UDA Action

Dentistry in the State of Utah

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PRESIDENT'S MESSAGE

CQI – WHAT IS IT?

CQI...what is it? Is it just another acronym to go along with so many others we see and hear every day? DDS, DMD, UDA, ADA, DOPL, JADA, HOD, GOAT, FYI, FOMO, LOL, GIF, JPEG, DIY, POTUS, HIPAA, HSA, HRSA, ERISA, PIN, SBA, ..... and the list goes on and on and on. As long as there are letters in the alphabet (ABC’s), there will be acronyms created.

The letters CQI stand for “Continuous Quality Improvement”, and those words have been the basis and purpose behind the annual CQI Visits made throughout the state every year between August and November by various officers of the UDA (Utah Dental Association), and other guest presenters. UDA officers and presenters have traditionally made rounds through the state to visit the local component districts, bringing information and continuing education to dentists in their own communities, and in a more intimate setting than the annual UDA Convention, or some other larger gathering. This has provided a wonderful opportunity for UDA leadership to become better acquainted with dentists and other dental professionals from all corners of the state, and also provides for open communication and connection to the UDA leadership.

CQI meetings were established in 1997 to provide instruction and information, and fulfill requirements for dental licensure in the state, as established by DOPL (Division of Occupational and Professional Licensing). The licensing board felt it was important that there should be a continuous improvement in quality of practice amongst the dental professionals throughout the state. Although no longer a requirement for licensure, the annual CQI meetings are still a very important part of keeping up to date, informed and educated, especially in those things pertaining to the Dental Practice Act. I personally still view the CQI meetings as a requirement to me for my own dental license.

Formerly these meetings were simply referred to as “state visits”. In the earlier days of my career I learned to look forward to the annual state visits and being able to personally meet the UDA officers, executive director, and others who accompanied them to present CE (continuing education) information, and updates about state and national dental laws and regulations. I thought it was about the best way there was of learning things that would affect and could impact my growing practice. But perhaps the best part of the meeting for me was being able to visit with my local colleagues, and with the state officers, and realize I was not alone in facing many of the challenges and ups and downs of my day to day practice. It’s nice and comforting to learn that someone else has also fractured a root during an extraction, or had to calm a screaming child, or had to calm a nervous parent, or had to send someone to collections. We all share some commonality in our experiences, and can learn

from and strengthen one another in our professional lives and practices by sharing the different things we learn through our individual practice experiences. We take practice pearls back to our offices and are able to measure the impact they make through increased production, or improved quality of care, or more efficient practice methods we learn from others.

But I have found that even more important than the nuts and bolts of dentistry that I learn from others and carry back to my practice, are the more personal stories of success I have observed of those who strive to find the right blend of personal and professional life. There was a young dentist serving as a district officer and trying to find that right balance of professional and personal life. When I called to see if he needed help with making meeting arrangements, he apologized for not getting things done sooner, and then confessed that his wife had just had a new baby a week or two earlier. I congratulated him and reassured him that his family and new baby absolutely came first! I hoped he felt supported in putting first things first. And, by the way, he went on to do a great job in helping get the meeting organized!

Another observation came when learning of a colleague’s devotion to his dear spouse, spending time with her every day in the care center where she resides, due to early onset dementia. He said that she doesn’t go to bed until he comes to see her each day, every day. I am not a counselor, but I remember my dad reminding me that I have two ears and one mouth, so I should listen at least twice as much as I speak. As I listened I could tell that even though the circumstances were hard, the best part of this great man’s day was not what he accomplished at the office, but the precious time spent with his sweet wife at the end of each day. Such examples of others are the things that bring to me perhaps the best continuous quality improvements in my life.

So, look forward to the annual CQI meetings! Attend them with an attitude of learning and sharing. Don’t find yourself obsessed with FOMO (fear of missing out) by missing one of these great meetings. Maybe you’ll gain something that will make you feel like the GOAT (greatest of all time)! And, as another important benefit of membership in the UDA, you’ll also receive two hours of free CE credit along the way!

Dr Kay Christensen UDA President

YOU HAVE SOMETHING TO GIVE AND WE NEED IT NOW MORE THAN EVER

Five years ago I received a phone call from Brent Larsen, the outgoing past-president of the UDA. He asked me if I would run for a ADA delegate position. To be honest, I didn’t know what that was at the time, but since I knew and trusted Brent, I agreed to do it.

I met Brent Larsen years before in the Great Basin Study Club. My original mentor dentist, Paul Baugh, introduced me to the study club and I enjoyed it. I was surrounded by excellent dentists that knew the importance of learning together. I was honored to be around them. They opened my eyes to what was possible as a dentist. Each of the dentists that I met in the study club became mentors to me and helped me become a better dentist than I would have on my own.

My practice philosophies and treatment styles have been heavily influenced by those mentors. Ultimately, it was through their influence that I felt brave enough to change my practice life forever. I decided to go out of network with all but one dental insurance over 10 years ago. Because of that change, my life has continued to change for the better and I’m enjoying dentistry more than I could have imagined before going out of network. Brent Larsen saw this transition and reached out to me. He wanted me to share my experience with Utah dentists and hopefully help you more fully enjoy your dental journey.

Mentoring each other is vital to becoming the best dentists that we can become. Every one of us has something to offer. Every one of us would be a good mentor to someone else. We are more talented and successful than we give ourselves credit for. Look for ways to share your knowledge with others.

Study clubs are a great place to start. Becky at the UDA has been compiling a list of the different study clubs around the state. She can help find one for you close to home. If you are currently part of a study club and would like new members, please contact Becky with the information. The more of us that are involved in study clubs, the better.

Even if you work in a DSO or large group practice with other dentists, we invite you to share your knowledge with others who are not part of your group. There is always something that you could learn from others outside of your current circle.

We are all in this together. The dental health of all the residents of Utah is in our hands. We owe it to our patients to be the best version of ourselves as we care for their dental needs. Utah is lucky to have some of the best dentists in the country, and we

can be better if we look for ways to grow together. Please share your talents and be a mentor.

I mentioned that through the invitation of a mentor, I am now serving on the UDA Board. This had been a very eye-opening experience. I never realized how much is going on behind the scenes when it comes to the UDA board working for Utah dentists. I am grateful for the hard work and dedication of all those that I have worked with on the Board. If you have ever questioned “what is the ADA or UDA doing to help dentistry?”, I promise that it is more than you realize. Even with all that we are doing, however, we could be better. We need to be better, but we need your help to do it. We need you to get involved in organized dentistry. We need you to serve in leadership positions in the state. We need you to run for the UDA Board.

In the past the UDA board positions included long-term positions for either an ADA Delegate option and a UDA Presidency pathway, however, going forward we are working on the possibility to shorten these service terms to allow for more of you to serve.

In the upcoming UDA House of Delegates there will be a proposal to allow for 1, 2 and 3 year options to be part of the board. We are still working on specifics, but we feel that these options will allow us to better serve our profession by encouraging more of you to run and serve these shorter terms. I invite any of you who are willing to help to run for office. Reach out to me or the UDA office with your questions and with your desires to serve and we will help you with the journey.

I invite you to look for ways to share your talents with others. However you feel you can best be a mentor to others please do that. Whether it is through a study club, dental board, local UDA district meetings or even just introducing yourself to the newer dentists nearby your office, please make your circle of influence larger. Reach out and share your unique vision with others. Only you can do you the way that you do you. Our fellow dentists will greatly benefit from what you have to share. Thank you for being part of the best profession.

Dr Rodney Thornell (801)652-1408 UDA Secretary

In the game of hockey, penalties for rule violations can result in the loss of a player, either for a few minutes, and occasionally for the remainder of the game. This player must wait out their penalty time in what is referred to as a Penalty Box. Minor rule violations typically require a twominute stay in the Penalty Box, while major violations can put a player there for five-minutes or more. Obviously, the team playing with one less player is at a significant disadvantage. For the opposing team, this is referred to as a “Power Play.” To even the playing field it is imperative that the player confined to the Penalty Box be released back into the game. Currently, a Power Play is being waged against the dental profession, as some of our players have put themselves in the Penalty Box.

In wrestling and boxing there are weight classes to even the playing field. If this were not the case, both sports would be dominated by the big and the powerful. Can you imagine a flyweight (112 lbs. max.) going up against a heavyweight (175 to 200 lbs.) and winning? While admittedly it could happen, it would certainly be the exception. Currently, the dental profession is going up against a myriad of heavyweights. We need our biggest, strongest and quickest athletes in the ring. We cannot do this effectively without broad support from dentists everywhere.

Every sport requires proper equipment. Consider a football team coming onto the field without helmets and pads? How about a golfer attempting to chip onto the green with a #2 driver, or a steer wrestler in sneakers? Better yet, Michael Jordan sailing through the air to dunk the ball wearing cowboy boots? You get the picture. The dental profession is currently not playing with the best equipment. It is as if we have abandoned our handpieces, leaving us with only spoon excavators to do our cavity preparations.

Mariners refer to “all hands on deck” when there is a crisis at sea and all crew members are needed to help solve the problem. Everyone is to leave the safety of the vessel’s interior, come topside, and do their part. This metaphor of “all hands on deck” is well understood as a call to action in all walks of life. Currently, the dental profession needs all hands on deck.

So, what am I getting at with all the sporting analogies? Simply stated, without a strong majority of dentists as dues paying members of the ADA/UDA, we are sorely disadvantaged as a profession. Whether or not you agree with every cause championed by organized dentistry, is not the point. The point is that the ADA and the UDA give us a voice. They represent us, and advocate for us and for the public. Currently though, they are doing so with one arm tied behind their back. We need the other arm. We need the other 41% of dentists who are not

members of our association to join with us in bringing that other arm out to help fight our battles.

Speaking of battles, do you realize the number of Goliaths out there trying to carve us up and have us for lunch? There are powerful interests that would gladly enrich themselves at our expense. This is not hyperbole, nor is it an overstatement of our situation. We are looking for the rest of you to help make us as David to go up against these Goliaths.

During the span of my career I have watched the American Medical Association (AMA) go from being a robust and powerful representation of our physician colleagues to becoming largely irrelevant. For many years, membership in the AMA hovered around 75% of active, licensed physicians.1 More recently, their membership has dropped to as low as 15%.2

The bottom line is they have no real influence in public policy anymore. Needless to say, the AMA is now simply a paper tiger. Is this what we want for dentistry?

I am nearing the end of my career. For selfish reasons I could just sit by and watch us get clobbered by outside interests. But, I can’t. The leaders in our profession that guided the ADA and organized dentistry long before I came along, left us with a pretty good gig. I am not content to not do everything in my power to leave our younger colleagues with that same, pretty good gig. But, we need a full team to make this happen. We need everyone suited up and on the field by being dues paying members of our association.

There are currently about 211,000 active, licensed dentists in the United States (Figure 1). Of those, approximately 125,000, or 59%, are dues paying members of the ADA. Just five short years ago that number was 63%. For the past two years, membership has dropped by almost 2% per year. This is not a good trend, and if it continues will put us at below 50% membership in less

than five years (Figure 2). Now, more than ever, we need all hands-on deck.

I get it. It has not always been easy to write out that roughly $1,000 check each year. It takes a lot of money to run a dental practice. I know. I did it for 34 years. Every dollar counts. I understand the challenges. But, as dentists, when it comes to return on investment, there is no better bang for your buck than the ADA, period! End of discussion.

So, this is my call to action:

1. If you are currently a member, please reach out to a colleague and invite them to join you at one of our meetings. If that colleague is already a member, great; then attend together. Keep extending that same invitation until you come upon one of our friends and colleagues who is not currently a member. If a dinner meeting, you might even offer to buy them dinner? But, get them to the meeting with you. It is just that simple. It starts with the invitation.

2. If you have let your membership lapse, or if you are a new dentist and are now faced with paying those dues with your hard-earned dental income dollars, I plead with you to just do it! And, then keep doing it.

There you have it. The task ahead is clear and focused. We need everyone. We need a full team, suited up and ready for action. We need YOU! Let us not allow those who would take unfair advantage of us or our patients have a “Power Play” at our expense.

