Dental KPIs - A Battle of the Brains & Which Metrics Matter Most?
Welcome to Dental Unscripted.
Where Mike Dinsio and Paula
Quinn break down the
practice ownership journey,
one episode at a time.
Starting up, buying,
and running a successful dental practice.
what is up guys welcome back
to another episode of
dental unscripted as
matthew mcconaughey would
say is all right all right
all right let's get this
party started we got
another episode coming at
you uh today it's just me
and paula and we are gonna
battle this is a battle of
the brains battle brains um
We thought it would be fun
to talk about what KPIs are
most important to dental practices.
And if you guys know
anything about how Michael
and Paula coach,
I'm the more financial marketing guy.
Paula's all business,
all operations and clinical.
She is all business,
but she's all clinical, all operations.
And so we have our things
that we look at when we're
coaching our clients.
And we thought we would have
a little fun today and just totally go
unscripted, but before we get into it,
little housekeeping, uh,
if you're watching this on dental startup,
unscripted or acquisition, uh,
dental acquisition, unscripted,
get over to the new channel.
It's called dental unscripted.
Uh,
it's one channel and we're going to
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startup acquisition and practice, uh,
success practice, uh, uh,
practice consulting topics.
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So Paula, hi, how are you doing today?
I'm great.
Great, great, ready.
Are you ready to battle today?
I'm fired up right now.
I don't even know what to expect,
but we'll go with it.
We'll do it.
We're just doing it.
This is totally unscripted.
Well,
let's start it by just kicking it off
with you.
When you are looking at a practice,
one of our clients, and you're using
all of your brain power to
figure out how to move the
needle and there's a
hundred things that you
could tweak and levers to
pull and whatever what are
some of the things on the
clinical side that you
think are super important
for practices to pay
attention to in your whole
world and I bet you I have
better ones so what's your
first one go first one
would be hygiene reappointment rates
Of course, because you're a hygienist.
So why is that important?
Because it is the heartbeat
of the practice.
It's why patients come.
So every dollar out of
hygiene equals two to three
in restorative.
And if we're not seeing
patients out of hygiene,
doctor doesn't get to do exam,
there's no restorative,
and we all go home.
So hygiene reappointment rate.
So what you're saying is the
hygienists are
are the most important
people in the world to a dental office.
It depends on who's reappointing.
It could be the front office.
Then they're the most important.
Okay.
So that's interesting.
So it's not really the hygienist,
but it's really just about
the patients that come into
the door for their cleaning
and how many of them reappoint.
Yes?
Yes.
I mean, I would suggest the hygienist.
They are the ones that
typically have a deeper relationship.
But yeah,
it's just getting them reappointed.
People get off track really easy.
I mean, I've seen practices where,
you know, again,
we're talking to a bunch of
dentists here so I can talk
about money or maybe
hopefully hygienists.
you know if insurance
reimbursement is twice a
year and somebody gets off
track not only are we not
taking the very best care
of the patient but now that
twice a year benefit
because you know we're
using it less and less and
maybe over a five-year
period we only use four of
the cleanings instead of
you know ten that we could
have used or whatever you
know I'm exaggerating there but
I've seen that happen again and again.
And quite frankly,
if you don't get them back on the books,
you create more work for
somebody having to fill the schedule,
track them down.
And we've seen it a hundred
times where that patient
becomes no longer an actual
active patient because they
haven't been in the practice forever.
So they're probably going to
go elsewhere if we're not
keeping them in the practice.
So yeah.
You better not steal one of my KPIs.
I feel like you're-
I feel like you're on the
brink of taking one of my
kpis I'm sticking to it I'm
just saying hygiene
reappointment rate is super
important what about you
what about what about you
um I you know my brain goes
to financials really
quickly I mean maybe it's
the ex ex-banker in me but
I think profitability I
think what are we doing if
we're not making money and
One of the things that I
have our clients look at is
wages in relation to collections.
And as you all know,
this is actually a very
complex KPI because there's
production and gross,
and then there's net,
and then there's collections.
So after all the waterfall, the write-offs,
blah, blah, blah,
you get to the brass tacks
of how much the practice collected.
And you compare what you
collected to how much the team costs you.
And in every single business,
wages is the most businesses,
unless you're tech, I suppose.
But most expenses are people, me and you,
our team, you name it.
