habits of highly effective equipment specialists · 2017-07-22 · contribute to the longer...

For Dental Sales Professionals December 2014

For Dental Sales Professionals June, 2010A partnered publication with Dental Sales Pro • www.dentalsalespro.com

HABITS OF HIGHLY EFFECTIVE

EQUIPMENT SPECIALISTS

2 132 14

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4 : December 2014 : First Impressions : www.firstimpressionsmag.com

December • 2014 For Dental Sales Professionals

EditorMark Thill

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Senior EditorLaura Thill

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Managing EditorGraham [email protected]

FounderBrian Taylor

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PublisherBill Neumann

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Director of Business Development/Sales

Monica [email protected]

Art DirectorBrent Cashman

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CirculationWai Bun [email protected]

Associate EditorAlan Cherry

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First Impressions (ISSN 1548-4165) is published bi-monthly by Medical Distribution Solutions Inc., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2014 by Medical Distribution Solutions Inc. All rights reserved. Subscriptions: $48 per year. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.

POSTMASTER: Send address changes to Medical Distribution Solutions Inc., 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publisher. Publisher cannot accept responsibility for the correctness of an opinion expressed by contributing authors.

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Editorial Staff

Sharpening Your Strategy p.6

What You May Have Missed p.8

Ask the ExpertA former practicing dentist and current sales expert answers your questions p.9

Growing pains – and how to prevent themAs more solo practitioners join – or expand – their practices, the front office staff faces a whole new set of rules for managing the practice finances. p.12

Thriving in the New Normal p.18

Digital Radiography p.19

The MachineScott Woodall takes care of his customers. Always. p.20

Seven Habits of Highly Effective Equipment Specialists p.22

Healthcare Reform andthe Dental CustomerThe Affordable Care Act says that pediatric dental care is an ‘essential health benefit.’ But the law may bring more adults than children into the dentist’s office. p.34

Dirty Little SecretsInfection control expert Nancy Dewhirst answers your questions. p.44

Ready All, Row!Whether he’s managing his Burkhart Dental team or racing down the Charles, for branch manager Matt Nordquist, it’s all about team effort. p.51

Dental Handpieces p.54

News p.56

Product p.56

p.51p.12 p.20

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publisher’s letter

Bill Neumann

This has been another compelling year in the world of dentistry, as our traditional business models and sales/marketing strategies continue to be challenged. Many of our customers’ revenues continue to remain flat, yet our personal and corporate goals are focused on growth. The dental industry is all about relationships, and that

remains true; however, depending solely on these relationships is no longer enough. It’s time to step it up.

As a rep, and as an industry, we need to educate our customers to be better business people. Most are competent clinicians, but in this rapidly evolving industry, more is required. With the growth of the DSO/group models, and most median patient incomes remaining flat or slightly down, our customers need our help. Being a business advisor will only become increasingly more important throughout the coming years as internet-based distributors put pricing and value pressure on full-service dealers.

All that being said, it is still a great time to be in dentistry, and you have an outstanding op-portunity to differentiate yourself and seize market share from your complacent and parochial ‘order taking’ competition. As we close out 2014, take some time to read our strategy sharp-ening articles. They will be a valuable resource to help you reach your end-of-year goals, while also helping you effectively position yourself for a positive and productive 2015. Some highlights include:

• The 7 Habits of Highly Effective Equipment Specialists (Page 22): Learn directly from dealers and manufacturers what simple tips and tricks you can use to become a more effective equipment rep.

• First Person (Page 12): Features Jill Nesbitt whose practice management experience can help you guide and educate your customers as to what works and what doesn’t.

• Dr. Tony Stefanou’s Ask the Expert column (Page 10): Providing authentic and enlightening views from the DMD’s perspective.

Wishing you a prosperous selling season. See you in the New Year.

Bill Neumann

Sharpening Your Strategy

Shannon Bruil, Burkhart DentalSteve Desautel, Dental Health Products Inc.Suzanne Kump, Patterson DentalDawn Metcalf, Midway Dental Supply

Lori Paulson, NDCPatrick Ryan, Benco Dental Co.Scott Smith, Benco Dental Co.Tony Stefanou, DMDTim Sullivan, Henry Schein Dental

Clinical boardBrent Agran, DDS, Northbrook, Ill.Clayton Davis, DMD, Duluth, Ga.Sheri Doniger, DDS, Lincolnwood, Ill.Nicholas Hein, DDS, Billings, Mo.Roshan Parikh, DDS, Olympia Fields, Ill

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Content from First Impressions’ digital supplements

A strong bond between equipment manufacturers and service techs yields satisfied customers and strong sales

Successful equipment sales rest, in part, on a strong and pro-ductive working relationship between the distributor equipment rep and service tech. The duo becomes even stronger with active support from a third player – the manufacturer. First Impressions asked a number of dental equipment manufacturers to charac-terize the most effective relationship between themselves and distributor service techs. Sharing their comments were:

First Impressions: What are your expectations of distributor service technicians?Christopher Wilson, product sales manager, Parker Hanni-fin Corp., Porter Instrument Division: To assist dental/veteri-narian/medical offices with installation, after-install service and maintenance of authorized manufacturers’ equipment/products. Service technicians represent manufacturers as well. A nice or poor experience influences how the customer values the prod-uct. If a service tech is comfortable with a product (knowledge), everyone wins.

Jim Aycock, director of marketing and business development; and Chris Kemper, regional technical manager, Midmark:

We believe that the relationship between the service technician and a dental practice is one of the most important relationships in the industry. We are very fortunate that our distributor service technicians are a knowledgeable, courteous group that provides optimum service for our customers.

Service technicians should be highly skilled in the installa-tion, maintenance, networking and servicing of the equipment in the dental office. That being said, they should routinely attend service meetings and training to acquire knowledge about the most current technologies as well as equipment safety. Techni-cians should always use a “safety first” approach when repair-ing a piece of equipment.

In addition, technicians also play a sales support role, as dental professionals value their technician’s opinion on pieces of equipment that are being considered for purchase.

Kelly Beauregard, director of sales and marketing, SolmeteX: The distributor service technicians play a key role for SolmeteX. The service tech is the person who is face to face with the dental office, providing the hands-on service that we are not able to. They are our eyes and ears on the street by communicating, assisting and keeping the dental office operational. I believe a service tech should be dependable and have a good relationship with the dental office they are working with. He will have the trust of the dentist and credibility to promote our products while providing great technical services. Additionally, I would expect a tech to be well versed, and have working knowledge of a dental office and our product, but that really goes without saying.

Lou Guellnitz, director of sales, Air Techniques: We have many dealer branches across the country. What we really look for is that they’re receiving information, and getting training and experience on our products. We offer training at our Co-rona and Melville facilities, as well as in the field. We prefer techs to visit our factory and experience all that we have to offer; however, the expectations are that they know how to service our equipment, know they can call us for support and/or go to our website for further information. We know the em-phasis falls on us to provide the information needed for the service technician to be successful. FI

WHAT YOU MAY HAVE MISSED

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November digital:

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By Anthony Stefanou, DMD, Founder, Dental Sales Academy

Editor’s note: Anthony Stefanou, DMD, will answer reps’ questions on their dental customers. E-mail him your questions at [email protected] or visit www.dentalsalesacademy.com.

ask the expert

Q: This is a follow up to a previous question you answered. In addition to knowing how to reduce the sales cycle, I’m also curious as to why dentists take so long to make decisions?

A: This is very important in understanding the big picture when it comes to selling to dentists. The most concise (and somewhat of a cop-out) response is … because they can. There are several reasons why it seems to be that the process is taking longer.

Ask Expertthe


ask the expert

I mentioned in a previous column that a high percentage of dentists surveyed said that they know whether they will be do-ing business with a rep/company by the end of the second conversation. The truth is that both sides (rep and dental office) contribute to the longer process. Here are five reasons as to why (not necessarily in the order of importance):

1. The rep is happy they have an active lead. In sales, it always feels good to have a productive initial conversation and then a follow up where there isn’t a “no” yet. However, it is easy to fall into the back and forth with these offices with product information and time. We accommodate it to keep things going. Instead, take a step back and review whether you have truly determined the dentist’s “Why” and focus on a consultative follow up rather than a passive one.

2. The free sample factor. Some reps have sampling

as a key aspect of prospecting process. It’s under-standable that in some circumstances, it can be effec-tive. However, if the free sample is always done and the process is overly dependent on it, it often can hurt the process. Dentists now use free samples as an easy way of delaying (even though they may have made the decision). Also, many reps just offer it without asking for an order because they feel it’s a softer approach. The idea is that the office uses it, is impressed, and orders. Very rarely does this occur. In fact, my surveys show that about 16 percent of offices who receive a “generous sample” of a product after a conversation or two with their reps actually become active accounts. There are many reasons for this, but it still goes back to the fact that very often they just don’t get around to doing anything with the sample because it has no true value. With hygiene products, even if the sample is used on a patient, the patient that is chosen is in such bad condition that the end result isn’t a good one. There is a way to sample selectively and effectively, and I cover that in my workshops.

3. The dentist feels that you are trying to get them to completely replace what they are using. This happens all the time. While you may not be “trying” to present your product line as the only option, the inter-pretation of the dentist is that they are being told that what they are using isn’t good, and that choice was a poor one. Psychologically, they fight the sales pitch even if they want to try your product. I always recommend to reps that if you know they are using a competitor, find out whether there are situations where your product could be an alternative and get your foot in the door without making it seem like it’s yours or none. If your product is as good as you think or say it is, they will start to switch over to yours as time goes on.

4. You are introducing them to your competitors. Dentists don’t always know your competition. It’s impos-

sible for the average general dentist to know every product in every category they use daily in their procedures, just as it is impossible to know every drug a patient may be taking and listing on their medical history (we have to go to our reference guides and look them up sometimes) Same thing here. If you start with “here’s our chart of all we do versus what all our

competitors do” you are often introducing them to the other companies. Dentists then might look up the com-petitors’ product out of curiosity or sincere due diligence. This can confuse them and/or delay the sales cycle.

5. You’re not prepared when rescheduling occurs. This one is simple. Many times during the prospect-ing cycle the office wants to meet with you and they have a time squeeze or an emergency occurs and they have to reschedule. This significantly delays the cycle. To keep this at a minimum, reps should be prepared every time with one or two options so that if you call and/or visit and are told they can’t meet with you, that you reschedule then and not have to call back and delay the process further.

It can certainly be frustrating when you feel you have an office that can benefit from your product and they seem inter-ested but aren’t going for it yet, and there are some factors that are out of your control. But, if you take a look at the five areas we mentioned and start making some adjustments, you’ll start to see some progress and shorten the cycle in many cases. FI

In fact, my surveys show that about 16 percent of offices who receive a “generous sample” of a product after a conversation or two with their reps actually become active accounts.

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first person By Laura Thill

Growing pains – and how to prevent themAs more solo practitioners join – or expand – their practices, the front office staff faces a whole new set of rules for managing the practice finances.

Jill Nesbitt, Mission 77, LLC, con-siders herself a practice manage-ment consultant for dental groups. Her clients, however, likely think

of her as a regular sleuth. Her analytical skills and industry know-how have led her to uncover office management mishaps, saving her clients substantial amounts of money and, in the process, helping maintain smooth office relationships. For instance, there was the time she received a call from a dental associate who was concerned he was being underpaid. As much as he valued his role in the prac-tice and enjoyed working with the senior dentist, he feared the payment process was flawed, notes Nesbitt. “After running some reports in their Dentrix software, I found the senior dentist was overpaid by almost $1 million, while the hygienists were underpaid by over $650,000,” she says. The associate dentist was owed about $15,000, she adds.

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“A discussion with the front office staff revealed they were entering payments correctly, but the years during which the senior dentist practiced solo and received all of the payments left the patient accounts mixed up internally,” she says. “The system worked fine in the years the senior dentist practiced alone, and it continued to work when the associate dentist joined, as long as he was paid a salary. However, once the associate dentist bought into the prac-tice, it became necessary to clarify the adjustments to make sure each dentist received the correct compensation.”

“It matters how you enter payments!” says Nesbitt. If a payment for the work one dentist performs is entered under another dentist’s name, the books might balance out, “but no one will ever see that one dentist did the work, while another was paid for it. And, since most offices run on a day sheet to determine collections for the month, and then pay dentists based on that collections number, dentists’ pay is affected by how payments are entered.

