm on Dentaltown I feel guilty already they will all be coming from people who will never Smith having an NFL career. I want to remind you that when you decide to step up and go for it and anything you do you will open yourself up to the world like Cody did last night. Their will be days where you make your kick and win the game and there will also be days where you miss your kick and you will feel like the world is ending and these moments remember that strength looks like remember that many times you stand alone in your defeats and these are moments remember to think like Cody for as tough a moment as this is for him behind it is a purpose which requires faith to understand and patience to experience, I applaud Cody amidst the waves of criticism he will face but anyway it was just amazing how this kid because I have the same problem with Mark Zuckerberg of Facebook because his dad is a dentist and he's been on this show like three times and Ed Zuckerberg MA we both we both are bald Dennis and have four kids and when I see his kid getting just eaten alive in the meteor grill Congress I feel sorry for Ed because if that was my kid I'd probably be in the corner second crying and sucking my thumb and everything and so when you're in the limelight holy moly but what I want to tell you is the reason I was so excited to get you on this show is you're dealing with dentists who don't even know where the uprights are. I mean this kicker instantly instantly knew he missed the field goal and they were gonna lose the game, you go into a dentist's office what is your overhead, I don't know. How many patients you get, I don't know. I mean you ask them any business question in the world am I wrong or right or I mean what percent of the two hundred eleven thousand Americans who have an active license to practice dentistry know their numbers?

Kevin: It's not a huge number I mean I would say at most 20%. That's probably being generous that are that know at any given time within a reasonable guess what their numbers really are or what they should be. It's kind of a just discouraging honestly.

Howard: Yeah they wonder why they're; it was Benjamin Franklin who said time is money he was the first guy he coined that and he said you know if you don't work half today you just lost a half day's wages. I mean time is money and you go in there and you look at the scheduling and someone will call up at 3 o'clock and say well I broke my tooth and the receptionist is saying you know what just come down tomorrow she doesn't even know what the break-even point is for the day. She doesn't even know that they opened at 8 it's 3:00 in the afternoon and they haven't even broken even yet and maybe squeezing that crown in at the last appointment or at the end of the day they're getting to come back might have been the only profit they made for the day. I mean they don't know their break-even point they don't know so go over first of all so let's start with you from scratch your journey. So your dad as a dentist and and you decided to run his office. Just tell us about you and your journey

Kevin: So about seven years ago my dad had half of his front office which was actually two thirds of his front office  get pregnant and decided they wanted to stay home with their kids both happen to be family members of mine as well and I was looking to transition into something else and I decided hey if you want me to come work with you I'd love to come you know take a little bit of a detour in my career and just see what it's like working in the front office of dentistry. I never followed him in the clinical side to dentistry because when I was probably four or five years old I remember he would come home with the photo books of his patients and their jacked-up teeth and their bloody nasty mouths and he'd put him on the coffee table in the living room and I was just I was turned off by that I thought no thank you I don't want to work with the people's mouths. So but I decided hey you know in dentistry working with their wallet I kind of joke about sometimes but I work with the front office anything outside the mouth decided to help with and really my dad's always been really focused on numbers he's had a number of different reports that we would look at every day when every week and when I started one of the tasks I had was I would have to run three or four different reports in our software we were using practice works at the time and then I'd have to update these other sheets these spreadsheets and I would spend 15 minutes here 15 minutes there throughout the day prob about 45 minutes a day just updating spreadsheets manually and I thought okay this is kind of crazy but I knew we needed the numbers so I did it. So a long story short through all the process and converting over to open dental really accelerated our learning process and the accessibility of information I figured out a way to track the numbers we really knew were most important to us to see them every day to get them delivered to us automatically so we didn't have to even remember to click the button and we'd have everything we wanted to see every single day and that's kind of how it got started and then I had a kind of a vola moment they could you know there's probably other people that would want this too and so I just kind of threw it out there between Dentaltown and the open dental users forum just said hey anybody interested in trying this out and sure enough a few hundred offices later. We've been growing slowly with very little marketing at all just word of mouth and happy customers. So it's been a lot of fun getting to know numbers just from our perspective but then also getting feedback from some of the best minds in the dental world just to know what numbers matter most to dentists and deciding what number we look at too.

Howard: So now practice works that's owned by they also in softdent right?

Kevin: That's right yeah

Howard: Yeah and the name they're in Atlanta Georgia, did they used to be a division of Carestream?

Kevin: Yeah they used so I'm not exactly sure the history I know Kodak owned them at one point and Carestream I think owns them now but I I don't know that I haven't really been following their development for seven years.

Howard: So when I got out 31 years ago softdent was the big deal and then it went from Kodak to Carestream and then now it's called practice works whatever but you and I both switch to Softdent and this is not a commercial I don't get anything free from anybody but tell them to journey why did you switch from practice works which is just a big major player to Softdent.

Kevin: So it was actually Open Dental that we've converted to. You know honestly when we first started looking at it was because we were going to transition from paperless charts to excuse me from paper charts to digital charts and when we tried practice works it just wasn't gonna work you know we see about 40 patients on a fairly normal day sometimes less sometimes a few more and we just saw some technical limitations with the software that just would not allow us to be efficient, So did some research I heard a lot of people back in 2013 early in the year talking about Open Dental back then and honestly I was underwhelmed by it when I first looked at it I downloaded the trial looked at I thought okay was all the hubbub about this this is kind of boring it's it's nothing great about it but then eventually I tried it out with the trial conversion and found that it was really easy to use super fast and you had full access to the entire database to do whatever you can dream up over numbers you want to pull out of the report either on your own or with some third-party integrations as well. So really after about a six month dragging my feet and talking with people I decided and with my dad we decided this was the right move to do and within about a week or two of making the conversion we thought this was the greatest decision we've made probably since digital x-rays it was a fantastic thing for us on every level and we've been really happy within it. I don't get anything from Open Dental either I happen to manage a fairly popular user group of theirs and I'm active on Dentaltown in the Open Dental forum as well but I mean I just a big fan of the software and what the many reasons I'm big fan of it is they don't they don't handcuff your data you own the data if you want to move away from it there's no problem you're not locked down with them artificial and I think that's one of the best reasons to use them because you then can do what you want with the data itself not just the software.