And it's no different than
any other business, typically.
And what I try to get my clients,
and depending on where you're at,
our clients, I shouldn't say my clients,
our clients.
What I try to get our
clients to think about is
if collections is down,
wages should be down.
And when collections are up,
it would make sense that
wages would be slightly up or maxed out.
And if you can manage that right there,
if you could manage wages
to fluctuate with collections,
you'll make more money.
but if every single month
your wages are fifty
thousand let's just say
that would be a big
practice like twenty twenty
thousand let's say your
payroll is twenty thousand
and you collect eighty
thousand one month and
fifty thousand the next
month and then a hundred
thousand and then thirty
man like as a business
owner that's super
stressful because you're
making money and then
you're losing your ass and
then you're making a little bit
And then you lose your ass again.
So if we could just look
ahead in the schedule and
just see what we're scheduled to,
and if you can see that
you're not scheduled for some production,
hey,
maybe it's a conversation with your
team that says, hey, guys,
let's leave early.
Or hey,
let's close down Friday and move
those patients into
Thursday or next week.
Because if you're willing to do that,
then you can lower wages.
that match your collections
and it's okay if
collections go down it's
okay that's normal business
is up business is down same
in our business right
collections are up
collections are down but if
you can control that wage
you make more money so
that's mine is wages to
you're probably going to
ask and I'll just beat you
to it where do I want your
wages to be that's tough
yeah you didn't ask me
where you want my
appointment rate to be oh
but I was going to ask you
because I was curious
Michael,
where would you want those wages to be?
So it's a tough answer
because regionally it's all
over the place.
So the way I answer that is
if you're in a very
desirable coastal states where I live,
Washington, California, I suppose Oregon,
all the way over in the East coast,
you know, all up and down the border,
people want to be with the coast and, and,
and the coastal areas, the expenses,
living expenses are higher.
So just,
just by that wages are higher in
those areas.
So the middle of the country,
I would love for you to be at like.
Twenty five, twenty, twenty eight percent.
And then, you know, more like Seattle and,
and, um, you know,
nicer areas on the East coast, California,
even,
You're going to probably be
closer to like thirty two to thirty five,
sadly.
Those are kind of some
ranges and that's a percentage.
But jumping real quick back
just so that we can close the loop.
What was your hygiene percentage goal?
The reappointment rate?
Yeah, I say most offices,
I would like to see them.
minimal ninety,
but ninety four would be my
get me excited.
Ninety four percent.
But I usually do.
I usually have them shoot
for ninety percent because
they're not there at all.
So the nineties,
what would you consider
average in that world?
In the eighties, probably eighty percent.
So out of ten patients,
eight would be average.
Well, point it.
Yes,
but we're talking a much bigger volume.
But yes.
Got you.
Okay.
I mean, hygiene is low-hanging fruit.
I mean, most people have benefits.
They get their teeth cleaned twice a year.
It really shouldn't be.
Maybe a fee-for-service
patient might have some hesitation,
but majority of practices are interns.
And if you've got benefits
and it's a hundred percent
covered benefit,
why in the world would
somebody not schedule?
So I think eighty percent is pretty
pretty doable in nineties,
you're becoming a rock star.
So.
I got a pop quiz challenge
question for you on that topic.
Okay.
I'll throw you off a little bit.
Okay.
Is your answer the same for new patients?
No.
You passed.
Why?
They don't know you,
you don't have a relationship with them.
Typically some of them might
be coming in on some kind of special
You know, just there's a lot of things.
Usually new patient average
is probably about fifty
percent and then top.
Well, actually,
probably even a little lower than that.
Forty, fifty percent.
And then top is sixty four percent.
So, oh,
I didn't realize new patient
hygiene reappointment rate
was lower than fifty percent on average.
That's nasty.
Yuck, yuck, yuck, yuck.
I'm going to get into some
marketing kpis wait I
didn't get to do my second
one no you are I just I you
are I'll touch back though
on this this topic of
reappointing new patients
in the hygiene chair so
what I heard you say just
to jump back and and put an
end cap is paula wants you
at eighty plus percent no
ninety ninety okay okay
follow once ninety percent
but the average was eighty
is what I heard
and of existing patient
hygiene reappointment but
for new patients you
wouldn't she wouldn't be
surprised if fifty percent
of your new patients
reappointed and she would
love at least sixty percent
is that what I heard yeah
dang yours was way more
complex than mine what's
your second kpi because I
got a really good one
that's going to smoke yours
case acceptance
Oh, shoot.
