We are proud to launch our monthly video podcast series, The Group Dentistry Now Show: The Voice of the DSO Industry. Episode 1 features Stephen Thorne, CEO & Founder of Pacific Dental Services and Brant Herman, CEO & Founder of Mouthwatch. Kim Larson and Bill Neumann also highlight their favorite news stories from the month and other important industry information including events.
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Interview with Stephen Thorne, CEO & Founder, Pacific Dental Services
Bill Neumann: Hi Steve. Welcome to the show.
Stephen Thorne: Hello.
Bill Neumann: Just wanted to introduce Stephen Thorne to my audience. Stephen is the CEO and founder of Pacific Dental Services. They’re a leading dental support organization, that’s DSO, established in 1994 in Irvine, California, PDS currently provides business support service to over 700 dental practices throughout 20 states and this year PDS is celebrating their 25th anniversary. Congratulations.
Stephen Thorne: Thank you very much.
Bill Neumann: Very good. So, we’re happy to have you on the show. I’ve got several questions for you and what I think we’ll do is we’ll start at the beginning and what I mean by that is if you can give us a little background on when PDS started, how you started out, kind of the vision, some of maybe the struggles that you encountered over the years and then where you are today and then maybe a little later on in the podcast we can talk about future.
Stephen Thorne: Oh, that’s a big question there. We’re gonna be here for a couple hours.
Bill Neumann: Okay, sounds good.
Stephen Thorne: Well, I think I have to go back before the founding of 1994 to frame up who PDS is and what we’re all about. I started out working for my father a couple days a week back in 1989, putting in a computer system into his office. He wanted to computerized his dental office and so I was working for him a couple days a week, but this 1989, so most of the team had never used a computer, they didn’t know how to use that system and then we’re moving onto how we would printout insurance claim forms and things like that.
Stephen Thorne: So, I had to actually get in there and learn the nuts and bolts of the business from day one working with my dad. Right about the fall of that year, fall of ’89, a practice that he had sold a while back, the guy had kinda bailed on it, it went back to the bank, my father cut me a deal, he said, “Why don’t you go fix it up? I’ll hire you full-time, you go fix it up and then we’ll sell it and I’ll pay you well for doing that,” and I said, “Sure, I’ll try it.”
Stephen Thorne: So that was my beginning into dentistry, really the nuts and bolts of getting in and helping the office get going, get profitable and really serving that local community, but that early time really paid off for the rest of the history of PDS. I worked for my father for a couple of years and then saw the business opportunity and decided to go out on my own in 1994.
Bill Neumann: So did you compete against your dad’s practice at all?
Stephen Thorne: Probably did a little bit, yeah. We parted ways amicably and one of the docs that I used to work for him, came with me and became our very first supported owner doc.
Bill Neumann: Interesting. Okay, and dad still talked to you after that?
Stephen Thorne: Dad and I still talk, yeah.
Bill Neumann: That’s good. Well, very good. So that was the early days and then when did the idea of really creating the DSO, so where the support was separate from the clinical or was that kinda from day one? How did that all transpire?
Stephen Thorne: Yeah, that was kinda part of the reason I split up with my father. I saw the opportunity there and so I went out and figured out what a DSO was. Back then there were only a couple probably in the United States, but there were definitely medical service organization that had come in and been doing their thing. some had failed too, so I got to learn from that, but learned the ropes from a physician friend of mine that was in an MSO here in Southern California, so saw that the business model was good.
Stephen Thorne: What I learned real fast is that the dentists wanted me help, so I wasn’t marketing it or doing anything like that. I was just getting calls, “Hey, can you come help me? Can come and do this, can you come do that?” So, the model evolved. I got some good advice early on, said, “Make sure that the dentists remain the owners and in control of the practice.” So when we designed our business model, it’s designed around dentists owning their practice.
Bill Neumann: When did you move out from one state? So, you started in California and then you got to a point and then you decided that the opportunity was beyond California I’m guessing.
Stephen Thorne: Yeah, I can’t remember the year we opened in Arizona. Arizona was our first state. Really we went from Southern California to Northern California and for most people they’re two different states, they operate totally differently. So we did Sacramento and we grew up there real fast and then we went over and opened in Arizona and we continued to move East.
Bill Neumann: So, 20 states right now, right?
Stephen Thorne: I think about that. We might be at 21 or 22 by now.
Bill Neumann: There you go, and I think I was a press release not too long ago over 9,000 employees, does that sound about right?
Stephen Thorne: Yeah, I think we’re approaching 12,000 now, yes.
Bill Neumann: So, I’m way off. Okay, 12,000, okay. So, from working for your father, helping him with his computer system and in his dental practice in 1989 to over 12,000 employees in 25 years?
Stephen Thorne: That’s the story.
Bill Neumann: There you go, okay. So, that’s good. See, that didn’t take that long, that’s the history.
Stephen Thorne: Yes, not all the ups and downs, we didn’t go there.
Bill Neumann: No, do you want to or not?
Stephen Thorne: Yeah, it’s a tough business. The industry is what I think I read, dentistry did $134 billion last year and the practice we support did about a billion-and-a-half. So when you look at the percentage and we’re one of the larger groups. I don’t know exactly what Aspen or Heartland does, but we’re right up in there. So we’re a very, very small percentage of the market still.
Bill Neumann: Right, yep, very interesting. So, what does the … You know what? I’m gonna hold off on the future until later on in the podcast.
Stephen Thorne: Yeah, no problem.
Bill Neumann: We’ll hold the future till a little bit later. So, let’s talk about volunteer work, charity work. You’re big, PDS is big into that, you have a foundation.
Stephen Thorne: Yeah.
Bill Neumann: So, you’ve got a couple different things going on. You got some community based charity work that you do and then you also have, I guess you would call it global outreach, right? So beyond the community and it’s more global where you’re sending your dentists and your staff to underserved countries. So, tell me a little bit about those initiatives and it’s incredibly what you’re doing and it’s exciting to actually read about it, getting people involved, but tell me a little bit about where that started. Did it start out community based and then you decided to expand globally or how did that all transpire?
Stephen Thorne: Yeah, it’s a great question. Thank you, by the way. What we have … Let me backup. So, in our organization we have what we call belief statement, appended in 1996 and the reason I wrote this belief statement was to document the type of business I wanted to lead and build and to document the type of people I wanted to work with because at the core of dentistry is a people business, right?