Howard: So you said you manage a what group with Open Dental, you manage a user group?

Kevin: Yeah so it's in Facebook I know you know their's a Facebook Open Dental users group that has a little over five thousand people and I'm one of the two administrators of the group and we just it's just one of those places there were people are already having conversations and we you know we keep it focused we don't let people just kind of randomly plug their own stuff without at least disclosing what they're doing. If it's related to Open Dental we're fine with it but it's a fairly active group and it's been a lot of fun see and people help each other out I mean it's kind of the spirit of the software too it's not just we want to protect ourselves we want to help each other know how to get the most out of the software.

Howard:  So you just go to

Kevin: Yeah so I think it's I want to say is what it is. That's what it is.

Howard: Well you know what you said was the the story of Open Dental that it was actually served by a dentist named Jordin Sparks and in Oregon and he had Dentrix and he was trying to extract his patient's name and address out of there so he commits labels to mail a card because bleaching had just come out. So me and Jordan about same age the big whitening thing and he found out that not only could he not extract the data but they had gone to great lengths to make sure he couldn't extract data. So he's like okay you're paying programmers to build extra walls, so he called them said what's that about and they said well that's our data, he's like what that's your data that's my patients. So he started Open Dental, so it's just the fact that it's open and when I go to call centers you know if they take a call center and it's from a dental office it as Open Dental they can gosh-darn go in and schedule appointments and say yes Kevin and you know what's going scheduler there they love it and then when it's any other practice manager software they just say it's difficulty so explain that more technical terms, it's just so Open Dental is just what its name is, it's just open. Is there any other open practice manager softwares or all or we say all the other ones like dentrix softwares are closed?

Kevin: I wouldn't say all of them I mean there is a like a spin-off of Open Dental I know that some people have made called practice web it's technically actually basically Open Dentals software that they've kind of put a little bit of their own polish on it I would say and I think their is maybe one other open one but here's it for me like the cloud is kind of where people are trying to move and their's Dentrix SN, Curve Hero and Fuse I think are three of the bigger ones out there and a lot of people want to get rid of having the server and the IT oversight and I get that but what I really don't like about that is what you just described with Jordan is they now they control your data completely especially in a cloud environment where if they go out of business what happens to your data you know it's not likely with things like Patterson or shine that they're gonna go out of business but we said the same thing about some of the big companies 10 years ago and look what happened a lot of the the major corporations they've gone under. So what I really think about with companies that say that they own the data I think about with a covered entity like specifically with HIPAA stuff if the data got breached who's it liable is the the software company gonna take responsibility for the data breach or is it gonna fall to the doctor we know the answer to that, you know somewhere in the agreement it's gonna say that they don't they're not liable for that kind of thing. So for me I don't know it's when when you have not only do you control the data but when you don't have these artificial walls like you described I just think that you can with just a little bit of effort or have a third party integration that does the stuff for you, you can get the information that you need because every practice is a little bit different. Yeah I know a practice in California where it's a semi-retired dentist to name Drew Stevenson and his practice is just Invisalign now you know so like he wants to know certain things with Open Dental he just writes a query and just modifies it a little bit that's very specific to an Invisalign only practice and so that's just an example of stuff you can do with a completely not always a completely open but they completely document everything for you as well. So you can if you don't want to do it yourself you can hire somebody though Up Work or Fiber that will figure out how to get you the thing or hire open dental themselves to write a query for you and get this specific information you want.

Howard: So then what's really the difference between Practice Web and Open Dental?

Kevin: I mean to be honest I haven't used the front-end a Practice Web but what they say is they try to eliminate some of the bugs that Open Dental has that I've heard that I just haven't personally experienced any bugs with Open Dental I don't want to like talk down about Practice Web I just I just feel like it's a they put their own wrapper over open dental and so a couple versions behind what Open Dental is. I think their might be some reporting that they have but I personally haven't seen it from a front-end experience honestly.

Howard: So my journey when I was 10 years old my dad opened a sonic drive-in in Wichita Kansas and he was my idol, hero taught me everything and back then their was a company I don't know if you're old enough to heard of it National Cash Registers NCR that later got swallowed up by IBM but I swear to God my dad's cash register could run a dental office better than what we have now and that was 40 so I mean 56 I mean that was 46 years ago and I've always thought I'll never be able to get over its the fact that you're a dentist and you have all this patient information address, insurance billing accounts receiving but then the accounting software is not hooked up to it. It's like I don't care how good the practice run software is if you like payroll I mean time is money we talked about I mean you ask a dentist's okay your hygienists works from 8 to 5 how much did you pay her, how much did she collect. So my next question is you say you use Open Dental software, what do you use for accounting software?

Kevin: So I don't do the accounting for the dental practice that's my dad that handles that he uses I think he well he used to use quicken and he's been converting over to QuickBooks.

Howard: Ok so then quickened and then QuickBooks and do you think that Open Dental someday will program bridges to quicken or Microsoft bought Great Plains accounting because I thought the smartest thing Bill Gates ever did the reason I cannot stand Bill Clinton you'll never Bill Gates was all that and a bag of chips, so Bill Clinton decided that was the time to go after him. I mean and he was trying to buy quicken and you know here's Microsoft that's got Microsoft Word and Excel and PowerPoint and I knew if Gates swallowed up quicken that every farmer in Iowa would know their damn cost and have their tractor the accounting the cost and then eventually I could be you know and so that never happened they veto that and then later Bill Gates went on to buy Great Planes Accounting which they now call Microsoft GP in the GPS degree planes I like I use a Peachtree and I don't really think I mean I couldn't run my business off quicken or QuickBooks Pro it's not sophisticated up anyway that's a whole nother topic that's just sad I spent yeah my donors and yes in this crazy journey that Bill Gates was gonna fix when I still had kids in grammar school and Clinton's infinite wisdom was to deny that merger and acquisition but anyway so but do you agree that the fact that all your accounting of payroll, rent, mortgage, equipment, insurance. All those things not in your cost I mean how do you figure the break-even point for this dental office. So they know they go in there eight o'clock and they got a they got this much dentistry just to pay the bills how do you how do you fix that?

