UDA Action

ADA News

Dr Len Aste

Dr Darren Chamberlain

Larry Darnell

Dr Richard P. Gangwisch

Bobi Seredich

Dr Mark R. Taylor

Dr Rodney Thornell

UDA Staff

Mary

Versaci

Dr Tim Wright

Sand Hollow State Park

Tom Till – Kodachrome Basin State Park

Dave Sansom – Antelope Island State Park

Goblin Valley State Park

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PRESIDENT'S MESSAGE

LOOKING FORWARD

Undoubtedly, this past year has been a busy one for organized dentistry both on the national level and here in Utah. We as a profession have been faced with several challenging issues. At the same time we have accomplished many things that have strengthened our members, improved our profession and benefited the public. It has taken a collective effort of many dedicated UDA members and officers to appropriately address our obstacles and achieve our successes. I have found for the most part, that those who agree to serve as officers and delegates in organized dentistry do so out of a desire to improve our profession. I would like to take this opportunity to thank Dr. Kay Christensen and Dr. Ken Baldwin for their many years of dedicated service as they complete their terms on the UDA Board. Also to express my appreciation to Dr. Randy Capener and Dr. Jim Bekker for their willingness to serve and begin their terms on the Board.

I would also like to thank our wonderful UDA staff for their hard work and dedication. Dr. Val Radmall, our Executive Director has guided us through some rough waters this year. He has gone beyond the clock, spending countless hours ensuring that our interests as a profession are understood and protected in dealing with new legislative bills, rewrites of the Practice Act and other important issues. Dotty and Becky both have done a terrific job seeing that our Convention and other activities have run smoothly. Perhaps, you as dues paying members, should get the most recognition for the financial support you offer. But most importantly for the professional way in which you chose to practice. Your service to your patients, staff and communities is why dentistry is repeatedly recognized as one of the most respected and trusted professions.

This past year I have had the opportunity to travel throughout the state and visit with many of you at CQI’s and in your clinics. This has been an enjoyable and informative experience which has lead me to recognize many significant similarities and differences among you. The things that I found we had most in common was our love for dentistry and a desire to serve your patients the best you possibly can. You are contributors to your communities and providers of an essential healthcare service. Our differences are the result of the autonomy that dentistry offers. The make up and design of our clinics are uniquely different. Some were outfitted with the latest furnishings and others more traditional. Each were clean and welcoming and reflected the personality and interests of their owners. I noticed differences in the types of equipment and materials used. Many had the latest pieces of technology, such as cone-beam x-ray machines, 3D printers, digital scanners and Cerec machines while others decided to continue to use what has worked for them throughout the years. Many offices differed in size. Some employed several dentists and office personnel while others only had a front office person and a single assistant. The hours

of operations and how much procedures cost varied from office to office. Autonomy also offers us the right to choose which, if any, insurance programs we want to be participate in. I found that most dentists were very understanding of the demographics of their locations and adapting to the needs and desires of their patients. I also came away from my conversations and visits believing that some of the greatest strengths in our profession are our differences.

This year will bring with it new challenging issues and will require us to revisit unresolved old ones. As a dental board we want to represent our members feelings and desires on important issues. In order to do that we need to hear from you. Your feed back and input is important to us. We will try to keep you informed of the issues affecting our profession through the various channels of communications we presently have established and new ones that we are developing. You can always call the UDA office or any of the Board members to express your concerns or suggestions. CQI’s and leadership conferences are also good avenues for expression. Some of the issues that we know will be at the forefront are revisions of the dental practice act, rules of practice for foreign trained dentists, acceptance of dental compacts that will allow mobility and portability among different states and the expansion of duties for dental hygienists and assistances. We have formed task force committees on the revision of the practice act and on the expansion of duties, we hope you will provide us with your inputs on these matters.

We as a Board thank you for your support and for those of you who responded to our “Calls to Action.” We can see the influence you make when you reach out on important issues. As a Board we are preparing for the challenges that this year will bring, but more so, hoping for success and prosperity for each of you as you continue to render service and practice dentistry.