“What I often hear from the staff I train is, ‘No one ever told me!’” Nesbitt continues. “When you become a group practice (and even two dentists working together make a group) you need to enter payments differently to ensure that each den-tist is paid properly. As today’s economic climate encourages more and more solo practitioners to combine their offices – and as more dentists grow their practices – front office staffs face a whole new set of rules for managing the practice finances. “They need to watch the internal plus/minus on the patient

accounts to ensure money is correctly moved,” she says. “These are things that haven’t applied to solo offices, but now completely affect how dentists in a group are paid.”

First Impressions Magazine recently spoke with Nesbitt about her practice management consulting experience, includ-ing the challenges her clients face and the tools she offers to address them.

First Impressions: How did you become involved in dental practice management?

Jill Nesbitt: In 1997, I was living in Cincinnati, Ohio, working on my MBA. I was working full time at an environ-mental firm in Kentucky, commuting back and forth. I accepted a position in a group dental practice on the north side of Dayton and decided to transfer to the University of Dayton, which made it eas-ier for both my husband, who frequently flew out of the Dayton airport for work, and me. Meanwhile, the owner dentist and I agreed that I would organize the business side of his group practice for the next three years, and he would give me the flexibility to work on my degree. But, after I earned my MBA, I was deeply involved in the practice and stayed on for another 13 years. By the time I left, it had grown to a staff of 25, with 18

operatories. Today, I serve as COO for two group practices while supporting other offices remotely through my online dental staff training levels.

First Impressions: What do you mean by training levels?Nesbitt: The dentist owner I worked with for 16+ years cre-ated a training system for his staff, whereby he wrote down each task that each staff person in the office had to complete. He then organized the tasks by level, from easiest to most complex. We ran the practice using these training levels, not only as a way to train new staff without dental experience, but also as the infrastructure for providing raises and career ad-vancement. Over the years, I wrote a mountain of information contributing to these training levels. When I left the practice, I wanted to put these levels online, and the dentist agreed that he and I would co-own them. To date, I have transferred most of the first three levels online for the front-desk team, dental

“ What I often hear from the staff I train is, ‘No one ever told me!’ When you become a group practice (and even two dentists working together make a group) you need to enter payments differently to ensure that each dentist is paid properly.”

www.firstimpressionsmag.com : First Impressions : December 2014 15

assistants and hygienists. Dental practices can subscribe to – and have access to – all of this training.

First Impressions: With regard to practice management, what are the greatest challenges facing dental practices?Nesbitt: The greatest challenges are managing finances (thanks to PPOs); making the transition from a traditional mar-keting approach to the use of online tools and social media; and recruiting dentists. To address these challenges I recommend that dental practices do the following:

• Finances. Set up their dental software to reflect their real production rather than inflated numbers, which will enable them to manage fees and services appropriately.

• Marketing. Successful practices track their referral sources to know what works, and then invest in online marketing once they measure the results.

• Recruiting. Recruiting dentists is always tough. It helps when dentists in a group network find great new hires, but, nevertheless, this can still be challenging.

First Impressions: In the 16+ years you worked with the Ohio-based dental practice, how did it grow? What role did you play in helping the practice meet – and exceed – its goals?Nesbitt: My job was to manage the entire practice and help everyone set and accomplish their goals. Originally, I oversaw a lot of work behind the scenes. I set up various spread sheets, from employee pay/benefits and technology to finances, which helped manage and track different parts of the business. Be-cause we were in a small town and could successfully recruit both general dentists and specialists, the practice was able to

expand. I helped it meet its goals by making good on our offer to allow the dentists and specialists to focus on their clinical care while we managed everything else, including scheduling, collections, equipment, staff, marketing and more.

First Impressions: I understand you partner with Den-trix practice management software. What is involved in training clients and staff to use it?Nesbitt: I work with new clients for about a week each month – usually for six months onsite and then, once I feel the team leaders and administrator are settled into the training levels and systems, I support them remotely through more advanced top-ics in the training levels. I work with the whole team, focusing on their different needs. When I am onsite, I work with dentists to understand their vision, values and goals; then I set up sys-tems in their practices to accomplish those goals. I believe in team leaders for large group practices, so I mobilize the top assistant, hygienist and administrator to have a weekly team leader meeting to help manage the practice. Finally, I work with the administrative staff to help them work through my training levels, as well as support the team leaders to use this training material with their staff.

First Impressions: You were trained in the Baldrige national quality approach. Can you tell describe the program and how it helps organizations improve their quality management?Nesbitt: The Baldrige is a national award, but also avail-able at the state level. Supported by the National Institute of Standards and Technology and The American Society for Quality, it is open to any organization, from manufacturing, retail, government and schools to healthcare. To apply for

“In my experience working with dental groups, I find that sales reps can provide meaningful

value to the practice when they work closely with administrators. Whereas dentists can get tied up

with patients, administrators have the time to meet with the reps, and they understand the

criteria affecting purchasing decisions.”


first person

the award, a dental group practice or dental manufacturer must answer a series of questions in seven areas, including leadership, strategic plan-ning, staff management, vendors, customers and finances. The ques-tions focus on systems and process-es (e.g., How do you communicate your vision and values? How do you train your staff to meet your patients’ needs?) The application also requires the organization to demonstrate its performance in terms of numbers. It must provide statistics reflecting production and collection, as well as measurable results for vendors, staff, patients and quality of care. This is the first and only place I have ever seen the question, “How do you know that you are providing better quality of care to your patients than your competitors?” This is a tough ques-tion! When dentists and their staff think about how they go about setting up systems to answer each of these questions, it helps them to create consistent quality. This is the biggest benefit of Baldrige.

First Impressions: What advice can you offer distribu-tor sales reps and managers to help them better service their dental office manager customers?Nesbitt: In my experience working with dental groups, I find that sales reps can provide meaningful value to the practice when they work closely with administrators. Whereas dentists can get tied up with patients, adminis-trators have the time to meet with the reps, and they un-derstand the criteria affecting purchasing decisions. Sales reps should find out if the dentist and manager have regular meetings. They should get a sense of whether the manager is responsible for managing expenses and income state-ments. By understanding the manager’s responsibilities and asking how they can help the practice – particularly in the case of dental groups – reps can build their relationship with a strong manager who can be a valuable resource.

First Impressions: On the flip side, what advice do you offer of-fice managers when working with sales reps?Nesbitt: I instruct my adminis-trators to begin by getting three separate quotes on equipment they are looking to purchase. Once ad-ministrators have their quotes, I tell them to place them side-by-side in Excel and use this data to forecast the total expense for the life of the equipment. So, for instance, if the practice is buying sensors, it can’t simply consider the current purchase price. Instead, it must evaluate the yearly expense of the warranty, and calculate the five-to-10-year total expense based on logical assump-tions, thoroughly comparing costs to determine the best deal. (Some ques-tions to consider: How will we finance the equipment? What other costs will be involved? What will the return on investment be?) This comparison can

be very helpful for dentist owners when they make their final call. With regard to supplies, I coach my clients that the expenses need to fall in line with industry benchmarks of about six percent collections.

First Impressions: Looking ahead, how do you antici-pate dental office/practice management will change over the next five to 10 years, and what will this mean for sales reps and managers?Nesbitt: As group practices grow rapidly, I expect we will see more dental administrators responsible for running a multi-location or single large office with multiple providers. These administrators will be responsible for staff, technol-ogy, marketing, vendors and overall management, and they will be professionals. This is wonderful news for sales reps because administrators will have time to meet with them, and they will understand how to work with sales reps. Plus, a sale to a large group may be far more lucrative than a sale to a solo practice. FI

For more information about Mission 77, LLC, visit www.dentalpracticecoaching.com.

“Understanding the manager’s responsibilities and asking how

they can help the practice –

particularly in the case of dental

groups – can help reps build their

relationship with a strong manager

who can be a valuable resource.”

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DTA column

Before you can really start to thrive in dentistry’s new nor-mal, you have to understand the economic, social and de-mographic trends that dentists are encountering in their professional lives. Then, you can adjust your business

model as needed to best serve your customers and your company.

According to the 2013 report Critical Trends Affecting the Future of Dentistry: Assessing the Shifting Landscape, prepared for the ADA by Diringer and Associates, there are 12 emerging trends that will have an effect on the future of dentistry and become the new normal. Below are three identified trends from that report that we believe will have a definite impact in shaping the new normal for dentistry and, in turn, for our industry:

1. An increasing number of dentists are being trained, but mounting debt load and changing demographics are alter-ing practice choices. Changes in student demographics, growing debt and lifestyle choices are heavily influencing new dentists’ post-graduation decisions. This includes the increasing trend of recent graduates joining joint, group or corporate prac-tices versus starting a solo practice in order to earn a steady paycheck while gaining practical experience. For the Dental Trade, this shift in where dentists are practicing means selling to organizations where equipment and supply purchase decisions are centrally controlled and access to individual dentists is limited. Are you and your organization up to speed on sell-ing and servicing these growing segments of dental service providers while also reaching key opinion leaders who will continue to influence product choices?

2. Pressures are growing for an expanded dental team to provide preventive and restorative services.With push back on increasing dental care costs from

individuals to government to employers, the call for less expensive delivery options is increasing. Accord-ing to the Diringer report these options will include, “expanding the role of mid-level practitioners and the use of tele-health technologies. Maine, Alaska and Minnesota already have mid-level practitioner laws on the books and a large number of state legislature are currently debating bills on the scope of practice and supervision requirements for mid-level prac-titioners in their states. As this trend in mid-level practitioners grows, the utilization of tele-health technology is predicted to grow as a way to provide

supervision and consultation between remotely located mid-level practitioners and dentists.” Is your company ready to address the product, information and service demands of this new segment of the dental service provider and

be able to provide added value to your clients for their tele-health systems?

3. With the increased demand for value in dental care spending, practices will need to become more efficient.

Even as reimbursements decrease, the demand for the latest technology and treatment plans from informed and cost conscious consumers is on the rise. In addition, insurance providers want more outcome metrics to ensure the optimum return on their care dollars. All of this

means dentists are feeling the pressure to be more efficient and utilize economies of scale when it comes to purchases. How are you positioned to help your dental customers meet these needs from managing costs to supporting the tracking of outcome metrics?

Those are just some of the trends that will impact the future of dentistry and a few of the pertinent questions to ask yourself to ensure you are ready and positioned to thrive in The New Normal. FI

Thriving in the New Normal

By Gary W. Price, Dental Trade Alliance CEO

With push back on increasing

dental care costs from individuals

to government to employers, the call for less expensive delivery options

is increasing.


sales focus

About the EquipmentA convenient workflow offered by a chairside digital radiogra-phy system produces immediate radiographs in nine seconds or less. The user must simply remove the flexible phosphor sensor from the patient’s mouth, remove the sensor from the infection control barrier envelope and insert it into the slot at the top of the unit. The scanner will develop the image, and the sensor will be available for reuse.

Probing sales questions • What are you using in your practice to produce

digital images?• If you use wired sensors, what back-up system do you

use for patients with small mouths, difficulty in opening wide, or gag reflexes?

• How much do you pay for chemicals or annual insurance?• How often have you broken the

wire to your direct sensor?• How important is patient

comfort to you?

New products • ScanX Swift. ScanX flexible

phosphor sensors complement direct sensors for use with patients with large tori, small mouths or gag reflexes. The ScanX Swift delivers better image resolution and faster image processing than film. ScanX has the same sizes and workflow as film, and no new protocol is required. Plus, ScanX phosphor sensors are positioned with existing XCP holders. They are durable, long lasting and can be reused hundreds of times. (No insurance is required). ScanX Swift is compatible with most dental imaging and practice management software, and is ultra-compact for chairside use.

• ScanX Barrier Envelope #2 Bulk Pack. ScanX Barrier Envelopes feature a transparent side for ac-curate plate positioning. A patented envelope prevents ambient light from reaching the sensitive side of the imaging plate. Rounded corners and soft edges maxi-mize patient comfort. The new ScanX Barrier Envelope Bulk Pack includes 1,000 size 2 Barrier Envelopes.

Preventive maintenance tips • There are no annual maintenance costs with ScanX

Swift. Included with the system are sensor cleaning wipes for cleaning the reusable phosphor sensors; barrier film roll for adhering to the top of the scan-ner before inserting the PSP and removing between patients; and scanner cleaning sheets for keeping the system’s rollers clean. FI

Editor’s note: First Impressions Magazine would like to thank Air Techniques for its assistance with this piece.

Digital Radiography


service tech profile

If one were to create a professional profile of Scott Woodall, it would include these bullet points:

Enjoys finding new challenges with every service call.Tries to treat customers the way he would want to

be treated.Enjoys being a trusted partner with his customers

and colleagues.Appreciates the company he works for.And, oh yeah, doesn’t like to be cooped up in an office.In other words, Scott Woodall pretty much loves what he’s

doing as a service technician for Midwest Dental Equipment and Supply.