Kevin: Well so one thing that you can do if you wanted to you mentioned you wish it was integrated with the software. Open Dental does have an accounting module it's kind of designed as Quickbook lights. I think they use it internally like I think they run their accounting software like in Open Dental software incorporated or LLC I think that's what they use don't quote me 100% on that. So theoretically you could do it all in one place I don't know anybody they actually uses their accounting module so if I mean if somebody does use this I'd love to hear from them, my emails I'd love to hear how you're using the accounting module. So you could hook it up it is possible to hook that in there I just think that it might be you mentioned about being limited by quick and I QuickBooks. I feel like you'd probably experience that with the accounting module because it's not designed to be a corporate level or enterprise level account module but to answer your question how do you know, I mean you do need to know what your expenses are and I think that you know back to kind of we talked to earlier trying to get people distracted or overthink things. I think that sometimes there's two different extremes you'll see that I've seen with dentists or dental offices either I don't look at anything or they look at too many things, you know like there's some people that they're running reports every day six times a day and they're looking at their online dashboard that updates throughout the day and that's what they're spending their time doing as opposed to knowing the bottom line and no one the trends because honestly some days are gonna be better than others and some days it's gonna be a huge win where you have a twenty thousand dollar net production day and fifteen thousand dollars got collected that's gonna be great or maybe that's terrible for some of your listeners. I'm sure it is, but there's gonna be some days you're gonna have a negative production day because you had to write off some old debt or something like that and so I tell people don't get too hung up on the individual days too much, yes you should know your numbers every day, you should know the bottom line things but pay attention to the trend more. So to answer your question on what do they need to know you need to have that baseline you and honestly I think you should know what does it cost to run your office for an hour, what's it cost to have your hygienist from as a cost to have a hygiene visit. So for example what I did and my dad's practice I want to know what are the actual hard costs for every adult recall visits and so I kind of walked through okay what are the things we use disposables, the sleeve for the x-ray and I found out that actual hard costs. If we factor in everything that we could be doing was less than 10 bucks it's like nine dollars and something cents and so with that and then I added what the salary was for the hygienist 30 minutes of their time in the office and I found okay well a breakeven number is like 40 dollars or something like that well 30 something dollars everything factored in so with that now you know what you have to do in order to hit your number. So to answer questions yes, it's not in one place it's not as sophisticated as the NCR in some way, so you do still have to combine a few different pieces together to know what the big picture is and I know you've been talking with that for years and I think you've had Nathan sparks on your podcast haven't you

Howard: Absolutely

Kevin: Yeah and I think honestly it'll just take more people asking for it because I honestly I just do I think, I know not a lot of people are spending a lot of time they're outsourcing it to their CPA they're outsourcing it to a billing department so they're not looking at the hard cost they're not thinking about that type of thing and if they were I think there'd be more pressure on companies like Open Dental or Henry Schein for Dentrix to incorporate more of that

Howard: and another one by the way I know you're all my listeners are about a 90% tell me they're commuting to work the unlucky 10% on a damn Stairmaster or a treadmill. So I just thank you do the 25,000 people who follow me on Twitter I just forwarded on Twitter Divergent Dental is at Divergent Dental and I just forwarded that tweet, so when you get to work you can find that tweet it's got his website by the way where's the name Divergent Dental come from?

Kevin: So it actually came from the Robert Frost poem; two roads diverged in a woods, I chose the path less traveled to make all the difference and it was basically no one kind of story of that poem and that poet was when you look back in life the choices you make end up taking you where your at to not have any regrets in life is really what it comes down to.

Howard: Nice, okay yes the tweet I retweeted was the return on investment on the call list and morning huddle reports are outstanding it definitely makes my life easier but also helps a lot others in my office organized and that's from Dr. Kyle Hickman in havens Family Dental but another one he's the next we says stats say that case acceptance can be between 30 and 50 percent divergent users are averaging 68.8% case acceptance. You know the thing about numbers is junk in junk out some dentists say yeah but the guy that has a 50% case acceptance all he diagnosed was cavities but if I diagnose cavities and bleaching and bonding and veneers and Invisalign, then I might only have a 20%. So you know how do you on track case acceptance I mean how do you separate the pie-in-the-sky election up, like I'm 56 you told me I needed bleaching, bonding, veneers. I'm like dude once you have a liver spot on your head you know you don't qualify for any of those procedures, so how do you track case acceptance?

Kevin: Yes so their's two different ways we look at it and that's a excellent question because their's not a generally accepted definition of case acceptance in the dental industry which i think is kind of crazy. So how we look at it in relation to the percentage of patients scheduled and replating at least one newly diagnosed procedure and so what i mean by that is what you talked about if the doc told you, you needed a filling you need three even four veneers or eight veneers whatever and then a periodontal maintenance you know whatever so just say well I just want to schedule that one filling doc we would count you as accepted for that day for that treatment plan for that day even though you only scheduled say $200 out of a two thousand dollar plan. So we would count you as accepted and that's how I encourage practice is to look at it because you mentioned the garbage in garbage out. Every practice it has their own clinical philosophy of how they should treatment plan and a lot of times their's going to be patients that can't even possibly schedule a third of what you present because it's stages. I mean denture appointments, you can't schedule the extractions until you've got all the different steps ahead of time same thing with implants, you can't restore the implant crown until the implants been placed and so when we look at it with that number specifically on that status 68% that number is based on the patient percentage not the percentage of the fees and what I found in relation in that Howard is that those who say that the case acceptance is going to go down when the treatment plan is more. Well if you count the fees percentage which we do look at as well in one of our reports yes that is true however I found the inverse of the patient side the more you treatment plan the more acceptance that you're gonna see as well it's just kind of a in some ways it's a larger net in a way but I also think it's a mindset for the dentist. I think when the doctor has the mindset of every exam I'm gonna look for what's in the best interest of this patient and I'm gonna treat them as who if this was my mother or my sister or a family member what would I recommend to them and they're not gonna hold back for that side you're gonna be honest with them and say here's what you need to have done, I found that the those who treatment plan more produce more it's kind of you kind of have to start with that.