Stephen Thorne: So that belief statement was in our culture from the very beginning. As we progressed, I looked for ways to inculcate some of the, we call it “We Believe” into our culture more and more. One of the key parts of dentistry is service, right, the act of service. So, I wanted to develop a way for PDS supported docs and the whole team to support their local communities.
Stephen Thorne: It did start as a local vision of how can we get involved in acts of service and in and around each supported practice and become an integral part of that community? We’ve done that and more, it’s expanded obviously since then. You already alluded to some of the other work we’re doing, but that was the root of it, of creating opportunities for people to get out and serve in the local community and to integrate the supported practices into their local community.
Bill Neumann: Sure.
Stephen Thorne: It’s gone from that to we’ve helped open a dental school actually in Ethiopia, we have an offshoot of a dental school in Guatemala, we serve down in Fiji at a dental, I don’t know what you call it, dental program or something they have done there. We have a mobile dental clinic that goes around the country and serves in communities where there’s no access to care, all free. The dentists come and work for free, the teams work for free. We partner we our main vendors and suppliers and then that’s all supported free.
Stephen Thorne: We have a dental assistant scholarship program, which is really powerful. I think we’ve had 26 dental assistants go through the program now, where we help fund their schooling and then help them get placed in jobs, whether it’s in PDS or outside of PDS.
So that’s a really, really cool program that we do too. Then we have lots of other service events that we do just around the country, whether it’s with the special needs programs, Special Olympics, and we are just about to announce the opening of our brand new special needs clinic that we’re opening in Arizona, so we’re really excited about that.
Bill Neumann: Well it sounds great. You’ve got a lot going on, actually a lot more than I thought, so I guess that’s why you have a separate foundation for some of it, right, because it’s a full-time job a lot of the work that you do.
Stephen Thorne: It is. It is. I was looking over the numbers here. So, since 2011, I think we’ve given away, the dentists have donated $25 million in free dentistry.
Bill Neumann: $25 million, wow.
Bill Neumann: That’s exciting.
Stephen Thorne: Yeah, we mix it up. We have service events that go through PDS and then we have our Pacific Dental Services Foundation.
Bill Neumann: That leads into my next question. My guess is that there are a lot of the dentists and beyond the dentists, the clinical and nonclinical staff that really enjoy giving back to the community and beyond the community with some of these initiatives you have. So, I’m guessing that’s one way to stand out from some of the other dental organizations, whether they’re other DSOs or whether they’re just other opportunities within solo practices, right, that community outreach that you have, that volunteer work. We have a lot of dentists in our audience, a lot of younger dentists and they’re all trying to figure out the DSO model, they’ve heard things, right?
Bill Neumann: As we know, sometimes it’s good, sometimes it’s not so good, and I think one of the things that I tend to hear or that the perception is that they think that one DSO is like the next DSO. So how do you differentiate yourself as a dental support organization and I’m sure, like I said, probably some of it is the charitable work you do, but if I’m a dentist and I’m looking for opportunities, how would I fit into the PDS culture? Are there ownership opportunities? What does that look like?
Stephen Thorne: Again, it’s a great question and I’m gonna reverse it on you. I think if you’ve seen one DSO you’ve seen one DSO. I think it’s the opposite. There are so many variations around the country in DSOs.
Bill Neumann: I totally agree. I think there’s the perception, like dentists that haven’t been exposed, right?
Stephen Thorne: Absolutely.
Bill Neumann: They know a couple of names and they’ve heard one thing or another about one large DSO or one small DSO, maybe it’s not good, maybe it’s good and so they think they all operate the same way. Is there a challenge for you to stand out or do you … I mean, it sounds like you kind of operate a little bit differently than most?
Stephen Thorne: I think in some states it’s a challenge to stand out for sure, but in many states it’s not. In some schools it’s tough to stand out, but in many schools it’s not a problem at all, we’re swarmed and you look at where students are going when they graduate from dental school now, I don’t know the exact numbers across the nation, but a big chunk of them are choosing to join a DSO. Last year over 300 of the new graduates joined us. This year it’ll be well over 400 new graduates will choose to join a PDS supported practice.
Stephen Thorne: So, if you look at the trends and where things are going, DSOs are growing really fast. Estimates are, based on my conversations with the big suppliers, whether it’s been Henry Schein, Patterson, and a couple of the others, we’re fast approaching 25% of the entire space of the dental delivery system in the United States.
Bill Neumann: Really, okay.
Stephen Thorne: Yeah, it’s much, much bigger than is posted out there in some of the older data and I think most of my peers would support a number up in that range based on what we see and feel in the markets.
Stephen Thorne: Is it tough to stand out? Yeah, but we have a great business model. We have a saying in our company, “Structure trumps strategy.” See the strategies for dentistry have changed over the last 25 years, it’s way more competitive than it ever was. There’s a dentist office on every corner in the United States practically, right?
Bill Neumann: Right.
Stephen Thorne: It’s very, very competitive. If you go back 20 years hardly any dentists were on PPO panels. Now just about every dentist is on a PPO panel. So, your strategies have to change, but we have a great structure. We call it our owner doc model. So, our supports docs are actually owners of that physical location that we provide the support services to.
Bill Neumann: And I think that’s important for the dentists that are listening to this today to understand because a lot of times I think that again, the perception is that they’re worker bees and they don’t have the opportunity for ownership in a DSO model and it couldn’t be further from the truth, at least with PDS. So how does that work? If I’m a doc and I have the opportunity to work PDS, is that from the get-go or do I have to earn-in? What does that look like?
Stephen Thorne: Yeah, that’s a question I get asked an awful lot, is how do they get in. The vast majority start within the organization as an associate for one of the existing owner docs. That’s the vast majority. They get to see the system, they like the system, and then they want to own and then we help them start a practice. That’s the majority of how it works. They may partner with that other more senior or veteran doc, they may not be more senior. Actually, they may be younger in some cases.
Stephen Thorne: We don’t acquire, so we only do de novos … I shouldn’t say only, we probably acquired two or three in the last 20 years, but we pretty much only do DeNovo practices, so we start them from scratch in the community and it’s just a great model. The dentist gets to build a practice up in their community, most of the time it’s where they live and our turnover at the owner doc level is low single digits at most if you look over the last 20, 25 years. All the docs except for one who passed away that I started with back in those early days that I was actually the guy supporting their practice, back in the middle ’90s, every one of them is still here.