“Every day brings a new challenge, as each service call I go on is different from the one before,” says Woodall, who

services his Texas-based customers in Waco, Temple/Killeen, Bryan/College Station and other cities within a two-hour drive of Waco. “I enjoy the staff and the range of personalities I en-counter in a day.

“My goal is to bring the customer the result they need and want. Sometimes that includes equipment or parts, other times, maybe just a question-and-answer session.”

OutsiderBorn in Texarkana, Texas, Woodall has spent the last 40 years in the Waco area. He lives in McGregor, 12 miles west of the city.

From way back, he has known that sitting behind a desk probably wouldn’t suit him for long. “I enjoy being outside,” he says, and at one time, had thoughts about being a surveyor or forester.

For 20 years, Woodall worked on an equine breeding and show training operation in Waco. The operation had 500 head of Egyptian Arabian horses on 1,100 acres, and 125 pad-docks. “My job included keeping the water wells, barns, show facilities, tractors and equipment functioning,” he says. “I was fortunate to work alongside master electricians and plumbers for several years. I learned so much from these professionals that I have been able to use since then.”

But tax laws changed, and owning horses became a less attractive tax shelter for the wealthy. The breeding operation – and many others – closed.

A close friend, with whom Woodall had grown up, was part owner of a local dental supply company. “His company needed to hire someone, and he thought I might like it,” recalls Woodall. “He also told me I wouldn’t be working inside all day long, that I would be out and about all day.” With that promise, he was sold on the opportunity.

For several years, Woodall learned about all aspects of dental supply, working in the warehouse, shipping and receiv-ing, customer service, etc. (“I had no desire to go into sales,” he says.) Occasionally, he would accompany service profes-sionals on calls, but it wasn’t until four years had passed that he started going out on solo calls.

In 2008, he joined Midwest Dental.

The MachineScott Woodall takes care of his customers. Always.

Scott Woodall is an avid photographer.


The MachineWoodall has a nickname – The Machine – because of his relent-less service to customers, notes Service Manager Eddie Cluley.

Says Woodall “I try to do whatever it takes to take care of our accounts. I want them to know Midwest Dental cares. I try to treat people the same way I would want to be treated. We are a retail business. If the customer doesn’t get what they want from Midwest Dental, they might try another company.

“Some of the accounts I service are two hours away,” he continues. “I don’t mind driving to take care of them. Comes from taking care of a rural territory.” Many calls are for simple repairs, but sometimes, they lead to more complex repair-vs.-replace discussions.

If Woodall determines that a piece of equipment will cost more to repair than replace, he tells his customers, and puts them in touch with the equipment spe-cialist. “I’ve dealt with the people in my territory for years. They trust me. They know I won’t tell them to buy something if they don’t need it.

“We have a strong equipment rep in my territory,” he continues, speaking about Ramon Miranda. “We have a great working relationship. He has the experi-ence and the knowledge to help our of-fices with their equipment needs. When either of us has a lead on equipment, or when the doctor has questions, we talk back and forth to make sure the doctor is getting what he wants and needs, and to make sure the equipment will fit and function in the office.”

Woodall says he owes much to supply salespeople Kaye Clark and Scott Kerr. “They have been co-workers of mine for almost 20 years. We all help each other as a team.”

Off hoursGiven his love of the outdoors, it’s no surprise that Woodall’s off-hours hobby would take him, well, outdoors.

“I started enjoying photography in the late 1970s,” he says. “At that time, all I shot was black and white. The high school I attended had a superb instructor – very technical and precise. No cutting corners. I attended a small school, and we were allowed to use the dark room and chemicals whenever

we wanted to. We cut our own film off bulk spools, developed the film and printed the photos. Because of this training, I have always had an interest and understanding of photography and the processes.”

His enthusiasm for photography hasn’t waned, though today, most of his shoot-ing is digital. In the fall, he enjoys record-ing the season’s beautiful colors. He also shoots old barns – a disappearing breed

– in the Texas countryside.In addition, Woodall has a special fondness for photo-

graphing motor sports, that is, car races. He regularly attends – and photographs – drag races, for example. And recently, he photographed the 2014 U.S. Vintage National Championship in Austin, Texas, which features refurbished cars competing against others of the same era.

When he’s not working or photographing, Woodall may be reading novels and magazines, and spending time with his wife of 32 years, Mary; their dog, George W; and their cat, Simba. FI

“If the customer doesn’t get what they want from Midwest Dental, they might try

another company.”


HABITS OF HIGHLY EFFECTIVE

EQUIPMENT SPECIALISTS

Editor’s note: In the spirit of Stephen Covey’s popular book “The 7 Habits of Highly Effective People” First Impressions examines the habits of highly effective equipment specialists.


• Multidimensional• Big thinker• Conscientious• Customer-focused• One-stop shop• Team player• Lifelong learner

“Today’s equipment specialists need to have a wide variety of skills,” says Don Hobbs, vice president of equipment and technology sales for Henry Schein Dental. “They have to act as

general contractor, balancing many different pieces in order to complete a project. They need to be a banker, able to talk about financing, lease negotiations and real estate. They need to un-derstand equipment clinically, and from a workflow perspective. They have a much more detailed responsibility than equipment reps in the past.

“They are truly partnering with their customers and be-coming a trusted consultant. They are involved from the start of a project and are side by side with the doctor building a three-, five- and 10-year plan. Being an equipment specialist has evolved from the nuts and bolts of the past, so to speak.”

Perhaps you know this person. It could be the person in the mirror, or perhaps someone you’d like to become. It’s the highly effective equipment specialist, and he or she is:

Habit No. MultidimensionalThe highly effective equipment specialist is multidimensional, according to those with whom First Impressions spoke.

“That person is organized,” says Mike Etheridge, eastern regional manag-er, SciCan Inc. “If they aren’t, then noth-ing else matters. They need to be able to juggle multiple projects effectively. They work a lot of hours and they are happy to do it, because they are paid well and it’s not an 8-to-5 job.” These specialists are well-educated in several areas – con-struction and product knowledge – and bring in manufacturer reps to pull from their expertise when needed. They can easily engage in a re-pair-or-replace discussion with the dental team, because they sell from a value angle and use facts, such as repair costs vs. new costs to make their case, he says.

Highly effective equipment specialists know about financ-ing options, but they defer to banks or dealer financing experts as a way of staying out of the financing conversation and fo-cusing solely on the needs of the office, Etheridge continues.

“That way they don’t have to be the one to discuss poor credit or what someone can or can’t afford.”

The highly effective equipment spe-cialist always works with the doctor, but brings in other staff as well, he says. “They are usually outgoing and can talk to anyone and get along with anyone, and they work well with their team of techni-cians, installers and internal support at the dealer branch. They can also man-age expectations in situations where they have to deal with a “dental spouse” in the office who is part of the process, but is

more worried about keeping spending down than getting the right equipment.”

Says Mike Lynam, manager, Porter Instrument Division, Parker Hannifin Corp, “It is all about time management and organization.” Highly effective equipment specialists use tech-nology to organize the avalanche of information that comes at them from the manufacturers, he says, adding that tablets seem to have become the most popular choice.

Highly effective equipment specialists

use technology to organize the avalanche of

information that comes to them from

manufacturers. – Mike Lynam


Seven Habits of Highly Effective Equipment Specialists

Habit No. Big thinkerThe highly effective equipment specialist sees the big picture.

“They are self-driven and always organized,” says Matt Buettner, East-ern regional sales manager, Midmark. “Because these projects can get out of

hand, with so many different arms and people involved, they become the quar-terback and run the project.”

Like all salespeople, successful equipment specialists are highly com-petitive, he says. “They’re very knowl-

edgeable. They have an under-standing of the entire process from start to finish. They use all the resources provided, whether through their own company or the manufacturer. I’ve also noticed they have good relationships with everybody across the board – ter-ritory rep, service technician, man-ager, manufacturer, financial team. They’re very disciplined as well.”

Habit No. ConscientiousHighly effective equipment special-ists are conscientious. They don’t take shortcuts.

“They’re typically involved, not only in layout design and pre-installa-tion, but in the installation too,” says Mark Asplund, Professional Sales As-sociates, which represents several dental equipment manufacturers.

“They understand that performance depends on the quality of the product

and the installation. They will be on-hand throughout the process.”

Highly effective equipment special-ists view everything they do as a long-term activity, continues Asplund, who covers the Pacific Northwest, northern Mountain States and Alaska. “It’s not just a matter of getting the order and hand-ing it off; they’re not in a relay race.”

These specialists build solid re-lationships with the territory reps, he

“ Because these projects can get out of hand, with so many different arms and people involved, they become the quarterback and run the project.”

– Matt Buettner

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When you think about facility housekeeping solutions, think Georgia-Pacific Professional. Our products are a leader in innovation, cost-in-use and hygiene just to name a few.

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says. “The ones who are above and beyond, who take it a step further, have the confidence of doctors and they get referrals. A true indicator of success is when that dentist says to [his or her colleagues], ‘You need to contact Tim or Dave or whomever.’”

They go the extra mile – and sometimes many extra miles – to make sure the dental practice keeps operat-ing smoothly, says Asplund. For exam-ple, recently, one distributor rep left his house at 4 a.m. to pick up a piece of equipment to bring to an office whose unit failed to power up. “We weren’t sure if it was the transformer or the equipment, so we made the decision to bring both,” he says. For the highly effective equipment specialist, “It’s not always a matter of, ‘What do we do?’” he says. “It’s about doing whatever we have to.”

One more thing: “Not a single equipment specialist in that upper ech-elon would ever ask somebody to do something he or she wouldn’t do them-selves,” he says. So, it wasn’t a tech who showed up that morning to pick up the equipment. It was the rep.

Buettner adds that the highly ef-fective specialist is hands-on. After weeks and perhaps months of meet-ing about the practice’s equipment needs, comes the time for installation.

“The good [equipment specialists] are there,” he says. “They’re not only there, but they get their hands dirty.” The suit and tie or dress is replaced with jeans. “They pitch in and help out,” he says. By the end of the process, that special-ist has become more of a consultant than salesperson. “They may get a call from that practice five years after the project is completed with a question not necessarily about the equipment, but about the practice’s operations.”

Patrick Ryan, director of sales, equip-ment and special markets, Benco Dental Co, has observed that the highly effective equipment specialist practices “absolute, rock-solid” follow-up. “That may seem like basic sales,” he says. “But it’s prob-ably more critical for the equipment rep.” And they rely on automated tools, such as CRM software, to help.

“Equipment sales is complex,” he says. “There are many details, and the best guys don’t miss them. They’re keep-ing track of the next step, they’re coordi-nating projects with the contractor, if one is involved. They’re big thinkers.

“In today’s environment, there’s no room anymore for an equipment spe-cialist who sits in the office and waits for a phone call, or who emails quotes. It’s the age of, get in the car, get in front of people, make cold calls and travel with your territory reps.”

“ They understand that performance depends on the quality of the product and the installation. They will be on-hand throughout the process.”

– Mark Asplund


Habit No. Customer-focusedObservers agree that the highly effec-tive equipment specialist is focused on the needs of the customer, to the point where he or she becomes a confidante or consultant to the doctor and the practice team.

Highly effective specialists have unique personalities, but often share similar characteristics, says Asplund. “Honesty is the first thing,” he says. “It’s their candor, their honesty, their focus. When they sit with the doctor, they identify with the doctor, with his or her needs, then share sug-gestions about what would be best for the practice. They’re not trying to sell a particu-lar piece of equipment, they’re trying to fill the doctor’s gaps in his equipment needs.

“The truly effec-tive equipment spe-cialist would never mail out a quote, unless he or she had a relationship with the dentist,” he continues. “Instead, when they get approached by a doctor or rep, they sit down, interview the dentist, and find out, ‘Where are you at?’ ‘What are you trying to do?’”

Says Etheridge, “I think this per-son is more consultative than a sales-person. The good ones ask a lot of questions, figure out what’s best for the doctor, and then find a way to fill that need. [They don’t] sell product

because they get a bigger commission or better spiff.

“They utilize manufacturers and work from a team approach. It’s not just one guy dictating what the doctor is going to buy. They sell from a value point of view, where they can show the doctor why spending a little more in an area increases their productivity levels or makes them more efficient.”