That's a good one.
Okay.
I don't know if I can
compete with case acceptance.
All right.
So what's case acceptance?
If you were a dentist,
you're a business owner,
you're tracking your KPIs.
When you say case acceptance,
what do you mean?
I'm usually doing dollar.
So I'm looking at if you
present ten thousand,
how much of that gets on the schedule?
Okay.
Okay.
and unfortunately you know I
suppose there's a lot of
ways to track it but it's
kind of like did they
schedule that day I mean it
would be a constant moving
target if you went back to
say like okay then how many
scheduled the next time and
the next time so
unfortunately there kind of
has to be a a way to
calculate that and so it's
you present they schedule
so yes of course
If it's a phased out treatment, you know,
maybe, of course,
they're not going to schedule.
There's no way for them to
schedule all of it if teeth
have to be extracted.
But because top is sixty four percent,
it takes that into consideration of.
Wait,
you said the top is sixty four percent?
Yeah.
Case acceptance.
Okay.
So can you just say that again?
Say how you define it,
because I know for a fact
there's listeners driving
to work right now and they're like, dude,
I have eighty,
ninety percent case acceptance.
I'm awesome.
And you're saying that the
the top is sixty, sixty, sixty,
sixty three, sixty four.
I know what you mean.
You need to tell the drivers
heading to work.
I say it again.
How do you.
How are you doing that?
It's dollars.
What do you mean?
It's dollars.
I mean,
because if you have ten patients
and you're diagnosing two
hundred dollar fillings,
all all all ten of them are
probably going to accept
that treatment where if you have.
Crowns and you're presenting
all kinds of mixed bags of stuff,
it's going to look different.
So if you're presenting one
hundred thousand dollars
worth of treatment,
And sixty three thousand of
that gets accepted.
That's good.
It's not the hundred.
It's not going to ever be
one hundred percent.
And it takes into consideration that,
you know,
some of that treatment needs phased out.
That's why top is sixty three.
Not.
So that makes me think that like.
I'm not going to say conservative.
I'm stupid for using that adjective,
but like.
If you're a dentist that does really,
really conservative
dentistry and you're truly
bread and butter and you
kind of stay away from
anything too robust, in theory,
you could have a much
higher case acceptance.
Whereas we have some clients
that sell sixty thousand,
forty thousand dollar cases
and their case acceptance much,
much lower because these are big cases.
You don't have any statistics on that,
probably.
You just have kind of
everybody thrown in one pot.
Exceptional would be would
be sixty percent, right?
Yeah, but but you kind of think about it.
The only time I feel like
maybe it shouldn't equal
because if I'm selling
forty thousand dollar cases.
And I win some my dollar is
going to be way bigger,
so I have to win a lot of
crowns to equal one all on four.
So really, but it's a percentage.
It's a percentage.
It's all percentage.
If you just,
if I do ten fillings and I get
everyone saying, so why,
why shouldn't their case
acceptance be equivalent to proportional?
It probably is.
The only reason it's not is
because it's harder to sell.
It's harder to it's harder.
That's what I was thinking.
Yeah.
However,
if that's my specialty and I'm
really good at enrolling
and people are picking up
my marketing and coming to
me because I'm marketing that.
We should have exceptional
treatment plan coordinator
with with exceptional
follow up and ways to finance.
I'm not saying it's not
going to be way more
difficult and I'm not going
to say their percentage is
probably on average or a little lower.
But if you really think about it,
it should be similar.
Now,
when someone the one caveat to that is
if I'm doing
You know,
I offer a partial denture versus
a denture or versus a
extract everything and do an all on four.
I'm going to have maybe a
couple different options
routes for the patient to go.
That's the exception because
I could have a hybrid,
like I could have two
different big cases in
there and saying we could
go this way or this way.
And until that gets cleared up, it could,
the acceptance rate could look lower.
So on those higher things, but.
you know,
if we're doing a bunch of ortho cases,
you know, presenting a lot, I mean,
we should win them, right?
I mean.
Yeah, yeah, yeah, yeah.
No, I think you're right.
I think that makes sense.
