Featured Guest: Beverly Wilburn, DAADOM

What she does:  Beverly is the office manager of Karl A. Smith, DDS, LLC Periodontics and Implants, a multi-site practice with locations in Virginia and Maryland. In addition to managing the practice full-time, she serves as an expert of dental business practices and standard of care in practice administration systems for several law firms across the US. She has provided expert witness testimony on behalf of the prosecution and defense at both the State and Federal level.  Beverly is a Diplomate and Lifetime Member of the American Association of Dental Office Management (AADOM) and awarded the 2022 Dental Practice Administrator of the Year and is a recipient of a Denobi Award. She is the founder of Dental Spouses in Business™, the Executive Director for the Virginia Society of Periodontists, chapter president of AADOM's Dental Spouse Business Network as well as a member of three local chapters, and serves on the board for Dental Entrepreneur Woman.

On risk:  "Risk is a possibility. It's not a fact. Risk is a thing, it's a factual thing. It's a possibility of something happening. And I think people have to remember that. A lot of people, when they hear the word risk, they assume it has some kind of negative connotation around it, and it really just means that we need to protect ourselves. It's a possibility that something could happen and we need to be aware of it. It's an awareness around situations that can happen, and it's a bringing to the forefront, a thought about making sure that we protect ourselves … When you're thinking about why do I have to be concerned about risk? It's ultimately because you want to protect your practice. You want to have longevity of the practice. If the practice doesn't survive, we now can't help people and help more patients … Part of the risk, part of where that comes to risk, is now we are having an access to care issue … Awareness is obviously number one, awareness of what risks can be, if things are in line and everybody's ducks are in a row and things are proceeding on, and you've got a good system in place, even when something does adversely happen, it's almost foolproof. You have the resources at your fingertips. You know what to do, when to do it. You're prepared and it helps to simplify knowing that risk is always going to be there. It simplifies the process when something does happen"

Transcript

Scott Nelson  0:01  
Welcome to The Risky Health Care Business Podcast, where we help you prepare for the future by sharing stories, insights, and skills from expert voices in and around the United States health care world with a mission to inform, educate, and help health care organizations and individuals, ranging from one doctor practices to large integrated systems and organizations throughout the dental, medical, and veterinary health care industry with risk, while hopefully having some fun along the way. I'm your host, Scott Nelson, a guy that grew up in Ohio and has been working all over the United States during my 20 plus year and counting career in the health care industry, with a commitment to accelerating health care performance through creativity, not just productivity. Let's dive in. 

Dental care, like all health care fields, is not without its traditional and non-traditional risk in administrative, business, and clinical areas. 

The American Dental Association recently released its "Economic Outlook and Emerging Issues in Dentistry" report for the 2nd quarter of 2024.  When asked about challenges in the next 6 months, dentists reported the #1 challenge to be workforce issues, such as hiring, recruiting, training, and retraining.  41% of respondents reported being too busy to treat all patients requesting care in the past 3 months or they have treated all patients but were overworked.  Workforce issues was followed by insurance reimbursement and increasing overhead expenses.

The potential for adverse events is a constant concern in dental care. Dental practices face significant risks that can lead to severe consequences for both patients and practitioners, including financial distress and legal repercussions.

In this episode I'm speaking with Beverly Wilburn about risk in dental care.  Beverly is the office manager of Karl A. Smith, DDS, LLC Periodontics and Implants, a multi-site practice with locations in Virginia and Maryland. In addition to managing the practice full-time, she serves as an expert of dental business practices and standard of care in practice administration systems for several law firms across the US. She has provided expert witness testimony on behalf of the prosecution and defense at both the State and Federal level.

Beverly is a Diplomate and Lifetime Member of the American Association of Dental Office Managers - also known as AADOM - and awarded the 2022 Dental Practice Administrator of the Year and is a recipient of a Denobi Award. She is the founder of Dental Spouses in Business™, the Executive Director for the Virginia Society of Periodontists, chapter president of AADOM's Dental Spouse Business Network as well as a member of three local chapters, and serves on the board for Dental Entrepreneur Woman.  Let's talk with Beverly about risk in dental care.

Beverly, welcome to the show. 

Beverly Wilburn  2:04  
Hi, Scott. 

