Monday, August 24, 2015
*CDT Codes: 2016 updates for the Code on Dental Procedures and Nomenclature (CDT) numbered 19 additions, 12 deletions, and eight deletions. The Code Maintenance Committee (CMC) comprised of 21 voting members operates under the auspices of the American Dental Association which schedules and chairs the annual update meetings.
The CMC operates in a transparent manner in an open annual meeting attended by Committee members plus a number of observers. There is full discussion and debate before the vote on each suggested code change. This year’s CMC met in March at ADA headquarters in Chicago, IL to examine and vote on 74 proposals for modification, inclusion, or deletion of specific codes.
Until November 1, 2015, the CMC is taking proposals for inclusion in CDT 2017. To suggest an additional code, a modification to an existing code, or the deletion of an existing code, visit ADA.org/publication/cdt.
*Serve Edentulous Patients: About 38 million people in the U.S. are fully edentulous or edentulous in one arch according to professional studies. The aging population plus growth in population forecasts a significant increase in this number in the next five to ten years. Is your practice prepared to deliver prosthodontic treatment whether implant-supported or conventional? If not, have you decided on the method of referral to a specialist or thought about ways these services can become part of the treatment mix in your practice?
*What is a CDHC? Would such a role help your practice?: 35 years ago I began working in a dental office to develop a program for which the dentist had no name. He could only describe what he wanted---an advocate for patients, a staff member who would educate patients about the prevention of dental disease, the necessity of regular oral examinations, the value of completing diagnosed treatment, and the vital connection between oral health and total body health. We decided on the term “Dental Health Educator” to describe my role. As the word spread, we began receiving community-wide requests for educational sessions in schools, civic group, patents’ organizations, other health care facilities, businesses, industries, and so on. We also received many inquiries from other dental offices around the country about how they too could add such a staff role. The effects of offering an oral health education program were surprising and rewarding, a unique opportunity to serve our community through health education and also an unexpected and unparalleled marketing tool for our dental practice.
Imagine my delight when I recently read about a new position that has been developed to serve Native American and Alaska Native communities, the role of Community Dental Health Coordinator (CDHC). The pilot project combines efforts of the ADA working with the Navajo Nation to “recruit Nation members to train as CDHCs.” Currently, there are 11 American Indian CDHCs providing services in 17 Native American communities across the country. Further, the curriculum to train CDHCs is being adopted by community colleges nationwide. Community-wide educational efforts by CDHCs are similar in practice and in purpose to the Dental Health Educator role I filled and highly valued so for many years.
The CDHC program operates under the auspices of the Indian Health Service (IHS), a federal agency. Continued funding for the CDHC program will come through budgetary recommendations of the U.S. House Appropriations Subcommittee on Interior, Environment and Related Agencies. We applaud the CDHC program and hope Congress appropriates money for its continued implementation by limiting or eliminating other less-necessary programs. We can certainly attest to the effectiveness of such a program.
Monday, August 17, 2015
A recent statement in a dental professional publication reads: “It is the responsibility of every dentist to be the first line of defense and patient advocate for prevention and early detection of oral cancer.” That is a heavy responsibility, one for which you dentists are prepared via dental school training and current, pertinent C.E. courses.
A red or white patch detected during a comprehensive oral examination alerts you to begin further tests to determine whether the spot is benign, precancerous, or malignant. Statistics support this imperative:
- In a busy practice, as many as 10% of patients examined have a red or white patch visible in the oral cavity.
- Squamous cell carcinoma accounts for 90% of all oral cancer.
- Men are affected by oral cancer twice as frequently as women.
- The mean age of occurrence is 65. However, studies show women in the 30 to 40 age range are the fastest growing group of affected individuals.
- In the U.S., approximately 30,000 oral squamous cell carcinomas are diagnosed annually with about 9,000 deaths occurring each year.
- While the etiology of oral cancer is still unclear, primary risk factors include the use of tobacco and excessive consumption of alcohol, human papilloma virus infection, excessive sun radiation, genetic predisposition, and the lack of comprehensive oral examinations.
You dentists ARE the first line of defense for prevention and early detection of oral cancer. This is another reason you and your staff can offer to convince patients of the importance of regular Recare appointments. With careful, consistent comprehensive examinations of all patients, you can help control and eventually eliminate death from this dread disease.