Of course,
typical Mike D'Incio
overcomplicating a very simple.
Yeah,
you said mine is complicated because
you ask a lot of complicated questions.
You know,
so if you're about in the forty
percent range, you're about average.
Okay.
okay average if you're below
that you know I always say
let's let's take a look
it's it's a combo of
patient experience
follow-up and case
presentation so it's not
all on the doc although it
could be you know it could
be the front failing
something you know it could
be so you really have to
know whenever we come in we
usually work on the front
office system first because
if we've got the input and
the treatment plan and all
of that looks good we got
the financing we've got the
follow-ups down now we can
say did it improve nope
okay now let's look at what
is the rest of the patient
experience look like or
that that case presentation
delivery so okay so let's
make this super dummy style
you you present
ten thousand dollars you're
at and and by the way most
of you that listening
probably don't track case
presentation dollars so
start that's that's
probably kpi one start
paying attention to how
much you gotta have the
hygiene reappointment rate
to get to look at the mouth
to do restorative all right
all right all right are we
I heard unless they're an
emergency or a new patient
I heard your first KPI.
We're on case acceptance.
So start tracking how many
dollars you diagnosed today, this week,
this month.
Then start tracking how many
of those dollars get accepted.
And if ten thousand dollars is diagnosed,
your average,
if you get four thousand
dollars accepted,
You're exceptional if you
get six thousand accepted.
If you're less than four
thousand out of the ten thousand,
start looking at some stuff.
That's what I say.
Wait,
is anyone voting on which KPIs are
most important?
We can we can look.
I'm I'm going to go to my
next one and I'm going to
give you round one,
but I just can't give you round two.
So you can't give me case
acceptance over wage percentage.
No, I can't.
Maybe if we're getting all
of our cases accepted,
we wouldn't have to worry about wages.
Which is why I'm giving you
I'm going to give you a win
for round two.
I thought you'd be humble
and give me round one.
But hey, that's it is what it is.
Can I give you my second KPI?
I'm already I'm already yielding.
You're the one asking like a
thousand questions when I
bring up one KPI.
Well, look,
I just want to make sure our
listeners understand what
you're going after.
My second KPI is patient retention.
I think dental,
this camera's driving me crazy.
I move a lot,
so it just tries to keep track of me.
But for those watching on YouTube,
it just jumps around
because I'm a fidgeter.
So my next one is patient
retention and it's similar.
It's similar to your hygiene
reappointment rate.
It's very similar.
It's, it's, it's mashed together.
So I thought that's where
you were going to go.
I'm glad you did it.
So we,
we talk about marketing a lot and
everybody's like, I need new patients.
I need new patients.
I need more volume.
I need more at bats.
I need more new patients, new patients,
new patients.
And I don't think enough of
you are looking at how many
of your existing patients
are staying with you or
leaving out the back door.
So new patients,
so it's a patient growth or retention,
patient retention factor.
So we look at how many new
patients you got in,
how many did you reactivate
that were inactive,
we look at how many patients
went into inactivity, which is leaving.
And then how many did you inactivate?
So it's like a plus minus, right?
So like we got five new patients,
we reactivated three.
So that's eight total,
but we lost ten to inactivity.
And Nancy Jo
moved away to a different
state and we inactivated her.
So it's like a plus minus.
And I just, I just feel like,
and I got an email today by a doctor,
you're on it.
And he's like,
new patients or life or new
patients will like,
it's all about the new patients.
We need more growth.
And the reality is,
is it's not all about new patients.
I'll quote Heartland.
I read an article about Heartland.
You've probably heard me say
this statistic that it
takes twenty two new
patients to to break even
or level out a practice.
Twenty two.
So if you're not getting
twenty two on average,
twenty two new patients,
you're you're dying.
So it takes twenty two to level up.
That's because twenty two
are leaving out the back
door or we're inactivating them.
So if you can really tighten
up the back end.
and then focus on new patients,
your active patient count will grow.
And I just feel like we need
to have more conversations
about not just new patients,
but the patients that we're
not paying attention to
that you already have in the practice.
So that's my second KPI.
Nineteen percent growth.
month over month is exceptional.
Uh, ten percent is average.
But I know that's the
industry telling us that, uh,
I actually have observed
that the average is zero percent growth,
just flat.
