Latest / The Dental Economist Show / Stephen Thorne on Moving Dentistry From Sick Care to Preventive Healthcare
Transcript
- TIMESTAMPED TRANSCRIPT — DDS Ep1 V1 Duration: 37:19 ============================================================ [00:00] Welcome back to The Dental Economist show. I'm your host, Mike Huffaker. If you're enjoying the show, please take a moment to like, subscribe, or even better yet, leave a review. It really helps us bring more conversations like this one to you. Our guest today is Steve Thorne, founder and CEO of PDS Health, formerly Pacific Dental Services. Since founding the organization in nineteen ninety-four, Steve has led its evolution into a national integrated healthcare services platform, [00:30] supporting more than eleven hundred dental, dental specialty, and primary care practices across twenty-four states. PDS Health has become widely known for advancing the mouth-body connection and dental-medical integration with a focus on prevention, collaboration, early detection, and whole person care. Under his leadership, PDS Health became the first large dental organization in the US to implement Epic, helping enable shared data, coordinated care, and scalable integration [01:01] across a national practice network. I would also recommend everyone go watch Steve's recent TEDx talk on the systemic importance of oral health if you haven't already. It's a great primer for where this conversation is headed today. Today, we'll dive into how Steve and PDS Health are helping shape the future of patient care, prevention, and the dental industry. Steve, welcome to The Dental Economist show. Thanks. That was a very kind introduction. Well, listen, you play a critical role [01:31] in promoting the importance of dentistry and overall health. How do you get clinicians to stop thinking of themselves as a dentist and start thinking of themselves as a physician of the mouth? Like, what has to shift there? Uh, that's a, a great opening question, and one of the, uh, biggest challenges I'm up against right now. And when we think about how dentistry has evolved over the years, I mean, originally, dentistry, I think, was, uh, covered under, like, the barbers [02:02] of the world back in the eighteen hundreds, right? And so it wasn't recognized as that important. And it obviously got better and better and better, uh, but mostly it was still all about fixing things that were broken, right? Fixing teeth, giving a denture, placing an implant if they lost a tooth, or scraping the teeth for periodontal disease. That's primarily... And it's still kinda primarily there. Um, we call it, um, sick care instead of healthcare [02:32] and fixing what's broken rather than fixing or helping them be more preventive. And so we really have to get in the mind of the clinician about who they are and how they want to take care of that patient in their chair. If they can transition their brain from being the dentist that just fixes stuff that's broken to a true physician of the mouth [03:03] and even more, and really think about how they can help that patient out be healthier and happier in the long run, that's when, that's when I say the magic happens. That's when cool stuff starts to happen. It's like patients don't care how much you know until they know how much you care. As a clinician demonstrates they have their best interest at heart about that patient with individual needs and wants and not just say, "I'm gonna fix, you know, I'm gonna do crown number three," um, good things start [03:33] to happen. It's really is the shift from just oral health to oral systemic health and from being reactive to predictive and preventative. Yeah. What's-- Which of those is harder to teach? We're on this journey of moving oral health from oral healthcare providers from, from fixing things to being more preventive. Now, take you on that jour- my personal journey. I started reading about this, [04:03] studying this, uh, in two thousand twelve. The surgeon general put out a report in two thousand. They put out another report in two thousand and ten, but really it wasn't grabbing hold. Maybe a little bit at Harvard Dental School and some other schools, but not much. But I started looking at that, what we call the mouth-body connection, and looking at how important oral health was to our overall health and especially anything related to chronic inflammatory diseases. And the number one chronic inflammatory disease [04:33] in the world, periodontal disease, so I started studying more of that. There's this, uh, military term, uh, OODA, maybe you've heard of it, observe, orient, decide, act. Mm-hmm. Spent years studying this, years learning, understanding, and be-before we started experimenting with dental medical integration. And then I learned just how hard that is in the, in the actual practice environment because they're, they don't do it, and nobody had ever done it. [05:04] Um, and so, and, and it's again a long-winded way to answer your question, but I think it'll be a thorough answer, is what we learned is that until physicians and dentists could speak in the same language, meaning they had