The experienced equipment spe-cialist knows the pitfalls to avoid in a project, says Buettner. After all, they’ve

done hundreds of offices. “To a doctor setting up his or her first practice, this is vital information,” he says. What’s more, the highly effective rep has the ability to communicate that informa-tion in an educational – not conde-scending – manner.

“The men and women I’ve worked with are ingrained in their communi-ties,” he continues. “They have worked with other dentists, and they have no problem referring to projects they’ve done for them.”

“ The good ones ask a lot of questions, figure out what’s best for the doctor, and then find a way to fill that need.”

– Mike Etheridge



The highly effective equipment special-ist works well with others, including service technicians, manufacturers and territory reps. He or she taps into their skills and knowledge.

“The most effective equipment special-ists realize they can’t be all things to all people,” says Lynam. They work effectively with their corporate office to implement the market-ing tools that will differentiate them from the competition, and they work in a strategic way with well-trained wholesales reps, he adds.

The service technician is an impor-tant part of the equipment team, and highly effective specialists treat them as such, according to those with whom First Impressions spoke.

Says Etheridge, “Service techs and installers make or break [the equipment specialist’s] reputation, so the good ones communicate well with them and help them with the process.”

The highly effective equipment specialists Asplund knows are all very involved in their respective service de-partments, he says. They know the im-portance of being in sync with the service techs when speaking to customers about repair-vs.-replace decisions. They have the confidence of the service department, and they also understand that the service technicians are a great source of leads. “The first indication of an equipment need often shows up in the service department,

Habit No. Team player

Habit No. One-stop shopHighly effective specialists “have the knowledge, are continually getting more education, know which products are available, and know the best direction for the doctor from a financial standpoint,” says Asplund. These specialists serve as a one-stop shop for their dental practice customers, and they will direct their cus-tomers to the people and resources nec-essary – including plumbers, contractors and others – to bring a project to a suc-cessful conclusion. In the process, they instill confidence in the doctor.

These specialists put the concerns of the dentist before any commercial gain. “One specialist I know came up with the phrase ‘an eloquent concession,’” he continues. By that, the specialist meant that in those situations where his com-pany doesn’t carry the right piece of equipment for the practice, he refers that customer to the proper source anyway. “The dentist knows [the specialist] didn’t make a dime on the sale, but that only re-inforces the doctor’s confidence that that specialist will always take care of him.”

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Highly effective equipment specialists are lifelong learners.

“The difference between the elite equipment specialist and others is, they never feel they know it all,” says Asplund. “They ask to be part of service classes and meetings, and they’re never afraid to ask a question. They’re never embarrassed by their ignorance; they’re very approachable; there are no defenses. They understand that as good as they are, they can get better.”

Adds Etheridge, “They are con-stantly learning, visiting manufacturers for training and spending time to take classes when necessary.”

“Highly effective equipment special-ists won’t assume they know everything,” says Buettner. “They’re still open to learn-ing from the manufacturer. They use the educational tools we provide to help educate their doctor. They put all their re-sources at work for the customer.” FI

because something has failed,” he says.The best specialists view the service

techs as partners, says Ryan. After all, in the eyes of the customer, the tech is often the most trusted person on the distributor’s team. “He or she is perceived to be abso-lutely neutral,” he says. Highly effective equipment specialists never treat techs as anything other than equals and partners.

Highly effective equipment special-ists cultivate strong relationships with manufacturer reps as well.

“Effective specialists use manufac-turers as they need them, and they ask for extras when they need them, but they don’t abuse anything,” says Ryan. “In the best of relationships, there’s enough trust that, in a pinch, the manufacturer rep can go into the practice by himself and nobody feels uncomfortable that anything untow-ard will happen.” In contrast, the ineffective equipment specialist may pass a lead to the manufacturer with little more than, “Go see Doctor Smith and let me know how it goes,” he says. “That doesn’t work anymore.”

Highly effective equipment special-ists are invested in their territory reps.

As a result, territory reps are more in-clined to talk about equipment to their accounts, and generate leads.

That’s not always easy, says Ryan. Af-ter all, territory reps can at times be reluc-tant to talk about equipment, for fear that if something goes wrong with it, they may jeopardize their merchandise business.

“The best equipment reps realize it may be their responsibility to get the ter-ritory rep to simply ask the doctor, ‘What is the next piece of equipment you need to buy?’ or ‘Do you have any equipment needs before the end of the year?’” he says. Slightly more difficult is encourag-ing territory reps to ask about specific pieces or equipment. But those kinds of questions can be productive in that they either generate interest in the equipment under discussion, or spark interest in another piece of equipment the dentist has been thinking of acquiring. Either way, the potential of a lead exists.

“And the effective specialist helps territory reps understand that if they’re not talking about equipment, someone else will,” says Ryan.

Habit No. Lifelong learner



Are highly effective equipment specialists born or made? A bit of both, according to those with whom First Impressions spoke.

“I think that they are born, or come into the job that way,” says Mike Etheridge eastern regional manager, SciCan Inc. “They can learn dental prod-ucts and equipment; but they have to be orga-nized, a good salesperson, smart, patient, trusting of a team of people, and have a great work ethic. We learn that growing up.”

Says Mark Asplund, Professional Sales As-sociates, people do have some inherent tenden-cies. “I don’t think you can learn everything; the leopard doesn’t change his spots.” That said, with

desire and attitude, anyone can do just about anything, he adds. “I can teach you products, but I can’t teach attitude or desire.”

As with great athletes, the desire to win isn’t enough, he says. The desire to prepare to win, is. “We all want to win, but will we hit a bucket of 400 balls in the rain, like Tiger Woods?”

To the extent that the specialist can grasp that each dentist’s equipment needs are different, and that the specialist must tailor his or her recommendations accordingly, then highly effective specialists can be made, says Matt Buettner, Eastern regional sales manager, Midmark.

Says Patrick Ryan, director of sales, equipment and spe-cial markets, Benco Dental Co, “I think that person is made. Here’s why: I have seen really great, natural salespeople who never sell to the same person twice. They have zero follow-up. I think the follow-up piece, the attention to detail, has to be made; I don’t think that’s natural to most people.”

Like car owners and a trusted mechanic, dentists want “a guy” they can trust, he says. “The highest compliment a dentist can give an equip-ment specialist is this: ‘When I tell you I need something taken care of, I know I’ll never have to ask you about it again.’”

The specialist has to earn that dentist’s trust in order to be that guy.

Highly effective equipment specialists: Born or made?

“ I think the follow-up piece, the attention to detail, has to be made; I don’t think that’s natural to most people.”

– Patrick Ryan

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trends

Healthcare Reform and the Dental CustomerThe Affordable Care Act says that pediatric dental care is an ‘essential health benefit.’ But the law may bring more adults than children into the dentist’s office.

It’s at times like these that First Impressions readers might be grateful they’re selling dental equipment and supplies instead of heading up their companies’ HR departments. Working through the intricacies of the

Affordable Care Act isn’t easy. Nevertheless, it’s a task with which dental practices are dealing, not only as small employers, but as doctors whose patients may be affected by the law.

First Impressions recently submitted questions about the Affordable Care Act and its impact on dental care to two experts: Evelyn Ireland, CAE, executive director, National As-sociation of Dental Plans; and Paul Reggiardo, DDS, national spokesperson of the American Academy of Pediatric Dentistry,

and public policy advocate, California Society of Pediatric Den-tistry, a state component of the AAPD.

Some highlights:• Although a pediatric dental benefit is considered an

“Essential Health Benefit” per for the Affordable Care Act, it only applies to coverage offered in the small group and individual markets.

• It is too early to tell how many individuals – children or adults – have visited a dentist as a result of the Afford-able Care Act.


• It is likely more adults than children gained dental benefits through the ACA’s Medicaid expansion, which increased eligibility from 100 percent of poverty to 133 percent of poverty.

• Although the Affordable Care Act strives to achieve the “Triple Aim” (improve the patient’s experience of care, improve the health of populations and reduce per capita cost of care), the current dental insurance products marketed in and outside state exchanges do not differ significantly from delivery systems of the past.

First Impressions: Describe the pedi-atric mandate of the Affordable Care Act. Does it apply to all kids – that is, those from low-income as well as higher-income families? What does it include? And does this mean that consumers must purchase dental in-surance for kids, or only that insurers must offer it to them?

Paul Reggiardo, DDS: The simplest answer is that under the Affordable Care Act, the inclusion of pediatric dental benefits, whether as a stand-alone product or as an embedded or bundled benefit of a qualified health plan, be provided for all children…regard-less of family income or how the insurance is purchased or provided. The covered oral health services are generally the full range of dental procedures found in either the state’s Children’s Health Insurance Program (CHIP) or the Federal Employees Vi-sion and Dental Insurance Program (FEDVIP).

With the exception of Utah (which offers only preventive services in the dental benefits package offered in the state health benefits exchange), the other 50 states and District of Columbia selected the full scope of dental services included in either their CHIP or FEDVIP plans. This is the full range of pediatric dental diagnostic, preventive, restorative, endodontic and surgical services one would expect to find in a commercial

dental product, as well as “medically necessary orthodontics.” Some plans offered in state exchanges also include a wider range of orthodontic benefits at an additional premium.

While it is clearly the intent of the Affordable Care Act that pediatric dental benefits be provided for all children, federal guidance in early 2013 indicated that such benefits:

Must only be offered in the state and federally facilitated health benefit exchanges. In spite of this, three state exchang-es (Washington, Nevada and Kentucky) made the purchase of these benefits in stand-alone dental plans mandatory in 2014, and a number of other state exchanges included these benefits by embedding them in the purchase of a qualified health plan.

Must be purchased (either as a stand-alone product or em-bedded in a qualified health plan) in the individual, small group, and (beginning in 2015) commercial large employer marketplace.

Acronyms:• SBM: State-based marketplace• FFM: Federally facilitated marketplace• SADP: Stand-alone dental plan

Note: The U.S. Department of Health and Human Services indicates that approxi-mately 88 percent of applicants purchased coverage, while stand-alone dental plans estimate that 70 percent of applicants purchased coverage

Source: National Association of Dental Plans, reprinted with permission


trends

(Editor’s note: See accompanying article for more details on what’s going on outside the exchanges.)

Evelyn Ireland: The ACA’s requirement for inclusion of pedi-atric dental coverage only applies to coverage offered in the small group and individual market, so it doesn’t apply to all kids and it is not income-related. For right now, “small employer” means employer groups with 50 or fewer employees. In 2016, “small employer” is redefined for all states as employers of 100 or fewer employees. So the requirement applies to coverage offered in the exchanges and outside of exchanges in the com-mercial small group and individual market.

The scope of pediatric dental coverage (defined as cover-age for anyone from 0 to 19 years of age) is set at the state level based on benchmark options set by federal rule. So, the answer to the question, “What does the pediatric benefit include?” differs by state. One state, Utah, chose a medical plan with a minimal dental benefit in it. All other states chose

medical benchmarks without pediatric dental, so they had to add a pediatric dental benefit. Federal rules gave states a choice to add dental coverage equivalent to their state CHIP program [Children’s Health Insurance Program] or equivalent to the most popular dental plan in the 2012 Federal Employ-ees Dental and Vision Insurance Program, or FEDVIP. States making no active choice defaulted to FEDVIP.

Not surprisingly, states running state-based exchanges generally chose their CHIP program. (Exceptions include the District of Columbia, Minnesota and Rhode Island). States with the federal exchange (referred to as the FFM, which

stands for Federally Facilitated Marketplace) generally de-faulted to the FEDVIP MetLife High Plan, issued in 2012. However, a state can use the federal exchange and choose its own benchmark. Eight states took this approach, i.e. chose the state CHIP program as a pediatric dental bench-mark while using the federal exchange. (Those states are Kansas, Oklahoma, Mississippi, North Dakota, Michigan, Virginia, West Virginia and New Jersey.) The three states that operated as partnership exchanges – Arkansas, Dela-ware and Illinois – also chose the state CHIP program as their pediatric dental benchmark.

The answer to the question, “Are consumers required to purchase pediatric dental coverage, or are insurers just re-quired to offer it?” is “It depends on where the purchase is made.” Inside exchanges, pediatric dental is offered by stand-

alone dental plans (SADPs), and when it is, medical plans do not have to in-clude it. In almost every state, there are medical plans with and without pediatric dental. For the coming year, i.e., 2015, California and Maryland will have only medical plans with pediatric dental and separate dental coverage available for adults. So in those states, if you get medical, you get dental. In other states and the federal exchange, you can purchase a medical plan without pediatric dental without being required to purchase pediatric dental. In 2014, a few states – Kentucky, Ne-vada and Washington – required that pediatric dental be purchased when medical coverage is being purchased

for a child. However, Nevada is switching to the Federally Fa-cilitated Marketplace in 2015 and will not be able to maintain this requirement.