Scott Nelson  2:05  
Before we begin our conversation about risk in dental care, let's go back to the beginning. How did you get into dental care and where you are today? 

Beverly Wilburn  2:42  
I started in a, actually, what was a large, pretty large scale dental office back in the year 1999. I was in a receptionist position. It was after college. I didn't know what I was going to do with myself, and thought, hey, you know, I had a girlfriend that was working in a dental office, and she was like, what do you think you want to come work here? And I said, okay, so I took a little course at a community college for like two weeks just to kind of get my feet wet with dentistry, and ended up working as a dental assistant for one whole day. It was probably the worst experience of my entire life. I said, I will never do that again. And I guess they liked my personality enough that they called me back and they said, well, if you won't consider dental assisting, which was, again, a little bit of a nightmare. They said, well, how about if you come up front and see if you kind of want to answer phones and stuff. And I was thinking it was just going to be a summer job, honestly, and ended up kind of falling in love with it. And by about day four, I was pretty much doing that job. And then ended up staying with that company for a little while, and handled some negotiations of buying new practices, and ended up doing a lot of their marketing and other things over about a two and a half year period, and met the love of my life there, who happened to be a periodontist and who was working in that practice, and we ended up with our own office several years later. So that's kind of my journey through this process. Risk was a whole nother thing, but that was my journey in dentistry in general. 

Scott Nelson  4:08  
In addition to your practice work and experience, you're also active in a variety of ways in multiple national, state and local organized dental professional groups. 

Beverly Wilburn  4:16  
I became affiliated with an organization called AADOM, which is the American Association of Dental Office Managers or Management, I'm sorry, and they are just a wonderful organization that is very, very supportive of the managerial side of dental office practice administrators or practice managers. And there was kind of no organization like that for us, you know, clinicians have a lot of places that they can go for help and resources. They can go to their state dental societies. They can go a lot of different places. They have a lot of networks, maybe even alumni networks or other things where they can get support from, but there really was nothing for us, for managers, and that organization started very, very small. I've been, I'm a lifetime member, so I've been a member for many, many years, and they just have really helped kind of springboard a lot of things for me in regards to my education. They do have a fellowship program so there's actually three levels of that fellowship program. And as you go through the ranks of learning all of those things, it's a lot of education on different areas of management that sometimes aren't thought about by everyday office managers and of dental offices, and they've just done a great job with how their education platform works, their networking systems, and, frankly, just their cohesion of the people you know that are members, the membership cohesion. And so it's, it's a really great organization. I recommend every single dental office manager be part of it in regards to it gives it just gives you a really big jump into owning your career as a dental office manager. I was fortunate enough to win Practice Administrator of the Year in 2022 which is a very big honor. It's peer nominated, doctor nominated, so they, you know, your doctor nominates you, and then there's a kind of a secret board that selects and it's a very big honor to win that so that was kind of a very big highlight and pinnacle of my career in dental management. 

Scott Nelson  6:13  
You've got a great story and great experiences you just shared there, and have accomplished a great deal in your career. I'd like to start by getting your thoughts on what is risk in dental care. Risk can, and usually does, mean different things to different people, and likely depending on the job or the role, whether or not you're the doctor or the hygienist or the dental assistant or in your position or other staff. So as a dental practice manager and professional, how do you view and think about risk in dental care? 

Beverly Wilburn  6:38  
I really think that risk is honestly a possibility. It's not a fact. Risk is a thing. It's a factual thing, but it's a it's not it's a possibility of something happening. And I think people kind of have to remember that a lot of people, when they hear the word risk, they assume it's has some kind of negative connotation around it, and it really just means that we need to protect ourselves. We need to it's a possibility that something could happen, and we need to be aware of it. I think sometimes some providers, offices, other things like that, allow their worry around risk to alter paths of treatment, and all of those factors involved around risk. And I think that they need to remember that it really is just a possibility that we need to be aware of. It's just an awareness around situations that can happen, and it's a bringing to the forefront a thought about making sure that we protect ourselves. 