Bill Neumann: Well, and I would say that a lot of groups, DSOs, can’t say that because turnover sounds like it’s one of the bigger struggles. When you go to a lot of these meetings and there’s doctor retention and doctor acquisition, so obviously your model is working. So that’s good to hear and I think again, to all of our dentists in the audience, you know that ownership opportunity is out there in certain DSO models, certainly like Pacific offers.
Stephen Thorne: Yeah, there’s others that have some version of our ownership model for sure. I think the vast majority do not. From what I understand private equity has come into the dental space in a big, big way and in that model sometimes it’s harder for them to establish an ownership type of model like we have.
Stephen Thorne: We have no private equity, it’s privately held. I own most of the company, so I think we have a bit of an advantage there in some respects for helping dentists build great long term, sustainable, profitable practices.
Bill Neumann: That’s great. So, let’s move away from what we were talking about as far as doctor ownership and talk a little bit about the mouth body connection. This is something that I’ve heard a lot about. I know you’ve coined the phrase, maybe you copywrited it too. I don’t know if PDS owns the rights to that.
Stephen Thorne: I get a nickel every time you say it.
Bill Neumann: There you go, uh-oh. All right, when I see you next time.
Stephen Thorne: Okay.
Bill Neumann: Tell me a little bit about what that means. We hear about medical-dental integration. There’s a lot of talk about that. I don’t see a lot of it happening yet. It makes a lot of sense, I think it makes a lot of sense to most people. So, what does it mean to PDS and then why hasn’t it already happened?
Stephen Thorne: That’s a great question and I just got asked that question the other day by a senior executive at Aetna and CVS, “Why hasn’t it already happened if it’s so true?” but let me back up a little bit.
Stephen Thorne: There’s a Surgeon General report in the year 2000 that said essentially, we have got to bring oral health into overall mainstream healthcare, and since that time there has been a movement to bring oral health back into overall healthcare and when we think about it, for those of us that aren’t dentists, it’s just logical. It’s like what’s happening here in our mouths is definitely happening in the rest of our bodies and we all know our teeth are connected to our bloodstreams and all the clinical side. So it’s almost a little crazy to separate oral healthcare from overall primary healthcare.
Stephen Thorne: I mean you think of the base of what dentists do. Dentists are mostly preventive physicians, they’re preventive oral healthcare physicians that are eliminating disease early and solving problems before they become emergencies, that’s sort of what dentists do. So there is a pull to bring dentistry back into overall healthcare.
Stephen Thorne: We’ve been watching it for a number of years, we’ve been learning a lot. There’s lots of studies out there showing that when patients go to the dentist and get proper oral healthcare, especially when they have a chronic disease, maybe it’s Alzheimer’s, maybe it’s diabetes, maybe it’s a cardiovascular disease or something like that, especially in those areas that are basically inflammatory diseases of the body, that dentistry plays a massive role in helping reduce overall healthcare costs.
Stephen Thorne: Study after study by large carriers are proving that out. There’s a recent one, Blue Cross Blue Shield of Hawaii just presented one and I think they all basically say the same thing. There’s also now science that is connecting those diseases of the mouth, whether it’s the bad periodontal bacteria or other problems of the mouth with those chronic diseases. So not relational anymore but causal. I think we saw one recently with Alzheimer’s and we’ve seen one come out recently with cardiovascular disease.
Bill Neumann: I’ve seen some of those reports, that’s for sure, there’s a lot more coming out.
Stephen Thorne: A lot more coming out and you know what’s interesting? We also have three physician practices that are located adjacent to our dental practices and you know what’s really interesting? Is that patients get it. Patients love it. It’s the dentist and physicians that don’t talk to each other very well yet, but patients get it.
Bill Neumann: So that’s really interesting. So PDS or maybe it’s a different organization … is it still PDS supporting those physician offices as well? Is it right next door, are they connected, are they referring to one to the other? How does that all work?
Stephen Thorne: Yeah, they’re connect. They’re connected, so a patient comes in to see the dentist and has elevated blood pressure, dentist can walk next door and grab the nurse practitioner, grab the physician, whoever is over there and say, “Can you come over here, check my patient out?” and it goes in reverse. We taught the physicians and nurse practitioners how to a proper visual oral exam. If a patient looks like they might have something going on, something wrong, maybe inflamed gums, they can go over and get the dentist and say, “Hey, come on over.”
Bill Neumann: So you have three right now, three physician supported offices?
Stephen Thorne: Correct.
Bill Neumann: Connected to PDS dental practices?
Stephen Thorne: Correct, PDS support practices.
Bill Neumann: Medical-dental supported practices. Do you see this as more of a trend? Will you start to do more of this? Would it be specific? I’m just curious. Again, it makes a lot of sense and we’re hearing some other DSOs and then maybe more some group practices I’ve heard doing it as well, but it sounds like it’s a trend, it makes a lot of sense. So, will PDS doing more of this in the future?
Stephen Thorne: In some form we will be doing a lot more of this in the future. I don’t know exactly the form it will take shape. I think from a patient care standpoint it appears that when the physicians and the dentists are under the same roof and can work together for a patients at risk, it appears to be the best environment, but there’s lots of physician groups out there already that want to work with dental groups too, so we’re talking to them, and they do their thing, we do ours, but there can be a referral relationship there and how that shapes up.
Stephen Thorne: The insurance carriers are getting involved. If you think about … Let’s take an ACO in any state and the ACO has a contract for a couple hundred thousand, but they’re fully responsible for a full contract, that if that CEO of that ACO really believes in the mouth-body connection, and believes that sending their patients to the dentist and getting proper oral healthcare can reduce overall healthcare costs, those type of interactions are starting to happen.
Stephen Thorne: So, one of your questions you asked, why hasn’t this happened in the past? The reason it’s not happened in the past, my belief, is there hasn’t been any groups on scale that could work with these larger physician groups and larger healthcare organizations.
Bill Neumann: Exactly, okay.
Stephen Thorne: We’re finally, at this size, in a year or two we’ll have 1,000 practices, we’re at the size where we can talk and we can work together.
Bill Neumann: Logical, and dentistry is behind medicine by X amount of years, depending on how you look at it, at least from a-
Stephen Thorne: I can say dentistry is ahead of medicine in a lot of ways too, so it just depends what the question is.
Bill Neumann: Sounds good, but from the scale standpoint behind and now we’re catching up.