to work in the same health record, that I couldn't drive the change. I couldn't move it to preventive, and I-- there's no way I could move it to predictive. So we are on this, this journey here to move, uh, to preventive. Predictive is [05:34] still a little ways away, um, and I think there's a group of physicians that want to get there quick because we have the technology. Change is slow in healthcare. Change is really slow. So, but there's a growing group of oral healthcare providers in the United States and primary care physicians and nurse practitioners and even cardiologists, gastroenterologists, OBs, that are getting much more preventive in nature. So that's super exciting for me to see happening. [06:04] What role do the dental schools have to play in this? And when you have new dentists that are coming into your practices straight out of school Like what are, what are the expectations that they have that are unrealistic, and how does PDS Health help them scale their skills to, to maybe speak that language that I, I'm not entirely sure everybody is speaking in, in dental school today? Yeah, just another great question. Dental schools play a gigantic role in this, by the way. Uh, they spend three years or [06:34] four years or in some, they've had some accelerated six-year programs, things like that, of their life learning how to do this new kind of skill first off, 'cause they have to have good motor skills as a dentist. All this stuff of fixing things that are broke in our mouth are, is not going away. Right. But we can also do so much more. So they've, they work so hard to get those hand skills down, the knowledge down, the ability to diagnose and, and all of that. [07:05] But there are schools now that are very progressive on the preventive side, using salivary diagnostics, teaching mouth-body connection, teaching the relationship between oral health and cardiovascular disease, or oral health and, and breast cancer, oral health and, and diabetes. And schools like, uh, Har- I think Harvard probably was the one that started a lot of this with, uh, Dr. Giannobile there, and some of the work that goes on in Boston. A lot of [07:35] science goes on in Boston, so it's a plethora of that. But, uh, more and more, I think probably University of Michigan has taken the lead here now in this area. But, but there's now I think about 20 schools that have moved over to Epic for this very reason, because they want to teach their dentists how to be more than just people that fix teeth or place implants or, or do dentures. So we obviously target those schools, um, because [08:05] we need, we need... We're growing, and we need dentists, right? And so we recruit from those schools specifically. We actually have a technology company that we support those schools now. So I think we're up to six, no, maybe seven or eight schools that use our version of Epic, which is really, really great. But, but it do- You don't have to do that. I guess I'm sort of pitching Epic, but you don't have to have Epic to do it. It, it's a mindset of that, and then you, [08:35] you have to be willing to get out in your community. And so if you can work with the local physician, I could tell you story after story of docs in our organization that have learned about mouth-body connection, but they don't have our medical group in that state yet or their city, and, and they're doing it. They're working with the cardiologists, they're working with the OBs, and they're working with-- I mean, you can't get a, a knee or hip replacement without getting a, a oral check, right? So they get it. [09:06] But getting it into the flow and making it all work, and then getting reimbursed for it is a whole 'nother topic. Yeah. Well, let's talk about these different technologies for a second, 'cause my dentist doesn't do any of this stuff. Right. And, uh, actually, when I had, uh, Joe on the, uh, the podcast, he's like, "Well, I got a few dentists there in Tempe I can recommend you to." And I was like- Yeah ... "Perfect. Maybe I-" Yeah, yeah. "Maybe I need to, to, to try something different here." But, you know, you, you've introduced saliva testing- Yep ... A1C testing- Yep ... blood pressure screening, inflammatory [09:36] markers, uh, genomics, all into a dental setting. Which of those has had, like, the quickest adoption? Mm-hmm. What are the ones that kind of take a little bit more convincing? Yeah, another really good question. So for years, blood pressure has been a standard, right? But it ha- it's not always done. Right. It's being elevated. But to answer your question, what has had the biggest impact is saliva. Yeah. Inflammation is the glue that's going to bring physicians, the medical side [10:06] and dental side together. Inflammation. Saliva is going to be the tool they use to make it happen, whether it's in a medical environment or dental environment. So I've been at this now 37 years, so I think I'm a little younger than you it looks like, and I can tell you the different phases in those 37 years where a new technology or a new test or, that came into, uh, dentistry that caused material impacts [10:37] in