Dr Mark Taylor UDA President Elect

1 https://www.phg.com/2000/01/physician-statistics-summary/ 2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3153537/

Source: ADA Treasurer, Dr. Ted Sherwin, Report to House of Delegates, Oct. 15, 2022

This year the annual UDA convention will be held March 30-31. For the mere cost of registration you can attend any of the lectures you choose for no additional charge and receive full CE credit. If you want to participate in a workshop it will only cost $25 in most cases; this nominal charge is necessary because space is limited and it is essential to fill these courses with committed registrants. At most other dental conventions the trend is to charge several hundred dollars to register for a workshop. In checking an upcoming meeting in another state I found that most 3 hour lecture courses were $85 after paying for registration, and a 3 hour workshop would cost $425. Most all workshops at the UDA are $25 and lectures are no charge after paying a nominal registration fee ($95 for dentists this year). Charging additional fees to attend courses and workshops has become common practice as dental meetings not only serve as a means for attendees to obtain CE credit but for the hosting organization to cover rapidly rising costs and capture as much revenue as possible in the process. Due to the “lean” operation at the UDA we are able to provide a quality CE event while keeping our costs to a minimum. The meeting is provided as a benefit of UDA membership and has intentionally been designed to help our members and their teams obtain some of the best CE available at a very nominal cost. For those along the Wasatch front it is possible to get training for the entire team without having to pay to fly everyone to a remote destination and put them up in expensive hotels. You just drive to the Salt Palace Convention Center, receive great training, network with friends and other professionals, sleep in your own bed at night, and have new ideas and techniques to implement in your practice when you return to work on Monday. For those travelling in from outside the Wasatch Front you can easily drive to this great location,

take advantage of negotiated low hotel rates in nice neighboring hotels, and participate in one of the top 10 state dental conventions (#5 last we checked) in the US.

This year we are responding to feedback from surveys and are implementing several additional workshops for dentists and their teams. These are perhaps the best value at the meeting. Make sure you look at what is being offered, which one(s) would benefit you and your team, then sign up early since they will fill up fast. You will need to contact the UDA office (www.uda.org) to register for these low cost workshops that are sure to benefit your team and your office. Here is a list of workshops so you can start considering which ones to sign up for while they are still available:

Head/Neck Anatomy Review –offered Thurs AM and PM

Dental Anesthesia and Nitrous Oxide Update – offered Thurs PM, Fri AM and PM

Pedodontic Technique Pearls –offered Fri Am and PM Rotary Endodontic Workshop –offered Thurs PM

Dental Assisting Workshop –offered Fri AM/PM (topics are different each session – so okay to attend both sessions)

CPR/BLS Certification Workshop – offered Thurs AM/ PM, Fri AM/PM

The convention committee has worked long and hard on this program hoping to provide the quality CE needed by our local professional community while keeping it affordable. Please make plans now to join us on March 30-31 and take advantage of the “best CE value anywhere!”

Dr J. Jerald Boseman UDA Convention Coordinator

The Utah Dental Association wants to Congratulate Dr David Okano. Dr Okano has been a member of the UDA for many years and has contributed to multiple CE events and meetings. Good Luck, Dr Okano on your Leadership of the AAP (American Academy of Periodontology).

The American Academy of Periodontology installed David Okano, DDS, MS, as its president during its 108th Annual Meeting in Phoenix, held Oct. 27-30. Other newly appointed officers include PresidentElect Stephen Meraw, DDS, MS; Vice President Mia Geisinger, DDS; and Secretary/Treasurer Ana Becil Giglio, DDS.

UDA BOARD

In 2015, after 30 years of private practice in Rock Springs, Wyoming, Dr. Okano accepted a fulltime academic appointment at the University of Utah School of Dentistry, where he is currently Associate Professor and Section Head of Clinical Periodontics. He has served on numerous AAP committees since 2001, and in 2019 became chair of the Task Force to Evaluate Predoctoral Periodontal Education. Dr. Okano has served as a member of the AAP Board of Trustees since 2012, serving as secretary/treasurer during the 2019-2020 term. Dr. Okano received his Doctor of Dental Surgery degree and Master of Science degree from the University of Nebraska Medical Center College of Dentistry.

Dr Kay Christenson, DDS President

Dr Mark Taylor, DDS President elect Dr Len Aste, DDS Treasurer

Dr Rodney Thornell, DMD Secretary

Dr Greg Gatrell, DDS Immediate Past Pres./ ADA Delegate

Dr Brent Larson, DDS ADA Delegate

Dr Ken Baldwin, DDS

ADA Delegate

Dr Scott Theurer, DMD ADA Delegate

Dr Darren Chamberlain, DDS ADA Council Rep

IMANITE

I bet you are wondering what the heck Imanite means? Well, now that I have your attention, I’ll tell you. It is the Haitian Creole translation for Humanitarianism. I chose to use that translation for my article on humanitarianism because Haiti is in need of and has been the recipient of more humanitarian aid in the western hemisphere in recent times than any other country.

Humanitarianism has been around since the dawn of mankind. Religious texts are full of admonitions and examples of good works of helping the poor and needy. Henri Dunant, a Swiss businessman and social activist who began a relief response to help wounded soldiers in the 1859 Battle of Solferino during the second Italian war of independence, is considered the father of modern humanitarianism. Dunant set about a process that led to the Geneva Convention and the establishment of the International Red Cross.

Humanitarianism is the universal work. It crosses all cultural and generational boundaries. It is socioeconomic free. Everyone knows what it is and is capable of participating to one degree or another despite one’s skills, talents, or abilities. We all have the power to give something we possess to those in greater need, be it physical, mental, or spiritual. Humanitarian work allows one to become a servant of the damned, provider to the dispossessed and inspirator to the depressed and hopeless.

I began going humanitarian work 25 years ago. My passion for it grew out of the circumstances of my upbringing, I was one of five children of a single parent. Times were difficult and the only male role models I had were outside my house. Fortunately for me, three of them were dentists. The first one was my family dentist, Dr Max Conley. He was always kind and encouraging to me and set a good example of a providing family man. He also provided dental care to my family for free or at a discounted rate and allowed my mother to pay off our dental bills over time without charging penalties or interest.

Second, was Dr Mel Erickson, he was my best friend’s dad. He included me in many of his family activities and paid for many other youth activities that I could have never afforded on my own. He also taught me the value of an education and the power it gave to help those less fortunate. The third one was a good friend and mentor, Dr Craige Olson. As I progressed through my undergraduate years of college, he was there to encourage me and help me prepare for my dental education. I’m sure these men have no idea how much they influenced my life. I will forever be grateful for their support and kindness towards me.

There are many reasons why people get involved in humanitarian work. For some it is just inherent in their nature. They have strong convictions to share their talents and money with those in need. Others may have family or ancestors from poor or devastated countries. Some may have served church missions or have members of their faith in underserved regions. For others

who have been the recipient of humanitarian efforts, it is simply to give back.

Early in my career I recognized that without the influence of these men in my life I would not be where I was, and it created in me a great desire to give back. I chose humanitarian work as the vehicle for my giving.

Over the years I have provided humanitarian dental work to the poor and dispossessed in many countries. In Nepal, I trekked to remote villages and taught women how to clean and pull teeth. In Bulgaria, I provided dental care to forgotten children in orphanages. In the Dominican Republic, I have traveled to remote villages where the people have never been treated by a dentist in their life and don’t have the resources to go to a clinic in the cities. I have taken over 3000 individuals on humanitarian trips of which 2000 were dental students from around the world.

Humanitarian dental work generally provides relief or assistance to people or individuals affected by conflicts, disaster or poverty, thus improving lives and reducing suffering. It focuses on patients with basic or primary needs, instead of the latest and greatest technologies.

Humanitarian dental work can result in many things besides just providing care to the poor and needy. It can provide a valuable teaching and mentoring experience for dental students. It can be a bonding experience for family and staff who participate. It can encourage or confirm for individuals to pursue a career in health care. It can teach appreciation for what we take for granted by showing the impoverished living conditions that the majority of the world live under. It will most likely engender a spirit of humanitarianism in the participants. I have had individuals tell me that participating in these trips is the most rewarding things they have done in their lives.

For the recipients of humanitarian dental treatment, the results can be life changing and long lasting. First and foremost, it can relieve and eliminate pain and disease. It can provide education needed to prevent future need for treatment. By restoring and improving a person’s dentition they can obtain a better education, secure better education, secure better employment and help attract a suitable mate.

Of course, there are many risks associated with doing humanitarian work. One of the risks is being bitten by a mosquito and being infected with the Zika virus or developing Dengue fever. But more than anything else, you will probably be bitten by the humanitarian bug and come down with humanitarian fever, which is the hardest fever of all to get out of your system.

In the next few issues of the UDA Action, I will share how to get involved in humanitarian work, identify local and national organizations that offer humanitarian opportunities, how to start your own humanitarian project and to populate the classified website tab with more Imanite information.

Dr Len Aste UDA Treasurer

The 4 ADA Delegates from Utah and the UDA officers traveled to Houston in October for the annual ADA House of Delegate’s (HOD) meeting and 14th Trustee District Caucuses. Actions of the ADA House included the following:

Strategic Forecasting Committee

A landmark and historic change to the ADA Bylaws established a Strategic Forecasting Committee (SFC) to provide ongoing ADA strategic plan review and give guidance to the Association leaders and professional staff. This 13-member committee meets 4 times per year and is composed of 8 dentist members of the ADA HOD (2 from each of 4 geographic areas), 4 ADA Trustees and a new member dentist.

This change in ADA governance is intended to facilitate a timelier response to changes in the profession – in member benefits and advocacy policy. The SFC will establish subcommittees whose focus is directed to four areas 1) Dentists, 2) The ADA Tripartite (ADA, UDA, State Dental Districts), 3) Enterprise (ADA non-dues revenue), and the 4) Professional/ Public (state and national advocacy). The subcommittees will have 4 Action Groups in each geographic region.

The West Action Groups are where the UDA and individual members can now influence ADA member benefits and advocacy policy, in real time. In the past, changes to ADA member benefits, advocacy, governance and tasking ADA Councils with projects could only be done as a Resolution to the ADA House - which meets only once a year in conjunction with the ADA’s Annual Meeting (SmileCon). A change proposed by a Resolution had to be reviewed by all ADA Delegates, debated in ADA Reference Committees then voted on at the next ADA HOD resulting in either bein adopted, not adopted, or sometimes referred to an ADA Council for study and reporting back at the next year’s HOD – starting the prolonged review and voting process over again.

The ADA HOD continues to maintain its governing body status, however going forward in many instances I believe it will be more as “ratifying” action rather than “proposing ” action to be taken in the future. As ADA Delegates and UDA Officers we will be making sure to move your concerns and suggestions to the West Action Groups.

Dental Plans – Third Party Payers

A Resolution passed creating “a model Explanation of Benefits (EOB) statement” which would include: “Any difference between the fee charged and the benefit paid is due to the limitations in your dental benefits contract. Please refer to your summary plan description for and explanation of the specific policy provisions which limit or exclude coverage for the claim submitted. The treatment reported on the claim by CDT codes as submitted by

the dentist and the procedures have been adjudicated by …(statement of how an individual plan processes claims.”

Provider rating systems by 3rd party payers: “Resolved that the Appropriate ADA agency prioritizes legislative efforts to prevent the used of flawed and misleading provider rating systems and that any third party who publishes rating systems clearly convey to the public that provider ratings are not based on quality of care, but on provider conformity to the dental plans’ design and cost containment. Additionally, that those third parties who publish provider rating systems should be transparent in the methodology, provide quarterly reports to providers, provide a mechanism for appeal and improvement of provider scores and an opt-out option from being publically rated.”

3rd Party network leasing: “Resolved, that the ADA urge that any amendments to existing third party payer contracts between a dentist and a third party payer, dental benefits administrator or a dental network leasing company require signature by the dentist, and that such amendments with any and all changes to the contract terms, policy manual and fee schedule be communicated to the dentist via certified mail with at least 90 days’

notice prior to the date of implementation and to require the dentist’s signature to opt in. And further resolved, that when third party payers choose to establish a new network using the name, image and likeness of dentists participating in the carrier’s existing network, then dentists should be provided the opportunity to opt-in to such new networks.”