Stephen Thorne: Yeah, we’re way behind on the scale standpoint.
Bill Neumann: All right, so again, a little bit more about mouth-body connection. What does that mean to a PDS supported dentist? Are they looking for specific things?
Stephen Thorne: First thing is that we offer a lot of training and education available to them just around periodontal disease, periodontal abscesses, all the other stuff going on in the mouth to help each dentist get more and more educated and each hygienist. They play a key role.
Stephen Thorne: We’ve started to implement oral bacteria testing, so we can test bacteria loads, introduce microscopes in so we can test the bug levels in patient’s mouths and all of that. We’re also working what percentage of … The CDC came out with the data on what percentage of patients have periodontal disease. If I remember right at 30 years old or older it’s about 50% of adults in America have some form of periodontal disease, and as you age it one gets more, right?
Bill Neumann: Right.
Stephen Thorne: So, we work hard with the docs to understand that and the patients and help them get into active periodontal care. So, I think we’re one of the leaders in that area in helping out.
Bill Neumann: Well, that’s great. So that is not really the future, that’s going on right now, but as far as some other things that are going on, we talked about at the beginning you gave us the history of PDS, told us where things stood, 700 practices, maybe a little bit more now, 20, 21 states. What does the future look like for Pacific?
Stephen Thorne: Well I think in some respects it’s just going to be more of what you’ve seen in the last five to 10 years, we’re just getting better and better at it. So, one of the key measurements we look at is of all the dentistry diagnosed, how much care do the patients actually get? I think that’s a pretty good way to measure effectiveness, right?
Bill Neumann: Right.
Stephen Thorne: And in so many categories in our organization, our supported dentists are getting better and better and better and better at helping patients get the care they need. We call it, “healthier, happier patients.” So, I think you’ll see more of that.
Stephen Thorne: We’re also gonna see, I think dentistry is gonna change from 2D to 3D. So, I’ve never seen a 2D tooth, but I’ve sure seen a lot of 3D teeth and so I think dentistry is gonna rapidly change now to move from 2D to 3D and some organizations have already made the shift. We’re in the process of putting in the infrastructure to manage that shift because the size of those images and how carriers work with those images and all that process takes a … that level of infrastructure is a lot of work and a lot of money. So we’re putting in the infrastructure and all that before we go out and buy 1000 CBCTs.
Bill Neumann: There you go, but that’s the future.
Stephen Thorne: That’s the future.
Bill Neumann: I’m gonna shift now from Pacific to an association that actually I believe you were one of the founders of the now called Association of Dental Support Organizations, some people know it as the ADSO. It used to be the DGPA, the Dental Group Practice Association.
Stephen Thorne: Right.
Bill Neumann: So, tell me a little bit about the history there. I know it started really small, it was more of an advocacy group and now it’s truly become, I believe it’s the largest DSO show in the country right now, I think in the world. So that’s coming up at the end of March in San Diego.
Stephen Thorne: Correct, at the end of March in San Diego we’ll have … I have no idea how many people we’ll have there, but it’s by far the largest and yeah, it’s international too, to your point, it’s not just the United States, but people from Australia and New Zealand and I think now China and Japan and Canada for sure and England for sure. So, it’s becoming an international organization.
Stephen Thorne: Yeah, I served as the original president of that organization. It actually started out as just a group of us, me and Rick, and Bob and Doug and a couple other guys that were the original … I guess we’d now be called the grandfathers of this space. We’d sit around on a couch outside either an ADA meeting or some other and go, “Everything going on over there doesn’t really pertain to us, so let’s all talk and see how we can help each other out.” That’s how it actually started. Then we moved on to the formal process of becoming a, I guess we’d be called an industry association. We think we’re more than that, but…
Bill Neumann: Yeah, for sure. What year was that? When was the sitting on the couch at the ADA meetings?
Stephen Thorne: I’d have to look that up. I’m getting old and I forget.
Bill Neumann: All right, well that’s okay.
Stephen Thorne: I know when we were sitting around the couches talking, I think it was in the ’90s, so there you go.
Bill Neumann: There you go. It definitely wasn’t a DSO then, it was a group practice?
Stephen Thorne: It definitely was not a DSO then, no.
Bill Neumann: So, I guess really advocacy and also a trade association is what the ADSO does, this is really my last question for you. So current challenges for DSOs in general right now and of course this is one of the things that the ADSO does well from an advocacy standpoint at the state level kinda helps DSOs so they can operate in states. Do you know of any challenges right now that are going on or anything that you need to be aware of if you’re a large DSO or an emerging group?
Stephen Thorne: Absolutely. We’ve had our challenges. There’s a large population of dentists still in the United States that would like dentistry to remain a very small, very, what we would call mom and pop and just like it was 30, 40, 50 years ago and a lot of those people are in positions of power in states, whether it’s an association or on dental boards and some have chosen to try to use that power to keep DSOs out of their state, even though if you look at the trend line from when I started in 1989, I can’t imagine large group practice was more than 1% of the whole business and now it’s approaching 25%, that’s the trend.
Stephen Thorne: So yeah, we’re having currently problems in the state of Maryland and some of the things they’re trying to push in there would make it nearly impossible for DSOs to do business in that state and support dentists in that state and that would hurt the population of Maryland because we bring a lot of support to dentists and we can help in so many different ways. We help in so many different ways in access to care, in helping maintain cost to the public and in education and philanthropy and in so many areas. So we still have some work to do in certain states that think that DSOs are bad people and we shouldn’t be there.
Bill Neumann: Okay, well it sounds like the ADSO is definitely setup to help fight those fights. So you will be at the ADSO meeting in San Diego and then I believe you’re also speaking at Henry Schein has a meeting coming up in Las Vegas, right, and you’ll be there?
Stephen Thorne: Yeah, I’m speaking three or four times this year at the ADSO Henry Schein, a couple more in the fall, so I’ll be out there telling the story.
Bill Neumann: Sounds good. Steven, thanks again for taking your time with us today and the audience of Group Dentistry Now thanks you as well.
Stephen Thorne: Hey, thank you very much. You guys have a great day.
Bill Neumann: Okay, thanks, Steve.
Stephen Thorne: Take care.