patient activation into care. One of the first ones was, um, the intraoral camera. It was gigantic 'cause we went from X-rays on the screen or reading them up to a light to the patient actually being able to see a, a picture on the screen. That changed how patients perceive dentists in a huge way. With saliva testing now for, we use a one called an oral fitness [11:07] check right now, and soon to be, we will have oral bacteria testing point of care. The activation rate from saliva testing is even better than an intraoral camera, if you can believe it. I think it's the best tool I have seen to help patients understand that, "I need to get this done. I need to get this taken care of." Yeah. So I think saliva is where it's, where it's at. So I had [11:37] Dr. Azness on the podcast a, a month or so ago. I know that you two know each other, and he was talking about the saliva testing as well, and m- my question for him, and I think you kind of just answered it, but for those listening that haven't invested yet into this type of technology, which I think is probably the vast majority of dental practices still have not- Right. Have not ... determined to make that investment. And everything in a dental group or dental organization is scrutinized, and the P&L and the budgets, and it's like there's always [12:07] some desire for a direct ROI that you can point to if you're going to make an investment in something like this technology. What, what's the argument that you would make to anybody that's out there listening that has not yet made this type of investment for why they should do so? And I'm curious what Dr. Azness told you. Uh, it's tied to the activation that you just talked about. Yeah. Yeah, it's activation. And, and providing incredible care for, for the patients- Yeah. Yeah ... and helping them to get a, a clear understanding of what's going on. So [12:37] let's, let's go back and, and start with why would you invest in an integrated health record? I did Epic, but you could integrate some of the others to a degree. And go through all that pain and, and dollars. In America, the average practice really only does maybe 35%. If they're really good, they're doing 40% of what they diagnose on a particular patient within a time period. Pick the time period. Year, two, three years, something like that. Okay, so let's just say it's only a third. [13:08] And if you can move that needle because you now can talk to that patient about their diabetes, you can talk about their history, family history of heart disease. You can talk about the importance of oral health care to a preterm low weight birth, and engage that patient to activate into more care, and y- then you run the numbers. I mean, you're, you're an operations guy, you run the numbers. It's a no-brainer. You just- Yeah ... you just do it. But you gotta have faith that you're going to [13:38] cause those changes in behavior. Yeah. That's, that's the faith part. With something as simple as an OFC test, which is what he's doing. We're measuring AM-MP8, we're measuring the collagen breakdowns. We're basically measuring how active disease is, for the most part, in your mouth. And we have had... We're probably up to 32, 33, 32 or 33% increase in activation into care, hygiene productivity, everything centered ar- [14:08] around that because of, of the, just that one test. Simple test, five minutes. You spit, no needles, no nothing. You run it through, five minutes, they get a score. I'll give you one more data point that's even more powerful than that. We have a small medical group, uh, but growing. When physicians in our medical group refer over to the dental group, the activation [14:38] in- into care increases even more. They are the most active patients. They follow through on their treatment plan the most, and they're, they're very sticky. They stay with us the longest. That's super powerful. Yeah. I'm not sure exactly where I got this note, so if it is incorrect, you can correct me. Okay. Um, but I thought I read somewhere that Arizona had been a notable market for A1C screening for you all. Yes. [15:08] Yes. Um, I'm curious what, what you learned there that you'd want, you know, other DSOs to know before they try it. As best I know, 'cause I don't know everything going on in our company. Best I know, we did a pilot- It's a big company now. Yeah, it's a big company now. We did a pilot with Delta Den- Dental of Arizona, um, and did testing on A1C. What we learned is that roughly 30% of patients who were di- pre-diabetic or diabetic had no clue. Yeah. Wow. So we could make the referral. So [15:38] that's how that worked out in Arizona, and, and what, what I think is behind that push from Delta Dental of Arizona, who's fairly progressive Delta, is if they can prove that oral health care can identify these patients early, 'cause it's all about predictive, you know, getting in early and/or do something with the data because now those patients are into care, so they're getting active scaling, root planing, and other or- other oral care. And that reduces overall healthcare costs. That's [16:09] really powerful for them