Len Aste DDS.

UDA President

The Utah Dental Association is looking to establish a “Health & Wellness Committee.” If you are interested in being involved with this, please reach out to Becky at the UDA Office. (becky@uda.org)

TREAT YOURSELF LIKE YOU ARE SOMEONE WORTH HELPING

I just celebrated my birthday. I like my birthday, I feel that it is a great time to reevaluate my life and decide if I am content with how things are progressing. There are many things about my life that I am happy with and also things that I know that I need to improve. I like to be able to tell myself that I like who I am. To be able to say that I like who I am is a big deal. If I don’t like myself, who will?

I do the same thing with my dental practice. On a yearly basis I like to evaluate how my practice is doing. What I like about it. What I’d like to improve. What I need to do with my fees, to combat rising expenses. I like to reevaluate what types of services I enjoy performing. What things I would rather stop doing, and what CE I am interested in to make my practice that much better. If I don’t like my practice, who will?

The often controversial clinical psychologist Jordan Peterson says in his book “12 Rules for Life”, “Treat yourself like someone you are responsible for helping”. He talks about how most people are more likely to take better care of their pets than they are of themselves. He explains that since most of us know too much about our failures, transgressions and insufficiencies, we tend to be overly hard on ourselves. We are prone to accept less than the ideal because we don’t feel that we are worth more than what we get.

Over the last several years I have tried to communicate to my dental colleagues the benefits of going out of network with insurances in order to be treated more fairly by the insurance companies. Most of the time I hear the same thing from dentists, “My patients will leave if I’m not on their plan”. Maybe they are correct or maybe they just don’t believe in their own value enough and need to listen to Jordan Peterson’s advice to treat themselves like someone worth helping. To treat yourself that way means that you need to consider what would be truly good for you.

I would understand being in network with an insurance company that pays on time, pays fairly and allows the dentist to treat patients in the best possible way. However, I don’t understand why someone would stay with an insurance company that doesn’t do any of those things. If you are happy with how you are being treated by the insurance company, stay in network with them. If you are not, get out. It should be that simple. Yet somehow it isn’t.

Our past UDA president, Mark Taylor, has been a great example of practicing as an out of network dentist. He started practicing in the 80’s when the economy was worse than it is now. He started completely out of network even when others told him he was crazy to do so. He not only survived, but he succeeded to run a very profitable practice and was able to maintain the highest standard of care for his patients. Mark has encouraged those of us dissatisfied with our current insurance contracts to “Just say No” if we want to be treated fairly. Mark is right, we need to

say no and we need to believe that we can have a practice that we are proud of and happy to be a part of.

When I was in network with most insurances out there, I felt like I wasn’t paid fairly for what I was offering my patients. I was running around a lot more than I felt my patients deserved. I felt rushed, irritated and was getting burned out. I hated to see fillings on my schedule because I knew that I would be losing money on each of them, especially if I took the time necessary to do them correctly. It was a horrible way to practice and I wanted to get out. So I did, and ten years later I am much more content with who I am as a dentist and with what type of practice I run.

I invite you to reevaluate your life and your practice life. If you are not happy with something, change it. Become a better person, become a better dentist, help your practice become better. With rising costs in all aspects of dentistry from education to materials to payroll, as an out of network dentist you can control your practice rather than letting it control you. After all, if you don’t like yourself and your practice style, who will?

Rodney Thornell, DMD UDA President Elect

BROKEN RECORD…

I really hate to sound like a broken record, but maintaining our membership in organized dentistry should be a no-brainer for every licensed dentist up and down the state of Utah and throughout the rest of the country. Once again, organized dentistry has stepped up to protect our careers, our livelihoods, and the public who trusts us. Our influence, as a body of dentists, has helped to drastically modify legislation that had the potential to put the public at risk and to harm every practicing dentist in this state. I have no doubt that the sponsors of HB 58 have the best of intentions with this legislation; but they failed to grasp the full extent of the harm it could have caused to dentistry, had it been left in its original form. We are indebted to the many legislators who have listened to our concerns.