Outside exchanges in the small group and individual market, medical insurers must include pediatric dental in the medical policies they offer unless they have “reasonable as-surance” that the individuals being covered under the policy have purchased pediatric dental coverage that meets the state benchmark. So consumers insured in the small group and indi-vidual outside exchanges should be purchasing pediatric dental coverage – in their medical policies or separately.

“ As we are still in the first year of the inclusion of pediatric dental care as an Essential Health Benefit under the Affordable Care Act, it’s still a little early to reach any firm conclusions about the effect on patient visits or services provided.”

– Paul Reggiardo, DDS, national spokesperson of the American Academy of Pediatric Dentistry

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First Impressions: How does the Affordable Care Act affect coverage for kids under the Children’s Health Insurance Program, or CHIP?

Paul Reggiardo: The ACA doesn’t directly affect state CHIP and Medicaid programs, but it does so indirectly by broadening or increasing enrollment eligibility in many states. Thus, pe-diatric dentists are also seeing an increase in the number of children enrolled in these two public programs.

Evelyn Ireland: Public exchanges set up under the ACA re-fer applicants that meet income requirements for public pro-grams – like Medicaid and CHIP – to those programs. There are no separately reported federal figures for enrollment in CHIP as a result of these Exchanges. However, the National Association of Dental Plans noticed an unusual thing about

the half million children who applied for commercial cover-age through exchanges, i.e., they represent only about 6 percent of the total applicants. Usually children are about 30 percent of total applicants in a commercially insured popu-lation. So, it is likely that about 2.5 million children came in through exchanges, and that 2 million of them were referred to state CHIP programs based on state income guidelines. (CHIP income guidelines range from 200 percent of pov-erty to almost 400 percent of poverty.) However, CMS only reports Medicaid/CHIP expansion as an aggregate number, so it is impossible to verify our rough estimate of expansion of CHIP enrollment.

The other public program that has resulted in increased dental coverage is Medicaid. But it is likely that more adults

gained dental benefits through the ACA’s Medicaid expan-sion (increasing eligibility from 100 percent of poverty to 133 percent of poverty) than children. In FY 2014, 26 states expanded Medicaid eligibility and two more states will do so in FY 2015. The Centers for Medicare & Medicaid Services (CMS) reported in August that approximately 7.2 million additional individuals are enrolled in Medicaid and CHIP, a 12.4 percent increase over the average monthly enrollment for July through September 2013. This enrollment has fu-eled expansion of adult dental benefits in the states that have some level of adult dental benefit in Medicaid. The American Dental Association estimates that nine states that expanded Medicaid eligibility have extensive adult dental benefits and 11 states that expanded Medicaid eligibility have limited adult dental benefits (more than just emergen-cy). As 19 of the 26 states that expanded Medicaid income

eligibility have adult dental benefits, a significant portion of the 7.2 mil-lion additional enrollment in Medicaid and CHIP are adults who have gained dental coverage.

First Impressions: What has been the impact of the mandatory pedi-atric dental benefit requirement, in terms of patient visits? Services performed? What’s your outlook for the years ahead?

Paul Reggiardo: As we are still in the first year of the inclusion of pe-diatric dental care as an Essential

Health Benefit under the Affordable Care Act, it’s still a little early to reach any firm conclusions about the effect on pa-tient visits or services provided. However, anecdotally, many of my colleagues report seeing patients under ACA benefit programs, especially very young patients, who have never before visited a dentist or established a dental home. This is what the ACA intended.

Evelyn Ireland: It is too early to gauge the impact of the rela-tively small number of children who obtained commercial cov-erage through exchanges under the ACA. The policies have been in place for less than a year. NADP plans to examine data on 2014 utilization next year, comparing it to 2013 to see if the new enrollment changed any trends.

The answer to the question, “Are consumers required to purchase pediatric dental coverage, or are insurers just required to offer it?” is “It depends on where the purchase is made.”

– Evelyn Ireland, CAE, executive director, National Association of Dental Plans

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trends

But in general, we can say that the expansion of com-mercial dental coverage for children is small compared to esti-mates. Of the 8 million who applied for coverage in all exchang-es (state and federal), just under a half million were children. And there is no information on whether those that obtained medical coverage got medical coverage with a dental benefit. We do know that 1.13 million of the 5.4 million applicants who came in through the federal exchange applied for standalone dental coverage. However, only 63,448 (6 percent) of them were children. Most were young adults. So you can see that the expansion of commercial coverage from a dental perspective is primarily expansion of adult coverage. It will be interesting to see if these adults change any trends in utilization as well.

You also have to remember that all applicants did not purchase coverage. The Centers for Medicare & Medicaid Ser-vices recently reported that 7 million of the 8 million – about

88 percent – actually paid their premium and got coverage. The percentage is somewhat lower in dental from what carriers tell NADP. While we do not have data to support their reports, dental carriers commonly report about 70 percent of those ap-plying actually paid premium and put coverage into effect.

First Impressions: Has the ACA pediatric mandate steered patients to in-network dentists? If so, how have dentists responded? Are more joining networks? And who sets up these networks?

Paul Reggiardo: It is still premature to reach any firm con-clusions in this area, but it is not unreasonable to expect that numbers will increase in both managed care (exclusive

provider networks) and more traditional open networks (pre-ferred provider organizations). I think dentists will naturally re-spond to market pressures as these become clearer, and will vary significantly across market segments, geographical areas, and population densities.

A very pertinent corollary question is how patients and providers will react to the inclusion of pediatric dental benefits embedded in their health plans (rather than offered or pur-chased as a separate stand-alone dental plan). In California, for instance, all health plans sold in the health benefits exchange in 2015 will include an embedded pediatric dental benefit plan selected by the medical provider. In addition, stand-alone fam-ily dental plans will be offered. Adults with minor dependents purchasing a family dental plan in order to gain their own dental benefits, will find themselves with two policies and, likely, two separate dental provider networks, for their children.

Evelyn Ireland: The most common dental product is a dental preferred provider organization, or DPPO. DP-POs pay more to in-network dentists, although some payment is made to out-of-network dentists. The ACA pedi-atric dental benefit offers an incentive to use in-network dentists. All treat-ment by in-network dentists counts to a maximum consumer out-of-pocket payment; treatment outside of the net-work does not accumulate to this limit. For separate dental policies, this con-sumer out-of-pocket maximum is $350 for coverage of one child and $700 for

coverage of more than one child. Pediatric dental coverage is-sued through exchanges or in the small group and individual market does not have an annual maximum, so when the con-sumer hits his or her out-of-pocket maximum, the carrier pays 100 percent of cost of treatment for the remainder of the cov-erage year. This is a powerful incentive for consumers to use “in-network” dentists.

Most dental carriers used their regular networks to support coverage offered on the exchanges. Dental carrier networks are being expanded regularly, but NADP data being collected now is for 2013, so we will not have 2014 data until next year. The only specific recruitment that has occurred to support new ACA-compliant products is recruitment of essential community pro-viders. Dental plans are required to include 30 percent of ECP

Most dental carriers used their regular networks to support coverage offered on the exchanges. Dental carrier networks are being expanded regularly, but NADP data being collected now is for 2013, so we will not have 2014 data until next year.


(essential community provider) dentists in their networks or file an explanation of why that percentage cannot be achieved. ECP dentists are part of federal health care centers, or Ryan White or Indian health providers.

First Impressions: How affordable is pediatric dental insurance under the Affordable Care Act? It has been re-ported that premium assistance (through tax credits) to low-income people isn’t enough to cover the cost of most standalone pediatric dental plans.

Evelyn Ireland: Based on the data from the federal exchange, the average cost differential between a medical policy with em-bedded pediatric and dental coverage (referred to as a “10,” because it contains all 10 required benefits) and a medical pol-icy without dental coverage (referred to as a 9.5 policy) ranges from $33.45 monthly for a family with one child, to $70.05 for a family with 3 or more children.

Standalone-dental-plan average cost per child for low (70 percent actuarial value) coverage is $29.14 across all federal exchange states (ranging from a low of $14.72 to a high of $43.89). In the federal exchange states, the average child-only cost for a standalone dental plan for high coverage it is $35.20 (ranging from a low of $23 to a high of $52.84.)

Federal subsidies pay a portion of the premium cost of individuals with incomes between 133 percent of poverty and 400 percent of poverty who obtain individual coverage through a federal or state exchange. Federal rules require that the sub-sidy be paid to the medical carrier first, with anything that is left going to the dental carrier. Because the subsidy pays only a portion of premium, the only instance where a portion is left for payment to the dental carrier is when an individual buys a lower cost medical plan than the benchmark medical plan on which the subsidy is based. These instances have been limited based

on reports from the dental carriers selling coverage through state and federal exchanges.

First Impressions: The National Association of Dental Plans had predicted last year that when children’s cover-age is separated from their parents in the small group market, many parents would drop their dental coverage for economic reasons. Has that occurred?

Evelyn Ireland: It is too early to tell whether this change has occurred. NADP does not collect 2014 enrollment data until 2015. In addition, most small employers that thought they would be affected by the ACA renewed 2014 coverage early (often on Dec. 31 of that year), so their policies will not be af-fected by the ACA requirement until 2015. In addition, with the Obama administration’s delay of the employer mandate, many employers are not currently grappling with the changes brought on by the ACA.

First Impressions: To what extent does the Affordable Care Act lead to pediatric dentists being rewarded or pe-nalized based on patient outcomes?

Paul Reggiardo: The delivery system reform provisions of the ACA strive to achieve the “Triple Aim” of 1) improving the experience of care for individuals, 2) improving the health of populations, and 3) reducing per capita cost of care. In order to achieve those goals, the existing payment models and ex-isting health care delivery systems will need to be reformed. The current dental products marketed in and outside of the state exchanges do not differ significantly, as yet, from the delivery systems offered in the past. Thus, dentists are not yet finding for the most part rewards or penalties based on patient outcomes. FI

Federal subsidies pay a portion of the premium cost of individuals with incomes between 133 percent of poverty and 400 percent of poverty who obtain individual coverage through a federal or state exchange.


trends

Though much of the impact of the Affordable Care Act ac-tion is occurring in the state and federal health exchang-es, plenty is going on in the small group and individual markets as well, says Evelyn Ireland, executive director, National Association of Dental Plans.

When employers make the adjustments for the ACA’s requirements later this year and next year, they will discover processes in place that attempt to require them to purchase pediatric dental coverage, she says. “It is not a direct requirement, but an operational one.”

Small employer groupsMedical insurers are required to include pediatric dental in the policies sold to small employer groups (defined, for

now, as companies with 50 or fewer FTEs), says Ireland. If the small employer says it already offers dental coverage, the medical insurer has to get some type of assurance that each person covered by the policy has purchased a dental policy that is “Exchange certified.”

“There is no explanation in the regulation as to what ‘assurance’ is acceptable,” Ireland points out. “Some states have tried to define it in regulation, but it is ulti-mately the medical insurer’s decision as to whether to accept the ‘assurance.’ Some medical carriers are happy not to have to add another coverage to their policy; some don’t believe there is a legally defensible way to accept any assurance. Responses are all over the map.”

“Exchange certified” is a different process in each state, but on the whole, it means that the separate dental policy has all the provisions that are required for pediatric dental coverage sold on the exchange, says Ireland. “And the pediatric dental coverage has to be in everyone’s policy – older empty nesters, young invincibles, middle-aged folks with families – one and all.”

In another twist, the coverage added to a medical poli-cy does not have to have the same benefit levels that are in a standalone dental policy, she continues. For instance, a medical plan can subject the pediatric dental benefit to the full medical deductible – in 2014, a maximum of $4,000 for a family. Typical dental deductibles are $50 and are most often not applied to preventive visits.

“So, if you take your child in for a preventive visit early in the year, before your family meets the deductible, that cost could be out-of-pocket under a medical plan while typically paid in full by a dental plan,” she says. “And the medical plan can also make the pedi-atric dental coverage subject to a the full medical consumer out-of-pocket maximum [for 2014] of $12,700 for a family.” (That out-of-pocket increases to $12,900 in 2015.) “When in-

cluded in this way, the only children that will actually get any pediatric dental coverage under a medical plan are those that have family members with criti-cal, expensive medical conditions.