Howard: How old is your company Divergent Dental?

Kevin: We're coming on for our excuse me we're coming on five years now we were founded in 2014 basically five years ago is when I started the infancy I just started it in the early part of 2014 just as kind of a beta testing and getting feedback, went live the fall of 2014 so dependent on when someone's listening to this five years.

Howard: and how many are you only dentistry

Kevin: Yes only dentistry.

Howard: Is it only general dentistry?

Kevin: We did have some specialists like pediatric and a few orthodontic offices but it is definitely focused more on the general dentist.

Howard: and can I ask how many clients you got?

Kevin: So we've worked with a few different a few hundred

Howard: So few hundred

Kevin: Yeah

Howard: and what do you and what lessons I mean do you have any like case like the average dentist when they started with you and here's what they were doing but having that biofeedback they're doing better I mean are they are they doing better well what kind you have any data about that?

Kevin: You know I haven't really done the strict analysis of before and after I'm not the greatest marketer. So that's one of those things that if I had that exact number and it would be helpful I do know Dr. Hitman and others like the one of the reports that we look at with the morning huddle just a simple process of going through your day and having a systematic way of knowing who's due for x-rays who's due for exams and looking at that and then actually deciding if you're going to schedule those things that'll find one too three percent every day with a very rare exception that they'll find times that you could add a bitewing, you could add a full mouth of panoramic or you could add an exam to the schedule just to bolster the production for that day just from that but as you know as a dentist when you do those things you're gonna find more dentistry to do as well and you're gonna diagnose things that need to be done. So the direct impact on the production on just a morning huddle report itself can be a 1 to 3 percent increase sometimes even higher every single day.

Howard: and this is New Year's and it's the new year and you're the pod casting on the first day of the new year podcasting and what percent of the fortune 500 companies already have a budget for 2019?

Kevin: I'd say a hundred percent

Howard: 100%  percent of the dentists do you think have a budget for 2019?

Kevin: Oh man that's a good question

Howard: So those three probably aren't watching right now but so the bottom line is and the other thing is you know they say marriage fails for basically three things money sex and substance abuse and when it comes to money you know you throw out on these terms like yeah I get a thousand dollars for a crown you come off work your spouse says how many how was your day oh good I did four crowns so the spouse saying it wow that's $4,000 because they don't know the difference between the fee and what you charge and the adjusted production and there wright off and then all the overhead. I love it when CPAs are so family-oriented they say no I'm not gonna do your wheat farm with the with the farmer on the track you're gonna bring your spouse in here. I need to talk to the couple and I think for 2019 what you got to do is get one of these dashboards get committed to your numbers and bring it inside the house, you're a family business and you know what I I've learned so much business for my mom and dad sitting at the dinner table and that was when they had calculators those little rolls of paper and I can still remember single yes on my dad and his readers are and holding up this strip of paper trying to look at this number and mom sometimes saying that's not a two that's a seven you know and and it's just I mean you got to make it a family business because this is a serious stuff. What do you think is your most popular features of your dashboard? What would what number do you think people are talking about the most they said man Kevin I'm glad I signed up for this this is I really like this feedback on these numbers.

Kevin: So on our daily report the thing that we hear the most about is the case acceptance number because that's a really difficult thing to track manually it's subject to error. So when you automate that you don't have to enter anything extra and you understand how it's calculated you get a really good feedback on that and then also reappointment rate. So those two numbers you'll be able to know those every single day what it was for the day, what it was for the week, what it's been for the year. So the case acceptance reappointment rate those are two things for me that I love to have practices know because with reappointment rate if you're not tracking it at all you're probably in this 60%. I mean that's probably where you're at that's usually from if someone's actually you know trying they're gonna hit 70 but unless it's a point of emphasis you're not gonna hit where you should be in the 80s you know 80 to 85 percent is definitely the target that I'd recommend based on what I've seen practice is doing as far as patients when they leave your practice what do they have their next appointment scheduled and honestly if they're not looking at this at all. I mean that's probably just an indication of the rest of the practice of things that are or aren't being analyzed and reappoint rate and then actually just as a big-picture thing goals and so one of the things we did early on we decided that we wanted to have not just what have you produced month to date because that doesn't really matter. I mean honestly it's January 7th today and have you produced ten thousand dollars so far month to date or have you produced twenty thousand or a hundred thousand dollars month to date. Just knowing that number in isolation doesn't really matter it's where you should be in order to hit your goal and so with our dashboard what we do is we have a default goal using a formula we've produced that if you don't know what you should be aiming for we set a goal for you and a lot of practices that's what their end up using anyway because they don't know what they should be looking for and so it's a little bit of a stretch it's a 5% growth over what they've averaged over the past year stay a little bit ahead of inflation and also encourage growth but then also it shows you where you should be month to date both with an indicator and also a color and honestly that thing is probably what we get the most positive feedback because you can know from whatever device you know you just pull up your iPhone your Android you just look at it you can see the colors without even zooming in and you can know at that moment in time if you're on pace to hit your goals for the month and so those are kind of three of the things I would say are that what people really enjoy about our service.

Howard: So the rule of 72 is you calculate, you take so divided by your growth rate so 72 divided by five means you would double your dental office in 14 years. 72 divided by let's say you're gonna grow at 8% you double your practice in nine years, 10% growth rate would obviously be 7 years. So you need to have these goals. What percent of your clients are using Open Dental?

Kevin: It's a large percentage, at least 2/3 probably a little bit more Probably 3 quarters because that's what we started with. I started it for me first something I wanted and I need and so it was only Open Dental for the first year half and then we've added dendrix and Eagle soft as well. So the majority of our customers are Open Dental and almost every startup is starting with Open Dental as well.