As of the writing of this article, this issue is still being played out on Capitol Hill. Nevertheless, enough has happened with the legislative process that I can share some of the back story, and with confidence say that it is going in a much better direction. By the time this is published in our UDA Action, much of it will be history. So, what happened?

To give a little background, first, the UDA hires lobbyists to keep track of legislation with the potential to impact dentistry, just one of many reasons every dentist in Utah should be a dues paying member of our association. We try to stay close to legislators with sympathetic ears toward dentistry. Second, the UDA works hard to maintain open lines of communication with the Department of Professional Licensing (DOPL). Their job is to protect the public. We try to be a resource for them because they realize we understand the unique nuances of our profession better than anyone else. They value and rely upon our input. It is a healthy working relationship.

So last fall, the UDA became aware that powerful forces within our state were intent on creating legislation to provide alternate pathways to licensure for foreign trained dentists. Concern over workforce shortages, whether real or perceived, were given as the reasons. DOPL held hearings to examine what effect these changes might have on dentistry. UDA Executive Director, Dr. Val Radmall, members of the UDA board, and other concerned dentists provided testimony during that hearing. The overwhelming majority stood in strong opposition to any relaxation of the requirements for licensure.

Then, as the 2024 legislative session began, HB 58 made its debut, under the title of International Licensing Amendments. Its stated purpose was to facilitate the licensing process for immigrants who had received their training outside of the country. It would make sweeping changes to licensing foreign trained applicants for many occupations within the state of Utah. Dentistry is just one of a very diverse group that included medicine,

nursing, cosmetology, engineering, and others. We were not aware of a single group in support of this legislation. From the outset, organized dentistry made it very clear that we are not opposed to foreign trained dentists practicing in our state. We welcome them! We also made it clear that there are already abbreviated pathways to licensure for those comparably trained elsewhere. We focused on the dangers of compromising that pathway and putting the public at risk. As many of you will recall, on February 6th of this year the UDA put out a “Call to Action” to the dentists of Utah. We asked you to contact your elected representatives and express your concerns with HB 58. Many of you responded and wrote to your legislators. Thank you! As a consequence of dentistry coming together, and expressing our concerns in a polite and respectful manner, we were given a seat at the table and an opportunity to help craft the language of the bill. HB 58 has been altered in such a way that 1) it preserves the value of a dental education and the value of a dental license, 2) it doesn’t encourage non-resident dentists to flood the state in search of an easier path to licensure, and 3) it maintains protection for the public. We really couldn’t ask for more.

I recount just how this played out for two reasons: First, to underscore the vital role organized dentistry plays, not just to us, but to the world. Second, to thank the many people who were a part of helping to shape the outcome of HB 58. The letters you wrote were invaluable! I wish to specifically mention Dr. Radmall. As our Executive Director, he spent many hours on this and represented our profession well. Thank you to everyone for a job well done! When we come together, we are a powerful force for good.

Mark R. Taylor, DDS UDA Past President

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1. Do you have or have you considered an exit strategy?

2. How long do you plan on being a practice owner? If your health allows, would you like to continue practicing after that point?

3. Do you know what your practice is worth today? How do you know?

When was your last Practice Valuation done?

4. Have you met with a financial planner and have a documented plan? Have you established a liquid financial resources target that will enable you to retire with your desired lifestyle/level of income?

A LETTER TO A NEW DENTAL COLLEAGUE

Dear New Dentist,

I’ve been a practicing pediatric dentist for 20 years. That may seem like a long time, but the years have come and gone very quickly. I’ve had some wonderful experiences in my profession, and a few challenges along the way, but I wouldn’t change anything. I’ve enjoyed thousands of high-fives, and quite a few hugs, but I’ve also been told by a 6 year old that I am the worst dentist in the universe (not the worst dentist in my community, or the state, or the nation, or the world, or the galaxy, but the universe - at least it’s not the multiverse). I’ve warned a lot of parents that their child is about to be treated by such a horrible dentist, but surprisingly none of them have grabbed their child and ran out of the office. On a regular basis, pre-dental students have come to observe in our office. Inevitably, I get questions about my occupation and they want advice for their future decisions. What follows is a list of things that I’ve talked with them about over the years…

