We help thousands of dental practices successfully implement Dental Sleep Medicine (DSM) and sleep apnea appliances into their practice. Some dental practices have implemented DSM so successfully that dental sleep is the only thing they do now! It is not always smooth sailing, as with most new services introduced into a dental office. With that in mind, we wanted to share the five most common challenges dental practices face when implementing dental sleep medicine and how to overcome these obstacles.
1. Medical Insurance
Medical coding, billing, and documentation prove to be the most frequently mentioned challenge that dental practices encounter when implementing DSM. The good news is medical coding, billing, and documentation are not difficult; it is simply different than dental! Keeping that in mind, the best way to avoid this challenge is to educate the billing team on best practices for coding, billing, and proper medical documentation. Even if your ultimate choice is to outsource the medical billing to a third party, it is nonetheless vital that your dental team become familiar with medical billing basics to ensure ethical and appropriate execution of your medical billing process. Beware of heeding bad advice from organizations or individuals who do not have your long-term best interest in mind. Nierman Practice Management offers exceptional medical billing in dentistry seminars with both live and virtual attendance options.
2. Team Buy-In
We have heard so often over the years that “we could provide so many more sleep appliances if only my team would get on board.” We get it. Having both your administrative and clinical dental team on board is crucial for implementing Dental Sleep Medicine. So, what is the best way to overcome this challenge? We believe this to be a multi-pronged approach. Consider educating the entire team on their new responsibilities. More importantly, educate your team on WHY screening & treating patients for sleep-disordered breathing issues is essential to a patient’s day-to-day mental, physical, and emotional well-being. Be sure that your team is comfortable discussing treatment and expectations with patients from the very first phone call through long-term maintenance care. Consider making your team members a sleep appliance of their own (or one for their significant other), so they talk to patients from first-hand experience and cultivate the passion for the life-changing results that can occur.
3. Sleep Testing
Currently, the only way to confirm Obstructive Sleep Apnea (OSA) diagnosis is through an overnight sleep study (polysomnogram). The majority of medical insurers allow for sleep studies to be performed in a sleep lab or with home sleep testing units, depending on the patient’s condition. Several challenges can arise with this process: patient pushback on being tested, finding an appropriate sleep testing site, and medical insurance & dental state board considerations for who can recommend and perform the sleep study, to name a few. To overcome this challenge, we recommend effective communication with treating physicians to build mutually beneficial referral relationships. When deciding the best route for obtaining the diagnosis, consider your patient population and your available local & virtual sleep testing options. It is crucial to bear in mind that many medical insurers will require that the patient be seen face-to-face by a physician either before the sleep study, or before placing a custom-made oral appliance for OSA (i.e., Medicare, United Healthcare). Working with local physicians or a virtual service that offers face-to-face virtual telehealth visits becomes essential in these cases.
4. Physician Referrals
While screening and treating your already established patient base is a wonderful way to get started in DSM, generating referrals from the surrounding medical community is pertinent to ongoing growth and success. Some dental practices we have worked with over the years reported difficulty “getting connected ” to the local medical community. To overcome this challenge, we recommend medical community outreach. You may be surprised to find that sleep physicians are not always the top referral sources for our most successful DSM practices! Consider other provider specialties that frequently encounter patients suffering from sleep-disordered breathing, such as cardiologists, pulmonologists, neurologists, ENT’s, psychiatrists, and primary care physicians. Here is a little-known tip as well: many medical insurers will accept prescriptions for oral appliance therapy for OSA not only from MD’s and DO’s, but also from PA’s, NP’s, and CNS’s working within their scope of practice! PA’s, NP’s, and CNS’s are typically more accessible to contact, and they spend plenty of face-to-face time with patients. Schedule a call, zoom meeting, or lunch and learn for medical practices in your patient population areas to learn more about them, and let them know you offer oral appliance therapy for OSA. Reassure physicians and their team that you refer the patient back to their office once oral appliance therapy is showing subjective improvements. Also, state that you will be screening your own patient base as you are looking for medical practices to refer to as well.
5. Patient Acceptance of Treatment
What is the trick of the trade to get the patient to say “yes” to treatment? Well, there is not a magic bullet. However, we have identified common traits amongst the most successful DSM practices that are the recipe for a high rate of success—first, having a knowledgeable & confident team that is comfortable discussing treatment with patients. The patient may already be wary that they are visiting a dental practice to address a medical issue, so be sure your team can switch out of their “dental pants” and put on their “medical pants.” Second, focusing on the patient’s chief complaints will help the patient understand you want to help them solve problems associated with their OSA. We like to call this the patient’s “hot button issues.” For example, if the patient’s primary reason for seeking treatment is excessive sleepiness during the day that affects their job or personal relationships, inform the patient that reducing the severity of or resolving OSA can significantly impact their quality of sleep and energy levels positively. Gathering patient testimonials (video testimonials, preferably!) from successfully treated patients is a beautiful way to showcase your successful outcomes. Lastly, working with the patient’s medical insurance to help reduce the patient’s out-of-pocket cost (or at least utilize their medical benefits) is essential.
While the journey to implementing dental sleep medicine into your dental practice may not be a walk in the park, these solutions to the top five challenges will undoubtedly help you avoid some pitfalls along the way for a smoother stroll.
Article by: Courtney Snow
Please feel free to contact us with any questions related to this article on Implementing Dental Sleep Medicine. We host CE courses on Medical Billing for Dentists and clinical treatment of TMD disorders and Dental Sleep Medicine. For more information, contact Nierman Practice Management at 1-800-879-6468 option 1, by sending us an email at firstname.lastname@example.org or by visiting niermanpm.com.
We have a variety of online and live courses for dentists, including topics such as dental sleep medicine, TMJ, craniofacial pain, and medical billing in dentistry. We also have a comprehensive, online course series for medical billing in dentistry.