Monday, August 10, 2015
Solo practice is on the decline; group practices and dentists practicing as employees of service management companies are increasing. In a recent study by a reputable practice management company, only 54% of dentists/respondents practiced alone, a record low. The predominant group practice has two dentists with an increasing number of offices combining three or more practitioners. Group practices allow better competition with the increasing presence of corporate dentistry. With two or more practicing dentists, groups can increase days and hours of operation for patients’ convenience and spread overhead costs among the several producers.
What does this mean for you if you are a solo practitioner? It means you may be searching for an associate much sooner than you thought when you began practice. And, as you begin the search, you must decide if you want an associate who will evolve into a partner who shares ownership and management responsibilities of the practice or one who remains an associate, either an employee or an independent contractor. There is a remarkable difference between the two. An associate is hired to provide clinical services, but seeks no ownership and may remain uninvolved in the management of the practice. Once an associate begins to buy into the practice, he/she becomes a partner with financial and management commitment and authority.
While an attorney and an accountant can spell out the conditions of a contract between two dentists who wish to practice together, most often it is the interpersonal relationship between the two that will make or break the arrangement. Senior dentists who contemplate bringing in another dentist, whether to remain an associate or to become a partner, may wish to seek the advice of a psychologist to evaluate the following points that are crucial when practicing with another professional. Evaluation of the attributes of the in-coming dentist is even more important if a buy-in or buy-out is planned. Analyze these questions:
- Is there satisfactory interpersonal compatibility between the two dentists? Do they have harmonious interests, standards, and humor? Are they equally sensitive to staff members? Respectful of patients? Able to work well with diverse personality types and styles? Will their personalities complement so that there is a peaceful, productive, fulfilling aura in the office?
- Is the level of dominance or aggression of the in-coming dentist acceptable to the senior? Is the young dentist so aggressive that he/she will overpower or alienate the senior? Or, conversely, is the young dentist so passive and unassertive that he/she will be unable or unwilling to keep the practice viable and growing when the older dentist reduces work hours or retires?
- Does the young dentist have a keen sense of integrity? Ethical behavior? Can one rely on his/her word so that, in fact, this practitioner’s promise is as reliable as the conditions listed in a contract? While a contract is necessary, are chances high that both dentists will adhere to the requirements of a contract without a legal battle should a split occur?
- Does the prospective associate/partner have a strong work ethic? Is he/she “hungry”? Is he/she willing to work extended hours, take call, limit time off? If asked, will he/she attend staff meetings or practice management meetings during off hours? A successful dentist knows that when the office door is closed at night, the problems of the practice do not disappear. He/she takes them home, works on their resolution, and constantly plans for future developments of the practice. Will the young dentist be able and willing to work at such a level?
- How does the prospective associate/partner persevere through difficult issues? Solve problems? Cope with stress?
Saturday, August 1, 2015
- On March 31, 2015 the Supreme Court (SCOTUS) handed health care providers a blow with the decision that providers cannot bring a lawsuit challenging any state for inadequate Medicaid reimbursement rates. Dentistry is particularly hard-hit by this decision. Most states allocate only two percent or less of their Medicaid budget for dental services while the number of patients on Medicaid is rising. The SCOTUS decision means there will be no recourse to address excessively low reimbursement rates through the courts for dentists still seeing Medicaid patients. Dentists in states with reimbursement rates which do not cover the cost of delivering dental care to Medicaid patients will have to decide how many of these patients they can retain without losing so much money that they cannot keep their doors open. Stay aware of further developments to address this quandary in your state. Access a PDF version of the SCOTUS decision under “Recent Decisions” at scotusblog.com.
- Per capita credit card debt in the U.S. has increased 1,500% between 1980 and 2010. WOW!! And studies show that dentists have added significantly to the 1,500% increase with frequent, unchecked use of credit cards for discretionary spending. In fact, dentists spend about 30% more on nice-to-have-but-not-necessary items when paying by credit card rather than with cash. Suggestion: use credit cards for convenience but pay the bill in full each month.
- In a recent survey of general dental practices and six specialty practices, 264 practices total, for the year 2014, 46% of practices report an increase in the number of new patients. Just over 22% report increased treatment acceptance rates. About 34% of practices enjoyed increased “busyness” with just over 37% operating at 90% to 100% of capacity. Average production for 2014 increased by a little over 4.5% compared to 2013. 25% of practices experienced an increase in discounted fee managed care production with the weighted average increase at 3.7%. A little over 24% of respondents reported over half their production came from patients enrolled in managed care plans. The weighted average increase in collections last year was close to 5% over that of 2013. Higher overhead costs were chiefly responsible for declining profits which dropped to an average of about 36.5%. For more details from this fascinating study of 264 practices, call The McGill Advisory at 888-249-7537 or go to the website at mcgillhillgroup.com. For a number of years I have recommended The McGill Advisory as the premier practice management newsletter. Having no connection whatsoever with the McGill & Hill Group, L.L.C., I can say, “Trust me! Subscribe now!”