Howard: So yeah and you know what this is how I'll tell you how I'm the dumbest guy in the world I own a media company, I have a magazine where people advertise my magazine, website and then I recommend Open Dental who doesn't advertise and so I mean not only is this Dentistry Uncensored, I'm telling the truth I mean I have people saying why do you do that well because I'm dumb. I mean I thought you, I want you to get the best information and Open Dental is just open I don't think there's really a substitute for it it's open and every time I'm talking to someone out there that's making software for online appointment or this or that they always tell you well I love Open Dental because like I can program to it and then and then you look at some of these dsos and they're starting to like get their their accounting department and they might be on Microsoft Great Plains GP or Peachtree or some of these big deals and they're hiring their same man I'm just gonna hire a programmer for 40 dollars an hour and start automating what we're doing because I mean it's a dashboard for reason you look out the dashboard of your car you've got to know where you're going and these dentists I love them to death I get it. I mean I'd rather pull I mean if you ask me what's the most fun thing I could get for Christmas would be a set of 4 impacted wisdom teeth with someone ready to go. I mean I get it the dentistry is fun I get that I get it if you in a restaurant you're a chef I know you want to watch the Cupcake Wars I know if you're a baker I get all that I don't have to be a leader to motivate you to do what you love. I got to be a leader to motivate you to like you said the path less traveled work to do like I've been in Ahwatukee for 30 years you know there's only three restaurants that have lasted the whole time my dental offices and all the other ones are burning and turning regularly and I could I would take my kids of those restaurants and I would tell my kids assume they were like like 8 10 12 14 I said what I said I'll ask him it's a few business questions and if he can't answer him this restaurant won't be here a year or two we played that game for 15 years my dad used to play it with me and I remember Zach was he was so cute this guy that anyway long story short yeah I think could have only been like seven or eight or nine he says I bet that guy's not in business by Christmas and you know yeah these don't know their numbers. So they got so how much is your service?

Kevin: So our monthly fee is $149 and we don't have any contracts or any set up fee because apart well first up for the no contracts that's how I prefer to have my look as a customer that's what I look for first and foremost but then more importantly back to the idea of not locking people in artificially. You know if we're not providing value or if it's not a good fit for the practice I don't want people to have to pay me for ten extra months because they don't like what we have to give. So you know there are other services like us out there and some of those are gonna be better fit for others but we try to provide something that's really easy to use it keeps people focused we're not the most complex tool out there and that's by design you know we're trying to not have net paralysis by analysis we by design limit the amount of data that we're providing and when we provide it. It's designed to be a routine of life and and not have you focus on the numbers every single minute of every single day.

Howard: Yeah I agree a thousand percent about contracts why would you want to be locked into someone you don't want to be locked into, especially when you agree when it comes to marriage do not get the contract don't get married just live as friends. So is that what you chose?

Kevin: No I've been happily married for 16 years.

Howard: You were going to be my idol saying no I have no contract with my wife, no set up fees we'd get out any time but yeah I'm telling you this I mean why do these companies like your phone carrier, I mean when you go get a phone I mean what is Verizon and Sprint what do they all try to lock you into some contract it's like oh yeah go get a long-term contract with Comcast they call me back in a year and tell me how that's going. So you should really do a survey of what happens to your users after the end of one year I mean this is 2019 you said there look this is what happens when the team leader and but by the way who are you working with mostly when you're doing this is it mostly with the dentist is that mostly with the dentist spouse is it the office manager who is usually the motivated contact person when you're working with a dental office?

Kevin: The majority of is coming from the dentist's and I would say probably about two or three quarters and we've done some stuff with Mark Costas and you know he does some podcasting as well and so people hear the podcast and they respect him they respect you and they get motivated. So what I find is best is when you have as many people as you feel comfortable with on track with your numbers, some people some practice owners they don't want to share their data with their team because they're worried about what they think about it and I think you know, I respect that and you know everybody runs to practice how they want to run it but the more people that know the numbers the better. You know people realize it's costs money to run a business and if they don't you should educate them. You know you have helped your employees think a little bit more like a business owner and you'll be more successful.

Howard: Yeah I love Mark Costas, I'm in Phoenix, Arizona where the poor people live he's up there in Prescott with a mile high beautiful you know what I love about Mark Costas the most and he promised me he'd help me do this in my house someday I'm gonna hold him to that, he's been on the show. He's got like what I don't know how many offices does he have a dozen.

Kevin: It's close to that yeah

Howard: Yeah and you walk into any operatory and open up the third drawer, it's got the same stuff in it as every I mean the guy is a genius he's a master of logistics you know that was the way Southwest Airlines said they tell her the only secret lower prices lower cost. You know you're not gonna lower your costs and unless you quit doing meals and we're not doing the hub-and-spoke or flying direct we're only using one type of plane on and on and on and these dentists you know they don't realize you know they'll add a new procedure to say well I'm gonna add like sleep apnea. Do you realize the cost of what you just said you got to go learn sleep apnea, you gotta buy all this something they come back and say oh now I'm gonna learn Invisalign then I'm gonna place implants. I believe that if you don't do a procedure once a week you're never gonna hit critical mass the faster easier higher quality lower cost and be profitable on it. Do you have any benchmarks numbers you can tell these people, the people listening to you are all alone, they're driving to work and they really don't know things like well what does the average dentist overhead or what does the average new dentist get new patients per month or you know or how many hygienists. Do you have any numbers so that solo practicing dentist Dentaltown's motto is no dentists should ever have to practice solo again. Can you give any more macro numbers since you are dealing with a lot several hundred dental offices?