Interview with Brant Herman, CEO & Founder, Mouthwatch, LLC
Bill Neumann: I’m really excited to introduce our next guest on Group Dentistry Now. Our next guest is the founder and CEO of MouthWatch, LLC. Now MouthWatch, LLC. Is a leader in innovative teledentistry solutions, digital case presentation tools and intraoral imaging devices? I’d like to welcome to the Group Dentistry Now show, Herman, CEO and founder. Thanks, Brant. for here and also being a sponsor of this video podcast.
Bill Neumann: So, Brandt, can you give us the definition of exactly what teledentistry is. I think there’s a lot of misinformation out there. People may not know exactly what it is and how it applied to dentistry and is telemedicine like teledentistry?
Brant Herman: I think there is a lot of tele out there and what we’re trying to do with teledentistry is go beyond that straightforward definition, maybe the ADA or a medical definition, which is just the digital exchange of health data.
Brant Herman: What we’re trying to do with teledentistry is make it more practical and effective for implementation in all types of dental settings. So that might look like collaboration between a GP and a specialist. It might look like a dentist and hygienist communicating and collaborating, collecting patient data, sharing it electronically and really just kind of eliminates the restrictions of a traditional brick and mortar practice and opens up a whole new world of opportunities for connection, collaboration, communication.
Bill Neumann: Interesting. Okay, so how long has teledentistry been around and is it evolving from state to state? I guess there’s some things you can do and can’t do, so I guess you have to understand how to navigate that.
Brant Herman: Yeah, I think it really proved itself in public health settings. I know the Army started with a teledentistry program maybe 20 years ago or so, but in recent iterations it’s more been a public health program, where you’re talking about rural areas getting connected to specialty consults, saving travel time and allowing that patient to, when they do come in for treatment, get the treatment they need, not have to make it two or three trips to get the ultimate benefit to themselves.
Brant Herman: Then recently there’s been a lot more momentum about it where the ADA has added CDT codes back in 2018 for teledentistry, recognizing the value of it and the implementation has gone everywhere from consuming facing models for, let’s say, teleorthodontics, to more where MouthWatch lives, which is in the place of connecting providers to providers ultimately to patients and then a lot more with where we see it going of kind of collaboration and remote mentorship and education and referrals.
Bill Neumann: So that’s interesting. See I think a lot of people assume, and maybe it’s just because of some of publicity out there, that teledentistry is mostly ortho focused, but it sounds to me like TeleDent looks at from or handles from a different angle, so whether it is specialty related may not just be for ortho, but also could be a hygiene related or connecting people in maybe rural areas or where they don’t necessarily have access to a dentist. Is that sound right, am I on the right track there?
Brant Herman: Yeah, I think we’re looking to take the most expensive resources in a dental practice, be it the dentist or a specialist and make more efficient use of them. So, it could look like a hygiene team going offsite, seeing patients in public health settings, nursing homes, schools or even on a corporate campus, where you’re doing onsite preventive care and then the dentist doesn’t have to be onsite. Dentists don’t always love being mobile, they like their operatory, so can we make that operatory much more efficient and high value while getting a lot of new patient referrals by sending the teams that can do those services offsite to do them?
Bill Neumann: Well, that’s really interesting, the whole idea of using teledentistry in an offsite situation. So maybe I’ll touch on that a little bit later in this interview because I wanted to ask you a couple questions first because I think the offsite ties into a little bit with what some DSOs are doing, but let’s find out … So, when did MouthWatch get involved in teledentistry and come out with TeleDent and then why, why did you decide to focus on this?
Brant Herman: Yeah, great. We started seven years ago and our first approach to teledentistry was more of a remote patient monitoring. We wanted patients to communicate directly with their dentist, using an intraoral camera, sharing images of healing, self-generated recall, and what we saw as we launched that product was, one, dentists loved our intraoral cameras, but secondly, they kinda kept modifying out software to meet their needs. So instead of saying, “Oh, I want the patient to communicate with the dentist,” they said, “I need a clinic to talk to the dentist,” or “I need this setting to talk to the dentist, so can you change my patient into a clinic?”
Brant Herman: We learned a lot of lessons from that and that’s when we kinda went back to the drawing board and said, “This is what teledentistry is looking like.” So we rebuilt it, we launched it as TeleDent about two-and-a-half years ago and have really been focused on connecting providers to providers and allowing for effective communication, collaboration, data sharing, all of that.
Bill Neumann: It really came out of these unique needs that your customers had that weren’t being address at the time?
Brant Herman: Right, like not one to love a customer breaking a product to make it work for them, but at the same time it’s fantastic and that you’re seeing this is the actual need and myself as an entrepreneur saw the opportunity and there’s still an approach with patient-facing that we are getting into, but we loved seeing how people said like, “I love what you’ve created, but I need to modify it a little bit,” and that helped guide us a lot and we’re always looking now for feedback from our clients as to kinda how to build a better mousetrap.
Bill Neumann: Speaking of building a better mousetrap, you had what you call a back to the drawing board moment with TeleDent not too long ago. Can you explain a little bit about what that looked like and why?
Brant Herman: Yeah, well that was really the conversion of it, from this patient-facing application to creating a platform that allowed for HIPAA compliant, turnkey teledentistry where our first iteration of TeleDent was more of a pass the football approach, of data was being collected, it was being handed off to the next provider for review, handed off to the next provider, either for conveying a treatment plan or communicating data.
Brant Herman: What we’ve done recently with TeleDent 2.0, which we just launched, is that we made it more of an open access, where the data is stored associated with a patient and then the specific decision makers or clinicians, whoever is relevant to that patient’s case, have visibility on it and can take action to result in getting that patient treatment, presenting a treatment plan, whatever is needed.
Bill Neumann: So that’s interesting. So that was really the change there, was from patient-facing to provider-facing?
Brant Herman: Right.
Bill Neumann: Okay, so that’s leads into the real big question for our audiences, so how does a TeleDent platform help DSOs, how does it work with … maybe take a look at it in a couple different lights. So one, kinda look at the emerging groups, they have three, four, they’re slowly adding practices on, three, four locations, how would that help an emerging group and then somebody at the other end of the spectrum that might have 500 or 600 locations, is the platform easily scalable? What does it look like in a smaller group versus a larger group?
Brant Herman: Right. Yeah, great question. We see some of the challenges that I think DSOs and group practices are facing are with that rapid growth and with opening operatories and new practices at a good clip, there’s a lot you’re gonna have to do beyond just, let’s say that traditional approach with teledentistry of reaching patients in distant locations. We think that’s a great revenue opportunity for groups, but we see this as a way where ensuring consistency and supervision of new associates that are coming onboard, allowing for kind of a trust transfer to take place, where with a teledentistry platform, when you stop thinking about it as just a rural consult from someone in the mountains down to a specialist in the city, then you’re really looking at it as how does an associate communicate treatment plans and clinical data with a more senior dentist?