Adopted 14th Trustee District Resolutions

Each year dentist and state associations in our 14th Trustee District (AZ, CO, HI, NM, NV, UT, WY), move Resolution to the ADA HOD for consideration, some important policy and actions to be taken by the ADA. At this year’s HOD, the 14th District Resolutions which were adopted included:

Paid Extended Leave: “Resolved that the appropriate ADA agency explore options to help employer dentists offer paid extended/family leave that could be purchased as a member benefit.”

This resolution recognizes that some employed associate dentists need to have the flexibility to take a paid leave-ofabsence for their own health, or care giving for a family member including such conditions as cancer, dementia, maternity, chronic disease, etc. Providing this benefit is a considerable expense to owner dentists so it is rarely available in employment contracts. The hope is the ADA can find an insurance product which will have a reasonable employer cost.

Tobacco and Vaping Cessation and Referral to QuitLines:

“Resolved that the appropriate ADA Agency establish relationships with each state’s QuitLine to gather accurate data on QuitLine referrals by dentists and other dental team members, facilitate a survey by state associations to understand QuitLine referrals by their members, and increase tobacco and vaping cessation counseling and referral to QuitLines.”

Social Media Reviews and Reputation Management: “Resolved, that the appropriate ADA agencies curate existing social media reputation management content to develop a Reputation Defense Toolkit to help dentists with the appropriate reaction to social media postings and reviews that are misleading or defamatory, to make the Reputation Defense Toolkit available as a member benefit and to initiate a plan to update the Toolkit as needed, and be it further resolved, that the ADA enter into discussions with social media platforms to assess the feasibility of revising user agreements to prohibit misleading or unverifiable posts and reviews, which cannot be responded to due to HIPAA limitations, and creating a fair and reasonable process for victims to remove misleading or defamatory posts.”

ADA Budget: The ADA HOD approved the proposed ADA Budget and set the ADA 2023 dues at $600 (UDA dues are still $310, and your districts’ dues vary). You can renew your membership for 2023 at UDA.org > Member Center > My Membership > Join/Renew or at ADA.org > Renew.

Federal Student Loan Forgiveness: “The position of the ADA is that dentists should not be excluded from government relief of public and commercial student loan debt without obligation or

condition. The ADA makes efforts to shape specific student loan forgiveness proposals by stating that education debt associated with graduate and professional programs should be eligible, any means testing should account for regional differences in cost of living and purchasing power, and consideration for eligibility and amount of forgiveness should account for the cost, length and rigor of dental education programs.”

ADA Dental Team Member Membership: A resolution to create a “Team Member” classification in the ADA failed. This was disappointing to the UDA delegation as along with many other state associations, we have “Affiliate Hygienist” members of the UDA, which helps create value for all members of Utah dental teams.

Amended ADA Policy on Evidence-Based Dentistry: “Prin ciples of Evidence-Based Dentistry: The Association supports the concept of evidence-based dentistry developed through systematic examination of the best available scientific data. Evidence-based dentistry provides a framework to help dentists use, appraise and apply research evidence in clinical practice. A primary goal of evidence-based dentistry is to improve the quality of dental treatment and oral health care through the objective appraisal of the best available evidence, improve clinicians’ skills in diagnosing oral and dental diseases and providing treatment interventions that help achieve optimal outcomes for patients.

The ADA works to support clinicians in making decisions about the provision of patient-centered, evidence-based treatment and care to allow such decisions to be based on current best evidence, individual clinical expertise and the individual patient’s preferences and values. The ADA also recognizes that treatment recommendations should be determined for each patient by his or her dentist, and that patient preferences should be considered in all decisions. Additionally, dentist experience, diagnostic findings and other patient circumstances should be considered in treatment planning and determining treatment needs. EBD does not provide a “cookbook” that dentists must follow, nor does it establish a standard of care. The EBD process must not be used to interfere in the dentist/patient relationship.

The ADA, consistent with its commitment to evidence-based dentistry and the improvement of oral health, supports including complementary and alternative medicine therapies as an adjunct to traditional diagnostic and treatment approaches, as long as they are based on sound scientific principles and demonstrated clinical safety and effectiveness.”

ADA Policy on Amalgam: “Resolved, that the ADA recommends that clinicians review the risks and benefits of all restorative options with their patients, and that dental amalgam restorations continue to be used when appropriate for patient care. The ADA supports the globally recognized need to reduce environmental mercury as set forth in the Minamata Convention on Mercury (September 2019) as a common good, and recognizes the responsibility of dentists to care for their patients’ well-being, in keeping with the ADA Principles of Ethics and Code of Professional Conduct.

Resolved, that based on current documented scientific research, the conclusions of conferences and symposiums on the biocompatibility of metallic restorative material, and upon joint reports of the Council on Dental Materials, Instruments and Equipment and the Council on Dental Therapeutics of the Association, the continued use of dental amalgam as a restorative material does not pose a health hazard to the nonallergic patient, and that to advocate to a patient or the public the removal of clinically serviceable dental amalgam restorations solely to substitute a material that does not contain mercury is unwarranted and violates the ADA Principles of Ethics and Code

Resolved, that the ADA strongly recommends that use only precapsulated amalgam alloy in their dental practices.”

Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists:

“The Requirements for Recognition of Dental Specialties and National Certifying Boards for Dental Specialists contain criteria that specialty applicants and the recognized specialty sponsoring organizations and certifying boards must meet in order to become and/or remain recognized by the National Commission on Recognition of Dental Specialties and Certifying Boards (National Commission). A specialty is an area a discipline of dentistry that has a separate, distinct and well defined focus based on unique advanced knowledge, skills and training. Dental specialties are recognized to protect the public, nurture the art and science of dentistry, and improve the quality of care in disciplines of dentistry in which advanced knowledge, skills and training are essential to maintain or restore oral health. Not all disciplines in dentistry will satisfy the requirements for specialty recognition and there should be no expectation that all disciplines in dentistry will meet the Requirements for Recognition of Dental Specialties.”

Medicaid Dental Loss Ratios: “the ADA recommends that U.S. Centers for Medicare & Medicaid Services (CMS) publish a state by state assessment of managed care organizations with the percentage of allocated Medicaid funding that is being spent on dental services, and the ADA recommends that CMS require each state Medicaid agency to monitor the dental loss ratio among their contractors.”

Amending ADA Policy to Stop Unlicensed Dental or Dental Hygiene Practice: “Resolved, that state attorneys general should be expeditious in prosecuting individuals who are practicing dentistry or dental hygiene without a license, that state dental boards should be empowered to deliver and enforce cease and desist orders and press charges for practicing dentistry or dental hygiene without a proper license, and that individuals charged with practicing dentistry or dental hygiene without a license should be prosecuted to the fullest extent of the law.”

ADA Policy on Oral-Systemic Health Integration: “Resolved, that the ADA supports and encourages treatment to optimize a patient’s oral health status prior to organ

transplants, joint replacements, cardiac surgery and other medical procedures and supports and encourages research, collaboration and appropriate treatment discussions between dentists and other health care providers to help identify systemic diseases which are strongly suspected to have a direct relationship to a patient’s oral health.”

Establishment of a Special Committee on ERISA: “Resolved, that a Special Committee be convened to develop a broad-reaching strategy for improving patient protections in dental plans regulated under *ERISA.

*Note: CQI meetings this past fall reviewed that some dental plans are state regulated – so they must comply with Utah statutes including recent changes the UDA has lobbied for including; non-covered services, virtual credit cards, retroactive denials, prior authorizations, network leasing (see UDA Action Jan 2022, pg. 9-11). Many more dental plans are federally regulated by the “Employee Retirement Income Security Act of 1974” (ERISA) and may not be subject to Utah statutes.

Dr Scott Theurer ADA Delegate

CONVENTION

UDA CONVENTION HOSTING

The UDA Convention Committee is looking for UDA Member Dentists and Hygienists that would be willing to host a speaker at the UDA Convention in March. Being a host is really pretty easy. You would contact the speaker before the meeting, introduce yourself and see if he/she had any concerns or questions. While at the convention you would also be coordinating with the speaker. As a host you would introduce the speaker and give any necessary announcements from the UDA Convention Committee.

The perks of being a host include getting to know a pretty great presenter in the world of dentistry. Also, your registration fee is waived to attend the convention. Look through the convention program and see if there is a particular presenter that you would like to meet and get to know.

Please email or text Becky at the UDA Office if you are interested in being a host. becky@uda.org or 801-261-5315

PRACTICE

ANTIBIOTICS: FRIENDS AND FOES

As Dental practitioners we sometimes get very complacent with the use of antibiotics. When patients come in with pain, swelling, erythema, and other signs of infection, it’s almost a knee-jerk reaction to place this patient on an antibiotic. It is sometimes helpful to review basic indications for antibiotics as well as guidelines for appropriate therapy. We have very limited space for this review and therefore it is not comprehensive, and we should refer back to our current therapeutic guidelines as well as training on appropriate antibiotic use.

The first principle of antibiotic use is to determine if there is in fact an infection. I have treated several patients who had classic signs and symptoms of acute temporomandibular joint disorders when in fact they had a mild odontogenic infection associated with an irreversible pulpitis on a mandibular molar and all they really required was extraction or endodontic therapy. It’s important that we are confident that there is in fact an infection to be treated before routinely prescribing antibiotics.

The second principle of antibiotic use is to determine the current state of the hosts’ defenses. Many times an odontogenic infection can be treated surgically by removing the source of the infection if the patient is not immunocompromised. There are however, an increasing number of patients who are immunocompromised because of the immunosuppressive drugs associated with cancer treatment, suppression of autoimmune disorders such as rheumatoid arthritis, ulcerative colitis, diabetes, and immunosuppression due to alcoholism or drug addiction.

The third principle of antibiotic use is to always remember that surgical intervention is many times necessary in addition to, or in place of, antibiotic therapy. Endodontic therapy, extraction, or debridement of necrotic bone is the primary form of treatment in addition to antibiotic coverage as indicated.

The fourth principle of antibiotic therapy is to identify the causative organism if it is at all possible. This means that incision, drainage, with appropriate cultures that many include hard and soft tissue samples as well is very important particularly in cases where the patient is failing to improve with appropriate antibiotics. Culture tubes along with appropriate sample bottles can be obtained from your local hospital microbiology lab or you may choose to refer the patient to an Oral & Maxillofacial surgeon for appropriate identification of causative organisms. Included in the identification of the organism is typically a sensitivity screening to common antibiotics and this can prove very helpful in providing the appropriate choice of antibiotics.

The fifth principle of antibiotic use is to choose a specific, narrow-spectrum antibiotic with the least toxic side effects that is appropriate for the suspected causative agents. This obviously includes choosing an antibiotic for which the patient has no history of allergy. This minimizes the risk of super infections and the risk of developing other resistant bacteria. We are all familiar with the propensity of clindamycin for the development of pseudomembranous colitis, however, it is just as common with the use of broad-spectrum penicillin’s and cephalosporins simply because these antibiotics are used more frequently.

The sixth principle of antibiotic use is to use a bactericidal antibiotic rather than a bacteriostatic antibiotic whenever possible. Commonly used bactericidal antibiotics in the dental profession are penicillin’s, cephalosporins, metronidazole, and ciprofloxacin. Bacteriostatic antibiotics are the tetracyclines, the macrolides such as erythromycin and azithromycin, clindamycin and sulfa antibiotics.

The seventh principle of antibiotic use is to give the proper dose of the antibiotic to achieve three to four times the minimum inhibitory concentration in the patient’s plasma and this is usually determined by the standard prescription protocol for the particular drug. Unfortunately, this is also dependent on patient cooperation and taking the antibiotic as prescribed. It is also important to remember that most antibiotics are cleared through the kidneys and patients with pre-existing renal disease and subsequent decreased renal clearance may require longer intervals between doses if overdosing is to be avoided.