“It would have been much clearer if, somewhere in the law, there was a statement that when pediatric dental is not included in the medical policy, individu-als insuring children must purchase a pediatric dental policy for their children. But that is not in the law, so we have a patchwork of regulations that try to effect that end result – and the regulations are imperfect in attaining the goal.”

Small employers grapple with healthcare reform

“ There is no explanation in the regulation as to what ‘assurance’ is acceptable,” Ireland points out. “Some states have tried to define it in regulation, but it is ultimately the medical insurer’s decision as to whether to accept the ‘assurance.’

– Evelyn Ireland, CAE, executive director, National Association of Dental Plans


Percentage of firms offering health benefits that offer or contribute to a separate benefit plan providing dental benefits, by firm size and region (2014)

Separate dental benefits

Firm size

200-999 workers 88 percent

1,000-4,999 workers 91

5,000 or more workers 91

All small firms (3-199 workers) 52

All large firms (200 or more workers) 88

Region

Northeast 46 percent

Midwest 60

South 59

West 45

All firms 53 percent

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2014.

Fifty-three percent of firms offering health benefits of-fer or contribute to a dental insurance benefit for their employees that is separate from any dental coverage the health plans might include, according to a recently released study of employer health benefits. This is not statistically different from the 54 percent reported in

2012. Large firms (200 or more workers) are far more likely than smaller firms to offer or contribute to a sepa-rate dental health benefit (88 percent vs. 52 percent). The study, “Employer Health Benefits: 2014 Annual Survey,” was conducted by the Kaiser Family Foundation and the Health Research & Educational Trust.

Among firms offering health benefits, percentage that offer or contribute to a separate benefit plan providing dental benefits, by firm size (2000-2014)

2000 2003 2006 2008 2010 2012 2014

All small firms (3-199 workers) 30% 37% 49% 42% 45% 53% 52%

All large firms (200 or more workers) 60 78 79 81 87 89 88

All firms 31 38 50 43 46 54 53

Source: Kaiser/HRET Survey of Employer-Sponsored Health Benefits, 2014.

Dental benefits in employer plans


Ebola concerns in dentistryOffices are concerned about Ebola protection. One office wanted to order N95 respirators and full protection suits in case they had a possible case. I’m not sure if I should say yes or tell them it’s ridiculous! It’s confusing, because I

read Ebola isn’t airborne, but can be spread by close contact. The CDC lists it as a bloodborne disease, but it also can be spread by mucosal exposure. What if someone who has it sneezes on you? What PPE do you need? Is Ebola a realistic concern in dentistry?

I understand the concerns people have, given the rapidly changing news about the Ebola epidemic. The most likely risk of exposure to Ebola-infect-ed patients in dentistry

would be from someone with previous exposure, who has early disease with no or slight symptoms. Patients with later stages are probably so sick that they are not likely to seek dental care. Here are some key facts known so far about Ebola virus disease (EVD).

• Ebola is one of the most deadly infectious diseases, killing between 50 percent and 90 per-cent of those who are infected. Case fatality rates are much lower for influenza (1 percent) and SARS (13-43 percent).

• Ebola is highly infectious because a very low number of viruses can efficiently transmit the disease. However, it is less infectious than the flu because it is not “airborne.”

• The Ebola virus is a bloodborne disease that can be spread by many body fluids, including blood, semen, tears, sweat, urine, vomit, saliva, breast milk and re-spiratory secretions. Men who have recovered from the virus can still transmit the virus through their semen for up to seven weeks.

• The virus enters the body through openings in the skin and through mucosal absorption. The permeable mem-branes of the eyes, nose, mouth, genitals and gastro-intestinal tract are considered mucosal surfaces. For that reason, Ebola is considered a bloodborne, contact and droplet disease.

• The CDC states the disease is not at this time consid-ered to be an aerosol-transmitted-disease (contracted by inhalation of suspended small particles), nor is it

thought to be transmitted by ingestion (swallowing). The direct handling of, and con-tact with, blood and fluids of infected bush meet in Africa has been identified as a mode of transmission.

• Ebola incubation period is 2 to 21 days.

• Humans are not infectious until they develop symptoms.

• The first symptoms are sudden onset of fever, fatigue, muscle pain, headache and sore throat. This might be confused with many other illnesses.

• The next symptoms are vomit-ing, diarrhea, rash, symptoms of impaired kidney and liver function.

• Some people have internal and external bleeding.

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• Diagnosis must be made with lab tests. Body fluid samples must be handled with extreme biohazard protection precautions.

• As symptoms progress, the chance of spreading the virus through body fluids increases drastically.

• Most cases have been contracted from direct contact with infected individuals (alive or dead). Visibly “clean” skin of infected people can be expected to harbor the virus.

• The role of environmental transmission is largely un-known. The virus can stay alive on blood-contaminated surfaces for hours or days. Intermediate-level surface disinfectants are considered effective against Ebola virus, but no products have specific Ebola claims.

It is important to have a plan for the possibility of encounter-ing an Ebola patient who should be reported immediately to the local health department. At this time PPE for treating Ebola is full

body protection. Training and practice is important for using that PPE. The decision to buy that gear and do the training depends on the likelihood of treating patients with possible exposure. For screening patients, the current recommendations are to use standard precautions carefully, avoid percutaneous exposures and skin or mucosal contact with patients, and pay special at-tention to donning and removing PPE to avoid exposure to ANY bodily fluids. Continue to visit www.CDC.gov for updates.

There are many ethnic groups represented in my territory. Several groups are from West Af-rica, where the Ebola outbreak is. It is reason-able to expect some patients will travel to their

homeland and might possibly be exposed to Ebola, or might be exposed to someone who was exposed. One office asked me if there was a simple recommendation for protecting the office from Ebola-infected patients, and what supplies they needed. They looked, but mostly found many complicated documents. What would you recommend?

While it seems unlikely that a person infected with Ebola would seek dental care, the pos-sibility exists. It is vitally important that dental offices, like medical offices, be equipped with

screening strategies and that they have the training, set-up and supplies to safely screen patients. The goal of this screening is to identify, isolate and report suspected Ebola cases while keeping everyone safe.

There are two basic criteria to address when screening patients: their exposure risk and their symptoms. A logical sequence for screening patients is to assess their risk of exposure to Ebola, and then assess symptoms. The patient can answer the exposure risk questions on a form or verbally, and can answer questions about symptoms the same way. However, a key symptom of Ebola infection is elevated temperature. Dental workers should be pro-tected with PPE when taking the tempera-ture and assessing the health of any patient suspected of being infected with Ebola.

• All dental offices should be taking every patient’s temperature. Sell them thermometers. This is vital to discover other conditions,

such as influenza. Patients with fevers and symptoms sug-gestive of infection should not be seen in dental offices.

Step 1: Classify patient’s risk of exposure to EbolaThe risk of exposure to Ebola is based on the patient’s history over the preceding 21 days (Ebola incubation period). Follow the CDC Assessment Guideline below:High risk: Direct contact of infected body fluids through:

• needle stick, or splashes to eyes, nose, or mouth• getting body fluids directly on skin• handling body fluids, such as in a laboratory, without

wearing personal protective equipment (PPE) or follow-ing recommended safety precautions

It is vitally important that dental offices, like medical offices, be equipped with screening strategies and that they have the training, set-up and supplies to safely screen patients. The goal of this screening is to identify, isolate and report suspected Ebola cases while keeping everyone safe.

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• touching a dead body without correctly wearing PPE in a country with widespread Ebola transmission (In countries with widespread Ebola transmission, it is not always known what a person died of. Therefore touch-ing any dead body in one of these countries is consid-ered a high risk exposure.)

• living with and caring for a person showing symptoms of Ebola

Some risk: • close contact with a person showing symptoms of

Ebola such as in a household, healthcare facility, or the community (no PPE worn). Close contact means being within 3 feet of the person with Ebola for a long time without wearing PPE.

• in countries with widespread Ebola transmission: direct contact with a person showing symptoms of Ebola while wearing PPE

Low risk (but not zero):

• having been in a country with widespread Ebola transmission within the previous 21 days and having no known exposure

• being in the same room for a brief period of time (without direct contact) with a person showing symptoms of Ebola

• having brief skin contact with a person showing symptoms of Ebola when the person was believed to be not very contagious

• in countries without widespread Ebola transmission: direct contact with a person showing symptoms of Ebola while wearing PPE

• travel on an airplane with a person showing symptoms of Ebola

No risk:• contact with a person who is NOT showing

symptoms AFTER that person was in contact with a person with Ebola

• contact with a person with Ebola BEFORE the person was showing symptoms

• having traveled to a country with Ebola outbreak MORE than 21 days ago

• having been in a country where there is no widespread Ebola transmission (e.g., the United States), and having no other exposures to Ebola

Reference: Centers for Disease Control and Prevention. Moni-toring Symptoms and Controlling Movement to Stop Spread of Ebola, www.cdc.gov/media/releases/2014/fs1027-monitoring- symptoms-controlling-movement.html

Step 2: Assess the patient’s symptoms. Ebola symptoms are:

• Fever greater than 100.4°F • Fever greater than 100.4°F AND any of the following:

• Severe headache• Muscle pain• Weakness• Diarrhea• Vomiting• Abdominal or stomach pain• Unexplained bleeding or bruising (may be internal)• Sore throat, mild cough, respiratory symptoms• Severe flu-like respiratory symptoms

If the patient has risk of exposure but is asymptomatic they should be monitored for symptoms. The local health depart-ment should be notified to monitor the patient.

If the patient has risk of exposure but is asymptomatic they should be monitored

for symptoms. The local health department should be notified to monitor the patient.

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infection control

If the patient has risk of exposure and any symptoms they should be isolated immediately. The local health department should be notified immediately. The patient must be medically evaluated.

• Learn the phone number of the local Health Depart-ment. It may take several calls to get the direct line for reporting a possible Ebola patient.

• Suggest that the office identify where and how they would isolate a patient, and practice. Consider the need to completely disinfect that isolation room, and the need for a private restroom for the person.

• Remember: Ebola is a nationally notifiable disease and must be reported to local, state and federal public health authorities.

If the patient has no known risk of exposure, but has any Ebola-like symptoms, they require medical evaluation. No symp-tomatic, febrile patients should be treated in dental facilities.

Personal Protective Equipment (PPE):Treating Ebola patients: Full body coverage is re-quired. No skin can be exposed. This requires special suits, training, and managers assigned to observe donning and removal of the suits. Ebola patients should not be treated in dental facilities.

Screening dental patients for Ebola symptoms: Physical assessment requires the appropriate PPE because the dental worker moves to within 3 feet to the patient. While screening patients avoid aerosolizing procedures. Prepare for standard, contact and droplet precautions. For contact and droplet precautions, don high level masks, face

and eye protection, gown and gloves before going to within 3 feet of the patient, or entering the room. Avoid all direct contact with the patient without PPE. Implement isolation and separation protocol.

Have enough of:• Impermeable gowns (fluid resistant or impermeable)• Gloves• Shoe covers, boots, booties• Appropriate combinations of:

• Eye protection (face shield or goggles)• Facemasks (goggles or face shield must

be worn with facemasks)

• N95 respirators as added precaution for maximum respiratory protection if needed.

• Other infection control supplies (e.g. hand hygiene supplies)

• Intermediate-level environmental surface disinfectants All workers must be trained to don, use and remove PPE

and to perform environmental asepsis safely.

Ebola exposure is most likely in West Africa, but due to world travel may be encountered in the United States. The recom-mendations are constantly being updated, based on informa-tion learned from the present outbreak. The following links will provide up-to-date recommendations:

www.cdc.govwww.ada.orgwww.who.int/enwww.osap.org FI

Physical assessment requires the appropriate PPE because the dental worker moves to

within 3 feet to the patient. While screening patients avoid aerosolizing procedures.


By Laura Thill rep corner

Ready All, Row!“I don’t count any rowers out,” says

Matt Nordquist of his crew team-mates. An avid rower for more than 20 years – and currently a

member of the San Diego Rowing Club – he is well aware of the value serious rowers bring to the race. Indeed, the challenges rowers face can range from adverse weather conditions to one’s personal strength and build, he says. “There are no weight restrictions, but if a rower is too tall – say, 6 foot, 8 inches – he will have trouble fitting into the boat.” At the other extreme, short rowers must work extra hard to pull their weight. “In college, I rowed with a guy who was 5 feet, 9 inches,” he recalls. “He had to work hard and modify his strokes to keep up with the others, but he was a fierce competitor. You never can rule out another rower.”