Scott Nelson  7:33  
The ADA recently released its "Economic Outlook and Emerging Issues in Dentistry" report for the second quarter of 2024 and the ADA received 798 responses to a question about what dentists saw as the three biggest challenges facing dental practices in the next six months. The top five challenges were workforce issues, insurance reimbursement, whether or not delayed or denied payments, increasing overhead expenses, increasing cost of staff and salary benefits, and inflation/economy. As a dental professional, and one that serves also, because we haven't touched on this yet, but you also serve as an expert witness in legal cases involving dental care, where is risk in dental care for you? Where should dental professionals and organizations be watching and monitoring or preparing as potential areas of concern may come up? 

Beverly Wilburn  8:19  
So as an expert witness, obviously we see patient harm or litigation are obviously areas of concern and risk, and as you can see from that ADA report it doesn't sound like a lot of people are so concerned about that and rightfully so. They shouldn't necessarily be. Patient harm and litigation are just a very small part of risk in dental care. And even when a patient does have some kind of harm or something like that it doesn't necessarily mean that that is going to be a big challenge for the office. As long as they do things right in the right situation that doesn't necessarily mean that that's going to be a problem even when a patient does have an adverse outcome to something. So I definitely think that's probably a good idea that people aren't so very concerned about it, and it didn't make like number one in the report, or any of those kind of things. But I definitely think that it some of the challenges and the things that we see are also in reputation. There's risk in reputation of risk, it's important because of practice protection and longevity as well. So when you're thinking about, you know, why do I have to be concerned about risk. It's ultimately because of you want to protect your practice. You want to have longevity of the practice. If the practice doesn't survive, we now can't help people and help more patients. So those areas of risk, obviously, patient harm or litigation, are some of those. It also is OSHA. We see a lot of things with, you know, OSHA regulations. Those OSHA regulations sometimes do end up coming into play when we're talking about patient harm, especially things nowadays, things like water line safety, other things like that. So it also, you know, health care data, private health information, those are big areas of risk that we're seeing now in regards to patients information being released. Cybersecurity is kind of another area of risk that I think is a little bit overlooked. Insurance, insurance, I don't see so much risk unless there's something negative that maybe a practice isn't billing exactly the way they should, and not that they're doing that from a not that they're doing that from a standpoint of trying to be I don't want to say illegal is not a great word for it, but kind of not that they're maybe trying to do something in the area of like to deceive, but they sometimes don't know, sometimes education or other things they don't know how they should be billing something, or how they should be doing other things. So that sometimes can be an issue with the insurance part of risk, of why we see risk in insurance claims or insurance payments or other things like that is really just in how things are billing. So all of those are risks that we face every day you know. We have a risk of an insurance company doing an audit. We have a risk of, you know, OSHA coming in and doing an audit. So there's a lot of areas there that we might see some risks in as well, other than the obvious areas of risk, which are basically patient harm or some type of litigation, which is what I deal with most obviously as an expert witness, usually when I'm called, it's at that point of the game. 

Scott Nelson  11:10  
There was a report recently of a dentist in Tennessee that abruptly closed a practice and filed for bankruptcy with a statement it was due to unforeseen financial difficulties.  This is becoming more prevalent throughout health care.  With that example in mind - or any of the ones you talked about - why is it important to think about risk in dental care and actively plan and be prepared?

Beverly Wilburn  11:27  
I think it's definitely because we want to make sure our practices survive. We want to make sure that we have places that are able to you know, dentistry, dental practices, dental offices, are still small businesses in a lot of ways. Yes, there are large scale corporations, there's DSOs dental service organizations, there's other things that kind of put that make that into a big business. But at the end of the day, your small dental practice is is really just a small business that needs to survive for again, being able to have patients have access to care, and being able to care for the team members that work there, and being have a place to employ people and just like any other business. So definitely, I think, one of the main reasons that we we need to pay attention and focus there is because we want to make sure that our businesses survive, and we want to make sure that there's longevity of the practice, and we want to make sure that, I think everyone gets into dentistry originally because they want to help people. I don't think most, let's say, don't choose dentistry because they see all the big dollars in it. They go in because they do have that nurturing passion to be able to help another human being with some kind of health care role in their life. Being able to do that and being able to service more patients and have access to care for more patients, requires our practices being able to remain open, and we need to make sure that we protect ourselves to be able to remain open and stay open and have a fruitful business. 