Our our dental intelligence,
who we use as as some of
our data authority,
say that ten percent growth
in active patients month
over month is average.
So I think it's somewhere
between zero percent and ten percent.
Exceptional is eighteen percent.
Start paying attention to that guys.
Okay let's vote.
I think mine's pretty
important but I'll give you
treatment treatment
acceptance as the win on
the second round.
Does that mean I have to
give you the first one?
Is that what you're saying?
I wouldn't be bringing it up.
Okay, how many more do I get?
That's the question.
You get you get one more.
So we're gonna go the third round.
This is the tiebreaker.
So I can't.
Yeah, this is a battle's best of three.
I mean,
I combo two because they kind of go.
Are you really trying to win
the third round is what
you're trying to do?
Sure, Paula break the rules.
What's your third KPI?
Uh,
would be production production
backslash collection.
So I'm saying it kind of goes,
they are two different KPIs.
Okay.
So what do you mean?
So doctors, everybody always,
and I get it.
People are saying, well, you know,
production doesn't meet
anything net production.
So we'll say, let's schedule the goal.
What, what are your production?
And they'll say, well,
what about collections?
But I can't schedule to
collection collection.
is done on the back end and
it's also sometimes
insurance driven and you
hope at the end of the
month or it'll go up and
down and some months will
be even and some will be up
and some will be down when
it comes to collections
because it really depends
on when did that check hit the account.
You're waiting on insurance,
but if we're really,
really tight in collections,
It shouldn't take any more
if it's an EFT electronic
deposit to if it's check no
more than six.
So we're talking about we
average out about a thirty days.
We should be doing that.
And then you're always chasing last month.
So you would hope that those
collections would come in.
So I always focus on net
production because it's
really the only stable
thing that we can control.
And then the collections,
if we're all doing our job,
should ultimately equal that over time.
So I'm focusing on net production,
scheduling to goal.
We would want, you know,
and it depends on the size
of the practice and the
patient flow and a lot of things.
But I'm usually, I would say my doctor's,
average somewhere between
thirty five hundred and
five thousand is their goal
um you know it just depends
if they do clear liners I
mean I have doctors that go
up to thirteen thousand a
day you know it's all over
the place but I think that
the important thing is
you've got to look at quite
a bit of metrics to get
there and then once you
know what you want for the
year you waterfall that
backward by the day but
that's an important KPI
that you're coming in every
day and you're looking at
that production and saying
did we hit it because
usually if we hit it and
we're doing our job on
collections again we're
going to be hitting that but you can't
If you're looking at collections,
it'd be maybe from two thousand.
So anyways,
I feel like production is a huge driver.
Production per day is a huge
KPI that you should be looking at.
The whole team should be
looking at every single day.
Yeah,
I don't think anybody can compete
against production per day.
So no matter what I say,
you win round three.
And I think you, in my defense,
in my defense,
my first KPI was about
collections compared to wages.
So it's kind of related,
but- Mine's production.
I feel like that's a dirty,
it's such a dirty move
choosing production per day, but okay.
Fair enough.
There were no rules.
Nor a prep, so I had to go with it.
We needed a referee.
That should have been on the
exclusion list, but since you did that.
All right,
then I guess I'll go to the last one,
and that is it's new
patient acquisition cost per new patient.
And that's a pretty loaded
KPI because most of the time,
when I look at doctors spend
for what they're spending
in the marketing,
like we've got an email right now, just,
I just saw it pop in and she's spending,
four thousand dollars a month in,
in marketing spend.
And then I can see how many
new patients she's getting.
So I can easily do four
thousand divided by how
many new patients and get a
cost per new patient.
And, and,
My number is somewhere south
of three hundred dollars per new patient.
The best ones are less than a hundred.
So I guess what I'm saying is, yeah,
I mean,
a hundred bucks per new patient is
incredible.
But a review is free.
A review is free.
That's right.
That's right.
So that amazing buying power
in today's world.
Yeah.
I mean, that's why reviews are so,
so important because that's
free marketing.
But, but to that point,
if you're doing external marketing,
you guys,
you have to track where your new
patients are coming from.
That's probably the number
one thing that we really
stress in any office is like,
if you're not tracking how
these patients hit your books,
like, what are you doing?
Because what happens is you
end up spending a lot of money,
maybe like this doc who's
spending four grand.