The rower’s regimenNot only are they competitive, seri-ous rowers are truly committed, notes Nordquist, who joined the sport in high school at the encouragement of his then girlfriend (now his wife), Sharlene. As much as he would like to see his children – Eric, 12, and Ella, 10, take

to the sport, he knows better than to try and sway them. “Rowing isn’t something you just push on someone,” says Nordquist, branch manager at Burkhart Dental. “It’s not a sport you just try. You have to love it. When the alarm goes off at 4:15 a.m., you have your feet on the ground and you are off [to train]. We are at the boat house by 5:00 a.m. and finished rowing by 7:00 a.m. When we train, we want the water to be perfectly still, like glass.”

Whether he’s managing his Burkhart Dental

team or racing down the Charles, for branch

manager Matt Nordquist, it’s all about team effort.


rep corner

Some rowers train later in the day to accommodate their schedules. But, regardless of timing, training at the Masters level often means three or four sessions every week for about nine months of the year. During the off season, rowers often work out using ergometers, or rowing machines, and tanks – “an in-door facility [designed to] mimic conditions rowers face on open water,” Nordquist says. Indoor training is certainly not as much fun as the real thing, he says. On the East Coast, where outdoor rowing generally shuts down between November and February,

rowers can get pretty restless, he points out. “They can’t row out-doors until you can break the ice,” he says. “I do know of crews who are so ready to get outside, they break the ice and row in layers of special clothing.” In his neck of the woods – San Diego, Calif. – “we can row 365 days a year,” he adds. “We are spoiled!”

Without yearlong train-ing, rowers can’t build and maintain the stamina re-quired for the spring and summer races, which are shorter but more intense, Nordquist says. Indeed, there’s a reason why col-leges typically recruit taller rowers, who have greater reach, and swimmers and water polo players, who are known for their drive and stamina. “You want to build a deep well of aerobic capacity before you get to the spring race,” he says, noting that

men’s college teams generally complete the 2,000-meter race in 5.40 or six minutes. (Women’s college teams typi-cally complete it in 6.40 or seven minutes.)

Whereas rowers average 22-24 strokes per minute in fall races, by spring they are up to 34-36 strokes per minute, he continues, requiring rowers to build from an aerobic to an an-aerobic state. In other words, athletes burn off fuel differently in the higher-intensity races, and without the proper training, their bodies won’t be prepared to handle it. “It takes a lot of training to get eight rowers and a coxswain to work well together,” he says. So, even the fall races are considered part of the rowers’ training, he says. “The work rowers endure to prepare for a race – plus the race itself – is incredible. And, your boat is only as fast as your weakest rower. When someone’s not pulling his full weight, the boat feels it.”

Never a dull momentBeyond injuries to ligaments and muscles, there are greater hazards involved in rowing than one might think. “One after-noon we were rowing for the University of California in the Oak-land, Calif. Estuary,” Nordquist says. “Rowers face backward. Only the coxswain faces forward. At one point, I heard a sound, like a huge amount of air being released. It turned out we were rowing alongside a whale and were close enough that our star-board oars had hit its back!”

“Another time, while rowing along Newport Beach, Calif., we had a seal jump onto the ballast and ride along with us for several minutes.”

Yet another time, “we were rowing along the Oakland Estuary in a dense fog,” he says. “The Oakland Estuary is a large commercial port with many container ships. Suddenly, the coxswain shouted out for us to swerve right. Boats can turn, but generally not on a dime. We just missed an enormous container ship!”

A growing sportTwenty years ago, rowing was a popular sport in the Northeast, says Nordquist. Today, the sport has picked up along the West Coast, as well as the Midwest and the South. “We now see a lot of teams in Oklahoma, Michigan and Wisconsin,” he says.

For the most part, Nordquist participates in regional races on the West Coast. However, at press time he was looking for-ward to racing at the Head of the Charles Regatta in Boston, Mass., and his repertoire of races includes the Canadian Na-tionals and the Masters Nationals, which rotate between New Jersey and another state (this year, Michigan).

“Rowing is not

a sport you just try. You have to love it.”


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There are 50-60 events for rowers to choose from each year, he says. It’s one thing to fly oneself from one corner of the country to another. But, a boat? “We drive them out,” says Nordquist. “There are a lot of West Coast crews,” he says, referring to teams from Washington State, south to San Diego, Calif. “Sometimes, multiple club members collaborate and drive a boat to the race.” Other times, teams located nearby the race site may share their boats with visiting teams.

There are several levels of racing, and all of them are open to anyone with the dedication and stamina to compete:

• Juniors, or high school level racing.• College rowing.• Open rowing, which has no age

requirement and is open to adults out of school.• Masters, which is broken down by age.

That’s not to suggest there are age restrictions. “We have an 80-year-old rower in our club, and at one time we had

a rower in his 90s!” says Nordquist. “They would do the same workout as me. It’s astonishing to watch.”

In a race, each boat must have a certain average age of rowers. For in-stance, the annual race at the Head of the Charles requires the average age of each boat in Nordquist’s racing cat-egory to be 50 years old. “I am 42 years old,” says Nordquist. “Some of our row-ers are in their 50s or 60s.” It’s a bal-ancing game, he says. “If your boat has younger rowers, you must balance that with older athletes.”

The rowers aren’t the only stars in a race. “Coxswains are very important as well,” he says. “The coxswain moti-vates and steers the crew, and a good one can make the difference between

winning and losing.” In addition, while rowers have no weight restrictions, male coxswains must weigh about 125 pounds, and female coxswains must weigh about 110 pounds, he notes. “If he (or she) weighs less, the team must carry extra weight, such as sandbags, in the boat to compensate.” FI

As one might imagine, much of the discipline that goes into row-ing can also apply to sales. For one, there is no instant gratifica-tion with either. “In rowing, you train for nine months for the big race in May. In sales, you must work hard to provide customers with the level of service they expect, and there are no instant rewards.” And, whether in a boat or on a sales team, “it doesn’t work when people aren’t rowing in the same direction.”

From rowing to sales


tech talk By The DENTAL ADVISOR

Editor’s note: At The Dental Advisor, not a day goes by without our phone ringing from a customer asking for the “best.” As a dental publication that was designed after Consumer Reports, over the past 25 years we have learned one thing – the best changes from day to day. Providing relevant and timely informa-tion to customers is something we strive for. This series of Tech Talks focuses on educating dental sales professionals on the products and technology they are selling so they can in turn educate their customer. Product evaluations are available at dentaladvisor.com.

One of the questions we receive routinely from dentists is whether or not to choose an air-driven or electric handpiece. For routine restorative dentistry, a traditional air turbine handpiece can easily handle tooth prepara-

tion, finishing and polishing. It allows maximum access and operator comfort with a familiar feel. In certain clinical situations, the power and control of an electric handpiece will offer great advantages. Crown and bridge preparation puts a heavy load on the bur, and efficiency will be increased by using an electric handpiece, espe-cially in cases involving multiple teeth. The same can be said for removing existing porcelain and metal restorations.

With the increasing use of high-power magnification and optical scanning of prepara-tions in CAD/CAM technology, dentists are becoming increas-ingly aware of the quality of their tooth preparations. Since minor imperfections in margin detail become obvious when viewed on a high-resolution monitor, dentists are looking for every advantage to perfect their work, including choosing an electric handpiece.

Handpiece basicsThe power of a handpiece is a function of torque and turbine speed. High-speed air turbine handpieces commonly operate between 27-42 psi, with operating speeds of 300,000-500,000 rpm. These handpieces are used with a “brush” or “feather” stroke to avoid con-stant, heavy load on the bur. When subjected to a heavy load, speed and torque decrease, resulting in decreased efficiency or stalling.

Turbine design and bearing configuration are major factors in the performance and durability of high-speed handpieces. Tra-ditionally, steel components have been used. The use of ceramic ball bearings is increasing, because they are harder, lighter and

Dental Handpiecesmore wear resistant than steel. Ceramic balls reduce wear on the bearing and they produce fewer wear particles, which in turn increases turbine life. They can also reduce the noise generated by the air passing through the bearing. Manufacturers specify the maximum air pressure tolerances for each handpiece model. Exceeding air pressure recommendations will cause the turbine to work beyond its capabilities and thus fail prematurely. Man-ufacturers are continually refining the features of high-speed handpieces to make them more efficient and user-friendly.

Handpiece maintenance tips• Have at least three handpieces for every operatory (one

in use, one in the autoclave, one cooling down). Excessive use and repeated autoclave cycles will greatly reduce the lifespan of a handpiece turbine and other components.

• Do not place handpieces in an ultrasonic cleaner or solution.• Apply oil to the correct opening. The drive air line leads

directly to the handpiece turbine while other lines (water, exhaust) do not.

• Run the handpiece after lubrication (3-4 seconds) to en-sure that the lubricant reaches all moving parts and that excess oil is expelled. Alternatively, use an automatic handpiece maintenance system.

• Remove bur from handpiece before sterilization. Leaving a bur in will shorten the life of the chuck and cause burs to “cement” into place.

• After sterilization, completely cool the handpiece before use. If the turbine runs while it is still warm (and expand-ed), it will quickly fail. The handpiece outer shell should be cool to the touch before use. Running the handpiece under cold water will not cool the turbine sufficiently.

• Properly clean and maintain the autoclave to avoid buildup that can occur, affecting the entire system, including the handpieces.

• Spray cleaner into the bur hole once per week. Debris builds up quickly inside the chuck (bur insertion hole). This debris clogs the spring and causes bur slippage. FI

Turbine design and bearing

configuration are major

factors in the performance and durability of high-speed

handpieces.

We know distribution and the channel knows First Impressions.

MORE WAYS TO IMPRESS!

Let us help you impress:Monica Lynch770.263.5266E-mail: [email protected]

Bill Neumann215.816.2866E-mail: [email protected]

We send First Impressions to 97% of the dental dealer reps in the US

We send First Impressions digital versions to dealer reps in Canada, Mexico and globally

We send First Impressions to virtually all 2,500 US-based service techs

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news

Henry Schein and Quintessence host first international symposium on digital dentistryHenry Schein Inc (Melville, NY) and Quintessence Publishing Co Inc (Hanover Park, IL), an independent publisher of scien-tific and clinical information about oral health, hosted the first international symposium on digital dentistry. The conference, entitled “Technologies That Enhance Clinical Outcomes,” pro-vided in-depth educational experiences for dentists and dental laboratory technicians and owners on the clinical benefits of digital technologies and open platform workflows. The confer-ence took place October 23-25, 2014 at the Renaissance Or-lando at SeaWorld in Orlando, Florida. Conceived as a pathway into digital dentistry for dental professionals, the conference focused on procedure planning and treatment and highlight-ing the ways digital tools can facilitate the clinical and esthetic results of tooth restorations and implants.

California approves dental telehealth programCalifornia passed a new law expanding the Virtual Dental Home (VDH), a program that uses telehealth technology to bring den-tal services directly to patients in community settings, such as schools and nursing homes. The bill was the outgrowth of a demonstration project established in 2010 by Paul Glassman DDS, director of the Arthur A Dugoni School of Dentistry’s Pa-cific Center for Special Care (San Francisco, CA). The law ex-pands the scope of practice for dental hygienists and assistants and provides payment for telehealth-enabled dental services under California’s Medicaid program. It uses dental hygienists to screen patients and send data electronically to dentists at

clinics or offices who advise the hygienists which preventive and routine restorative care should be done. Services provided include cleanings, sealants, fluoride, X-rays, chart preparation, oral hygiene instruction, nutritional counseling, and placement of interim therapeutic restorations. Patients requiring more complex care are referred to dentists who review the records before an office visit.

Midmark announces year-end sterilizer promotionMidmark (Dayton OH) announced a dental sterilizer promo-tion in support of the 2014 Midmark Dental Family Program, Great Alone Better Together. During the promotion, customers can receive incentives with the purchase of eligible Midmark sterilizers and Soniclean® Ultrasonic Cleaners through the end of 2014. The promotion includes rebates ranging from $300 to $1300 with an additional rebate offered for the donation of an old sterilizer to Direct Relief (Santa Barbara, CA). The order period is October 1 through December 31, 2014 and custom-ers must take shipment of products by January 15, 2015. The last date to claim incentives is January 31, 2015. For more information, visit midmark.com/dentalsterilizer

Patterson Dental and Quality Systems forge strategic partnershipPatterson Dental Supply (St Paul, MN) entered into an agreement with Quality Systems Inc (QSI) (Irving, CA). QSI will leverage Pat-terson’s special market division sales force to establish a new line of business with dental group practice customers, thereby increasing the company’s footprint within the market segment.