Brant Herman: Now they can screen share, they can do a live video conference, they can walk through a series of cases that came in that day or over the last couple of days and say, “Look, how do we treatment plan this according to our values and our approach as a group?” I think then you’re able to get that young dentist to kind of learn how the approach looks for the group and put together a treatment plans that naturally through our systems can be shared directly to the patient, but I think overall encourage community team building within an organization and help that knowledge get filtered down through the organization.
Bill Neumann: That’s really powerful. So what I’m hearing is that you can look at is as an onboarding tool, as well as a mentorship type of tool and I could see where TeleDent could be used for emerging groups or maybe they don’t have as many senior doctors that can be chairside with the younger doc at all times, so they can have this knowledge shared by a TeleDent and then of course it makes a lot of sense with some of the larger groups that are scaling rapidly and able to communicate through TeleDent that was as well. So, the mentorship and the education piece I really didn’t think about, but that seems really powerful.
Brant Herman: Yeah, that seems like one great opportunity and then we know a lot of groups and DSOs are using kind of an efficient application of a specialist. You might have a specialist who’s traveling among multiple locations, but with teledentistry technology suddenly that specialist expertise is available to any of the practices that would normally wait for a consult with that doctor.
Brant Herman: So now you’ve got, perhaps a patient’s chairside and they can dial up that specialist, get a live consult, so the patient meets the oral surgeon or the periodontist, they have a conversation with them and then all of the data is available for review right away by that doctor. You could even save the trip for the patient coming back in just for a quick consult and get right to work with the procedures that need to be done.
Bill Neumann: Right, yeah, you’re right, a lot of this specialists rotate around, so they may only get into a specific location a couple of times a month. So in this case they’d have access to them almost immediately or at least when that patient is there, so the patient doesn’t have to come back.
Brant Herman: Right, it’s great, and we also see now the dentist is actually looped in on the specialist treatment planning, so you’re kinda building that team again, where now the GP is learning from how the surgeon or the periodontist might approach that case and again kind of reinforcing the expertise that that GP wants to learn and know and everyone’s in that loop.
Brant Herman: We talk about closing the loop with TeleDent where if you wanted to, not only is the treatment plan coordinated between the GP and the specialist, but you’re now taking that treatment plan and you can share it directly to the patient. So now the patient feels like, “Oh, Doc Smith, who I’ve worked with for 10 years, he’s showing me the treatment plan even though it’s an oral surgeon I just met for the first time.” So you really get patient buy-in and they understand and they see like, “These are providers who are now, I’ve got a care team looking after me.”
Bill Neumann: Right, that’s very cool and of course the technology is probably pretty impressive from patient perspectives. So they go, “Hey, they’re using the latest and greatest,” so I think-
Brant Herman: Yeah, we think so. It’s a cool differentiator in the market.
Bill Neumann: Yeah, it sure is. Well that’s exciting.
Brant Herman: Yeah.
Bill Neumann: So talk to me a little bit about new business models that you could see developing from TeleDent, and new revenue streams, things like that. What else can a DSO or an emerging group look for with this kind of platform?
Brant Herman: Yeah, great question. So we see opportunities to reach patients at the point of care. We think there’s some, I don’t know if you call them great statistics, they’re great for us, but where let’s say 77% of patients say they’re going to the dentist every year. Only 37% do go to the dentist every year, and we think there’s a huge opportunity understanding a state practice act, allowing hygienists or mid-level providers, whatever it may be, to go to the point of care of patients.
Brant Herman: We see that becoming more and more popular, that you can take a conference room at a big corporation, bring portable equipment, which keeps getting better each year, and do onsite preventive care. You’ve got patients who have good insurance, they just don’t have time. So now you open up dental care to them, you don’t have to send your dentists out there for an unknown of what kind of restorative. You’ve got a hygienist out there doing preventive care and all the data is available for the dentist to see any restorative needs, share that treatment plan directly to the patient and loop them in for treatment. So you’re again, really making high value use of the surgical suite in the office, but creating an opportunity for more and more patients to kind of get initially connected to care.
Bill Neumann: Really interesting and a lot of the DSOs are using that onsite model, whether it’s onsite at a company, like you said, people don’t have time, so they don’t have the time to go to see a dentist, whether it’s after hours or during work, so to have them come into the office and … So I’ve seen probably four or five onsite models in the past year develop different DSOs, so that seems to be a trend, right, you go where the patients are so you’re right-
Brant Herman: Right, we’ve seen people succeed with that model, even when they’re going into, let’s say a lower reimbursement group, like a school setting or a nursing home setting, because you’re bringing all of that efficiency there and not having the cost of the dentist onsite, but you are able to reach a new patient base, getting a lot of volume of new patients in one setting and done efficiently and effectively that treatment plan turns into a new patient coming into the brick and mortar practice.
Bill Neumann: It’s a good point. Instead of I just think businesses, but it’s senior facilities, schools, so there are a lot of opportunities to go right to the patient.
Brant Herman: Yeah, we think the more touchpoints you can reach a patient. We do a lot with medical-dental integration too, so how can practices do more than just give their business card to pediatricians’ offices or family practices, but actually create a touchpoint where an oral screening can be done and the referrals, all the information about that patient is now shared to the dental practice who can then follow-up and get that patient in.
Bill Neumann: Yeah, interesting you mention that with the dental-medical integration. Stephen Thorne from Pacific touched on that in the interview on the same podcast and it’s just really interesting seeing that evolve with several DSOs where they’re partnering with healthcare systems in some way. I think that’s gonna become more and more important with that communication, not just with dentists and specialists internally, but with medical facilities, physicians as well. So that’s pretty powerful stuff and it’s kinda following a trend and something that seems logical, but there’s always been that divide.
Brant Herman: Yeah, and I think it’s interesting. We get in a lot of conversations about the difference between telemedicine and teledentistry and we see that growth and I think there’s a lot more consumer-facing telemedicine or a lot more live consultations in telemedicine, but in dental to us it’s all about connecting a patient to a provider. So how do we do that in a way that gets them some initial contact, but then also gets them into the chair to see a provider. It’s not just an app that a patient is using to get a prescription called in, which might work in medical, but that’s not gonna work in dental.