Always tell the truth - For most children it doesn’t take long to build trust, but that trust can disappear in a heartbeat. Every day, I get asked by children if I am going to give them a “shot” (the dreaded “S… word”). I will say, “How about we use some ‘cold water’ instead?” They also ask if this is going to hurt. I tell them that they might feel a little pinch and I demonstrate it on their hand. Knowing what is going to happen helps put children at ease. We also change the names of a lot of our instruments to make them more child friendly. Not only does the injection become “cold water,” but the rubber dam becomes a raincoat, the highspeed handpiece - Mr Whistle, lowspeed handpiece - Mr Bumpy, air water syringe - squirt gun, saliva ejector - Mr Thirsty, etch - blue shampoo, prime/bond - conditioner, and we wash away the sugar bugs which can tickle instead of drill teeth. By changing the nomenclature to something that children can relate to, dentistry doesn’t become scary and the relationship with the dentist is strengthened.

Behavior modification - The best investment that I made in my office was to put TVs in the ceilings. No longer did I have to perform a song and dance for each operative procedure. Distraction is a wonderful way to modify a pediatric patient’s behavior. I’ve found that an even better way to help a child’s behavior in the dental chair is to have profound anesthesia. For me, that means inferior alveolar blocks when I am working on permanent teeth or performing extractions/pulps and crowns on primary mandibular molars. I have colleagues that will perform intraosseous injections or inject into the PDL to gain the necessary anesthesia required to perform painless dentistry. If a child is having a difficult time with a procedure, make sure they are numb, it will make for a much more pleasant dental experience.

Live frugally - The best advice my wife and I ever received in dental school was to live like a student/resident for the first five years after dental school and the rest of your life,

you can live like a dentist. Try it, you’ll be amazed. Find a hobby - If dentistry is your whole life, you will burn out very quickly. Find something outside of the office you love to do and make time in your schedule to do it, regularly.

Stay in shape - Core exercises are the key to avoiding back problems. Do push ups, situps, planks and abdominal stretches at least three days a week. Don’t forget to work on your shoulders as well, those are the most common areas that inevitably break down amongst our colleagues.

Find a good mentor - I attribute how I practice now to the people I associated with early in my career. However, don’t ever stop learning. I have learned more over the last five years from my associates and younger dentists than I ever did at the beginning of my career.

Give back - I have never regretted giving away free dentistry. Look for ways to give to those in need; whether it’s in your office, at Give Kids a Smile, or in a developing country. The more you give, the more you will receive.

Enjoy what you do - We are blessed to be part of a wonderful profession with amazing colleagues. I still wake up every morning thankful that I am able to help those with needs return to health. Pediatric dentistry might be challenging at times, but the rewards far outway the difficulties. Every day in my office my team and I laugh and have the most amazing experiences with our patients and their parents. I will always cherish the trust that they show to us.

These are the things that have made a difference in my life over the last twenty years, but I would take all of this advice with a grain of salt. After all, it does come from “the worst dentist in the universe.”

Sincerely,

Darren Chamberlain DDS

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FREQUENT GENERAL QUESTIONS REGARDING DENTAL PROCEDURE CODES

When it comes to the Code on Dental Procedures and Nomenclature, better known as the CDT Code, most dentists have similar questions about this ADA intellectual property. The questions (and answers) below, compiled by the ADA Practice Institute, are often asked by ADA members who seek a general understanding of the CDT Code, and who are interested in how their own unique questions can be addressed.

ADA has also developed a comprehensive reference library with coding educational material for dentists. Here you will find videos, webinars and PDF guides that provide an in-depth look, as well as focused questions and answers, on specific services that are documented and reported with their own unique CDT Codes. These items are found on the ADA’s Coding Education web pages.