Scott Nelson  12:46  
Going back to the challenges facing the dental care and that ADA Q2 2024 economic outlook report, one question asked dentist about actions they've taken this year, including investing in new equipment and software, adding staff and dropping some insurance networks. You had touched on insurance, and I want to talk a little bit about that, and maybe take a little different approach or different thought on insurance based on feedback that's shared a lot these days. It came up in that report, more than 50% of the respondents in that report said that either, yes, they've dropped insurance networks this year, so about 25%, others, 26.9% said they may do that later this year. How is insurance impacting dental care, not necessarily from billing and coding issues, but more of even reimbursement rates and how doctors are getting paid, how is insurance impacting dental care to a point where dentists are either dropping or considering dropping insurance networks? 

Beverly Wilburn  13:41  
Insurance is, it's insurance. And there's I think that what is a hard part to understand is insurance is actually kind of not even the word for what you receive in dentistry. So when you buy insurance, let's say your vehicle insurance, you go out and you pay this premium to your vehicle carrier, and the their goal is ultimately to take that premium from you every single month and to hope that you don't have an accident, but if you do, then you need to have some kind of funds to be able to pay for that. And then hopefully they'll come in and do what they are supposed to do. However, as we know, even when we do sometimes, if anybody has ever had the unfortunate situation of being in a vehicle vehicular accident, the insurance is going to do everything that they can to not pay or to pay out as little as possible for that accident. And dental insurance kind of works the same way. I mean, their goal is to they're built around a healthy mouth. They're built to do very good things when it comes to dental cleanings and oral care just routine. However, anytime there's some kind of major thing, it's usually very minimal benefits in regards to what a patient is provided. So the reason the reimbursement rates are kind of an issue is because what a lot of patients don't understand is that, yes, they have a policy, and they have, you know, something that they're paying for, and we would hope that at minimum, they would get every dollar that that plan and that policy is going to provide based on whatever they have written on that outline of benefits. However, that's not always the case. The insurance companies are, every day finding new ways to, and I'm not completely insurance adverse either, so I do want to kind of put that little note in there. I think insurances can be a really good thing and help out some patients in need in certain situations. It's just not always the best thing. It doesn't always give the patient the most care that they are, they should, and really that's just because of the amount that, you know their businesses as well. They are just like dental offices. They have a business to run and their business is to have people buy their product, which is the insurance reimbursement, and their if they pay out more than that reimbursement on every single person, they won't have a business either. Their business won't be solvent. So I do tend to look at it a little bit from the business aspect of it. And I think you had mentioned earlier about some practices having bankruptcy. I think sometimes that might just be that they have either taken a little bit too much interest in what the insurance is going to do, not so much on the business side of things, and if there's you're taking, you don't have a balance in your practices, so if you're taking either too much insurance, or not enough private pay, or there's not enough balance there the practice can't be solvent, businesses can't be solvent to do that. So that part is a challenge and I think that's where some people see that. The reimbursement rates are going down all the time. And I shouldn't say they're going down. Down is kind of a bad way to do it. They're not increasing. $1,500 was the average insurance maximum in the year 1960. Well, here we are in 2024 and I would say probably 70 to 80% of insurance plans $1,500 is still that. Well, in 1960 $1,500 could buy you a significant amount of dentistry. In 2024 that's not necessarily the case. Our expenses are increasing every year, just like everything else, and I believe, honestly, the insurance company's expenses are increasing every year as well. They have staffing just like we do. Their team members probably want more money every year just like ours do. It's kind of a round for round. So I think it's really good in certain practice situations to obviously entertain that insurance aspect of it and do everything we can to help the patients get every reimbursement that they can. But I think we also can't be so locked into that insurance network that it prevents us from giving patients the best outcomes that they can have. I think patients find a way to do things, sometimes, regardless of the insurance situation. So I think we can't be reliant on it. I think we do have to be able to work together well with them, to be able to get the patients, to be able to have an advantage of what they're paying for. But ultimately I don't think we can be married to those policies forever. There needs to be a relationship but maybe just not a marriage. 

Scott Nelson  17:58  
Going from patient balance and insurance reimbursement and flipping from revenues to expenses, the Bureau of Labor Statistics recently compared annual dental hygienist pay to inflation and noted the average annual salary for dental hygienists increased from $84,860 in 2023 to $89,890 in 2024 while inflation decreased during that period.  As practices manage finances and both sides of the income statement how should they manage the financial risk?

