Invisalign in the PPO general practice

If you have been in practice long enough, you should remember the days when becoming an Invisalign provider was like joining an exclusive country club.

How a reluctant provider earned $300,000 in 9 months

Miguel A. Casañas, DDS

If you have been in practice long enough, you should remember the days when becoming an Invisalign provider was like joining an exclusive country club. It might have seemed like a great idea at first, but after paying for the expensive training and factoring in the case requirements, like me, you probably dismissed the idea as impractical. Why should I invest all this money for services that I may never be able to provide to my patients? I'll take that endo course instead. That is something that I do every day!

Several years ago, I again considered incorporating Invisalign into my practice. I found out that they no longer have those exclusive club dues anymore. The problem was that I kept seeing Invisalign specials on Groupon and Living Social. Local dentists were advertising the service for as low as $1,700. Great . . . Invisalign has become another "compare product" in dentistry. Why should I invest time and money into providing a service at cost? Few of my patients could use the service anyway-or so I thought.

The other problem I considered was that I have an insurance-friendly practice. Although I don't participate with any capitation or state plans, my patients are very dependent on their insurance benefits. To be quite honest with you, it is rare that I do a $5,000 prosthetic case. For Invisalign to be profitable, that's what you need to charge.

Toward the end of 2013, the local Invisalign representative visited my office. I don't like to meet reps since I usually end up buying something I never use. So I made it a policy not to meet with reps anymore. The message I got from my receptionist was that she invited me to take an Invisalign course at the Greater New York Dental Meeting. Feeling somewhat arrogant and self-centered, I just assumed that they were allowing me to take the course complimentary. After all, they were pursuing me, and I had no intention of doing any Invisalign.

I was wrong.

The day before the course, I confirmed with my rep. "I'm sorry," she said. "There must be a misunderstanding. The course is not complimentary, but there is a promotional discount." Argh! I had the day set aside for some continuing education, and I figured I may as well pay for it and get my CE even though I probably wouldn't be doing any Invisalign. Thankfully, I didn't walk out. That decision helped me grow my practice by almost 20% in one year.

The speaker, Payam Ataii, DMD, was very entertaining, but more importantly, he was informative. "You mean to tell me that Invisalign is not just about straightening a few crooked teeth? And that any patient with abfractions and incisal wear can benefit from Invisalign?"

One thing going for me was that I had a pretty busy hygiene department seeing 300 to 400 patients per month. I also became aware that 74% of my patients had some kind of malocclusion. As I ran the numbers, I calculated that as many as 300 patients who visit my office each month can benefit from some orthodontic services.

I returned to the office with new enthusiasm. I reached out to my rep and scheduled time so we could get the staff on board. We met a week later, and she asked me, "How many cases would you like to start this year?"

"Ten," I replied.

"Done!" she said. She made it sound so easy. Perhaps I was aiming too low. "That's an easy goal, but first we need to train your staff on how to properly educate patients on the benefits of clear aligner therapy."

The first thing she asked me to do was increase the recall appointment an additional 10 minutes to allow for patient education. I wasn't happy about this, but I couldn't expect change if I wasn't willing to change. I decided to try it for six months and evaluate if the extra time made a difference. We registered the assistants and hygiene staff for an Invisalign records course and scheduled time in the office for them to practice impressions and photos on one another. The rep from Invisalign became like an unpaid employee at my office, meeting with the staff several times for training.

My administrative team quickly learned how to bill patients' dental insurance for the procedure. We also were trained on how to navigate the website. We held a leadership meeting where we implemented an incentive program for the staff. It was about two to three months before we were finally ready to educate, promote, and deliver Invisalign.

The hard work paid off when my first patient accepted treatment. We took impressions and photos, and off the case went. I called my rep to give her the good news. She congratulated me and then introduced the benefits of having an iTero in the office. "Maybe next year," I replied. "Why don't we set up a demo so you can see the new technologic advancements for yourself?" she suggested.

Remember . . . I'm the guy who hates to meet with reps. But I immediately fell in love with digital impression technology and realized that it is a no-brainer in a busy restorative practice. By the time we were trained in the iTero, more and more of our patients were saying yes to Invisalign. The idea of PVS impressions for Invisalign felt archaic. We began running monthly specials and reached Preferred Premier status within nine months with 65 cases. Which reminds me, remember the extra 10 minutes for the hygiene appointment? Well, it turns out that not only did I produce over $300,000 in Invisalign production, my hygiene production increased as well!

Also, I am using the iTero for many of my restorative cases, especially my longer bridges. Digital impressions are much more predictable and I'm completing my cases much more quickly. I have completely done away with the half-hour seating appointment. There's no need-the accuracy is remarkable. So I am not only providing higher quality dentistry to my patients, but I am saving time as well. It's an "upward spiral" that allows more time for patient education, which yields higher case acceptance. Now my initial goal of 10 cases has grown to 285 this year, along with reaching Elite Provider status.


Miguel A. Casañas, DDS, practices in Mineola, New York. He earned his bachelor's degree from Fordham University, his dental degree at the State University of Stony Brook, and completed a general practice residency at Booth Memorial Medical Center. Besides spending time with his beautiful family, Dr. Casañas enjoys yoga, cycling, and dancing salsa. He loves music and is an amateur percussionist with an interest in folkloric music of Latin America.

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