The eight principle of antibiotic use is to monitor the patient. For example, it has been suggested that if a patient fails to improve significantly with a mild or moderate infection after 48 hours of use of a single therapeutic that consideration should

Photo: Image licensed by Ingram Image

be given for adding a second antibiotic or a combination antibiotic such as Augmentin. Combination therapy has been discouraged in the past but with the increased amount of resistant bacteria to monotherapy it is now more common to prescribe combined therapy such as penicillin or amoxicillin in combination with metronidazole. Monitoring the patient for adverse reactions such as hypersensitivity, developing allergy, antibiotic-associated diarrhea, or more severe antibiotic-associated colitis is imperative.

The ninth principle of appropriate antibiotic use is to use prophylactic antibiotics as currently indicated. In general patients with prosthetic joints do not require prophylactic antibiotics. If they have had surgery and are undergoing invasive dental procedures then consultation with their orthopedic surgeon may be indicated and appropriate. Prophylaxis for prevention of infective endocarditis is indicated in patients with a presence of prosthetic cardiac valves, previous infective endocarditis, unrepaired congenital heart defects and cardiac transplant recipients who developed cardiac valvopathies. Of significance is that if a preoperative antibiotic prophylactic dose is inadvertently missed the medication can be administered up to two hours following the procedure. A review of the American Dental Association guidelines is a great guide in this area.

Some specific suggestions for antibiotics are to rely on the penicillin derivatives whenever possible with cephalosporins as a substitute for the penicillin derivatives if the patient is unable to use these. If they had an allergic reaction that was of a mild nature then this is a reasonable substitute as they are unlikely to have a cross reaction. The only oral cephalosporin that provides coverage for anaerobic bacteria is cefuroxime (Ceftin) and this is an excellent choice. Clindamycin is still a primary choice even though there is an increase in resistant bacteria noted in our community. The quinolones such as ciprofloxacin, levofloxacin, and moxifloxacin are secondary choices because of the potential side effects of tendonitis/tendon rupture, peripheral neuropathies, and central nervous system effects. The quinolones do not have activity against anaerobes and therefore many times need to be used in combination with beta-lactam antibiotics, clindamycin, or metronidazole. The macrolide antibiotics such as azithromycin, clarithromycin, and erythromycin are effective treatment choices for mild odontogenic infections. They may also be used in combination with metronidazole.

Antibiotics are a mainstay of dental treatment but are not a substitute for definitive surgical management. Minor odontogenic infections can be treated effectively with antibiotics and many times with surgery alone but most of the time combined therapy is the treatment of choice.

Dr Ken Baldwin ADA Delegate

CONVENTION

LOOKING FOR A FEW GOOD DENTISTS!

Have you ever wondered how to get involved with the UDA at a level you feel you are actually contributing to the future of organized dentistry and our profession? One of the easiest and most enjoyable ways to do this is to become part of a functioning committee that works on things you are passionate about. Currently we are looking for individuals that are passionate about continuing education, love to attend dental meetings to learn new things, and want to be a part of planning and executing the annual UDA Convention by serving on the UDA Annual Convention Committee. We are hoping to have those interested in serving step forward and identify yourself so we don’t have to search you out!

To serve on the committee we are looking for individuals that can commit to approximately 4-5 years working on the committee to scout speakers, plan the yearly program, and help during the convention to see that it runs smoothly. Although this commitment can be less lengthy it does take time to learn from others on the committee in order to be effective. Some committee members are eventually asked to serve as the scientific chair over the UDA Convention and be more intimately involved with the planning and decision process; this usually happens toward the end of their tenure on the committee. Those invited to serve on the committee are asked to:

i. Attend periodic evening planning meetings at the UDA office in Bountiful (often 1x/mo Sept – Jun)

ii. Travel to one major dental meeting of their choosing outside of Utah each year to scout speakers, exhibitors, and gather ideas to make our meeting successful (a stipend is paid to offset most or all of the expense for attending this meeting)

iii. Accept different assignments leading up to and during the UDA Convention dealing with hosts, exhibitors, etc.

iv. Attend the yearly UDA Convention when possible to learn and to help with logistics and assignments during the meeting

Most who have served on this committee have found it to be a fun rewarding opportunity that they look forward to. Much of the current success of our annual convention is due to the input and contributions of these past and present committee members. If you are interested and wish to be considered or want more information please reach out right away to either myself, Jerald Boseman (bosey@aol.com, 801-891-3911 cell), or Dotty Tanner at the UDA (dotty@ uda.org, 801-261-5315).

ASSOCIATION

UTAH DENTAL ASSOCIATION LEGISLATIVE SUCCESSES

Association

Year after year, there is always a certain amount of frustration in a dental office. The one topic that usually causes the most frustration amongst all offices, is “dental insurance” issues. More correctly identified as third-party payer issues. That frustration generally originates from problems created by the third-party payer companies.

For Utah, passing this bill in 2017 means:

• A dental insurer is prohibited from setting fees for dental services that are not covered services under the dental insurance.

UTAH DENTAL ASSOCIATION LEGISLATIVE SUCCESSES

• A contract between a dental plan and a dentist to provide covered services may not prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the noncovered services.

Year after year, there is always a certain amount of frustration in a dental office. The one topic that usually causes the most frustration amongst all offices, is “dental insurance” issues. More correctly identified as third-party payer issues. That frustration generally originates from problems created by the third-party payer companies. In August of 2022, the UDA sent out a survey asking which third-party payer issues were the most frustrating. (See below). This frustration is almost unanimous across all dental offices nationwide. Utah dentists and their dental team members definitely agree, third-party payers are their biggest frustration.

In August of 2022, the UDA sent out a survey asking which third-party payer issues were the most frustrating. (See below). This frustration is almost unanimous across all dental offices nationwide. Utah dentists and their dental team members definitely agree, third-party payers are their biggest frustration.

• This does not apply to a dental plan that is regulated by federal law.

• For exact language of the law, see Utah statute 31A-22-646.

More Recent Insurance Reform:

In the years since 2017, the ADA and UDA have been working on other third-party payer issues that continue to be a frustration to the dental team. The ADA identified several key frustrations and formed “Dental Insurance Reform” messages to assist states in achieving legislation that could ease some of the frustrations of the dental team, in regards to third-party payers. Four of those key topics developed with the help of the ADA, are:

• Retroactive Denials of Coverage

• Prior Authorization

• Virtual Credit Cards

• Network Leasing

Let’s go over the significance of each of these areas and how the UDA has been able to make progress in Utah for dental offices on each of these common frustrations.

Retroactive Denials:

Although the ADA nor UDA cannot dissolve the contracts a dentist has signed to be a PPO provider, our organization is still actively engaged in finding some resolve to the third-party payer issues. Recognizing the dentist’s frustration, the ADA expanded the attempts a few years ago, to get involved with “Dental Insurance Reform” across the nation. Several key topics began to surface, and efforts were put forth to see where changes or improvements could be made. States are sharing with other states, their legislative strategy, and their legislative successes. One of the early topics pushed in state legislatures was Non-Covered services.

Non-Covered Services:

Although the ADA nor UDA cannot dissolve the contracts a dentist has signed to be a PPO provider, our organization is still actively engaged in finding some resolve to the third-party payer issues. Recognizing the dentist’s frustration, the ADA expanded the attempts a few years ago, to get involved with “Dental Insurance Reform” across the nation. Several key topics began to surface, and efforts were put forth to see where changes or improvements could be made. States are sharing with other states, their legislative strategy, and their legislative successes. One of the early topics pushed in state legislatures was Non-Covered services.

In 2016, the UDA with the help of Senator Allen Christensen and the ADA, proposed a bill that would be presented to the 2017 Utah Legislature. This bill passed the 2017 legislature and became law (statute) and went into effect Jan 1, 2018. Similar Non-Covered Services laws were passed in over 40 states. Showing the US Congress the importance and the need to address this in the US Congress and make this applicable to federally regulated third-party payers.

Non-Covered Services:

In 2016, the UDA with the help of Senator Allen Christensen and the ADA, proposed a bill that would be presented to the 2017 Utah Legislature. This bill passed the 2017 legislature and became law (statute) and went into effect Jan 1, 2018. Similar Non-Covered Services laws were passed in over 40 states. Showing the US Congress the importance and the need to address this in the US Congress and make this applicable to federally regulated third-party payers.

For those that may not understand what this term means, you all may be familiar with the actions that occur that are defined as Retroactive Denials. I myself, have been a victim of these efforts by third-party payers. Retroactive Denials are when a third-party payer tries to reclaim money already paid to the dentist, when insurers discover they paid a claim mistakenly, even if the claim was processed years prior. In other words, an expected covered treatment is performed on a patient and the claim is processed and paid by the third-party payer. Then months or years later, the dental office receives a letter saying the office was overpaid and the office now owes the third-party payer a certain amount determined by the insurance company. It’s my understanding that often, the third-party payer strips out the “over-paid” balance out of other pending claims from other patients. This alleged overpayment notice often comes at a time

when an office can no longer legally go back to the original patient to bill for the performed services. In my case, the letter of “over payment” was received three years after treatment was performed.

There is now a law in Utah that prevents this. The current recoveries language on Retroactive Denials applies to healthcare and is found in UCA 31A-26-301.6(14). This law is already on the books and does not allow an insurance company to come back years later to try to reclaim overpayments or claim disputes long after the date of service. The state Representative we have been working with, says the third-party payers only have 1 year from date of payment to try to reclaim the money. This time period is doubled for Medicaid claim overpayments.

Prior Authorizations:

In discussing Prior Authorizations, we should explain the difference between Prior Authorization and Pre-Treatment estimates. Usually, Pre-Treatment estimates occur when an office staff calls the third-party payer and tries to find out the extent of coverage, if certain procedures are performed. This pretreatment estimate is not technically a Prior Authorization. A Prior Authorization means the third-party payer has agreed to make payment for the services being sought prior to treatment (usually this is done in writing, and possibly after dental consultant review).

The concern with dental offices is an increasing number of insurers are denying claims for services previously authorized, reversing their agreement with both patients and dentists. In 2019, SB 264 regarding to Prior Authorizations passed. The Bill was sponsored by Senator Evan Vickers and Representative Suzanne Harrison. This Legislative bill spelled out that a Prior Authorization, if done correctly, would be more like a contract or commitment by the third-party payer for payment. When a dental office has received a prior authorization and the third-party payer elects to not honor that prior authorization, the office should appeal to the third-party payer company citing the Utah law, reminding them the law states they are committed to the payment they acknowledged in the prior authorization. See statute UCA 31A-22-650

Virtual Credit Cards: This is a term given to the process where an insurance company reimburses a dental office through a virtual credit card, which can include a per-transaction fee of as much as five percent. In some cases, insurance companies even share in the revenue generated from these fees. You likely have seen this as a letter that contained a 16 digit credit card number that your office is to run the number through your credit card services as if you were being paid with an actual credit card. This results in an additional loss of income since a percentage was removed by the credit card services company.

In the 2020 Utah Legislative session, the UDA advocated for language in HB 37, that would allow a dentist to opt out of Virtual Credit card payment methods. Thus, saving the office from the credit card fees associated with credit card payments. Representative Jim Dunnigan and Senator Curtis Bramble sponsored an insurance Amendments bill and worked with the

UDA to give dental offices an option to accept or opt out of Virtual Credit card payments methods.

The dentist needs to notify the third-party payer that they want to opt out of Virtual CC payments and inform them you want to receive payment by check. The Utah law says they can request the opt out for the dentist from that particular third-party-payer company. The dentist would have to repeat this notification for every third-party payer company they participate with. It is not automatic. The dental office will have Utah law backing them when they request to opt out. See UCA 31A-26-301.6

Some insurance companies were making the dentist specify each patient they were opting out on. The new law says they can tell that Insurance company they opt out for all their payments from that company. The dentist should clarify, they want the Ins Co to pay them by check rather than Virtual Credit card.

Network Leasing:

Many may not recognize the term Network Leasing. Network Leasing is when third-party payers sell participating dentists to a different insurance network often without the dentist’s knowledge or consent. Basically, when a dentist signs up with a third-party payer to be a provider for them, the third-party payer leases that contract to other third-party payers. This can result in the dental office being contracted with several additional PPO plans. The dentist may not even be aware of all the dental plans of which they are then contracted. This can significantly impact the insurance benefits available to the patients. Often the dental office will be reimbursed at the lowest rates of those companies in the network. This also erodes patient/dentist trust, which can lead to assumptions in treatment plans and costs based on a false understanding of patient coverage.