The ADA also publishes coding information in print and e-book form that is available for purchase through the ADA Store These publications are:

• CDT 2024 and Coding Companion Kit with App — Includes the CDT Manual, CDT Coding Companion, and CDT App for iOS and Android

• CDT 2024: Dental Procedure Codes - Manual and App — Includes the CDT Manual and CDT App for iOS and Android

• CDT 2024 Coding Companion: Training Guide for the Dental Team — Includes the book only

1. Why is the CDT Code updated annually?

Annual updates enable the CDT Code to accommodate new and evolutionary changes to dental procedures, as well as increasingly robust patient record-keeping. As the named HIPAA national standard for documenting dental procedures the ADA is also obligated to maintain an annual review and maintenance process.

2. Who requests CDT Code additions, revisions or other changes?

You do — Dentists, as primary providers of dental care, are an important source of requests for additions and revisions. Requests also come from the ADA’s Council on Dental Benefit Programs, dental specialty organizations, third-party payers, and others in the dental community. The maintenance process is open to anyone who is interested in requesting a CDT Code change.

Information about requesting a change, and other aspects of the CDT Code maintenance process is available online at Request to Change to the Code | American Dental Association (ada. org). Please review the request form completion instructions and evaluation criteria before completing and submitting the required forms.

3. How do I know which CDT Code is appropriate to document the service I delivered?

A dentist’s clinical decisions determine what services (procedures) are delivered to a patient. The full CDT Code entry as published in the current CDT manual must be considered when determining which dental procedure code should be used to document services provided. A procedure code entry consists of the code and its nomenclature that are printed in boldface type; some procedure code entries also have their own unique descriptors, printed in regular typeface. Also, some code categories or subcategories have descriptors applicable to codes within that category.

A careful reading of the complete code entry should provide the information needed for a dentist to decide which code most accurately describes the procedure that was performed. Codes should not be chosen based on what will gain the most reimbursement.

4. Why is there no CDT Code for the procedure I am providing today?

There are times when, in the opinion of the dentist, no CDT Code entry accurately describes the service provided. This is when an “unspecified …procedure by report” code may be considered (e.g., D2999 unspecified restorative procedure, by report). All “by report” procedure codes must include documentation that explains the service provided. In addition, this is an opportunity for you to submit a CDT Code action request to fill the CDT Code gap you discovered.

5. Who do I call for more information about the CDT Code or claim submission?

CDT Coding assistance is available to all ADA members, plus any non-member who has purchased the current manual. Coding matters are forwarded to the Center for Dental Benefits, Coding and Quality staff, who are within the Practice Institute. Contact the ADA Member Service Center (MSC) at 800.621.8099 or via e-mail at dentalcode@ada.org

6. What other CDT Code information is online?

There are webinar recordings and guides to specific procedures and their CDT codes that may be viewed online or downloaded at no cost from the Coding Education web pages. Topics and codes covered include case management services, scaling in the presence of gingival inflammation, teledentistry events, and more.

7. Why don’t third-party payers cover all CDT Code procedures?

The CDT Code is a taxonomy that enables codified documentation of services provided. A dental benefit plan reflects the purchaser’s decision on what services will be covered for the plan’s cost. A dental benefit plan’s coverage limitations and exclusions provisions identify those procedures reportable with a valid CDT code that may not be covered.

Covered procedures vary between dental benefit plans, even those offered by the same third-party payer, especially those that are considered cosmetic (e.g., tooth bleaching). This is why it is important to verify the patient’s available benefits, and potential patient out-of-pocket costs, when treatment planning.

8. Doesn’t HIPAA require a third-party payer to cover every procedure code listed on a claim submission?

No, HIPAA’s administrative simplification provisions are limited to standards for information exchange between the sender (e.g., a dentist/practitioner; provider) and the recipient (e.g., dental benefit plan / aka third-party payer). HIPAA says that information must be exchanged in a standard format and use specific code taxonomies, which includes the CDT Code. HIPAA’s administrative simplification provisions do not determine what you do within your practice, or what a payer does in its individual claim adjudication policies.

9. Why isn’t the CDT Code available at no cost to members?

The Code on Dental Procedures and Nomenclature is important and valuable ADA intellectual property, and it has significant maintenance costs. Volunteer leadership views non-dues revenue from CDT publication sales and licensing as a means to offset a portion of the maintenance cost.