Bill Neumann: Right. So let’s talk a little bit about the ADSO, the Association of Dental Support Organizations. They have their big meeting coming up at the end of March, so it’ll be here before you know it and that will be in San Diego and I believe this is the first time that MouthWatch is actually exhibiting, correct?
Brant Herman: Yeah. Yep, we’re excited to, this will be our first time.
Bill Neumann: That’s pretty cool. Tell me what your goals are there as far as exhibiting and then I’ll let the cat out of the bag, you’re actually gonna be speaking there as well, right? So it’s kind of a big deal. You have the opportunity to talk about teledentistry.
Brant Herman: True.
Bill Neumann: You’re speaking with somebody that’s relatively well known in the DSO space, right?
Brant Herman: Yeah, so Rick Workman and I are gonna be speaking about teledentistry and kinda showing the trends and background and really just planting seeds, I think, with the audience, give them an understanding of the technology, how it can come to bear in their practice and show a range of applications for it.
Bill Neumann: That’ll be exciting. I’m definitely gonna make sure … because it’s a breakout session, so there’s some options, but I’m gonna sit in on that one for sure. That’s great and then you’re also exhibiting. So what you gonna do, besides speaking with Rick, what else are you gonna do?
Brant Herman: We work with a bunch of great DSOs and groups now with our intraoral cameras, so we have a high quality, low cost intraoral camera that’s great for putting into every operatory. So our goal is to kind of share that with the members and attendees, let them see the quality, see how it integrates into their imaging software and show what we have with TeleDent and really learn a lot. I think have conversations, see how practices and DSOs are looking to integrate this kind of technology into their group. We have some ideas, but I think it’s really kind of just a foundation for seeing each group’s specific needs, challenges that they’re facing. So I hope to have really great conversations. Please come by our table or stop me anytime you see me and would love to learn about your group or your DSO and see how we could help.
Bill Neumann: Well, that’s great. This has been really, it’s enlightened me a lot. Sometimes I think I pretend I understand teledentistry, but you’ve helped me a lot and I’m sure you’ve helped our audience out and it seems that DSOs and emerging groups in particular could really take advantage of this technology and as you alluded to, all DSO models seem to be a little bit different, everybody is gonna use it a little bit differently and that’s why there’s a lot of flexibility in the facts. The fact that you can scale the platform is pretty incredible.
Bill Neumann: So thank you, Brant. Thank you for sponsoring this podcast and thanks for the information. Make sure you stop by, if you’re gonna be at ADSO, stop and see Brant speak and stop their booth. Okay, we’ll see you there.
News & Events with Kim Larson and Bill Neumann
Kim Larson: Well, thanks, Bill, those were two great interviews with Stephen Thorne of Pacific Dental Services, and Brant Herman of MouthWatch, our sponsor.
Bill Neumann: Yeah, it’s a great way to kick off the Group Dentistry Now and augural video podcast and now, Kim, we’re gonna focus on current news and events for emerging groups and DSOs.
Kim Larson: Well, thanks Bill. Let’s start out with your publisher’s letter that you wrote in response to an article that we had published in December about a Aspen Dental practice opening up in a Walgreens in Florida.
Kim Larson: Our DSO audience loved this article. As a matter of fact, the article went viral. However, the response from other people in the dental industry, mostly solo practitioners, was not as positive. As a matter of fact, they were incredibly hostile and very vocal about their thoughts and feelings.
Kim Larson: So your publisher’s letter addressed it and analyzed the industry, where we were, where we are, and where we as an industry still need to go. So that was a really interesting article about that.
Bill Neumann: Well thanks and you’re right, they certainly were very hostile and you can read some of the quotes and the article.
Kim Larson: Another DSO I’d like to talk about today is a brand-new DSO, just started a few months ago, called Revolutionary Dental. Actually, two specialty clinicians went to their PE firm and said that they wanted to expand, start a DSO. They looked to the PE firm obviously for money as well as advice. Now the PE firm is never invested in a healthcare related business before-
Bill Neumann: But they understand real estate.
Kim Larson: They sure do. All of their investment has been in real estate. So, it’ll be really interesting to watch this DSO in a very highly fragmented State of New Jersey. A few years ago, only about 5% of the state was consolidated, so this will be great to see where they take it.
Bill Neumann: Excellent.
Kim Larson: Another story I’d like to touch on a little bit today is the Affordable Care recently acquisition of DDS Dentures and Implants. Actually, Affordable Care is the largest DSO for tooth replacement services in the country. They had about 260 offices before the acquisition. Now they’ve added another 52 offices.
Bill Neumann: And Affordable Care goes by Affordable Dentures and Implants, that’s their brand name out there and from what I understand at least temporarily the two brands will remain independent of each other, Affordable Care will be the DSO that manages both brands and then there is an integration team that is going to be involved as they integrate the two support organizations together.
Kim Larson: Right, they’ll be taking best practices from each other and integrating that.
Bill Neumann: Makes sense. So, it’ll be interesting to watch and see how that all changes.
Kim Larson: Yeah, very interesting. Another DSO I’d like to talk about is West Coast Dental. So they have a new credo now, which we talk about in the article.
Bill Neumann: S.E.R.V.
Kim Larson: S.E.R.V., right, exactly. In addition to that, they have about 36 dental practices. They’re mostly for adults, but they have one called Magicland, which is their flagship in Torrance California and it’s for children and teens and it was successful that they just opened up an additional Magicland and this is a child’s dream, this dental office. Not only do they have interactive video games and interactive game stations, they actually have a movie theater. We have the actual tour of the facility on our website. If you really want to see how to cater to children and teens-
Bill Neumann: Watch the video.
Kim Larson: … watch this video because this is a destination, it’s not a dental visit. I can’t imagine any child or any teen not wanting to go there.
Bill Neumann: I certainly didn’t go to a dental practice like that when I was a kid, so check it out.
Kim Larson: No, I don’t think many people have. It would be a great example to follow if you’re interested in opening that type of dental practice.
Kim Larson: Another article I’d like to touch on today is a DSO in New York called ProHealth Dental. Obviously, there is a connection between your oral health and your overall health, but many Americans are not aware of this. So, this DSO is trying to integrate themselves with medical affiliates throughout New York and they’re having really amazing success with this. As a matter of fact, between 35-40% of their dental customers come from their medical affiliates. They have cross promotions going on.