Beverly Wilburn  18:25  
A lot of what we're seeing nowadays, just trending across dentistry in general, is a lot of outsourcing, doing things from just a company handling things versus a physical person handling things. So in some ways, that's not helpful, I think, to jobs, because you're basically replacing an employee with AI technology or with some type of outsourcing system. However, it it does positive things as well on one side of it, because those employees that you do have, the one you it's never going to be where it's you're able to get away completely with that. I mean, I do have some practices that are completely, I would say, teamless, almost, with the exception of the doctor and a hygienist and maybe one person everything else, I mean, I'm talking nowadays we have things where people walk into an office and you're greeted by a kiosk. So it's, which is interesting, is interesting, but it works. And I think if it works for your practice, nobody should say that's right or that's wrong. If it works for you and your patients are happy with it, then I think that's the best way to do it. However, it is a challenge. Hygiene alone, in general, averages and practices right now is hourly rates for hygienists, or salary rates for hygienist is up 20% from where it was in a lot of cases, three years ago, just pre-covid. So supply and demand of employees, of trained employees, of quality trained people who are trained from a just from a quality standpoint, hygiene schools, I mean, I just read a report yesterday one of the hygiene schools in our area, in Virginia, literally increased by about five members, because they normally graduate about 42 and they were going to graduate 48, they're adding five positions. But even the hygiene schools right now are having trouble finding educators to be able to come in and educate them, so it's just creating that shortage. It's kind of my public service announcement out here to the world that if you have children who maybe don't want that full, full college, get them into hygiene, because they can do two years and have a really, really great career cycle ahead of them, hygiene is kind of the way to go. Nurses who maybe are kind of burnt out a little bit, not that I want to take anybody from the nursing industry, because you guys have a shortage as well, but definitely nurses, other things like that are consider hygiene, because it's gives them a little bit better of a hourly schedule. They're not as stuck there in regards to working evenings, weekends, all of those kind of things. So we're definitely seeing all of that. But the one part of the risk part of that where that kind of comes back to risk, Scott, is in now we are having an access to care issue when you are talking hygiene, because these hygiene practices sometimes are booked out. I talked to a peer yesterday. They're booked out until February. Their first opening is next February. That is incredible when you have some patients where you might be seeing for a new patient who haven't had a hygiene visit done in maybe two or three years, and you can't get them in until February. So it definitely provides an access to care problem which patients can have contraindications during that period of time of waiting just the delay of getting them in. So, and you can't outsource a hygienist, you can't out there's certain positions you can't outsource. You can't outsource the dentist. You can't outsource certain things. So we're seeing a lot of burnout in the industry just because of that, because people are trying to do double the work, or using an assisted hygiene platform or things to get patients in and through the doors. So we're definitely seeing those, those the fallout of a lot of that, of those shortages here. And I think outsourcing definitely is a is a big trend, and I think it's a great thing to do. It also allows the team members that you do have and those people that you do have on site to be able to give really true, focused patient care while they're there, versus having to handle a lot of all the administrative duties and administrative tasks that we have on our plate sometimes. So it's very, very helpful in that regard.

Scott Nelson  22:19  
That ADA report also highlighted 2 out of 5 dentists report being too busy to treat all patients requesting care in the past 3 months or they have treated all patients but are overworked.  Reported wait times during Q2 2024 were down from June 2023.  23 business days in 2023 to 14.7 in 2024.  In another question dentists responded recruiting hygienists and assistants is still a challenge.  To your point about burnout, patients are increasing, there are staffing gaps and shortages, those issues and others contribute to burnout and more challenges.  What actions should doctors and groups take to strengthen and manage risk and decrease vulnerabilities?  What can individuals and groups do to simplify risk and make it easier to manage?

Beverly Wilburn  23:01  
I definitely think automating systems is the biggest part of that. So in order to simplify the risk, you're really going to need to have the people that you do have highly aware. So awareness is obviously number one, awareness of what risks can be. And you've got to use your peers and your trusted resources. We have owners that some, some owner, practice owners are very, very in tune with risk is, some aren't. Some dental office managers are very in tune with risk and some aren't. There are team members who understand it and don't. There's your insurance agent, their job you know, your your risk management or your risk insurance agent, not not your dental insurance company, but they also obviously want to sell you policies and other things that way. So you've got malpractice experts out there, you know, like things like I do, dental consultants, there's other things to help to simplify that, especially a good practice management consultant or health care consultant can come in and help get systems in place to help streamline those things which help simplify, I think, risk in general. It makes it so that again, kind of what we where we started this, is that it's not so worrisome, you know, if things are in line and everybody's ducks are in a row and things are proceeding on, and you've got a good system in place, even when something does adversely happen, it's almost foolproof. You have the resources at your fingertips. You know what to do, when to do it. You're prepared and it helps to simplify knowing that risk is always going to be there it simplifies the process when something does happen. 