In preparation for the 2021 Legislative session, the UDA was working with Representative Jim Dunnigan to craft a bill creating transparency and options for a dentist in regards to Network Leasing. The National Council of Insurance Legislators (NCOIL) and the ADA had been working on model legislation that would help solve many dentist’s frustration with Network Leasing. The ADA, various State Legislators, and many Insurance Companies had already vetted this topic for months and had come to several agreements for transparency. The result was the NCOIL Model Legislation. The UDA used this model legislation in initiating a bill for the 2021 legislative session (HB 359 sponsored by Representative Jim Dunnigan and Senator Karen Mayne). See UCA 31A-22-646.1

Since the Fall of 2020, the UDA has worked with Dr Rob and Tracy Thorup of “My Practice, My Business”, in specifically creating legislation regarding HB 359. Their additional ideas presented included two topics that were included in the 2021 HB359. Many hours of work with Representative Jim Dunnigan, the UDA and Dr Rob & Tracy Thorup were put in to finally create the final version of HB 359. The Thorups, UDA Representatives and Rep Dunnigan virtually met for several weeks and brought in many representatives of the larger insurance companies. The discussions resulted in some

understanding of the dentist’s frustrations caused by these thirdparty payers in regards to Bundling and Downcoding.

As part of 2021’s HB 359, An insurer may not maintain a dental plan that:

• based on the provider’s contracted fee for covered services, uses downcoding in a manner that prevents a dental provider from collecting the fee for the actual service performed from either the plan or the patient; or

• uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure.

Also, an insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result. See UCA 31A-26-301.7. or HB 359 (2021)

There had been a great deal of significant effort made to negotiate and resolve conflicts with third-party payer companies during all aspects of the crafting of this bill. As a result, HB 359 was placed on consent calendar for both the House and Senate. This essentially means, enough debate and crafting took place before the writing of this bill, that it sailed through legislation unopposed. This was a great “Win” for Utah dental offices on insurance reform topics made possible by the efforts of the UDA and My Practice, My Business (Dr Rob and Tracy Thorup).

We again are currently working on additional legislation with “Dental Insurance Reform” issues for the 2023 Legislative session. We will continue to work on ways to find solutions to the often-frustrating tactics used by third-party payers. Regardless of our legislative efforts, the high PPO participation by dentists in Utah still directly determines the declining dental reimbursement rates. We continue to educate and encourage dental offices to look at the PPO’s they are “in-network” and make wise business decisions by taking control of your circumstances, rather than be controlled by your circumstances.

In Summary, although legislation intends to improve and sustain what is best for the public and professions such as dentistry, there are always plenty of groups out there trying to take advantage of well intending practitioners. Legislation that will only contribute to sustaining and maintaining the dental profession as we currently know it, is not likely. Between the DIY dental companies, the trend toward mid-level providers, and growing aspects of DSO’s, and other groups working to fragment dentistry, the profession we love is gradually and significantly changing. The UDA is constantly defending and encouraging dentists and their dental team members to provide the best oral care for the public. If we remain united and do not become a fragmented profession, we will be better able to direct Legislative and Congressional successes, maintain public safety and improve sustainable oral health care.

Dr Val L Radmall UDA Executive Director

(801) 576-0335.

WHAT DOES IT REALLY MEAN WHEN YOU HIRE A “TEMPORARY EMPLOYEE?”

Temporary employees (Temp) are defined as individuals hired to assist an office to meet increased short term needs. There are many reasons why a dental office needs a Temp. For example, Mary calls in sick at the last minute, Joni’s having a baby and the office needs a Temp for a month, and unexpected patient “over-load” for cleanings. And the list goes on. However, it’s important to understand the legal and payroll implications of hiring Temporary employees. That is, when a Temp comes into your office, what are you truly responsible for? Below is a list I’ve put together to assist you navigate this minefield. These do’s and don’ts will hopefully help you steer clear of potential issues with Utah employment laws, Federal tax laws as well as several other laws that apply. Please be advised that this is not legal or tax advice and that you should consult an attorney or tax expert to understand how these laws specifically apply to your office.

Payroll considerations:

According to Utah Employment Law you must pay the Temp for hours worked in your office including any training, working interviews or other administrative assignments. Also, each Temp will need to complete a W-4 and you must withhold taxes according to their W-4 selections.

Independent contractors/ 1099’s: When you give someone a 1099, it means that the government considers them to be self-employed. Independent contractors are responsible to pay their own taxes, including Medicare and Social Security payments, to the IRS. In some cases, independent contractors are required to estimate their annual income and make quarterly income tax payments to the IRS. As you know, office staff need to be directly supervised by a licensed Dentist and therefore cannot be considered independent contractors. This means all office staff need to be employed by the Dentist. Issuing a 1099 to an employee under your supervision is a common mistake which may result in an audit from the IRS and/or the state. According to the IRS website https://www.irs. gov, mis-classifying employees as independent contractors is one of the main reasons for an employee audit and failing to provide W-2 forms can subject an employer to back taxes of as much as 41.5% of the contractors’ wages. These penalties may be applied retrospectively for three years. Regardless of whether the Temp has made more or less than $600 in your office, they still cannot be self-employed and shouldn’t receive a 1099.

Unemployment or Workforce Services:

Once you’ve paid the Temp, you need to register them as a new hire on Workforce Services website (https://jobs.utah.gov/) according to the Employment Security Act. The unemployment insurance program is operated on general insurance principles wherein the employer pays the contributions into the Utah Unemployment Compensation Fund (trust fund) to sustain the program. If the Temp ever files for unemployment you will be sent a letter about your potential costs based on your contribution

rate. If you’re unsure about your coverage call Utah Workforce Services 801-526-4400 for additional detail.

Worker’s Compensation:

It is also important to know that the Temp employee also falls under your worker’s compensation plan. That is, if they poke, pull, fall, trip, knock or flip there’s administrative work to do in addition to sending them to instant-care or emergency room! Remember to call your carrier to ensure you have Temp coverage or fill out a form online with your company of choice. I found the Workers Compensation Fund easy to work with. Their phone number is (385) 351-8000.

Best-Practices:

While this shouldn’t be news to anyone, it needs constant repeating. There always needs to be a current licensed Dentist physically overseeing the office!! That goes for all the dental staff and patients.

Another safeguard is to develop a list of what your expectations are for the Temp. Create a list of your office policies and what the Temp needs to do while Temping in your office (sterilize the room, where the barriers go, how to sterilize instruments, who take X-rays, etc.) have the Temp sign and date it so you know they understand what to do so there’s no questions or problems later.

Outsourcing the Problem:

Outsourcing these issues to a Professional Employer Organization (PEO) may be the way to go! POE’s like Doctors Staffing & Resources, Inc. will take care of the payroll, payroll taxes, Workforce Services and Workers Compensation for your Temporary employees. Some think of this as Doctors Staffing and the Dentist co-employing the Temp! That is, the Dentist oversees procedures, protocol, etc. and Doctors Staffing and Resources will handle the payroll, Workforce Services and Workers Compensation. Doctors Staffing will then ensure that the employee will be paid in compliance with all applicable state, federal and IRS regulations.

Dr. James D Johnson of South Jordan said, ‘Doctors Staffing has saved me countless hours of record keeping and hassle in regard to Workforce Services and year end accounting records for Temporary employees”.

As we all know, the “Gig Economy” is growing, and the IRS and state want to make sure that every person is correctly categorized, and all taxes are correctly paid. Make sure you go over all this with your accountant and you’re ready for any audit that comes your way!

This article was written by Stephanie Sawatzke, President of Doctors Staffing & Resources. She has over 28 years’ experience serving the needs of the Utah Dental Community. She can be reached at (801) 576-0335.

This article was written by Stephanie Sawatzke, President of Doctors Staffing has over 28 years’ experience serving the needs of the Utah Dental Community. reached at

Correct answer: (b) Antral Pseudocyst

Antropseudocysts are a common radiographic finding on panoramic radiographs. They usually present as a sessile, dome-shaped lesion with varying degrees of radiodensity that arises from the floor (sometimes the wall) of the maxillary sinus. It develops as there is an accumulation of serum and inflammation under the sinus mucosa. The reported prevalence is between 1.5% to 14% of the population. Possible etiologies include odontogenic infection, sinusitis, allergies, etc. Most lesions are asymptomatic and don’t require treatment but some patients report sinus pain, post nasal drip, headaches, etc. In symptomatic patients, or when significant expansion is noted, a referral to an otolaryngologist, oral surgeon, or another health care provider may be warranted. Removal is usually completed by way of a Caldwell-Luc procedure.

2022-2023

University of Utah, School of Dentistry

FRI SEPT 9 2022

THUR OCT 20 2022

8:30 am - 4:00 pm at The University of Utah, Alumni House

The 4th Annual G. Lynn Powell Lecture Series: Digital planning and execution: from simple to complex

Featuring: Mark Ludlow, DMD, MS 6 credit hours

In-person

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Dental Sleep Medicine: The role of dentistry in the treatment of sleep-related breathing disorders

Continuing Education Lectures

THUR JAN 19 2023

THUR FEB 16 2023

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Endodontics: Endodontics Complications: Prevention and Management

Featuring: Richard Bauman, DMD, MS 2 credit hours

In-person and broadcast live on YouTube

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Oral Radiology: Seeing is believing, but sometimes we are not seeing as well as we should.

Featuring: Robert Timothy, DDS 2 credit hours

Dr Bryan Trump is a Board Certified Oral & Maxillofacial Pathologist and full-time Associate Professor at The University of Utah School of Dentistry. Bryan grew up in Centerville, Utah. He attended Weber State University, where he earned a Bachelor of Science in Microbiology. His DDS is from Virginia Commonwealth University School of Dentistry, and he completed his Oral & Maxillofacial Pathology Residency as well as a Master’s in Biomedical Sciences at Texas A&M University College of Dentistry.

In-person and broadcast live on YouTube

An osteoma (benign tumor of mature compact bone) would be more radiopaque/radiodense. Paranasal osteomas are more common than those occurring in the jaw bones. The frontal sinus is more commonly involved followed by the ethmoid and maxillary sinuses. Chronical apical periodontitis (odontogenic infection in general) may be an etiologic factor but usually present as a radiolucency at the apex of an infected tooth. An odontoma is the most common benign odontogenic tumor but would have the same radiodensity as tooth structure and are usually found within the medullary bone.

Works Cited Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.

Dr Bryan Trump University of Utah School of Dentistry

HELP IS JUST A CALL AWAY! ADA THIRD PARTY PAYER CONCIERGE™ 1-800-621-8099

THUR NOV 17 2022

Featuring: Gary Lowder, DDS 2 credit hours

In-person and broadcast live on YouTube

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Periodontics: Updates in Periodontics Featuring: George Bailey, DDS, MS 2 credit hours In-person and broadcast live on YouTube

THUR MAR 16 2023

FRI APR 14 2023

6:30 pm – 9:00 pm at The University of Utah, School of Dentistry

Pediatric dentistry: Pediatric Dental Emergencies: What every provider and parent needs to know

Featuring: Hans C. Reinemer, DMD, MS 2 credit hours

In-person and broadcast live on YouTube

8:00 am – 12:30 pm at The University of Utah, School of Dentistry

Restorative Dentistry; The real beauty of anterior composite resin restorations. Easy, beautiful, profitable Featuring: Jaimee Morgan, DDS 4 credit hours

In-person and broadcast live on YouTube

Karin Mishler at 801-587-2023 or Karin.mishler@hsc.utah.edu

As Utah’s only practicing Oral Pathologist, Dr Trump is able to provide fast and accurate pathology services to Utah and the entire intermountain west. Dr Trump can usually provide your office with a diagnosis within 24 hours of receiving the specimen. He offers consultation services and is more than happy to accept referrals to his faculty practice located within the University of Utah School of Dentistry. If you are interested in sending pathology samples, you may request free biopsy kits. Kits will include a bottle of formalin, requisition form, a plastic bag in which to place the bottle, instructions to give the patient regarding billing (should they have any questions), and a Tyvek envelope or box with overnight FedEx return shipping.