selling their bus- selling their, you know, dental plans. So we looked at 20,000 patients who had been into care within our organization. Then we looked at how, um, how over a two-year period, how many, um, scaling root planings they had received. These were, um, diabetic, pre-diabetic, and diabetic patients. So I think there'd be, oh, no, I think they might've been just diabetic. Don't-- Only two. I think it was a 6.7 [16:39] or above on the A1C score. Mm-hmm. And then we looked at these patients, how many times they were coming into the dental office versus how many times they went to the emergency department or actually got admitted. We learned that we're saving these companies millions of dollars by helping patients activate into good oral health care. And it, it's not a published study or anything like that. It's all internal as we're ramping up that, um, muscle in our organization, that data science muscle. [17:10] But we have access to Cosmos with Epic, which has 300 million patients in it. So we have the best, some of the access to some of the best data on the planet. And it's great. So that's, that's what was underneath that, um, test- Yeah ... we did with, uh, with Delta of Arizona. Yeah. Well, it's pretty compelling data there. And it kind of ties into the next question I had for you. And you, uh, you answered about the D- uh, about Delta there in Arizona, but how, how have insurance [17:40] companies responded to an integrated oral systemic approach to care? The blunt answer, not well yet. Yep. But it's coming. I'm seeing glimmers of hope. Delta Dental of Massachusetts has been reimbursing us for saliva tests. They get it. They have to figure out where they fit in this whole insurance world, right? I mean, we, we're all, we all realize there's no such thing as dental insurance, right? They're dental plans. And so where [18:10] these dental plans fit into the insurance world to help patients stay healthier, help reduce overall healthcare costs. The dental plans that do that are going to win, and they're gonna win, win big. So I think Delta, they get that. Um, United Concordia's doing some good work there. Delta Dental of Arizona's doing some good work there. I think, I think Delta Dental of California, which is the biggest Um, plan in the United States is trying, and, um, we just recently... There's some [18:40] other, um, groups now. I think we just did something. There's other groups starting to want our data around blood pressure because high bloo- uh, obviously, high blood pressure's not a good thing. So, um, wanting to collect that data. So we still have separate coding systems for medical and dental. Why, what, why does that still exist, and what, what does it cost the industry in terms of integration? That's a great question. It should... The coding system, the separate coding system should not [19:10] exist. It, it's controlled by the ADA, American Dental Association. They control that CDT coding system. Um, actually, I think they just did approve some saliva things, so hats off to the ADA for doing something a little more progressive. But why, why? Why not just move over, do the CPT coding system? It's a more accurate system than, uh, the CDT, and the carriers move over to it. It's probably a little bit of work. I mean, we, we bill medical [19:41] all the time using Epic, and I know a lot of groups do, and so it all came when dental split from medical back in the 18- in the middle 1800s. And it's actually quite sad for the entire, um, US population that we have a different coding system. The way the dental sys- coding system works is you don't a- a dentist doesn't have to tell them why they did something. A physician does. Right. Right? A dentist [20:11] gets to do something, send a bill in, and say, "Hey, I saw it needed it, so do it." And then that's where the, the, the angst happens because the carrier may question it, send us an X-ray, and then it just becomes a big mess because they piss off the patient, the clinician gets pissed off, and you know what I... My, my nirvana if I- since you have a good, um, executive audience, my nirvana would be a plan that pleases [20:42] all the parties to that plan: the patient- Mm-hmm ... the provider, and the employer. Mm-hmm. They don't exist right now. I've never seen one. Yeah. Where all parties look at it and go, "Okay, that's fair." It's never gonna be perfect for any one group. But they'd, they would look at it and go, "That's fair. That's cool. That worked." Yep. Yep. So you just mentioned the ADA, and I think recently you participated in a saliva congress that they had. Yep. Just curious, what were some of the takeaways [21:13] that came out of that, that conversation that the industry should be paying attention to? Yeah, for clarification, it wasn't me personally. I couldn't make it 'cause of my travel schedule, but I had a team there. Hats off to them, and there's w- there was one this week by Santa Fe Group too. They get it. They get that it's the future. Um, my team was underwhelmed with the progress because it's been ta- I'm in all these meetings, right, for, like, a decade, and it's been talked