Sleep MatterS - Dental Sleep Practice

COVERstoryProSomnus Sleep Technologies Dream Team: (standingback row left to right) Brian Kiser, Senior Account Manager;Jerry Vogel, VP Sales; Mark T. Murphy, DDS, VP Marketing;David Kuhns, PhD, VP Technology; (seated middle row)Sung Kim, VP Engineering & Operations; Len Liptak, CEO;Robert Starr, Chief Administrative Officer; (seated front row)Kimberly Martin, Technical Services Manager; and HeatherWhalen, Senior Director of Marketing & Education.In his book “The World is Flat” Thomas Friedman notes that“Analysts have always tended to measure a society (substitute“Dental Sleep Medicine Profession”) by classic economicand social statistics. Such statistics are important and revealing.Friedman prefers to ask a more telling question; “Does this society or profession have more memories or dreams?” If memoriesprevail and we speak of the ‘good old days,’ the profession orsociety is dying. If there are more dreams than memories, thefuture is bright. In the case of Dental Sleep Medicine, the futurelooks so bright you ought to wear shades. Digital technology,faster turnaround times, doctor preferences, designs, rapidly evolving physicians’ acceptance, insurance reimbursementdrivers and broader patient awareness and education aboutOSA provide us a clean canvas we can paint our future on.DentalSleepPractice.com7

COVERstoryThe next generation appliances take advantage of digital design, storage and processes to helpdentists treat more OSA patients with better efficiency and effectiveness.Go Digital or Go Home!Dental digital technological developments are improving the consistency, fitand efficacy of oral appliance therapy. TheProSomnus Sleep Technology CAD-CAMprocess provides several advantages thatnext generation appliances enjoy. Precisionmedicine allows a patient-centric approachrather than hoping the they can conform towhat the lab can make. Physicians and otherproviders in this arena have found comfortin the reduction of side effects and complications as well.With in-lab times of seven days, we canget patients into treatment faster. The digitaldesigns allow manufacturers to customizedoctor preferences and deliver them consistently. Changes in fin angle, titration schedule, retention and more can be stored in adoctor’s design file and replicated perfectly.Details can include: desired mm length oftitration, verification of protrusive setting,1mm, 0.5mm or less incremental adjustment, anterior opening, discluders andmore. The bio-compatibility of milled andprinted appliances is second to none. Justas traditional dental labs have created thedigital highway for CAD CAM production,so too have select medical device manufacturers embraced this exciting pathway. Although the majority of impressions receivedtoday are analog, the ratio is changing rapidly as dentists adopt intraoral scanning.The accuracy, fit, storage and reproducibility translate to less tooth movement and amore stable dentition. Clinicians report thatthe lingualess design and thinner materialshave resulted in less mandibular advancement to achieve clinical success. Brightfuture indeed.The largestpercentage of thepopulation remainsundiagnosed anduntreated, providinga fertile health carefield for dentists andphysicians alike.Patient Centric TreatmentThe barriers are crumbling as study afterstudy demonstrates the efficacy of OAT. The8 DSP Spring 2017Infographic from sleepeducation.orgmedical profession is realizing that patientcomfort and compliance are important considerations in designing effective treatments.Insurance companies are starting to realizethat OAT lowers short and long term expense. The cost to third parties to treat themassive comorbidities of OSA translates intolower reimbursements and higher premiums. 100% effectiveness, 40% of the time,the score for PAP therapy, is not an acceptable patient outcome. The large and growingpercentage of the population that has OSAand remains undiagnosed and untreated,providing a fertile health care field for dentists and physicians alike. Some companieshave chosen a direct care path developingtreatment centers and eliminating the general dentist population. Others support bothCPAP and OAT with their product offerings.ProSomnus Sleep Technologies is dedicatedto helping more dentists get more patientsinto treatment faster and more efficiently.As a profession, we will need as manyadvantages as possible. The recent FDA approval and addition of compliance chip technology to our appliances allows pilots, truck