Kevin: Well one interesting insight that I found this past year I really had a similar question you know, what is the value of a new patient and when the question was from that you know some people have some ridiculous lifetime value of a new patient that's not what the question was, the question was within six months of a patient being in your practice for the first time how much have you collected from that patient no so that's that was a more I think that's a better question than the lifetime value some mythical fairy number that really doesn't really matter that much but six months will pay the bills in someone. So I looked at a new patient from the type of exam they had done, so I looked at a large number of the our practices and we looked at a comprehensive exam, limit exam and the comprehensive periodontal exam and we figured okay within six months what's the average dollar figure collected based on those new patients and the question then was which one of those is the most valuable and so what we found was $811 is really what the number is collected but drilling down even more than that you mentioned about the toothache or someone's ready to get the tooth fixed. A comprehensive exam the average collection was only $706 versus a limited exam or emergency exam $951 and so the motivation now tell you for the a practice owners listening to this is, help your team understand that their's nothing more motivating in dentistry than pain and actually in life you know people often will refuse to change until the pain of staying the same is  greater than the pain of changing. People don't want to get a tooth to crown damage they still want to have that done but if it hurts and then it doesn't matter how much it costs like fine I want to get it fixed I don't want this pain anymore, so if the patient calls hey my tooth hurts get him in as soon as possible. I mean that's a benchmark I tell you is like hey you know that more than anything else new patient emergency exams is something that you should prioritize getting them in your schedule as best as possible but then as far as another benchmark one thing that you talked about systems with Mark Costas with your dad with whoever a periodontal disease. When I first get our practice set up all we have a monthly report and we provide information about their periodontal department and basically look at what percentage of their adult recall patients are being treated for periodontal disease and what I found is on average in North America a private dental practice is only treating right around 9% of their patients for periodontal disease in some form or fashion and that number is nowhere close to what the centers for disease control, not a dental company but a health company organization a health government they say that I think it's 40% of the adult population suffer from periodontal disease. So it's about a four to one difference and then the average period being treated first the periodontal disease that is their and so for me a benchmark is. I don't think 40% if you're only hitting 9% periodontal disease coming and saying our goal is enough 40% that's a little bit of a stretch. We used to say if we're hitting 10% now let's aim for 20% let's aim to hit 20% of our adult patients, let's look at our system are we do we have a protocol in place for how we diagnose periodontal disease because that is one of those big things that hygienists love doing that they'd rather do scaling the root planing that adult prophy any day of the week and then on top of that the hourly production is significantly higher for the practice. So everybody wins the patient gets the treat they mean the practice produces higher and the hygienists love what they're doing too so I think everybody wins when you know your periodontal thing so those are couple things prioritize the new patient emergency exam and then figure out do you have the systems in place to effectively diagnose.

Howard: You know another thing these young dentists will do, you know the the average home the sells the 3-bedroom 2 bath the average dental office of sale is a $750,000 practice. So this young millennial is an associate somewhere for two or three, four years and graduated with $400,000 of student loans and now buys the seven hundred and fifty thousand dollar office. They are a million dollars in debt and they don't even know that they're not watching that hygienist in the appointment right, so she see is that hygienist works eight hours a day Monday through Friday 8-5 and she only schedules half of her cleanings for a six-month recall. I mean she's basically half the office is walking out every single day and did you then you look at old dogs like me who has seen thousands of offices get 25 new patients a month every month for 40 years and they still have one full-time hygienist. So you say well if I just work 40 hours a week 50 weeks a year that's 2,000 hours. So she sees a thousand people twice a year and if you take a thousand people there since a thousand people divided by 25 I mean it's just they just have people coming in the front door going out the back doors and then when you drive from Phoenix to Las Vegas there's a Hoover Dam where shows you if you have water retention and don't lose any of those water molecules you can't even see across the lake and they don't understand that and they'll always tell you that they always want them new patients. They're always like what do you do for new patients and it's like some drug and it's like well we live in a town of Edna,Texas of 5,000 people for 40 years I mean doesn't the whole town know you exist, don't they all know your there, why do you still need these new patients for all these years because you're not tracking the reappointment rate. So talk about patient retention and for a little fill a little investment of a hundred and forty nine dollars a month. I mean what is $149 and Mo composite on number three I mean so for one mo filling on number three on a PPO fee schedule, talk to them what you're technology can do to build a Hoover Dam and to monitor how much water is leaking out and going down the Colorado River.

Kevin: Sure so we have probably three different things that we provide that do help prevent against attrition. First and foremost we do track attrition for you let me define how we count it, we count attrition as a patient who has not been seen for an appointment in over 18 months. So we just finished 2018 that means in December patients that had not been seen since June of 2017 have now been counted as attrition. I don't really care what the patient status is in the software people move they come back they get mad and they decide that you're not as bad as they thought you were, so I don't care what the patient status is I'd care about did they have their butt in you're in a chair that's what I count for attrition. So we provide a monthly list for you of patients that have just fallen into attrition and you can then act on it and what I'll tell you is your automated systems your regular phone calls whatever you've been to so far it's not working to get those patients back you know. So you need to have this list and have a different plan in place a specialized calling campaign where you're not just calling and leaving a voicemail those are things that you need to do with this is attrition list. So that's a monthly thing that we provide and then a weekly reports we have two different reports. So we have a recall list, sort of prevent them from getting into a attrition so it's designed to complement you know again if you're already using the automated system with emails or text messages it's designed to complement that with a phone call because still their are patients that aren't going to schedule unless you call them and then on top of that sometimes you just have to annoy them just enough so though we're actually remember that they have a dental visit a lot of people they leave and they don't even think about the dentist until they're two thirds and or until you call them 17 different times and then like oh yeah I think I'm due for a dental appointment years later. So our recall list generates a fresh list of patients, it's very strategic and a schedule we've developed in order to keep them from going into attrition and to fail your hygiene department. So that's the other thing and then we do have a weekly unscheduled treatment report as well that's to help people schedule their diagnosed treatment that you've done with them, so I'd say that's three different services that we provide all part of our regular monthly service right there.

Howard: and people are just incredibly complex I mean the one thing that seems to amaze me more and more as I get older and older and older is just how complex this wild animal Homo Sapien is. I mean asking someone to schedule an appointment for six months doesn't seem like anything to you and me on a smartphone we open up our outlook calendar do it but I mean what percent of Americans just can't even fathom scheduling an appointment three months from now. I mean they're very very complicated creatures and their's no one-size-fits-all. When you talked about automated systems are there any that you recommend or works well with your Divergent Dental?