about, talked about, talked about. I remember sitting next to Maria Ryan the other day. She's head at Colgate, [21:44] and she's a periodontist, and she gets all this stuff. Finally, and we leaned over to each other and said, "Why are we still coming to these? All they do is talk about it. They don't do anything." And I go, "We're doing something. We're trying it." Um, but hats off to them for moving it, moving the needle, and Santa Fe Group too because the science is clear. I can get- Yeah ... why maybe 10 years ago they weren't pushing it, 'cause maybe the science wasn't quite there. That horse has left the barn. The science is clear as a bell. Um, maybe not causal, but definitely associated, [22:15] in some places demonstrating causal. Slight shift of topic here. So CPS Health is a, an anomaly in the, the world of DSOs in a, in a few different ways, and one of them is that you are not a private equity-backed organization. Out of the top 50 DSOs, I think 47 are PE-backed at this time, and there's a lot of noise in the space about some of the lender-controlled businesses and then some of the challenges that the industry's faced over the past year. What's your perspective [22:45] on private equity in dental? It's probably the question I get asked the most because we're private. I, I didn't even know there were only three of us. I thought there was one of us that was in private equity of the top 50. And there's a pretty big span from a size of organization from the top few to number 50, where you get down to, you know, 70 locations, so. Okay. So big difference. Definitely. Yeah. Definitely a different world there. Yeah. We'll finish over 12, 1,200 locations this year, so yeah, big, big difference. [23:15] Um- Yes ... look, it's not all bad per se, but it, we've, we look at the fallout in recent years, and there's been some tough fallouts, challenges, right? It's a hard business. It's not doc in a box. We're in the people business. We try to help them be better clinicians any way we can with CE and systems and structures, and we help them build great businesses too. That's really what a DSO does, and, [23:45] and we help people elevate too 'cause a, a dentist can't do it alone. They need assistants, they need hygienists, they need good revenue cycle management, good technology stacks. Done right, it can be a, a nice profitable business. I mean, we're never gonna have the margins of a tech company, but we can have reasonable margins, good growth rate. Our, our CAGR is over 25 years. We're probably at a 20% CAGR, and it's, it's harder. A lot of big numbers. Our CAGR keeps coming down, which bums me out, [24:15] but it's, it's a lot. In real numbers, we're growing up. It's harder to scale for sure. It's harder to scale the percent, but the dollars are getting bigger. Yeah. The bad part is when they put in leaders who don't get the business. Yeah. Scott Asness gets this business. Pat Bauer gets this business. Steve Bill gets this business. Rick Workman Bob Fontana. We get this business. We understand how to [24:46] help and how to, to navigate that world of, of clinicians and non-clinicians and, and all of that. So if they don't spend the time to understand this, this profession and how it actually operates, that's when some bad things can happen. Yeah. And the other one would be just over-over-levering the company. And so when you hit a tough time, you know, that just happened to one of them. They make [25:16] the call and, you know, all the equity got... It was all over the press, right? All the reels. Couple companies, all the equity got wiped out, and the debt holders came in and they take it, took it over. Talked to both those CEOs, and they're in a good spot right now. At least they feel they're in a good spot and ready to rock and roll. And, uh, I think Aspen was in there too, but I talked to Bob, and he s-seems like he'll pull this off and get through it. So we need capital. Mm-hmm. To get capital, you need banks, [25:46] you need private equity stepped in. And then there's sellers too. I mean, there, it, it's not all on the private equity people too. Well, what do you, what do you think about the viability of public markets for dental? Oh, yeah. Well, there's, uh, one in Canada, I believe, that's public, and then a, a small little group up in, um, Minnesota just went public, I think. Yeah, Park. Yeah. Yep. And so I was around. I cut my teeth on the legal side when OCA was around, Orthodontic Centers of America. Maybe that's... You know them? [26:16] Okay. I, I just learned about them from- Oh, okay ... uh, Brian Kaleo was showing me, uh, they're, they're doing a little history of DSOs before Dykema. Oh, okay. And he, he tells that story in this video, but I had never heard of it prior to that. Yeah. It's a horror story. I'm sure- It is a horror story ... he's gonna do a great job of... And it really set a lot of bre-bad precedents for, for me and Dr. Workman and Steve Bill. We had to fight through all that stuff in the early days, in the late '80s and '90s. Um, but then, uh, the first company [26:47] that went public was, I think, General Dental up out of