COVERstorydrivers, servicemen and dozens of other sleepcritical professions to confirm they are following guidelines and treatment recommendations. PAP devices work well when the patient wears them. Recent studies suggest thatfive nights a week and four hours per nightdo not have the intended outcomes. Evolvingapplications, new technologies and innovative designs will help more doctors treat thegrowing number of OSA patients. “Dental”achievements, such as a healthy periodontium, with excellent implant restorations andnaturally esthetic porcelain, are trumped byimproper airway management. We standon the front lines as systemic health issues,dentistry and precision medicine come together. A long time ago, dentistry learned toquit extracting teeth and battled decay instead. We then grew to understand that losing well-restored teeth to bone loss was notproductive. More recently, we have becomeadept at managing the forces of occlusion.Today, an airway centric approach is guiding the medical decisions of general practitioners, orthodontists and oral surgeons. Asmy good friend, Dr. Michael Gelb, says, “Airway trumps everything.” We can go 3 weekswithout food, 3 days without water, but only3 minutes without air. 24 hours without sleephas the same effect as being drunk. Multiplenights with poor sleep have physiologic consequences throughout the body.Sleep Matters!The Dream TeamHaving a great appliance, advancing themandible predictably, patient comfort andfast turnaround are table stakes to get into thegame of medical device manufacturing today.Digital platforms have a distinct advantageover analog today. We will see an increasein digital solutions, platforms, manufacturersand appliances. Dentistry has and will alwaysbe about the people: You, your team, the patients and the various vendors, lab and medical device manufacturers you partner with.At ProSomnus Sleep Technologies, we designdevices that make it easier for dentists to optimize health outcomes for patients. It is morethan just AHI. It is more than just being easyfor the dentist to use. It is about making a device that patients will use. It is about ease ofuse. It is about convenience. Success in thepatient’s hands and in your practice. A realpartnership.part-ner; noun. a person who takes partin an undertaking with another or others,especially in a business or company withshared risks and profits.Interesting definition indeed. Shared risksand profits is something that often doesn’tshow up in every partnership. Vendor partnersshould be involved in helping you in manyways: Providing patient education materials and opportunities, Shortening treatmenttime, Team training about sleep, Customizedappliance manufacturing, Shared financialsuccess and Volume rebates. At ProSomnusSleep Technologies we have assembled topdrawer leaders in design, manufacturing andeducation in dental sleep medicine. With anEngineer, a Material Science PhD, a Dentist with over 25 years experience in sleep,a Marketing and Education Director who issecond to none, a CEO with incredible leadership and passion, and several technicalsupport, sales, manufacturing and fulfillmentpeople, we indeed have the Dream Team.dream team; noun. a team or groupwhose members are among the mostqualified or talented in their fields.At ProSomnus, we have a diverse groupof highly skilled people, dedicated to yoursuccess and the fulfillment of this preferredfuture vision for dental sleep medicine. Every patient encounter, even routine dentalcare, should be examined with airway centric eyes and treatment plans. If you havebeen frustrated with a ‘one design fits all’approach, delayed patient treatment orunresponsive device manufacturers, reachout to ProSomnus. The Future is Bright.Sleep Matters!Dentistry has andwill always beabout the people:You, your team, thepatients and thevarious vendors, laband medical devicemanufacturers youpartner with.With no metal parts, less overallvolume and a lingualess design, theMicrO2 raises the bar for patientcomfort, safety and effectivenessin OAT.Mark T. Murphy, DDS, FAGD, is Lead Faculty for ClinicalEducation at ProSomnus, serves on the Guest Faculty atthe University of Detroit Mercy, is a Regular Presenteron Business Development, Practice Management andLeadership at the Pankey Institute and is the Principal ofFunktional Consulting.He has served on the Boards of Directors of the Pankey Institute, National Association of Dental Laboratories, the Identalloy Council, the Foundation for Dental Laboratory Technology, St. Vincent DePaul’s Dental Center and the Dental Advisor.He lectures internationally on Leadership, Practice Management, Communication, Case Acceptance, Planning, Occlusion, Sleep and TMD. Hehas a knack for presenting pertinent information in an entertaining manner.DentalSleepPractice.com9