You may contact Dr Trump directly to request biopsy kits or to consult on any pathology questions by email bryan.trump@hsc. utah.edu or by phone at (801) 587-6189. For patient referrals (scheduling) please contact (801) 587-2006.

ADA Third Party Payer ConciergeTM Service is back and available to you as a member of the ADA & UDA.

• Helps dentists with insurancerelated questions

• Assists with understanding coordination of benefits

• Provides guidance on the claim appeals process

HOW TO TRAIN YOUR DRAGON (NEXT CLINICAL TEAM MEMBER)

A dental office can be like the Viking village of Berk - frequently attacked by dragons. Lately, the most dreaded dragon is the need to replace a team member.

Spoiler alert if you haven’t viewed How to Train Your Dragon (2010). Hiccup, the awkward fifteen-year-old son of the village chieftain, is deemed too weak to fight the dragons. His father enters him into a dragon-fighting class. His failures in the class send him into the forest for consolation where he finds Night Fury (he renamed Toothless) living in a cave - a rare and dangerous dragon Hiccup had previously fought, but only injured. Hiccup uses his lived experience from working in the Berk village blacksmith shop and some ingenuity in devising a prosthetic fin for Toothless, so he can once again fly. A lasting friendship ensues and in time Hiccup and Toothless destroy the nest of dragons which has threatened to extinguish Berk. For Hiccup this regains the trust of Astrid, his crush. Sounds like some Viking dentistry with an expanded scope of practice?

Finding your next clinical team member can be a challenge. Especially difficult is determining what compensation level will attract good candidates. Consideration must be given to how that salary may affect the pay of current team members in an environment of inflated supply costs, retention raises, and declining dental plan reimbursements.

Here’s a highly endorsed solution. Commit time on a regular basis to participate in one of the clinical dental educational programs which exist across the state – both publically funded and private. Many compensate part-time, and adjunct faculty.

The Utah System of Higher Education has four hygienist (RDH) training programs at degree granting institutions (Salt Lake Community College, Utah Tech University, and Utah Valley University, Weber State University). Additionally there are four Technical Colleges with dental assisting programs (Bridgerland Tech, Ogden-Weber Tech, Davis Tech, Dixie Tech). Private hygienist programs include the Utah College of Dental Hygiene and Fortis College. There are numerous private dental assisting programs in our communities across the state.

An ongoing need at all these institutions is for dentists to be available to provide “general supervision” for review of medical histories, order radiographs and determine both restorative and periodontal treatment plans.

“General supervision” means that the supervising dentist is available for consultation regarding work the supervising

dentist has authorized, without regard as to whether the supervising dentist is located on the same premises as the person being supervised. Utah Code 58-69-102 Definitions

Urgently needed are additional dentists at Hygienist training programs to be in-person for “indirect supervision” when local anesthetic is being administered to a student or a patient who needs scaling/root planning.

“Indirect supervision” means that the supervising dentist is present within the facility in which the person being supervised is providing services and is available to provide immediate face-to-face communication with the person being supervised. Utah Code 58-69-102 Definitions

“A dental hygienist licensed under this chapter may only practice dental hygiene: (3) under the supervision of a dentist, for an employee leasing company or temporary personnel service company providing employees to a dentist or other person lawfully providing dental services: (a) under the indirect supervision of a dentist licensed under this chapter at any time the dental hygienist is administering an anesthetic or analgesia (c) under the general supervision of a dentist licensed under this chapter, and the practice is conducted outside of the office of the supervising dentist, if: (i) the dental hygiene work performed is authorized by the supervising dentist as a part of and in accordance with the supervising dentist’s current treatment plan for the patient (ii) no anesthetic or analgesia is used (iii) the supervising dentist has determined the patient’s general health and oral health are so that the dental hygiene work can be performed under general supervision and with an acceptable level of risk or injury as determined by the supervising dentist; (iv) the supervising dentist accepts responsibility for the dental hygiene work performed under general supervision” Utah Code 58-69-801. Dental hygienist -Limitations on practice.

A “profession” is not a trade or industry. Historically there have been only three recognized: divinity, medicine, and law. A profession has three distinguishing components: 1) a group who adheres to ethical standards, 2) those who possess special knowledge and skills derived from research, education and training, and 3) those who apply knowledge and these skills in the interest of others.

I believe we as dental professionals have not only a responsibility for the quality of care in our practices, but

STATE OF UTAH

INTRODUCING THE NEW STATE DENTAL DIRECTOR

Hello! I am Stacey Swilling, and I’m the new State Dental Director. In the summer of 2022, the State of Utah merged the Department of Health and the Department of Human Services into one entity, now called the Department of Health and Human Services (DHHS). As a part of this merger, the Oral Health Program was moved to the Clinical Services Section and is housed under Primary Care and Rural Health Division. The State Medical Director, Dr. Michelle Hofmann, is the Executive Director of the Clinical Services Section, and she is committed to integrating the profile (and importance) of oral health into overall health and wellness.

As many of you know, at one time the Utah Oral Health Program had three full-time employees: a full-time State Dental Director (SDD) and two Oral Health Educators (OHE), both registered dental hygienists and was housed in the Maternal and Child Health Division within Family Health. Over time, the Oral Health Program footprint got smaller and smaller, and in early 2022, we had a State Dental Director (SDD) for eight hours/week and one full-time Oral Health Educator (OHE). I am very thankful to my predecessor, Dr. Kim Michelson, and OHE Lauren Neufeld, RDH, who managed to keep our program going while doing remarkable things with such time and personnel limitations and for being allies and resources to me in this role. In addition to them, the previous SDD, Dr. Steven Steed, and our other OHE, Michelle Martin-Baxter, RDH, started a strong legacy for future Oral Health Programs in Utah. The Utah dental community has had great leaders in our State offices.

Recently DHHS was awarded a Health Resources & Services Administration (HRSA) grant for an Oral Health Innovation Project with several components. I’ll share information about our pilot project in a future UDAction, but I include it to share the news that one piece of the grant included funding for increasing the Office of the State Dental Director from 0.2 FTE (8 hours/week) to 0.5 FTE (20 hours/week), with an ultimate DHHS goal of the State Dental Director being a fully funded, 1.0 FTE employee (40 hours/week).

How to Train Your Dragon (continued from page 21)

we have a social responsibility for the quality of care in our community. Another way we can be the leading advocate for oral health in our community, is to help train students as they start a dental career.

How to Train Your Next Clinical Team Member?.......... Get involved in their training. As you build relationships with students, you will discover those you would consider inviting to join your practice. Possible intern opportunities in your office during their training can make your offer of a job, their first

I’ve met many dentists here in Utah, but there are many more I haven’t yet had the opportunity to meet. I moved to Salt Lake City in 2018 to start a career in academia. I am continuing as a faculty member at the University of Utah School of Dentistry in a part-time role as I take on the role of SDD. When I moved here, I jumped quickly into volunteer roles with the Utah Dental Association, to include service on the Convention Scientific Committee and the House of Delegates. I currently have the honor of serving as the Scientific Chair for our 2023 Meeting.

Prior to moving to Utah, I owned a private practice in Sheridan, Arkansas, my hometown. I am a graduate of the University of Tennessee Health Science Center in Memphis, Tennessee. In addition to my own solo practice, I have been employed and volunteered in other dental settings to include group practices, correctional dentistry, mobile dentistry for nursing homes, and Mission of Mercy events. I have always been a strong believer in giving back to my profession through leadership roles and membership in organized dentistry on the national, state, and local levels. I also currently serve as an examiner for the Commission on Dental Competency Assessments (CDCAWREB-CITA), one of the national competency-testing agencies.

I look forward to leading our State Oral Health Program and developing an Oral Health Strategy to improve the health and well-being of the citizens of Utah in concert with the DHHS vision of advocating for, supporting, and serving all individuals and communities in Utah, ensuring all Utahns have fair and equitable opportunities to live safe and healthy lives, through effective policy and a seamless system of services and programs. I look forward to meeting you as I settle into this role, and I encourage you to reach out to me to share your concerns, ideas, and thoughts related to the Utah Oral Health Program. My email is sswilling@utah.gov, and I hope to get to know more of the Utah Dental Community soon.

Stacey Swilling, DDS State of Utah Dental Director

choice. Building trusting relationships with faculty members can get their endorsement and their encouraging students to reach out to your practice to start their careers.

Our training programs across the state need your help, and more importantly, you may need their graduates on your clinical team.

Dr. Scott Theurer ADA Delegate Member, Utah Board of Higher Education

ADVOCACY FROM THE ADA

For over a year I’ve had the privilege of being a member of the ADA’s Council of Government Affairs. During that time I’ve been privy to the ADA’s advocacy efforts on a national level. I’ll attempt to list a small portion of what the ADA has done during my time on the council.

Massachusetts Ballot Initiative

The ADA authorized a significant contribution to a statewide ballot initiative—Question 2 in Massachusetts—which could mark a significant change for dental insurance across the country. In doing so, the ADA took a decisive stand on behalf of dentists, dental team members, and patients and shining a light on a practice that has gone on for far too long—dental insurance companies pocketing premium dollars from patients with no requirement to provide a minimum percentage of those dollars in actual patient care.

Dental insurance is one of the most frustrating issues for dentists nationwide. And as doctors, dentists want their patients to get the most value possible for the dental insurance premiums they pay. This issue has national implications— the win in Massachusetts will set the stage for future dental insurance reform nationwide.

Question 2 in Massachusetts requires dental insurance companies to spend at least 83% of premium dollars collected on dental services or refund the difference to patients, as opposed to insurance companies using the money for executive salaries or other administrative costs. This type of percentage requirement—called a medical loss ratio (MLR)—is already in effect in Massachusetts for medical health insurance. The passing of this ballot initiative established the same type of requirement for dental insurance in that state as well.

The ADA, UDA, and most state Dental Societies along with individual dentists across the country joined with the Massachusetts Dental Society to donate almost $10 million to help support this measure.

The public realized that voting yes on Question 2 will hold the dental insurance companies accountable when it comes to the hard earned dollars patients have paid in premiums. Dental plans should serve patients first and foremost, and the companies that offer them should welcome transparency and accountability, which is what voting yes on Question 2 accomplished. The win in Massachusetts will spur future advocacy in other states. This ballot initiative has national implications.

Lobbying Efforts

With guidance from CGA, the ADA’s Congressional and Regulatory teams lobby the federal government on issues of interest to the ADA. This lobbying is focused around supporting legislation and regulations that increase the value of ADA

membership and reflect the values of ADA members. Recent highlights of this advocacy include the following:

Medicare Medically Necessary Dental Care

The Centers for Medicare and Medicaid Services (CMS) invited comment by September 7 on its 2023 Medicare Physician Fee Schedule proposed rule, which includes proposals on a targeted expansion of Medicare to cover dental care deemed medically necessary prior to procedures such as organ transplants, cardiac valve replacements, and valvuloplasty.

The ADA said that it largely supports CMS’s targeted expansion; yet the ADA also wants CMS to address issues related to the administration and reimbursement of the benefits in Part B especially as they may be rendered in out-patient settings. The ADA’s concerns include the fee schedule, claims submission, coding, and ensuring an adequate network of dentists to treat Medicare patients.

The CMS proposal asks commenters to share their opinion as to whether Medicare dental coverage for conditions such as diabetes is warranted given the emerging evidence for improved health outcomes. It is important to note that the current proposal does not expand Medicare to cover dental services for patients with clinical conditions such as diabetes. The ADA acknowledged the evidence but sought clarity from CMS on the cost and financing mechanisms for such a broader benefit expansion. This clarity is of the utmost importance before the ADA can determine the viability of potential future Medicare expansion proposals beyond the current, targeted proposed expansion.

Medicare Advantage

The ADA sent suggestions to CMS on improving Medicare Advantage (MA) plans and their dental benefits to provide value and transparency for dentists and their patients.

McCarran-Ferguson Reform

At the request of the ADA, five bipartisan members of the House of Representatives sent a letter to the Department of Justice (DOJ) to ask for information on how the DOJ is enforcing McCarran-Ferguson reform and examining anticompetitive activities by health insurance companies.