Oregon. Danny C. was running it then. And I think he was trying to do a good job. Um, merged, became Interdent, merged with DCA. But I think it's a different, different point now. I think there are very good, stable companies that have very predictable performance and results, and we should command a fair price in the public marketplace. I think in the long [27:17] run, there will be some public companies, and I think they'll perform very well. Yeah. Now, if I could have you take your crystal ball out for a second, what do you think is gonna separate the dental organizations that lead over the next five to ten years from those that fall behind or become irrelevant or unsuccessful? I think the winners in the space are going to be able to continue gr-to grow older practices. That is the key. [27:48] If you can't grow older practices at at least a three percent clip or more, it's going to be really hard because of the expense side of the equation, and it's really hard to grow older practices. A l-lot of same practice growth, or they call it same store sales or whatever, I call it same practice growth, they're in the ones or twos. And if you look on a long term, if you're, if, if you're an acquisitive company, and you're buying [28:18] practices where the doc is fifty-five or sixty years old, then retires, and you have to replace that high-producing doc with a new doc and hopefully get that doc ramped, that's really hard business. We don't acquire. We do de novo for that very reason. We can continue to provide the same structure, same systems, and, and grow. I think there's a balance there. Um, maybe someday we'll get back in and acquire. I did acquire in the '90s, but I haven't in a while. Heartland's probably the best at doing both de novos and acquiring same time. Um, [28:48] but that's, that's the stan- that's the gold standard which we'll be measured by. And the way to continue that is through what we call continuing care, is keeping your patients. So you've gotta have great operations, keep your patients, 'cause you can't advertise forever and, and keep, you know, ad spend up, keep going up and up to get enough new patients. That's, I think that's a losing model. And then also the winners will have good integrated care. Uh, GPs control eighty percent, eighty-five percent of where [29:19] de- patients go for their specialty care. Specialty care is, is a little more profitable, as you're seeing with this growth of the specialty DSOs right now. Uh, but that party will end because the, as the GP group grows bigger and bigger, they will bring more of that in, in-house. So we'll see how that all shakes out. Maybe those get bought up by the bigger GP groups or whatever. But I think the gold standard to look at is who can continue to grow older practices and then manage their [29:49] cost structure. What do you think needs to change for prevention to become not just a, a clinical priority, but a sustainable part of the healthcare business model? So in order for it to be sustainable on our side, for the oral healthcare side, we have to prove the model that we improve patients' overall health and we reduce patients' overall healthcare costs. As we prove that out more and more, [30:19] we will be inextricably linked with the, all the primary care physicians out there. And I think, my personal opinion, is dentists can be, play such a pivotal role in most patients' primary care health. They could be the point person because we all go to the dentist more often. And so they can identify earlier if they had all the right systems. So That's gonna be the key. Yeah. Do you see, do you get a sense that separate outside of [30:49] PDS Health, that there is starting to become more traction within that, with that model in other DSOs groups or s- or private practices? Thankfully, uh, that's not happening yet against my competitors. It's good. But they're-- I, I told my team, "You guys keep sprinting. Get out further and further," 'cause they're gonna, they're gonna have to pivot, and they're gonna come chase us down and, and copy us and, and go for it. So there's not a cell in my body that doesn't believe it. No, it's gonna happen. It's going to happen. It's [31:19] just when and how. Yeah. You've been, uh, pushing towards this integrated health now for, well, more than a decade. I remember going to a conference listening to you speak in, like, twenty nineteen. It was my first kind of entry into, to dental at that point. Um, I'm sure you could probably tell a million different stories about things that you look at differently today than you did when you first started. But is there anything that's, like, been surprising to you or something that, um, you know, that you learned that you didn't expect? The most surprising [31:50] thing to me, uh, you know, I'm a, I'm a business guy. I'm a data freak. I make almost all my decisions based on data. It, it doesn't always give you everything. Some, then you, then you put together, and then you got instinct and experience and others you gotta add to the equation, right? You make decisions too. I'm always amazed at how slow clinicians can be to modify