Scott Nelson  24:33  
There was a news report about a Minnesota dentist that used a canoe to transport staff and patients to and from the office for emergency visits due to being surrounded by floodwaters from unprecedented water levels. What I'm thinking about with that example is what might be some challenges or obstacles that a practice may face whether or not they're expected or unexpected, and when you talk about risk as being a possibility that's always out there and not necessarily a fact, how can people overcome obstacles that may be a possibility?

Beverly Wilburn  24:59  
I say be prepared and be insured. You have to think outside the box sometimes. And the canoe, I had not heard that story, but actually that is an excellent story, and I would love to give that dentist a hug, because that's a great story. I really think that that is some out of the box thinking that really kept their practice, and their patients, and their team working and employed, and all of those things. We just had a hurricane, obviously Beryl, go through Texas, right? I have a couple of dental, I'm a president of a dental spouse network, so I have a couple of dental spouses in that Houston area, South Texas area, and they, they go into their no power, there's no power in their offices, they're rescheduling their patients, they're picking up cell phones, they're doing all of those things that they can. But that's an area that's kind of prone to hurricanes, so they have been through it before. They know what to expect. They had a system in place for knowing. They had a phone tree, you know, and sometimes they're down power. They knew to send out things to their team members in advance to get power banks charged, other things like that. So you're always going to have those challenges. I mean, I've had, I've had my colleagues that they're, they're in the middle of a practice startup, and they go in and the next to their business the next morning, which hasn't even opened to see patient one, and they've been invaded by, I guess, teenagers with spray paint who have painted their whole brand new, brand new office, not even open yet, broke into their office and spray painted the whole walls and all kind of tore up some of the new furniture and all of those things. So, I mean, there's things that happen all the time, not that that's that's obviously extremes, kind of like the canoe, but it there are things that happen. There's some that have built practices that they have had, the practices burned to the ground before they even get off the off the ground. So I think being prepared, being insured, having a good relationship with a good both, both not only like obviously malpractice carrier, but you know, your business insurance, your just business overhead. Having a plan in place. A health care, my husband had a major, major health event in 2021, it's, we're going on three years now. His aorta actually ruptured. He had a, he had what's called a Triple A, which is, it's an aneurysm in your stomach that can sometimes sit there for very, very long. But if it ruptures, it's less than one, nowadays they've improved odds, it's probably less than about 5% of people survive, but he did survive, thank goodness. But we come in one day, he's doing surgery, and it happened as soon as he had finished a patient. So we were immediately closed for three months without any warning, any anything. And so it's just something to be aware of, that it can be there. We survived, not one patient left, not one patient refunded. It's about the communication of how you handle that as well. I think we were able to communicate well and quick and fast with our patients and people and our teams, and we were able to keep everything up and running regardless of the fact of an emergent family situation. There is a slight different dynamic when obviously you're married to the person, but I think having good team members behind you and those who can handle, can weather any storm, I guess you could say, is a is a great way to help in any situation that's going to involve risk. 

Scott Nelson  28:09  
If an individual, like a practice manager or dental assistant or other staff member, or an organization, wants to proactively plan for risk either in their job or for the practice what can individuals and organizations do?