Ensuring that the DOJ investigates the anti-competitive activities of health insurance companies would help with dental insurance reform and provide value to dentists.

Dental Team Workforce Shortages

Given the ongoing shortages of hygienists and assistants, the ADA sent a letter on September 6 to the Health Resources and Services Administration (HRSA) that emphasized the ADA’s support for Title VII grants for the education and training of hygienists, and urged HRSA to make dental assistant programs eligible for these grants.

In response to a report from the HRSA Advisory Committee on Training in Primary Care Medicine and Dentistry that recommended that Congress include dental therapy programs in Title VII, the ADA urged HRSA to prioritize training for hygienists and assistants rather than fund expensive and unproven new programs.

Operating Room Access

The ADA has been working with the American Academy of Pediatric Dentistry (AAPD) and the American Association of Oral and Maxillofacial Surgeons (AAOMS) to ask CMS to increase operating room access for dental surgeries on young children and people with special needs and disabilities.

Hospitals and ambulatory surgical centers are booking surgeries with a higher reimbursement rate and denying access to dentists and their patients.

In July, CMS issued a proposed rule that would increase the facility fee for dental surgeries in hospital operating rooms from $203.64 to $1958.92.

The ADA, AAPD, and AAOMS are continuing to ask CMS to increase the facility fee for dental surgeries in ambulatory surgical centers. Twenty bipartisan members of Congress also sent CMS a letter at the dental groups’ request in regard to dental surgeries in ambulatory surgical centers.

Student Loan Reform

To support dental students and new dentists and provide value to them, the ADA sent out a grassroots action alert that asked ADA members to contact Congress in support of several student loan reform bills. The grassroots alert resulted in over 6,000 emails from ADA members being sent to Congress.

The ADA also commented to the Department of Education on a proposal to eliminate the interest capitalization on certain federal student loans and reform the Public Service Loan Forgiveness program.

Medicaid

To support the values of ADA dentists, including the values of health equity and providing care to the underserved, the ADA has been advocating for the Medicaid Dental Benefit Act, which would mandate comprehensive adult dental Medicaid benefits in every state. Currently, less than half the states provide these benefits to adults.

As part of the advocacy on this bill, the ADA hosted a Capitol Hill briefing on “Making the Case for Dental Coverage for Adults in All State Medicaid Programs.”

● The ADA also led a coalition letter to Congress in support of the Medicaid Dental Benefit Act.

● Additionally, the ADA continues to work with Rep. Mike Simpson (R-ID) on introducing a bill that would reduce administrative burdens in Medicaid, which would also increase the value for ADA members.

Ensuring Lasting Smiles Act

● The Ensuring Lasting Smiles Act (ELSA) would require all

private group and individual health plans to cover medically necessary services resulting from a congenital anomaly or birth defect. These services would include inpatient and outpatient care and reconstructive services and procedures, as well as adjunctive, dental, orthodontic, or prosthodontic support. Insurance coverage of these services would provide value to dentists who provide them, and it would also align with the ADA’s values.

● In April, ELSA passed the House of Representatives. The bill currently has 42 bipartisan Senate cosponsors.

Non-Covered Services

● The ADA has been working to prevent dental insurers from dictating fees a participating dentist may charge for noncovered services.

● The Dental and Optometric Care (DOC) Access Act continues to gain support in the House of Representatives and Senate. If passed, this bill would provide value to dentists who are struggling with insurer mandates.

Mobile Dental Units

Another values related issue is that the ADA is supporting legislation to expand the ways health centers are permitted to use grant funds in order to care for underserved communities with mobile dental units.

The Maximizing Outcomes through Better Investments in Lifesaving Equipment (MOBILE) for Health Care Act passed the Senate Committee on Health, Education, Labor, and Pensions, and also passed the House Energy and Commerce Subcommittee on Health.

Military Dental Care

The ADA sent a letter to Rep. Andy Kim (D-NJ) and Rep. Trent Kelly (R-MS) to thank them for introducing the Dental Care for Our Troops Act.

The Dental Care for Our Troops Act would provide no-fee dental coverage through TRICARE to the over 800,000 Americans in the National Guard and Reserve. This would support the ADA values of providing oral health care to those who serve the country.

Military Spouse Licensing Relief Act

The ADA supports the Military Spouse Licensing Relief Act, which would give military spouses with valid professional licenses in one state reciprocity in the state where their spouse is currently stationed on military orders.

It is not uncommon for civilian dentists to be the spouses of military servicemembers, and this bill would provide value to them.

The House Veterans Affairs’ Subcommittee on Economic Opportunity held a hearing on this bill in May.

VA

The ADA recommended changes to the VA Workforce Improvement, Support and Expansion (WISE) Act that would better support the VA’s dental workforce so that veterans can

have access to the best dental care. These changes would provide value to VA dentists as well as support the ADA values of helping veterans.

HRSA

Dr. Adam Barefoot was appointed in May as the Chief Dental Officer of HRSA. HRSA oversees a range of programs that treat the underserved and train dentists, so this aligns with the ADA’s values and also supports dental students and new dentists.

The ADA had lobbied the HRSA leadership to appoint a Chief Dental Officer to oversee these important programs. After Dr. Barefoot’s appointment, the ADA sent him a letter and met with him to outline the ADA’s priorities for the agency.

Smoking and Vaping

The ADA and other stakeholders are asking the Food and Drug Administration (FDA) to ban menthol cigarettes and flavored cigars.

In August letters, a coalition led by the Campaign for Tobacco-Free Kids commented on two FDA-proposed rules. One would ban menthol in cigarettes; the other would ban added flavors in cigars. Removing these ingredients will help advance the ADA’s values of reducing the likelihood that young adults will begin smoking.

Nutrition

The ADA is leading a coalition that is nominating Dr. Teresa Marshall to the 2025 Dietary Guidelines Advisory Committee. Formerly known as the Food Pyramid, the Dietary Guidelines are updated every five years to help the public make informed choices about their nutritional needs and diets.

Nominating Dr. Marshall to the Committee would help advance the ADA’s values of supporting good oral health through healthy nutrition.

These are just a few of the efforts from the Council of Government Affairs team during the short time that I have been on the council. With support from dentists like us, our voice is being heard on Capitol Hill. As we join together, we will continue to make a difference locally and nationally. Thanks for all your support of the UDA and the ADA.

Dr Darren Chamberlain ADA Council

ASSOCIATION

UTAH DENTAL ASSOCIATION

DENTAL

HYGIENE AFFILIATE MEMBERSHIP

The Utah Dental Association is excited to continue the growth of the UDA Dental Hygiene Affiliate Membership. This program started in Fall of 2019 but had been on the mind of the UDA Board for many years before that. The UDA Board wanted to and continually wants to give hygienists in Utah an opportunity to network with other hygienists, and to be able to attend UDA CE Meetings.

In 2022 the Dental Hygiene Affiliate members participated in Spring Seminar, learning about Oral Medicine from Dr Bryan Trump, Digital Dentistry from Dr David Howard and Opioid Addiction from Dr Jared Hemmert. They also attended the 2022 UDA Convention in March learning from speakers including Dr Michael Czubiak and Janet Press, RDH. September also brought about an opportunity to participate in the Fall Hygiene Seminar. This meeting included presentations on HVP Cancer Prevention, Pediatric Dentistry and the National Diabetes Prevention Program.

2023 will also be a great year to be a member of the UDA Dental Hygiene Affiliate Membership. The Spring Seminar will include lectures on TMJ from Dr Kevin Mangelson, Ethics from Dr Brent Larson, Implants from Dr Nicholas Egbert and Ergonomics from Gayle Masters, RDH.

The UDA has heard from many hygienists that they would like to have a refresher course on local anesthesia. The 2023 Convention will have a 3 hours local anesthesia refresher course with the additional option of taking a hands on local anesthesia class. These courses are specifically for dental hygienists and the UDA Convention Committee hopes that they will take advantage of these courses. The Convention will also have classes both days presented by Amber Auger, RDH, MPH. Amber is a national speaker and speaks on multiple hygiene related topics.

2023 will be the second year the UDA will host a hygienist luncheon. This will be held at the Marriot across the street from the Salt Palace. The speaker will be Michelle Hendrickson, RDH, MEd. Michelle will cover Dental Implant Maintenance for the Dental Hygienist.

The UDA Dental Hygiene Affiliate Membership is an annual membership, January to December each year. The cost is $50 for the year.

A member hygienist will save $70 to attend the Spring Seminar. A member hygienist will save $70 to attend the 2023 UDA Convention. A member hygienist will save $25 to attend the Hygienist Luncheon held at the Convention.

A member hygienist can attend the Fall Hygiene Seminar for free.

If you are a dentist that pays for their hygienist to attend the convention. By paying for your hygienist to be a member of the UDA Dental Hygiene Affiliate Membership you can save money and he/she will be able to take advantage of other CE that is offered just to Affiliate Members.

Hygienists can register as Dental Hygiene Affiliate Members at www.uda.org

THE ADA IN CRISIS

In August of 1859, twentysix dentists representing various dental societies in the United States gathered in Niagara Falls, New York, to form a national professional association. They saw a need to promote good oral health to the public while developing and representing a national dental profession. William Henry Atkinson, DDS, was elected as the first president. That meeting resulted in what is now the AMERICAN DENTAL ASSOCIATION. The efforts of that Association have resulted in what we have today--a profession that is highly respected by all health care organizations, the legislature, and the public. We are part of a profession that provides and promotes the highest quality dental care in the world.

The need to promote good oral health and maintain our profession is equally important today. We need an association that cares about the public, and promotes and protects our profession and us in the following among other areas:

• To provide certification of training programs and licensure

• To foster scientific research and continuing education

• To advocate for dentistry on the national stage with legislation concerning Medicare or Medicaid reform, OSHA, HIPAA, and EPA regulation

•

•

To negotiate health crises and medical care/dental care integration efforts

To validate dental products for the public and to promote good oral care

• To represent us locally with burdensome regulation, taxes, and other issues

The strength of our association has always been our membership. Historically, the ADA had more than 75% of our nation’s dentists who were members. The ADA endeavors to represent all dentists with policies that promote equity among all races, creeds, and genders. It continues to address major issues facing private practice general dentists, specialists, employee dentists and dental educators. Over the past few years, our membership has declined dramatically, especially among younger dentists. If the current trend continues, by 2027 the ADA will represent fewer than 50% of our nation’s dentists. This trend could have catastrophic impact in two major ways:

1. Loss of membership diminishes our collective voice. We will no longer have the influence that the ADA voice has enjoyed in the past. Without members, we lose our representation.

2. Loss of revenues. With loss of membership, we lose revenues from dues, and see a decrease in the amount of non-

dues revenue we can generate. Our sponsorship will have less impact and our products, less validity.

2020 was financially catastrophic, but because of prudent, conservative financial planning (good reserves), we efficiently weathered the black swan events caused by the pandemic. During that time, our association represented us like never before. The events of that year did point out some weaknesses in how quickly our association can respond to urgent needs of our members. In response to that challenge, significant changes are being implemented to improve reaction time. The ADA’s ability to understand and react to the urgent the needs of its members will be even better.

Secure Financial footing remains a top priority. Dues paying members allow the ADA and the UDA to represent and protect us-- individually and collectively. Having that representation is a cost of doing business. In the past, dues paying members have supported the free riders who take advantage of the ADA/UDA efforts but do not contribute to the cost. Since 2006, the decline in membership has accounted for 10 million per year in lost dues revenues. As a profession, we can only endure these losses for a short time if we are to maintain the respect we now enjoy.

As you look at your professional association and think about membership, look down the road and think about what tomorrow will bring. The future looks bright if we participate in the process of oversight and change. For me, belonging to our professional association is not optional because I have seen what the ADA/UDA has done in the past. I know how vital its role will be in the future.

For a list of direct local benefits, please see our UDA webpage or just ask one of your UDA leaders.

Thank you for your membership: Every individual matters,

Dr Brent A. Larson ADA Delegate

WHAT EVERY DENTIST SHOULD KNOW ABOUT DENTIST DISABILITY CLAIMS IN 2023

A Q&A with Disability Insurance Attorney Derek R. Funk

Mr. Funk’s law practice focuses on “own occupation” disability claims filed by professionals. The majority of his clients are dentists, and he has been a guest writer in prior UDA Action magazines. Below, Mr. Funk discusses recent trends in the industry, and answers a few of the most common questions dentists ask him about the disability claim process.