Kim Larson: So for example, if you go to your cardiologist, they’ll ask you, “When was your last dental visit?” And encourage you to go to the dentist and they have links on their website, they have signage in their offices, posters. It’s really a new feature that I think is just gonna keep growing.
Bill Neumann: And from what I understand they’re in close proximity to the medical practices or in the same building.
Kim Larson: Right.
Bill Neumann: That makes a ton of sense. Stephen Thorne, who we spoke to earlier, we had the interview, he talked about the oral systemic connection and how Pacific Dental Services is addressing that right now. So I think you’re going to see many more DSOs, if not all DSOs somehow figure out how to work in conjunction with medicine and I think they’re all gonna probably do it a little bit differently right now, because there’s no system that’s in place or a best practice let’s say, but I think it’s gonna be exciting to see how that connection becomes closer and how dental and medical work in conjunction with each other for the betterment of the patient.
Bill Neumann: Something to really watch. I think we’re gonna see that evolve, one of the top things we’re gonna see change in the next four to five years.
Kim Larson: Yeah, and there is no relation between these medical affiliates and the dental practices.
Kim Larson: However, some of them actually share the same names. It’s ProHealth Dental and then the medical side is the ProHealth Care.
Bill Neumann: Makes sense.
Kim Larson: … but they’re not actually the same entity, legal entity. So let’s talk about some events, Bill. I know you’re gonna be speaking at one.
Bill Neumann: I am, yes. So the ADO Summit, which is coming up March 28th-30th and that will be in sunny San Diego California.
Kim Larson: Really nice.
Bill Neumann: I’m really looking forward to that event. I have the opportunity, as you mentioned, to speak at that event on Friday, March 29th, from 3:00-4:00 I’ll be on the marketing panel and I will be focusing on marketing beyond the patient.
Kim Larson: That’s great.
Bill Neumann: Yeah, what marketing beyond the patient means is marketing focused on recruitment, HR and then also marketing on business development side. So there’s gonna be some great networking opportunities there, at Seaport Village and also at Petco Park.
Bill Neumann: Then one other speaker that you’ll want to make sure that you see is the closing keynote speaker on Saturday. It’ll be Erik Wahl, who is an artist and also motivational speaker. I had the opportunity to see him a couple years ago and definitely somebody you want to watch and listen to.
Kim Larson: So if you want any information about those two networking events and Erik Wahl, go to our website, we have articles on all of that.
Bill Neumann: We do.
Kim Larson: So when are you speaking exactly, Friday? You said Friday at 3:00, right?
Bill Neumann: March 29th, Friday at 3:00.
Kim Larson: Great. Well, there’s another event coming up called The Academy of Laser Dentistry.
Bill Neumann: Yes, their annual meeting, which even though it’s not specific to DSOs, Heartland is sending 30 plus people to the event. So I think keep in mind it’s in Dallas, Texas, it’s April 4th-6th. If you’re using lasers currently in your practices or considering it, that’s an event to go to.
Kim Larson: Yeah, it’s a great clinical event and if you want to learn more about the event or signup for it, you can do it through our website.
Bill Neumann: Sure, so what’s the next event?
Kim Larson: Henry Schein.
Bill Neumann: So the next event-
Kim Larson: Actually, Futuredontics.
Bill Neumann: The next event Futuredontics and that’s 1-800-dentist and that is also in California. That’s in Sana Monica, California, April 10th-12th and they do something called a DSO diagnosis. So that’s the first time they’re doing this, so they’ll be pretty interesting.
Kim Larson: And DSOs can send two executives to this event for free.
Bill Neumann: Yeah, that’s pretty cool, for free. So check that out. The next event-
Kim Larson: Henry Schein.
Bill Neumann: Henry Schein. So Henry Schein has their DSO education forum, that is gonna be in Las Vegas again, as it was last year. This year it’ll be at the Aria though this year and that’ll be May 17th-18th-
Kim Larson: And they have three tracks there.
Bill Neumann: They have three tracks, what are those tracts.
Kim Larson: They are national and emerging DSOs, hygiene and a brand-new leadership track.
Bill Neumann: Brand new for 2019, the leadership track.
Kim Larson: That’s right.
Bill Neumann: So I’m excited to attend that event as well. Then the last event that we’re cover in this podcast is the DEO, the Dentist Entrepreneur Organization Summer Summit. That is at the end of June, 27th-29th at the JW Marriott in Phoenix, Arizona.
Kim Larson: Right, if you play golf, that’s a great one to go to.
Bill Neumann: Yeah, for sure.
Kim Larson: Also, if you’re going to that event, please go to our website, read all about the event and then use our coupon code, GDN1-
Bill Neumann: To save?
Kim Larson: 30%.
Bill Neumann: Excellent.
Kim Larson: That’s a pretty significant savings, so don’t forget to use your coupon code.
Bill Neumann: Absolutely. So I know Kim wanted to thank some people.
Kim Larson: Yes, absolutely. If you value what we do here at GDN, if you go to our website and do your research, your due diligence and you get all of your group dentistry news from us, please support our sponsors because without them we couldn’t do what we do.
Kim Larson: So we’d like to give a special thanks to Brant Herman and MouthWatch for sponsoring this podcast. Also, we’d like to thank Bisco, Patient Loyalty, Villa U.S.A., Planet DSS, Henry Schein, DEO, Implant Direct, Scaling Up, CallBox, Kleer, Zyris, and the Academy of Laser Dentistry. Thank you so much. Please visit our website for full articles on all of this if you’re not subscribed. So subscribe to our enewsletter. Thank you for all of your incredible support.
Bill Neumann: Yes, and make sure that if you want to get news you go to groupdentistrynow.com and if you are a dentist that is looking for a career opportunity with a DSO or dental student looking to find out more about what DSOs actually are, and we also have a job board there.
Kim Larson: Amazing.
Bill Neumann: So go to joindso.com and either click on the career site if you’re looking for career opportunities, you can go to the job board to find current openings. If you’re looking to sell your practice, if you’re a dentist that might be looking to transition and get away from the support side of it, which would be the HR and the paperwork and focus on clinical, go the sales side and you can find a DSO that will be looking to buy your practice.
Kim Larson: Yeah, and we’ve got some incredible things planned for you guys in the next month, so stay tuned.
Bill Neumann: Thanks.
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