FINANCIALfocusFive Things Your401(k) ProviderDoes Not WantYou to Knowby Tom ZgainerImagine giving up 50% or more of your future nest egg to excessive fees. This is precisely what is happening when youutilize a traditional 401(k) plan (which represents 95% ofthe plans in existence). Seemingly, small percentages havea massive impact when you look at how they impact youraccount growth over time. Just 1% in excessive annual feescan add up to hundreds of thousands, even millions, of lostretirement dollars.Figure 1: Assumes both plans have a starting balance of 1 million, a 7% annual growth rate, and 100,000 in annual contributions10 DSP Spring 20171. Fees matter, and their impact canbe devastating.Have you ever been told your plan is“free?” Many 401(k) providers will markettheir plans as essentially “free” becausethere are no explicit checks being cut forrecordkeeping, administrative fees, etc.But we all know there is no “free lunch”in this world.If you encounter a “free” plan, ironically, you could be in an extremely expensiveplan. The fees are simply being subtractedfrom your retirement savings, which canact like a hole in your boat! Make no mistake. Just because you may not be cuttinga check for your plan, you still may be cutting into your future nest egg.Figure 1 is a real-life example of twoidentical plans with the same growth rate,same ongoing contributions, but with different fee structures (0.65% versus 1.68%annually). All things being equal, the additional fees erode more than a million dollars in potential retirement savings.

FINANCIALfocus2. Layers upon layers of fees are hidden in plain sight.The traditional providers have beenpushing the same old 401(k) plan for 30years, but in 2012, the law finally requiredfees to be fully disclosed. The good news isthat the curtain was pulled back. The badnews is their layer cake of fees is hidden in30-50 page fee disclosures that the averageperson has no chance of deciphering. This isevident by the fact that 71% of Americansthink they pay NO 401(k) fees. Nothingcould be further from the truth.Not only do providers make money bykickbacks from mutual funds, they are alsohappy to layer on additional, seemingly arbitrary fees that can double or even triplethe cost of your plan. If that weren’t enough,many will also hit you with a one-time salescharge (aka commission) on every single dollar that goes into the plan. It’s an expensiveand entirely unnecessary toll for the “privilege” of saving money.Here are the charges that should raisered flags. Contract asset charge/Asset management charge — a layer of feescharged on the entire balance of yourplan. This is over and above the costof the investments. Required revenue — an almost comical line item, this is a fee charged tosmaller plans where the providers insist they aren’t making enough. Sales charge — a one-time commission that subtracts 3% to 6% from every dollar you deposit. Surrender charge — many insurancecompany providers have figured out away to have your 401(k) held withina “group annuity.” This means theycan penalize you with hefty surrendercharges if you decide to switch plansto another provider.— stuffing your plan’s fund menu with thefunds that are most profitable for the provider. Worse yet are the providers that stuff themenu with their own more profitable namebrand funds.Odds are that your 401(k) plan is packedfull of expensive “actively managed” mutual funds that are hoping to beat the marketby being the best stock pickers. The problemis that although they may have a hot streak,the studies overwhelmingly show that in duetime, they will often lag the market. So youare usually overpaying for underperformance.What’s the alternative?A great number of Nobel laureates andinvestment legends such as Jack Bogle andWarren Buffet would recommend that mostinvestors use low-cost index funds. Indexfunds simply track a basket of leading stockslike the S&P 500, for example. David Sw-The vast majorityof 401(k) providersmake huge sumsof money fromkickbacks from themutual funds inthe plans they sell.3. The mutual funds in your planmenu are often chosen for all thewrong reasons.The vast majority of 401(k) providersmake huge sums of money from kickbacksfrom the mutual funds in the plans they sell.This payment for “shelf space” is a legal butopaque process called revenue sharing. Thenet result is what we call “menu stuffing”DentalSleepPractice.com11