their behaviors when the data is staring them in the face. That's how... Go back to your question [32:20] you asked about dental schools. You know, they got just beat up in dental school to do this, do this, do this, do this. And they were, in many dental schools, they were taught by, uh, another dentist that had graduated thirty or forty years ago. So it just ke- It's self-perpetuating. And so until they get curious and really wanna learn, go, "Hey, this stuff is real. Hey, how would I change, modify my behavior?" I have a great s- I listened to a great story, I'll do it really quick, [32:50] of one of my docs down in, um, she's down in Tennessee. Our medical group is not there, but she took the bull by the horns and started interacting with a cardiology group, and I guess the cardiologist was at this, uh, hospital. I'm gonna butcher the story a little bit. But then he moved out, and he's created a more of a concierge-style practice with different people, and they've become so tight on the referral process back and forth. He s- he, I think she said he sent her six hundred patients over the last two years. Wow. Six hundred patients, right? That's incredible. A cardiologist who gets [33:20] it. He's not just a plumber. No. Right? And they even put her onto the website, their website, as their oral health care, care, um, specialist. That's, that gets exciting. Yeah. That's awesome. Yeah. So you've been doing this for, for a few years now. What- Yeah ... what, what still gets you up in the morning? Like, what, what still excites you about the business? Why, why are you still bullish on this industry? We have a project internally right now called Finish the Job. I wanna see this mouth-body connection [33:52] inculcated fully throughout our entire organization. Everybody gets it. I'm not naive to think every doc's gonna practice the highest level or people are going to suddenly, everybody's gonna change. But we can change a lot. Uh, we've already proven we can change on a big percentage basis. So that's in the near term. Longer term, what I would love to see, what did, what did Steve Thorne leave on the industry? I'd love to eliminate this concept of a dental insurance form. I don't see any need for it. [34:22] I see with technology the way it is, with AI the way it is, with audit provisions and legal provisions we could do, and I know there is some fraud and abuse out there, but it's so small. There's no reason to cause that angst between the doc and the patient and the insurance company. If you look at where patients complain the most, I think in, across all our big organizations, I know it is true in mine, that's the single point of stress, that [34:52] the plan didn't provide what they thought, the doc didn't get paid what they thought, the downgrade, the this, the that, the, the doc can't see this patient. They're seeing a ton of patients in their practice, but they're not eligible to, um, credential, is the word I was looking for. They're not credentialed on this particular plan, so they can't see that patient. Or the carrier sends a check to the patient at home. They get a thousand dollar check, they cash it. It, it's just, that, that's gotta stop. That, that gives all of us [35:22] a black eye. That, I wanna, I wanna change that forever. Yeah. Well, last question. Um, you know, clearly you've been a, a lifelong learner. You've talked about reading these studies and diving into things. You know, as, as you look forward and just kind of as your general practice, like, how do you, how do you stay up to speed with everything that you need to continue to be shepherding this business, leading the organization, and staying on top of kind of the [35:52] new technologies and other things that are going on out there? Right. Well, we have a responsibility as, as leaders to try to figure out where everything's going, right? I mean, one of our main jobs is investing capital, whether it's real dollars or human capital. And we have to get it right or we're bankrupt. And so I spend an enormous amount of time just asking questions and learning and reading and studying, getting around to meetings [36:23] as much. I don't do quite as much as I did anymore tra- less than my travel schedule. But I used to say, before I could afford to travel everywhere on a plane, I lived in a car. Then I lived on a plane for fifteen years just traveling around. Spent a lot of time learning from the field. Walk into a dental office and just talk to the dental assistant. Ask him, "How's it going here? You know, what can we do better? Um, h- how do you like working here? How do you like your doc?" [36:53] Ju- just the simple stuff. Uh, but then at the higher level, you've gotta be studying, um, like I said, OODA, observe, orient, decide, and act. You gotta s- you gotta look at the future. The overused Wayne Gretzky quote, right? "Be where the puck's going." You've got to do that and then allocate the resources to get there. And I think the better organizations have done a great job of that, the ones you have mentioned. Steve, thank you so much for coming on the podcast. Yeah. Well, thank you, Mike.