10. Why do I need a CDT Manual when my practice management system vendor sends a procedure code update as part of my maintenance package?

The CDT Manual includes information that is often omitted in software updates – especially the complete nomenclatures and descriptors applicable to every CDT Code entry. Practice management systems routinely truncate this information which makes choosing the correct code more difficult.

11. What is the relationship between the CDT Code and SNODENT?

These code sets each have a different purpose. The CDT Code is the HIPAA standard for codified documentation and reporting of dental procedures. On the other hand, SNODENT (Systematized Nomenclature for Dentistry) is not a HIPAA standard and may not be reported on a dental claim, but does support a codified description of the patient’s condition (e.g., diagnoses and findings) and other factors that may affect treatment. The CDT Code and SNODENT do overlap in one area – both are recognized by federal agencies as code taxonomies to be used on Electronic Health Records of dental patients.

12. What is the relationship between the CDT Code and ICD Codes?

Both the CDT Code and ICD Codes are HIPAA standards applicable to electronic dental claims. ICD (International Classification of Diseases – 10th Edition – Clinical Modification) is the only diagnosis code set that may be used on claims submitted to dental benefit plans when needed, as well as on claims for dental services submitted to medical benefit plans where diagnosis codes are always required. The CDT Code is maintained by the ADA Council on Dental Benefit Programs’ Code Maintenance Committee, and ICD Codes are maintained by agencies of the federal government.

Information and guidance on reporting ICD codes with CDT codes is included in the ADA publications Current Dental Ter-

minology and CDT Companion: Training Guide for the Dental Team that are available at the ADA Store

13. I’ve received an Explanation of Benefits that shows reimbursement either for fewer services, or for different procedure codes, than those reported on the claim. How can this happen? Isn’t the third-party payer doing something wrong or illegal? It looks like the CDT Code is being misused. An explanation of benefits that shows reimbursement for fewer services or for different procedure codes than reported on the claim raises eyebrows and prompts dentists to call the ADA and ask these questions. What may be perceived as a payer’s code misuse or illegal action is likely neither, but rather a result of the dental benefit plan’s coverage provisions, and provisions of a participating provider agreement in effect on the date of service. Many patients and some dentists do not fully understand how dental benefit programs work, and that coverage limitations and exclusions may limit reimbursement for necessary care that is correctly reported with the appropriate CDT code(s). Such a misunderstanding is compounded when EOB language suggests that the dentist is at fault. Ensuring patients understand the limitations of their dental plan prior to treatment may help avoid problems and maintain a strong dentist-patient relationship.

Some dental claim adjudication practices are appropriate when based on plan design and should be clearly explained on the EOB to prevent misunderstandings. Other situations, where the EOB message suggests the dentist is in error, may pose problems. Each of these conditions is illustrated in the following examples:

• Acceptable EOB Explanation: A claim for a “D4355 full mouth debridement…” and a two-surface restoration is adjudicated and only the D4355 is reimbursed. The EOB message states that the benefit plan has limitations and exclusions, one of which is that the plan does not cover any restorative procedure delivered on the same day as a D4355. In this example the payer has not paid for the procedure due to benefit plan design limitations – there is no suggestion that the dentist has done anything improper.

• Unacceptable EOB Explanation: The dentist reports a D1110 on the claim because the patient is 13 years old with predominantly adult dentition, but the EOB lists D1120 with a message that this is the correct code for a patient under the age of 15. In this example the payer is wrong, as the message implies that the dentist reported the incorrect prophylaxis procedure code. Here the payer ignored the CDT Code’s descriptor where dentition, not age, is the criterion for reporting an adult versus child prophylaxis. What the payer should do when the benefit plan specifies an age-based benefit limitation, is accept the claim as submitted and note on the EOB that the claim has been adjudicated based on benefit plan design.

The second example illustrates why it is important that the dental office help the patient understand the clinical basis for treatment. In this case the type of prophylaxis is determined by the state of the patient’s dentition, not age, even though the patient’s benefit may be determined by age.