Kevin: So the one that we've used in my dad's practice for the past few years is Practice Mojo but honestly we're about to switch over to the Open Dental EServices. So it's designed to be implemented with the e service and the reason I am going to switch to that is because they have an online web scheduler as part of the integration now, so that you mentioned about the phone you know now instead of sending an email hey call us to schedule the appointment they check their email 11 o'clock at night well now they say hey you're due for your cleaning click here to schedule your appointment now I can do that. So my recommendation actually well two fold; number one find one that's not overly expensive and if you're paying 300 bucks a month for your reminder service you're probably overpaying because there's other options out there for half that cost but then also find one that has integration with new technologies so that patients can schedule with their technology. I mean I use like I know urgent care centers or even scheduling your car for maintenance or ordering food. You know we're all using our smartphones for that type so I thing, that instead of being afraid of the technology and saying hey what if this patient screws up my schedule for that day realized that your patients are already gonna screw up the schedule for the day when they don't show up so it's gonna happen already no matter how you schedule but I think that by having that technology honestly the one thing I'm most excited about is that patients will appreciate having that option more and they'll it'll be build rapport with them. So personally if you're Open Dental I would encourage you to check out their eServices bundle it's a if you schedule one or two appointments a month it's gonna pay for the cost of the eServices.

Howard: and who owns practice mojo?

Kevin: It used to be owned by Smart Practice their in Arizona but I think they got sold over to I think owns them now. My dad actually was good friends with the founder of Smart Practice which was one of the reasons we went with Practice Mojo in the first place nothing against practice mojo if anybody's listening we're not upset or anything it's just that you know we think we're ready for the integrated thing with open and all their eServices.

Howard: and who was the founder of Smart Practice

Kevin: It's Jim

Howard: Jim and Naomi Rhode I love that guy so much man what I look what I could not believe about Jim Rhode is when I was up here was 87 and he was all that and a bag of chips, had this big smart practice I think it was called samandidotics back then they had like a thousand employees and I would drive down there I think was on like 2600 South McClintock and I would walk in there they go how may help you, yeah I want to talk to Jim Rhode and they take me right to his office and I'd sit down he give this stupid young 24-year old dentist an hour of his time and the thing he was just an amazing man and his wife Naomi Rhode who became the president of the National Speakers Association which is so silly cuz in Tempe their's this big building as this NSA and half the people around there what most Americans say when they hear that is that's the

Kevin: National Security Administration

Howard: Yeah they don't actually realize its the National Speakers Association that's funny. I'm pretty sure the NSA is not in Tempe, Arizona but anyway yeah so these numbers these dashboards are just everything online scheduling we have. One of the reasons we also switched to Open Dental the online schedule first of all when we switch from Softdent to Open Dental the people that kept telling me Howard, have you been talking about this time I do it was actually my programmer my Dentaltown programmer, he just started Dentaltown 20 years ago is still there Kent Scott because it was crashing all the time something was always crashed. He says I don't have time for this and since we put an Open Dental we like to say it's faster it's number crashed on the idea but what do you think of their online scheduling we use that now and by the way when we put up the online scheduling you know I took one day, first person to schedule online what would you think of that?

Kevin: I love it. So I've done the analysis some people think that someone's schedules an appointment line they're less likely to show up that's not what I found, what I found is they're probably more likely to show up honestly because the people who are looking as scheduled online are already motivated. We still have some no-shows but again we do have no-shows with every type of appointment so.

Howard: but I've already seen this rodeo twice I remember when the ATM machine came out I first saw my dad we were laughing we walked into National Bank of Wichita on West Street and central in Wichita and we saw this guy and we're like well why don't you just go inside and talk to the lady I mean let me get a sucker and he was sent here on this thing doing this thing. So we walk in we make the deposit I get my little red sucker or walk it out we stop by and talk to him again on the way out he's still deacon with this thing of my dad and I said yeah that's never gonna work out and and then now I just took over. I think people who can schedule appointment online or just a cut above the rest of me go back to your last Thanksgiving dinner what percent of your cousin Eddie's and uncle Larry's couldn't even do an online scheduling deal these are more technologically oriented people they have jobs that have computers probably more likely to have dental benefits. It's just it's an entirely different breeding I mean seriously what percent of America could not make an online appointment?

Kevin: Very few maybe maybe 5% couldn't do it, couldn't I say 90 95 percent could from your phone I mean I don't know what the number is but I think it's I think it's 80 plus percent of Americans have a smartphone and so if you have a smart phone you could schedule your appointment from your phone anywhere anytime and it just makes sense to leverage that technology and offer that as an option it helps you I think it builds your rapport with your patient base because it shows that you're keeping up with technology it's not just a form that you fill out to say hey I'd love to request an appointment you're actually scheduling the appointment online I think that that speaks volumes for the practice and and just keeping up with technology that you're not falling behind and not just this old dying dental practice

Howard: So let's do some terms because a quarter of, by the way please leave the thanks for the almost 9000 subscribers on the YouTube channel, please put your questions in the comments afterwards or email me but about a quarter these kids will email me and say I'm a second year third year fourth year dental student and then the rest are all under 30 and I get like one old guy a month that sends me an email and says dude I'm as old as you but let's do terminology on your monthly KPI report KPI means key performance indicator report you start with the gross and then you talk about write-offs, adjustments, net production. They don't even know what that means so what is the difference between a gross and a write-off and an adjusted production and for a net production will you go over that terminology for them?

Kevin: Yeah for sure you know that's a great question because I have had some of my customers use the term true production and have you I've had two different people use that term completely opposite. So some people say true production they're talking about the gross production and some people say true production they're talking about the adjusted production, so gross production that's whatever your regular fees are so let's just say you have a crown that's a thousand dollars that's your gross fee for that and that only thing you did that day you're gross production for the day would be a thousand but if you're in network with MetLife or whatever other insurance out there the PPO fee might be $800, so at that point you would have a write-off of $200 and then your adjusted or net production is going to be $800 and so with adjusted production of net production what we're encouraging practices to do is focus on that because I like...