Nothing to do with dentistry, but here’s a remarkable list of athletic milestones for you sports enthusiasts:
“Impossible” achievement in track
Roger Bannister ran the first sub-four-minute mile in 1954.
Scaling Mount Everest
First done by Sir Edmund Hillary of New Zealand and Tenzing Norgay of Nepal in 1953.
Running for 2000 yards in a season
First done by O.J. Simpson of the Buffalo Bills in 1973.
50 goals in 50 games
First done by Maurice Richard of the Montreal Canadiens in the 1944-45 season.
60 home runs in a season
First done by Babe Ruth of the New York Yankees in 1927.
Stealing more than 100 bases in a season
First done by Maury Wills of the Los Angeles Dodgers in 1962.
Perfect 10 in an Olympic gymnastics event
First done by Nadia Comaneci of Romania in 1976.
Shooting under 60 in a PGA Tour event
First done by Al Geiberger in 1977.
Winning the Triple Crown in horse racing
First done by Sir Barton in 1919.
Sunday, July 26, 2015
Years ago when I began working in a dental office, my assignment was to develop a patient education program to teach patients the basics of an oral hygiene regimen for themselves and their children. The program included homecare instructions, facts about infant oral health for patients with young children, caries-preventive dietary information, an occasional explanation of proposed treatment to clarify a case presentation, and a good measure of schmoozing with patients to increase the sense of superb service and extra care they experienced at each visit.
The efforts paid off handsomely as the program evolved into an excellent marketing effort, raising the profile of the practice with which I worked. I began to get requests from community agencies and organizations, health care facilities, schools, and even other dental offices to present programs focusing on education about oral health for children and adults, the specifics of dental hygiene, infant oral health, and dental needs of the elderly. I was surprised to find that the seminars and training sessions were particularly well accepted at nursing homes and assisted living facilities. Staff members at these facilities were trying diligently to meet their residents’ need for oral hygiene because many of the residents were infirm or had physical limitations that prevented self-care. Additionally, many had a critical need for dental treatment. As interest spread about care needed by this patient population, efforts to provide the care gradually increased.
Fast forward 15 to 20 years to the June 1, 2015 issue of our local newspaper which carries a syndicated series, DEAR ABBY, a personal advice column. The title of that day’s column caught my eye---“Dental care in nursing homes can be difficult to arrange.” A reader in West Virginia whose mother is an Alzheimer’s patient in a care facility wrote Abby to explain that although her mother cannot speak, she had indicated great pain from untreated dental disease by groaning and gnashing her teeth. Upon inquiry the writer/daughter was told that it would be at least six weeks before a dentist would visit the home to provide treatment. The daughter was horrified to think of the pain her mother will have to endure while waiting for treatment.
The writer wrote to urge readers with elderly relatives or friends in nursing homes to learn to help with daily oral hygiene tasks and to take the elderly person to a dental office for regular checkups and on-going care before dental problems progress to the point of chronic pain. Abby’s response began, “As you noted, people are keeping their teeth longer. We now know that a healthy mouth is important for good overall health, no matter what your age.” Abby mentioned that in some states dental hygienists can provide hygiene services in nursing homes as well as in facilities housing special-needs patients, and they will refer a patient to a dentist for further treatment if necessary. She continued by urging readers who have responsibility for a nursing or care facility resident to seek more information and follow the writer’s advice.
Think about the facilities housing elderly people and other compromised patients in your community. How can you and your staff help these residents? What can you do? Upon asking himself that question, one long term dental client of mine decided that he and several staff members would volunteer to work one day quarterly in a nursing home or assisted living facility. That’s just one example of community service that marks a practice committed to providing quality dental care regardless of a patient’s personal living conditions. In addition to the sense of professional fulfillment a dentist and team members will reap from helping members of this population, the obvious “We care!” reputation community-wide will be a dynamic marketing tool for his/her practice---a sure-fire new patient generator. Though not begun as a marketing program, such commitment to patient care results in practice growth.