And a lot of it's just going
to stupid activity.
And,
and the strategy needs to be figure
out what works,
figure out what doesn't cut,
what does it and double
down on what does and track it.
And I'll, I'll leave you with, with this.
But I have a comment to make
before you leave, leave.
Well, well,
There's a lot of comments to
make on this topic,
but thank you for trying to steal my KPI.
You made lots of comments on my KPI.
The thing about it is,
if your referral sources are vague,
So like, for example,
a new patient goes online, signs up,
how did you hear about us?
And they click Google.
That's very vague, Google.
And you could have driven by
the office and Googled.
I don't know.
Was it the sign that made the call?
Your friend could have told you, oh,
Lakeview Dental Office.
And then you Google that.
Well,
it was really your friend who referred,
but I Googled it.
It could have been an actual
advertisement that you paid for.
That's probably what you
mean when you say Google.
It could have been the
postcard we mailed you.
And then that patient Googled you.
And all the patient said was Google.
So you have no idea what Google means.
That's a perfect example of
being too vague.
So drill down on where
you're getting these
patients and then truly
figure out the ROI return
on investment of what
marketing your marketing is doing.
So yeah, what did you want to add to that,
Paula?
Well, I just wanted to add, you know,
circling back around to
case acceptance is when
you're doing this marketing
and you're putting in the referral source,
it's also measuring, you know,
marketing is a lead that's brought in.
How your team and you handle
it is up to you.
So once you get the rear and the chair,
you may only get five
patients out of that marketing strategy.
But if those five patients
equal fifty thousand dollars.
Yeah.
You've got that measurement.
And then you got did you close those case?
Are you good at enrolling?
So there are so many things
that go into marketing.
We'll have doctors all the time say, well,
that didn't work.
It's like, well,
how many patients you get?
Well, five.
What's the dollar amount you
got out of that?
And I think that's...
I'll call you out because
even when you owned,
we tried a mail campaign
and you know where I'm
going with this story.
You did not want to do the mail.
It was very expensive.
And I'm like, you got to try it.
We drop a ton of mail.
Paula just owned practice.
She just like any buyer was
being very conservative with her spend,
trying to try to try to maximize profit.
You did all the things everybody does.
It's not, not, not wrong.
but marketing is your money now.
Yeah.
It's your money.
So we do the mailer and it by the numbers.
And by the way, that was my KPI,
three hundred dollars or
less per patient.
But you'll notice the cost
per patient is different
than production per
patient on those.
And so that's what you said, Paula.
And so like, let's say we do a lesson.
So I learned a lesson and now you did now.
That's right.
Let me, let me close the loop though.
You,
you only got like maybe five patients
on that mail campaign.
And you're like, that totally sucked.
That was like, I, it costs me whatever, uh,
call it eight hundred
dollars per patient.
That was the cost of each patient.
You paid thousand.
You got whatever.
Right.
It was you paid five thousand.
You got five patients.
I'd be a thousand dollars per patient.
Not very good.
But one of those patients
was like a ten thousand dollar case.
So absolutely it works.
That's what you're saying, Paula,
is you got to look at it two ways.
And I agree.
You stole my KPI.
So it's cost per patient.
You said I'm wrapping up.
I had I actually did.
enhanced your kpi you could
have won you might have won
that round now because I
also because I are you
saying that I win the third
round no I I'm out of the
audience yes I wasn't I
didn't say that I said I
enhanced you might have you
did enhance you did enhance
so so it's cost per patient
and production per patient
new patient and acceptance
acceptance okay paula all about
Okay,
all about your KPI in the second round.
All right, I hear you.
Well, I concede.
I'm not going to give you the third round.
Let's put this out on social
and have everybody vote.
I think mine are great.
We'll leave it to the third
round for people to vote on.
I think mine are great.
Vote for me below.
I love it.
All right.
Well, that's the episode for today.
We busted it out in thirty six minutes.
I'm shocked that it took that long,
but we probably could have
debated another hour again.
I had to suppress it.
All right.
Thanks so much for your time, guys.
Again, reminder, please like, subscribe,
vote.
vote write google reviews no
they do need to vote they
do need to vote that's
right um and uh yeah stay
tuned we'll be putting out
some more stuff later this
uh this month thanks guys
all right bye see you I win
definitely win bye thanks
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