FINANCIALfocusensen, the Chief Investment Officer responsible for growing Yale’s endowment from 1 billion to 24 billion, warns us, “When you look at the resultson an after-fee, after-tax basis, over reasonably long periods of time, there’salmost no chance that you end up beating the index fund.”Most plans do not offer access to low-cost index funds because they can’treceive kickbacks (aka revenue sharing) from these ultra-low-cost funds. Manysmall or midsize plans will be told they don’t qualify for index funds becausetheir 401(k) is not large enough. (Translation: “We wouldn’t make enoughmoney off of you if we granted you access.”) Or worse, if they do offer them,they charge an outrageous markup. One plan we reviewed offered indexfunds with a 3,000% markup from its normal retail price. That’s like buying a 30,000 car for 900,000. All clients of America’s Best 401k have access tosame low-cost index funds regardless of the size of the plan. No commissions,no kickbacks, and no markups.4. Many of the biggest providers have been named in lawsuitsfor excessive fees and self-dealing.There has been a flurry of recent lawsuits against 401(k) providers. Theprimary reason is for excessive fees and the use of proprietary products. Interestingly, it’s not just the customers who are suing, but many providers havebeen sued by their OWN employees for their own in-house plan. Providerswere caught with their hand in the cookie jar by peddling their own, more expensive name-brand mutual funds and, thus, profiting from their employees’retirement savings.Business owners beware!You have a legal obligation to make sure the fees in your plan are both fairand reasonable. As the plan sponsor, the Department of Labor states that thefiduciary obligation falls on you to make sure the plan is set up for the solebenefit of your employees. Nothing external can influence the decisions youTable 1: 401(k) with 1 million in total assetsAmerica’s Best 401kTransamerica*John Hancock*0.65%1.50%2.25%Year 1 (start) 1,000,000 1,000,000 1,000,000Year 5 1,722,690 1,660,243 1,606,716Year 10 2,705,886 2,523,154 2,371,881Year 20 5,863,251 5,124,922 4,553,892Year 30 11,707,110 9,569,117 8,024,433Fees*These examples above are actual examples of specific plans where the fee disclosure was provided for both Transamerica and John Hancock. We have analyzed hundreds of plans from Transamerica and John Hancock where the fees are both higher and lower than the amounts listedabove. Fees in plans vary drastically even from the same providerTom Zgainer is CEO and founder of America’s Best 401k andhas helped thousands of companies repair or rescue their retirement plans over the past 15 years.Take control, start here: americasbest401k.com/fee-checker-medmark12 DSP Spring 2017make for your plan, including a relationshipwith the existing broker. More importantly,it’s your legal duty to periodically benchmark your plan, so a side-by-side comparison is a task that is in your best interest toperform. America’s Best 401k will provide acomplimentary benchmark at your request.5. The traditional model is beingdisrupted and rapidly becoming adinosaur.The 401(k) industry is ripe for disruption.Much like Uber has the transportation industry on its heels, our company is seekingto transform a decades-old industry that isriddled with conflicts of interest and oftenputs profits ahead of people. They haveseemingly forgotten that it’s YOUR money,NOT theirs. America’s Best 401k is a nextgeneration solution that eliminates brokers,levels the playing field with transparency,and provides a combination of high-techand high-touch interaction for our clients.Your next step: Get a complimentaryside-by-side plan comparisonMost of our prospective clients are astonished when they see the results of theirside-by-side plan comparison. In manycases, the immediate savings is more than 10,000 in the first year alone. But thereal impact is what happens over 10, 20,or even 30 years. Below is a chart showing a 401(k) with 1 million in total assets.Here we show our average plan cost versustwo other common providers. Note that although fees vary from plan to plan, we often see fees that are even higher from thesetwo providers as well as other major insurance companies and national payroll companies. Assuming the plan is growing at 7%and has modest contributions of 60,000per year, there are millions in potential savings being left on the table if a switch is notmade immediately.These savings will go right back into thepockets of you and your employees and makesure your money will last as long as possible into retirement. By sending us your feedisclosure form (to info@americasbest401k.com), which we can help you locate, andby taking 15 minutes to review the results,we hope to show irrefutable evidence why aswitch is in your best interest.

CONTINUINGeducationPrecision Medicinein a Dental Sleep PracticeImportance of better screening, moreefficient clinical workflow and patientselection in dental sleep medicineby Dr. Shouresh CharkhandehToday, according to the American Academy of Sleep Medicine, about 30 million patients suffer from ObstructiveSleep Apnea (OSA) in the US alone. And unfortunately,about 80% of these patients remain undiagnosed, despite allthe efforts and advancements in raising awareness, screening,diagnostic technology and clinical guidelines. The cost ass

and Mandibular Positioning Home Sleep Test. Presented at AADSM on June 10, 2016 by Dr. Remmers and Dr. Vranjes during poster and oral presentations. University of Calgary in Alberta Canada, Zephyr Sleep Technologies, Calgary, Alberta, Canada, The Snore Center, Calgary, Alberta, Canada. ProSomnus Sle