Beverly Wilburn  28:21  
Education, absolutely education. Educate yourself about what types of risk are out there for dental offices. Be an advocate, as a manager it's definitely to be an advocate for your office and for your doctor, and it is my motto, I say this all the time, an office manager's job is to get it done, to get it done well, and to do it fast. And so that it doesn't matter what situation you're faced with, your job is to do it and get it done. And so it doesn't matter what that is. And if that means that just knowing, educating yourself to know, relying on your peers, having an annual checkup. You can't put a value on having like an annual risk assessment done by there's lots of resources out there for risk assessments, both with not just physicals of the practice, so not just what do our clinical notes look like? Could we make sure that we're full proof in our clinical notes to make sure that we're not going to have any issues if anything does arise. That's one area of risk that definitely managers should be on top of, some kind of auditing system to be able to make sure that our clinical areas are in check. That helps prevent part of risk, which is obviously litigation, patient harm, things like that. But there's also other risks. What do we do about our IT? Are we protected from a security standpoint? There's state dental associations and the ADA and people are releasing reports every day, and risk, we're getting an email probably once every couple of weeks that says, hey, this is where we're seeing a lot of risk factors in cybersecurity or these types of practices. There was just one recently for oral surgeon practices that they were basically being targeted. I have a personal friend who walked into turning on her computers and now there's ransomware on her computers. And we're talking, you know, they want a ransom of $60,000 and you've got to figure out what you're going to do. So obviously, learning from our peers and learning by their mistakes, their challenges is also very helpful, but you have to be able to educate yourself. You have to be able to stay connected to networks of people. To be able to do that you have to know what you're looking for. So regulatory agencies, ADA, states, societies, all of those things, usually will put out some kind of factor. I even have a checklist that I carry that I usually will give to people if they're like, I'm like, here's just a quick risk, you know, and it's more for what do we do if we come in and there's a flood? What do we do if we have an earthquake in the middle of the day? You know, California, I don't experience that in Virginia very often, we did have one, but California, that might be a very common thing. We need to figure out what we're going to do if there's going to be gonna be an earthquake. What do we do if there's a hurricane? What do we do if there's these kind of things? So it's just kind of having a checklist of what that looks like, relying on your peers together and education. Educate yourself. Use platforms like American Association of Dental Office Management. There's a lot of resources out there, even calling your insurance carriers and saying, what resources do I have? Through AADOM we have a resource, well through AADOM, if we are going for what's called fellowship or mastership or diplomat, those are three levels of distinction through AADOM that you can earn. So they have their regular membership platform, but they do also have other things. Part of that, that platform of earning those distinctions, are learning about these things and getting connected and making sure that you as a manager have the skills to be able to lead in that position for your practice and for your doctors and owners. AADOM actually offers a couple of different platforms, and there are several, I mean, there are state dental societies, there are consultants that offer education, through my group, I have a group, Dental Spouses in Business. Dental Spouses in Business is kind of a little bit of a separate organization that is, it's in the kind of the process of heading towards a nonprofit. We're kind of working out the details of all that, because it's fairly new. But we have a group of about 130 dental spouses who we connect with monthly. We have a book club. So sometimes we'll do those kind of things. Next month we will be doing an embezzlement feature. Sometimes, from an embezzlement standpoint, obviously, that's another area of potential risk, but from an embezzlement standpoint, when we're talking with spouses, there's certain things that we're a little more comfortable talking about openly than sometimes in other groups, because you do have that dynamic of being married to the person who's in the practice and those kind of things. But even in a regular practice situation, embezzlement obviously should be something that a doctor, an owner is watching out for. So there are people that come in, there are experts who, we have one ourselves, who is coming in to do a webinar specifically for us. I'll give a little shout out to my chapter, I'm actually a member of a couple chapters, Baltimore/Annapolis is one area. Even though I'm in Virginia, I do have a Maryland practice as well, and so we have a great little chapter in that area where we do some monthly meetups or other things on education. Sometimes it'll be about insurances, sometimes it'll be about embezzlement, there's all different topics, but education is the number one way you figure things out, and you have to educate, and you have to network, and then sometimes you network about the education that you add, and you learn new things too. So it all kinds of tends to work, work itself out at the end of the day, but you definitely anytime I learn a lot, obviously with risk on the patient harm and litigation side, because of the expert witness work. But we got started with that work because we were the treating doctor on a case, and it just sometimes happens that we happened to be the one who were treating and once you kind of get in that realm and know how to do things, it's drastically changed how we have done things in our own practice, to how we make our clinical notes, to how we do other things, because we've seen the backside of it to where things weren't good. So if you can learn those things through each other first, then that obviously mitigates a lot of the risk over the long, you know, the long haul of the practice. 