What are the most recent trends you are seeing in disability policies issued to dentists?

When companies first began issuing private disability policies, the policies were much shorter. Companies were primarily focused on generating premiums and signing up as many dentists as possible, and less concerned about policy language.

This changed in the early 2000’s when insurers realized they had oversold the policies and began engaging in bad-faith tactics to deny claims. High-profile insurers, such as Unum, were hit with multi-million-dollar sanctions and jury verdicts, and some insurers determined the industry was no longer a good investment and left the industry.

The remaining insurers began modifying their policies to expand their investigatory powers and limit the scope of their financial liability. Over time, policies that used to be only a few pages transformed into 50-to-60-page documents, as the companies added language intended to make it much harder to collect, including:

• Adding additional requirements for qualifying for benefits, such as only paying total disability benefits if you are not working at all (in any capacity);

• Offsetting or reducing total disability benefits if your income from a new job (or sometimes income from other disability policies) reaches certain income thresholds;

• Limiting recovery for mental health conditions or conditions with subjective symptoms to a timeframe substantially shorter than the policy’s maximum benefit period (typically 24 months);

• Requiring formal interviews under oath (essentially equivalent to a deposition, even if no lawsuit has been filed);

• Reserving the right to require a wide range of in-person exams (e.g. medical examinations, functional capacity examinations, psychiatric examinations, vocational evaluations, and rehabilitation evaluations);

• Requiring you to seek treatment intended to return you to “fulltime duties” or “maximum medical improvement;” and/or

• Requiring you to produce your taxes, profit and loss statements, billing codes, and other financial information for audit, upon request.

While this may seem daunting, it does not mean that you should give up or cancel your policies. If you are legitimately disabled, you can collect disability benefits.

That being said, insurers added these provisions for a reason, and they invest significant time and money into vetting dentist disability claims. As a whole, dentists tend to file more disability claims than most other professions, and each longterm, permanent dentist claim is a significant liability for the insurer. As a dentist, you should not be naïve to this, and should approach your disability claim with a similar level of seriousness and attention to detail.

What are the most common claim management tactics you are seeing right now?

In the past, insurers under financial pressure simply wrongfully denied claims, and this still holds true to some extent. However, we are also seeing insurers engaging in more subtle tactics to reduce the amounts they are paying out. For example, we have noticed that disability insurers are:

1. Conducting more rescission reviews. “Rescission” is a legal principle that allows insurers to void a policy and avoid payment if there were misstatements in the policy application— typically the health questionnaire. This is a complex area and if you believe your insurer is conducting a rescission review, you should contact a disability insurance attorney immediately.

2. Revisiting and reinvestigating claims that have been paying for years. We have also seen an increase in insurers targeting claims that have been paying for years—particularly mental health claims and claims based on subjective symptoms, such as pain or numbness. The most common approach is using in-house doctors to conduct a paper review of the records that results in “uncertainties” about the “ongoing nature” of the disability, or the “scope of limitations.” The insurer then invokes the exam provision of the policy and sends the insured to a doctor of its choosing, who looks for a basis to find that the policyholder is no longer disabled.

3. Delaying claim decisions due to pending information requests. Recently, more and more dentists are calling us because their insurers have not reached a claim decision after months and months of submitting documentation. Many dentists entirely rely upon their insurer to tell them what information is necessary, or fail to fully produce what is being requested. This gives the insurer an excuse to back-burner the claim, and can lead to an endless loop of follow-up requests

from the insurer, if the insurer is seeking to delay or avoid payment. It is better to proactively gather and produce the relevant information to support your claim from the start, to avoid delays.

Do you have any tips for filling out disability claim forms?

1. Read each form through carefully at least one time before answering any of the questions. Most disability paperwork is divided by topic, and each section often has specific instructions that can be easy to miss. Often, different sections of the forms ask about different timeframes, and submitting complete and accurate timelines is critical when filing a disability claim.

For example, analysts determine your “occupation” and categorize claims based upon your pre-and-post-disability work history and activities. Most claims also involve several other key dates that impact preexisting condition limitations, whether you timely filed proof of loss, what your prior income should be for purposes of partial disability calculations, and the list goes on.

If you create confusion regarding your claim’s medical or occupational timeline, it can lead to significant delays and, in some instances, denials that can only be sorted out through lawsuits.

2. Review your answers to make sure they are not too sparse or generic. If you have not been involved in a disability claim before, some questions can seem overly intrusive. Over the years, we’ve become involved in several claims where dentists skipped questions and returned partially completed forms.

If you do not understand a question or why certain information is being requested, or are concerned that answering a question may expose you to legal liability, you should not answer without first consulting an attorney. However, if you are refusing or failing to provide relevant information, you are not only giving the insurer an excuse for delays, but potentially making it easier for the insurer to deny your claim.

3. Re-read all your answers to ensure they are accurate. Like other insurance forms, disability paperwork includes fraud disclaimers and fine-print stating that you carefully and accurately completed them, whether or not that is actually the case. Once you sign and submit your responses to the insurance company, your insurer (and courts) will hold you to those responses.

Additionally, each time you submit additional information or forms, claim analysts are trained to identify any inconsistencies with prior information in the claim file. If there are inconsistent answers, this undermines your credibility and can cause your claim to be flagged for heightened review, surveillance and possible denial or termination.

Do I need an attorney to file a disability claim?

Some claims may not require attorney involvement—for example, a loss of a limb or something very serious, such

as paralysis from the waist down. However, most of our dentist clients have more nuanced conditions, such as slowly progressive radiculopathy due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a dentist. Or mental health conditions that cannot be verified by a single, definitive objective test.

If your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. However, lawsuits with insurance companies can drag out over several years. Even if you prevail it can be an exhausting process.

It is more prudent to approach your claim carefully from the outset and address any concerns that the insurer may have over the course of the investigation itself. In our experience, the most common areas where complexities can arise in dentist claims include:

• The timing of the claim (particularly in situations where a disabling condition is slowly progressive);

• Claims made by dentists who own their practice and need to decide whether to sell, bring on new associates, or keep working in a limited capacity;

• Claims where the underlying condition is a diagnosis by exclusion;

• Claims involving multiple co-morbid conditions;

• Claims involving recommendations for or against surgery; and/or

• Claims involving mental health conditions.

This is not an exhaustive list, but if your claim encompasses one or more of these areas, it is a good idea to at least consult with a disability attorney to determine what issues may arise over the course of your claim.

* Derek R. Funk, Esq. is a Phoenix-based disability insurance attorney licensed in Utah and Arizona. He works with dentists at all stages of the disability claims process.

The information in this article has been prepared for informational purposes only and does not constitute legal advice. Anyone reading this article should not act on any information contained herein without seeking professional counsel from an attorney. The author and publisher shall not be responsible for any damages resulting from any error, inaccuracy or omission contained in this publication.

(UDPAC)

Dr William Anderson

Dr Craig Allan

Dr Alan Anderson

Dr Kent Arbuckle

Dr Len Aste

Dr Ken Baldwin

Dr Brent Baugh

Dr Richard Blackhurst

Dr Don Boren

Dr Gregory Brown

Dr Jeff Burg

Dr Jonathan Campbell

Dr David Cannon

Dr Randell Capener

Dr Darren Chamberlain

Dr Jason Chandler

Dr Angela Christensen

Dr David Christensen

Dr John Christensen

Dr Kay Christensen

Dr Bill Davis

Dr Richard Denos

Dr Mary Draper

Dr Chad Eardley

Dr Cory Fabrizio

Dr Kyle Farley

Dr Joseph Feller

Dr Jeremy Felt Dr Jaleena

Fischer-Jessop

Dr Scott Folkman

Dr Jonathan Ford

Dr Richard Francis

Dr Greg Gatrell

Dr Robert Gibson

Dr Bart Goldsberry

Dr Michael Green

Dr Jordan Hansen

Dr Ivan Hendrickson

Dr Brian Holman

Dr Brad Holmes

Dr Michael Hutchings

Dr Paul Innis

Dr Gregory Jessen

Dr Kenneth King

Dr Brent Larson

Dr Lloyd Liu

Dr Spencer Luke Dr Trace Lund

Dr Brian Lundberg

Dr Scott Matson

Dr Scott McGavin

Dr John Myers

Dr Andrew Nield

Dr Scott Nord

Dr Justin Nybo

Dr David Okano

Dr Robert Page

Dr Sheldon Peck

Dr Morris Poole

Dr Paul Porter

Dr Brandon Priebe

Dr Val Radmall

Dr David Reynolds

Dr Dave Roberts

Dr Dean Robinson

Dr Lawrence Romney

Dr John Smith

Dr Mike Smuin

Dr Cory Stark

Dr Kip Sterling

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Dr Allan Thomas Dr Troy Thomson

Dr Rodney Thornell

Dr Micah Thornley

Dr Robert Thorup

Dr Ruedi Tillman

Dr Jennifer Wahlen-Poorman

Dr Gary Wiest

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Dr George Winder

Dr Troy Winegar

Dr Benjamin Young Dr Glenn Zeh

GIVE KIDS A SMILE

UDA Members,

I would like to take a moment and thank all of you for your unwavering support of the Salt Lake Area GIVE KIDS A SMILE for all these, almost 20 years. You have helped thousands of children that otherwise would not have been able to get dental care. They were not able to function in school and have had to live with terrible pain and discomfort. You make me proud to be part of the Utah Dental Association family.

As you are painfully aware, COVID has hampered us all since 2020. GIVE KIDS A SMILE has been no exception. We found it impossible to run the event safely with that many people. Thankfully after a two-year hiatus, we are back and ready to again provide help to the children who so desperately need it.

We’re again putting out the clarion call for your support and help. We need you, and your staff that want to, to volunteer as providers of the event. The UDA’s co-sponsor of the event is the University of Utah, and we hold the event the last Saturday of February to coincide with Children’s Dental Health Month. It goes from 7 AM to 2 PM with lunch provided Chick-fil-A.

AWESOME TIPS FOR PEDO TREATMENT AND MINOR ORTHO TREATMENT

Board certified in both Orthodontics and Pediatric Dentistry. Dr. Barney Olsen presents an awesome opportunity for us to update and simplify our treatment of children. He maintains a full-time private practice in Orthodontics and Pediatric Dentistry. He is a fellow of the American Academy of Pediatric Dentistry and the American College of Dentists. Don’t miss this opportunity for hands-on instruction on plastic models that you can use next week in your practice.

Register NOW for this Hands-on-Course

Your staff will be assigned to you, or a dental student will assist you if needed. Dr Larissa Skene is over the providers and will assign you a spot. Please contact her at 801-207-7070.

For those that have a conflict that day or feel more comfortable working in your own offices, we desperately need you to provide a voucher committing to 1,2,3 or however many patients and whatever procedures you feel comfortable providing the children in need. Please contact Dr Williamson by email at info@ saltlakefamilydental.com, put GKAS Voucher in the subject line and we will take care of getting the vouchers for you. You can also call the UDA at 801-261-5315.

We are a 501 3C charity; therefore any expenses are deductible and so incredibly rewarding. Please sign up again and do something good. There are cutoff dates so that we have time to prepare please don’t delay and let us know at what level of commitment you are willing to help.

Thank you all so much. May 2023 be the best year ever!

Dr James Williamson

The Future of Dentistry: Thriving in an Era of Change and Uncertainty

FEATURING:

WHAT YOU WILL LEARN:

1. Understand critical trends impacting dental practices, including dental insurance trends, consumerism, growth of group practice, and shifting patient mindset 2. Identify key future-focused initiatives the ADA is launching to safeguard the profession in times of change. Understand why it is more important now than ever to be involved 3.Explore opportunities for practicing dentists to innovate and take advantage of key market trends in the next 2-5 years This is a University of Utah School of Dentistry and Utah Dental Association Joint lecture/webinar.

Marko Vujicic, Ph.D., Chief Economist of the American Dental Association And, Raymond A. Cohlmia, D.D.S., Executive Director of The American Dental Association