Howard: So are you using adjusted production and that production is the same synonym?

Keven:That's yeah for sure for sure

Howard: So adjusted production is net production?

Kevin: Correct that's right yep so adjusted production and net production those are synonyms each practice man that software kind of uses a different term for that so that's why we use that. I know Open Dental calls it net production I think the others might call it adjusted production but and personally what...

Howard: Sorry to interrupt but this leads to something I gotta tell these kids, you said earlier about how their's really no agreed-upon terminology and you're sitting there at the your in  Texas, you're sitting there with some Texas good old boy study club and dentists start talking about their overhead and so Billy bothers yeah my overheads only fifty percent okay he doesn't even know that he owned his land and building paid it off and so he doesn't charge himself rent every day. So yeah that's very different than someone who's a true accountant says well you own this landed building and it's worth you know seven hundred and fifty thousand dollars and the according to the IRS the standard and customary rent for this would be you know five percent of production would be rent. So you know he so and then and then the Dennison do talk about the numbers every practice management consultant on earth will tell you that during the phone interview they'll say oh Kevin what's your overhead it's about sixty percent what's your labor oh it's about twenty percent then you get there and Labor's twenty nine percent and overhead is 86 percent you like well you just told me all these numbers and then so their's no agreed-upon terminology. I've been trying to work with the Tim law where we can just you know can we just agree on how to set up an accounting you know coding you know, their's no I guess I'm saying there's no standards and imagine if there were no standard you know I know people hate dentists or you know they hate the government you know they're they do I mean the majority of my homies don't like the government don't like big government but imagine if they didn't set standards on electricity and ever every electrical plug was different imagine if they let the railroads that was a problem that people are having these railroads would go bankrupt and then the other rail Road down the street couldn't use it because they had different widths so as the government stepped in and said we're gonna use the Roman Empire's chariot wheel and the exact axis of the chariot will for the Roman Empire was with these railroads because then when you go bankrupt someone else can run their train down your tracks so and we don't have any of those standards in any of accounting. So the only reason I'm going on and rant on this it's because a lot of dentists no Dentaltown so you don't practice all again a lot of times you're sitting there and you're reading posts on Facebook or you're hearing other dentists talking about their numbers and I assure you whatever number that dentist says is completely asinine. I mean the chance that that dentist is using the right terminology really knows his numbers and it's telling you something that a CPA could sign off with I mean it's a better chance that you'll be killed by a meteorite tonight on your way home. I mean so on these terms like you just said true production yeah you're dealing with the same dentist in the same country who speaks the same language and they have exactly opposite meaning of this term and you get when you don't have standards.

Kevin: I think a better phrase when I've started using recently as collectable production because that's the number that you're going to want to try to collect on, you're gonna get paid on so adjusted net whatever but like collectible that's the number that that $800 is collectible production after the write-off or any courtesy adjustments so and actually just on that non standards Howard I think it's amusing, their's new patient reports in different software's and all of them have this where their's different types of new patient reports I've see Dentrix, Eagle Soft and I've seen it Open Dental. You run a new patient report for the same month inside of the same software it has different lists of patients depending on how they're counting within the own software and so it's one of those things that yeah the lack of standards is crazy and that's why one of the reasons when I talk about our stuff I try to define what it is we're counting and that's where you know when I look at most of our numbers I very rarely show gross production because I think that that's just a kind of a mythical number sure you can charge eight thousand dollars for your crown but if you're unless you're a high-end cosmetic dentist in Manhattan or maybe in Aspen Colorado you're not going to be having that as your actual collectible production for those crowns because you might be in network with certain insurances and your actual collectible production is actually closer to a thousand dollars.

Howard: and you know those I can't believe it man we've gotten I told you our shows an hour and I'm so grateful you came on the show we're only 10 minutes over an hour we need to wrap this up but Its just just amazing how I you know the DSOs you know, I've podcast interview to all the major DSO players and it's no secret that private practice dentists and DSOs have a hard time keeping their associate dentists because most people don't go to school eight years to be Kevin Rossen's boy, you know they didn't say oh yeah when I was in high school one day I went to grow up to be Kevin's boy. I mean they wanted to be your dad wanted to be a doctor and owned his own building and own his own practice and when people sit there and say oh these big DSOs they have really high turnover or their associate dentist dude so does the private practice nobody's keeping associates and so the bottom line is they want to own their own practice and they always think they're gonna solve the universe like traveling around and learning the greatest quality dentistry if I just learned occlusion and implants and sleep apnea and if I just learn all these things you build it they will come and I'll tell you what the DSO has shown you that with the average associate dentist only lasting a year or two by having great understanding of their numbers great understanding of their math great marketing great just all the great management that even though the dentist is turning over every year or two they're making Bank and some of these locations like Aspen and Heartland and Pacific they're all somewhere between 700 and a thousand locations because they got this right, they got what you're doing right and so then you go into the dental office and say well this dentist has practice their they didn't have any dental turnover for 40 years this guy worked from 25 to 65. So what you need to do is ask yourself you know what you don't like about the big dsos well what are they doing right and what if you took what they're doing right and you brought it home and  then if one-third of marriages are gonna be divorced over finance maybe used to get your spouse involved you know I always love it when a dentist's to sit there and say I can't believe the president United States doesn't cut Social Security or cut Medicaid like dude you can't even get your wife you can't even get Muffy to quit blowing ten thousand dollars a month oh but the president he can easily do it for 320 million people but you can't even bring it home to your own spouse and one of the reasons your spouse is spending so much money is because not only do you not know your math and adjusted production and net production and all these things your spouse doesn't and she thinks you're rich, you don't even know what you are then we started this podcast with the bears kicker hit the upright and I'm telling you that at least that guy instantly knew he hit the upright and lost a game and I am afraid that 80% of dentists don't even know where the uprights are. Thank you so much for your 500 posts on dental town thank you so much for bringing the discipline of knowing your numbers to starting off with your dad and now to several hundred dentists around the United States it was a real honor and privilege to podcast you today.

Kevin: Hey thanks for your time Howard I really appreciate it. 


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