Submit your people news and new product announcements to: Monica Lynch at [email protected]

Air Techniques introduces new ProVecta S-Pan panoramic X-rayAir Techniques announced the all new ProVecta S-Pan Panoramic X-ray, featuring a new level of im-age sharpness in dental radiography, paving the way to faster and more precise therapy. A full adult panoramic X-ray is available in just seven seconds and offers 17 image programs. Among these 17 pro-grams there are four specifically designed for children, offering a reduced radiation exposure. The heart of the S-Pan image technology starts with the patient specific path that the Csl sensor follows and con-tinues as 20 layers of images are collected, sliced into 20,000 image segments, and then one amazing-ly sharp image is automatically constructed from the best selections. Patient comfort is accommodated by height adjustment and outward facing orientation and assured positioning with three laser guides. For more information, visit www.airtechniques.com.

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news

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Brian Miles Anna Phelps Zachary Smith Larry Waters

Eric Bramel John Budden Bill Crone Todd Cullmann

Anthony Danseglio Daphne Devora Tracey Earls Syndell Goode Damon Grant

Daren Huey Adam Jackman Chip Jones Doug Laney Caroline McClurg

Patterson Appointees Announcements

Benco Dental New AppointeesEileen Kelly, Territory RepresentativeEileen Kelly joins Benco Dental in the Dallas region. The Radford University graduate brings seven years of experience in the dental industry to the position.

Kristin Murray, Territory RepresentativeKristin Murray joins Benco Dental’s team in the Chesapeake region. Murray, a University of Mary-land graduate, brings more than 9 years of dental sales experience to the position.

Cindi Nairne, Territory RepresentativeBenco Dental is pleased to welcome Cindi Nairne to its SoCal region. She will call on customers in Santa Clarita, Palmdale and West Valley. Nairne brings more than six years of dental sales experience to the position.

Danielle O’Dell, Territory RepresentativeThe Benco Dental team in the Rocky Mountain region welcomes Danielle O’Dell. The Certified Dental Assistant will call on customers in Colo-rado Springs and Pueblo, Colorado. O’Dell previ-ously worked in the sales industry.

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news

Henry Schein Appointee Announcements

John A. Shernock III, Territory RepresentativeJohn A. Shernock III joins Benco Dental in the Rocky Mountain region. The graduate of Georgia Southern University will call on customers in Al-buquerque and Santa Fe, New Mexico. He bring four years of experience in the dental industry to the position.

Michelle Smith, Territory RepresentativeMichelle Smith is now part of Benco Dental’s Carolinas region. She will call on customers in Columbia, South Carolina and Augusta, Georgia. Smith, a Certified Dental Assistant and Certified Preventive Functions Dental Assistant, brings more than 7 years of dental experience to the Benco family.

Caryn VanEck, Territory RepresentativeThe Benco Dental team welcomes Caryn VanEck in the Chicago region. She attended the Univer-sity of Iowa and brings two years of dental sales experience to the position.

Sandy Vestal, Territory RepresentativeSandy Vestal, a Drury University graduate, joins Benco Dental in the Gateway region. She is a Certified Dental Assistant and brings 11 years of dental experience to the Benco family.

Alena Yapport, Territory RepresentativeThe Benco Dental team welcomes Alena Yapport in the Long Island region. She will call on customers in Brooklyn, Manhattan, and Staten Island. Yap-port, a graduate of Queens College, brings more than five years of dental experience to the position.

Medina Cox, Field Sales Consultant Cox will represent Henry Schein Dental at its center in Richmond, VA. She has 19 years of experience in the dental industry and was previously employed as a senior district manager. Cox received her B.A. from Michigan State University in East Lansing, MI.

Mike Stovall, Field Sales Consultant Stovall will represent Henry Schein Dental at its cen-ter in Rocklin, CA. He has 12 years of experience in the dental industry and was previously employed as a field sales consultant. Stovall received his B.S. from California State University, Fresno in Fresno, CA.

Chris France, Field Sales Consultant France will represent Henry Schein Dental in the North Los Angeles area. France received his B.A. from Harding University in Searcy, AR.

Mandy Harrison, Field Sales Consultant Harrison will represent Henry Schein Dental at its center in Charleston, SC. Harrison received her B.B.A. from James Madison University in Harrisonburg, VA.

Kevin Starr, Field Sales Consultant Starr will represent Henry Schein Dental at its center in Kansas City, MO. Starr received his B.S. from Missouri State University in Springfield, MO.

Mike Debalski, Field Sales Consultant Debalski will represent Henry Schein Dental at its center in Columbus, OH. Debalski received his B.S. from the University of Akron in Akron, OH.

Renee Friedel, Field Sales Consultant Friedel will represent Henry Schein Dental at its center in San Diego, CA. Friedel received her B.B.A. from the University of Akron in Akron, OH.

Diana Lee, Field Sales Consultant Lee will represent Henry Schein Dental in the Los Angeles/Orange County area. Lee received her B.S. from Trisakti University in Indonesia.

Amanda Tewksbury, Field Sales Consultant Tewksbury will represent Henry Schein Dental in the Northern Virginia area. Tewksbury received her B.S. from Virginia Tech in Blacksburg, VA.

Matt Bauscher, Field Sales Consultant Bauscher will represent Henry Schein Dental at its center in Boise, ID. Bauscher received his M.S. from Concordia University in Irvine, CA.

Diane Webler, Field Sales Consultant Webler will represent Henry Schein Dental at its center in Boston, MA. Webler received her B.A. from the University of Massachusetts, Amherst in Amherst, MA.

Chris Bennett, Field Sales Consultant Bennett will represent Henry Schein Dental at its center in Medford, OR.

Casey Merricks, Field Sales Consultant Merricks will represent Henry Schein Dental at its center in Baltimore, MD. Merricks received her B.S. from the Institute for the Arts in Philadelphia, PA.

Blake Harms, Field Sales Consultant Harms will represent Henry Schein Dental at its cen-ter in Des Moines, IA. Harms received his B.A. from the University of Northern Iowa in Cedar Falls, IA.

Lawrence Nguyen, Field Sales Consultant Nguyen will represent Henry Schein Dental in the San Francisco Bay area. Nguyen received his B.A. from the University of Houston in Houston, TX.


Dave Massi, Field Sales Consultant Massi will represent Henry Schein Dental in the Metro NY/NJ area. He has three years of experience in the dental industry and was previously employed as a dental assistant. Massi received his B.S. from Stony Brook University in Stony Brook, NY.

Heidi Marr, Field Sales Consultant Marr will represent Henry Schein Dental at its center in Seattle, WA. Marr received her B.A. from Washington State University in Pullman, WA.

Daniel Zoeb, Field Sales Consultant Zoeb will represent Henry Schein Dental at its cen-ter in Woodbury, NY. Zoeb received his B.A. from the University of San Diego in San Diego, CA.

Alexa Jonson, Field Sales Consultant Jonson will represent Henry Schein Dental at its center in Indianapolis, IN. Jonson received her B.A. from the University of Dayton in Dayton, OH.

Leslie Cole, Field Sales Consultant Cole will represent Henry Schein Dental at its center in Tucson, AZ. She has 21 years of experi-ence in the dental industry and was previously employed as a dental assistant.

Craig Dreiling, Field Sales Consultant Dreiling will represent Henry Schein Dental at its center in Oklahoma City, OK. He has three years of experience in the dental industry. Dreiling received his B.S. from the University of Central Oklahoma in Edmond, OK.

Bobby Broughton, Field Sales Consultant Broughton will represent Henry Schein Dental at its center in Albuquerque, NM. Broughton re-ceived his B.B.A. from Texas State University in San Marcos, TX.

Jordyn Adams, Field Sales Consultant Adams will represent Henry Schein Dental at its center in Nashville, TN. Adams received her B.A. from California State University, Sacramento in Sacramento, CA.

Stacey Ehlers, Field Sales Consultant Ehlers will represent Henry Schein Dental in the Connecticut area. She has 17 years of experi-ence in the dental industry and was previously employed as an assistant professor of dental hy-giene. Ehlers received her B.S. from the Univer-sity of Bridgeport in Bridgeport, CT.

Megan Duddy, Field Sales Consultant Duddy will represent Henry Schein Dental in the Dublin/East Bay area in California. Duddy re-ceived her B.A. from California Polytechnic State University in San Luis Obispo, CA.

Annette Melovitz, Field Sales ConsultantMelovitz will represent Henry Schein Dental in the Metro NY area. She has 20 years of experience in sales and was previously employed as a clinical sales representative. Melovitz received her B.A. from Temple University in Philadelphia, PA.

Derek Farber, Field Sales Consultant Farber will represent Henry Schein Dental at its center in Woodbury, NY. He has three years of ex-perience in the dental industry and was previously employed as a dental assistant. Farber received his B.S. from Hofstra University in Hempstead, NY.

Jon Uselman, Field Sales ConsultantUselman will represent Henry Schein Dental in the San Francisco Bay area. He has 12 years of experience in the dental industry and was previ-ously employed as an account executive.

Mike Lamorgese, Field Sales ConsultantLamorgese will represent Henry Schein Dental at its center in Orange, CA. Lamorgese received his B.S. from the University of Dayton in Dayton, OH.

Patrick Patterson, Field Sales ConsultantPatterson will represent Henry Schein Dental at its center in Des Moines, IA. He has eight years of experi-ence in the dental industry and was previously em-ployed as a sales consultant. Patterson received his B.A. from University of Northern Iowa in Cedar Falls, IA.

William Rotert, Equipment & Technology SpecialistRotert will represent Henry Schein Dental at its center in Fresno, CA. He has 20 years of experi-ence in the dental industry and was previously employed as an equipment & sales specialist. Rotert received his B.S. from the University of Kansas in Lawrence, KS.

Paul Piccirillo, Dental Technology SpecialistPiccirillo will represent Henry Schein Dental at its center in Boston, MA. Piccirillo received his B.A. from Stonehill College in Easton, MA.

Chas Pajares, Field Sales ConsultantPajares will represent Henry Schein Dental at its center in Austin, TX. He was previously employed as a national account executive and received his B.B.A. from Texas State University in San Marcos, TX.

Bart Hillman, Equipment & Technology SpecialistHillman will represent Henry Schein Dental at its center in Seattle, WA. He was previously em-ployed as an account executive for three years.

Sterling Shearer, Equipment & Technology SpecialistShearer will represent Henry Schein Dental at its center in Anchorage, AK. He was previously em-ployed as a civil engineer and received his B.S. from Montana State University in Bozeman, MT.


leadership

What is your leadership brand?

You absolutely have one. It may not be what

you think it is. Others decide what your brand really is.

Why does it matter? People want leaders to predict within broad ranges what to expect. In a world increasingly characterized by uncertainty, it becomes crucial to have some core things upon which people can depend. As a leader, your brand provides a sense of order.

Your brand is another way of say-ing what you stand for. It clarifies what is important to you, what you value, and what others can expect. It is a declara-tion about who you aspire to be as a leader. Because it is aspirational, we expect to fall short while also expecting that we will constantly strive to be who we desire to be.

We often focus on the behaviors of leaders, and that lens is important to our brand. The stating of the brand is equally important. Being transparent and pow-erful about my leadership brand gives others the framework for how they should evaluate my lead-ership. Your brand will prob-ably consist of strategic intent (what matters to you) and a set of descriptors that depict what you value as a leader. A strate-gic intent might be something like “building a cross-function-al team to create a new sales

strategy.” A set of descriptors might in-clude words like bold, creative, future-oriented, courageous, and heartfelt.

The power is in putting those two things together. So your branding state-ment becomes something like this . . . I will be bold, creative, future-oriented, cou-rageous, and heartfelt so that I can build a cross-functional team to create a new sales strategy. Then you have to deliver that statement with powerful presence AND live it in a bold and authentic way.

Leadership presence is commonly misunderstood. We often conflate it with charisma. Because presence is an authentic reflection of our way of connecting with others, each of us will have a unique presence about us. We cannot learn presence by watching someone else. This is related to brand in the sense that our brand should be aligned with the type of presence we most naturally possess. When I work with leaders in this type of presence I’m more often than not trying to get the interference out of the way, not create something new.

Finally, I have had some leaders tell me that discussions about their brand or legacy feels selfish in some way. It feels like it is about them. I would simply respond that you are part of a system, and as you change, so changes the system. If this work makes you better and stronger, it makes the system the same. FI

By Randy Chittum, Ph.D

Leadership Brand and Presence

Because presence is an authentic

reflection of our way of connecting with others, each of us will have a unique presence about us.

We cannot learn presence

by watching someone else.

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