Scott Nelson  34:13  
From a macro, high level, big picture perspective, looking back over recent history, what's been expected versus unexpected in dental care and what could have been done differently. And then looking forward, what do you see as trends and potential issues we're facing in dental care that are concerning that individuals and organizations should anticipate and be prepared for? 

Beverly Wilburn  34:32  
Looking backward, reputation was probably one of the biggest risks, I think, and that's just over the past few years, obviously, with the advent of social media and all of those things. So I definitely think that reputation was a was a large risk, and our reputation of making sure that we have ourselves in a position to be kind and be good and be all of those things for patients and make sure that our reputations are in check so that we can protect again the longevity of our practice. That has kind of slowed I feel like, people don't, people are kind of in a new direction with reputation. They, everyone kind of gets up in arms if they get this negative review, or they get this thing that's kind of blasting their practice. And we obviously have limits in what we can do and say in response to some of that, because of the privacy and health care responsibility that we have as providers. However, sometimes a bad review nowadays doesn't always affect your reputation as much. And so I think people aren't, I think that's changing, that's a little bit of a trend that's changing. People aren't, they're they're formulating their own opinions, and they're going into places even when maybe the reviews aren't so spectacular on every case, but they do have a few good ones. So I think one of the one of the things that we're seeing backwards, from a risk standpoint, just in longevity of the business, is probably just that reputation part of things. And looking forward, I definitely see some of the biggest challenges being probably cybersecurity, cyberattacks. That's just something that we're seeing more and more of, even if they're small, sometimes they're not even large scale where you're going in and you know, seeing things like Change Healthcare where, you know, that was just a huge fiasco, I will say, but it's you don't see them even on that large of scale. They're going into smaller places and smaller spaces. And so I think those practices where you might have a lot of data, and maybe you have a dental service organization that might have five or six locations, they're they're going to be targeted because the volume of what they're doing, but yet, they're a little, oftentimes, a little bit easier to get into. So I definitely think going forward, one of the things that we need to be aware of is just those cyber issues, making sure that we're just staying on top of the regulatory agency's recommendations, ADA, you know, those kind of things. And paying attention to state dental societies. I think patient harm and litigation are always going to be areas that we need to focus on. I think patients some of the things that we do see is in the era of social media, we do see patients will complain about one thing, and then somebody's like, oh, well, I think I had that same instance with my dental office, and then they start looking at more things. So I think patient awareness of situations becomes more which does affect the harm or litigation part of it so, but I don't think that's something that's necessarily going to be like, super trending ever. And I think as doctors become more in tune with it, and more, I guess, unafraid of it, because their systems are in place better. It kind of puts that risk part down as well, a little bit like it doesn't make it so risky anymore, or feel so risky, I guess you I guess we could say. So I think definitely just cyber, cyber security, embezzlement, obviously, with the economy and other things, sometimes the way that it is, we do see a little bit higher trending of embezzlement, people's rents and things are out of control. So I just think it's something we need to have our fingers on the pulse of a little bit more and making sure we have our systems in place in regards to watching for embezzlement and our checklists and our all of those things in in perspective, so that we make sure that we don't have any kind of embezzlement issues. And really that's kind of the two, two areas that I see going forward where we probably need to pay the most attention to, I also think we definitely need to keep a little bit, maybe not completely yet, and maybe in two years or three years, my answer would be different, but I think AI obviously, definitely needs to have some kind of focus just on future risk. Only because I think AI has a place and a space, and I think it's excellent what it's providing us, but I think we do just need to be a little bit careful in regards to how much we're going to be relying on it. I see that kind of going in a pattern of where some dental practices may start to rely on it a little bit too much. And in those regards, you have to be just a little bit cautious about your systems, making sure that they are almost perfect to be able to work around that risk in AI.

Scott Nelson  38:49  
That’s a great point to conclude our conversation.  We'll have to get back together and talk again because we could have a conversation just focused on technology and AI risk.  Beverly, thank you very much for your time and sharing your thoughts today.  I really appreciate it.

Beverly Wilburn  39:01  
Okay, Scott, I appreciate it. Thank you so much.

Scott Nelson  39:05  
Thank you for listening to The Risky Health Care Business Podcast. You can listen to all episodes from the resource center page of the SpringParker website, springparker.com, or click the Listen link in the show notes to listen and subscribe for free on your platform of choice. And remember, accelerating health care performance is achieved through creativity, not just productivity.