Note: Every dentist should be aware of the following guidance when preparing a claim and reviewing an EOB.

• The Health Insurance Portability and Accountability Act (HIPAA) requires the procedure code reported on a claim be from the CDT Code version that is effective on the date of service.

• Neither HIPAA nor ADA policy, or the CDT Code itself require that a third-party payer cover every listed dental procedure. Covered dental procedures are identified in the contract between the plan purchaser and the third-party payer.

• Procedure code bundling is frowned upon by the ADA. However, dentists who have signed participating provider agreements with third-party payers may be bound to plan provisions that limit or exclude coverage for concurrent procedures.

14. The insurance company has denied a claim for procedure code D4212 (gingivectomy or gingivoplasty, to allow access for restorative procedure, per tooth), saying that it is always an integral part of the restorative procedure submitted on the claim. Doesn’t this look like the company is violating its CDT license by redefining the codes?

A D4212 and a restorative procedure are separate and distinct clinical services. The insurance company may not redefine either one or both. If however, the dental benefit plan does not provide

a benefit for D4212, the denial must state that there is no reimbursement due to benefit plan limitations and exclusions. The payer should not disallow this procedure based on bundling.

Accurate patient record-keeping requires that all services delivered to a patient be fully documented. An insurance company’s adjudication policies are completely separate matters. If you experience this type of situation, please contact ADA.

15. What fee can I charge for procedures reported with CDT codes?

The Code on Dental Procedures and Nomenclature (CDT Code) provides dentists a means to consistently document services delivered to the patient. There is no fee information in the CDT Code.

Note: Every dentist should be aware of the following guidance regarding fees for services.

• Neither the ADA nor the CDT Code establish fee schedules for the listed procedures.

• A dentist individually determines her or his full fee for any procedure delivered and reported with a CDT code.

• The dentist’s full fee for a service is reported on a claim

• Third-party payer reimbursement is determined by provisions of the dental benefit plan or applicable participating provider contract.

• The payer’s reimbursement amount may not be the same as the dentist’s full fee for the procedures listed on a claim.

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2024 NATIONAL SIGNING DAY

February 28, 2024 marked a significant day for fourth-year dental students at Roseman University College of Dental Medicine and the University of Utah School of Dentistry as they participated in the ADA National Signing Day. This event, held annually, serves as a pivotal moment for these students as they transition from student membership to full dentist membership in the American Dental Association (ADA). The event was not only a celebration of their hard work and dedication but also an opportunity to highlight the myriad benefits of being a member of the ADA.

The ADA National Signing Day is more than just a symbolic gesture; it signifies a crucial step in the professional journey of these aspiring dentists. By transferring their student membership to full dentist membership, these individuals gain access to a wealth of resources, support, and opportunities offered by the ADA and the UDA.

One of the most significant benefits of ADA membership is access to continuing education opportunities. Dentistry is a field that is constantly evolving, with new technologies, techniques, and research emerging regularly. ADA members have access to a vast array of educational resources, including seminars, webinars, and conferences, which enable them to stay abreast of the latest advancements in the field and enhance their skills and knowledge throughout their careers.

Additionally, ADA membership provides dentists with valuable networking opportunities. Dentistry is a profession that thrives

on collaboration and community, and the ADA facilitates connections among its members through local, state, and national events and conferences. These networking opportunities not only foster professional relationships but also provide a platform for dentists to share ideas, best practices, and experiences with their peers.

Furthermore, ADA membership offers a range of resources to support dentists in their practices. From practice management tools and guidance on regulatory compliance to advocacy efforts aimed at promoting oral health and advancing the interests of dentists, the ADA provides invaluable support to its members as they navigate the complexities of the profession.

Beyond these tangible benefits, ADA membership also represents a commitment to professionalism, ethics, and excellence in the practice of dentistry. By becoming a member of the ADA, dentists demonstrate their dedication to upholding the highest standards of patient care and professional conduct, earning the trust and confidence of their patients and colleagues alike.

As the fourth-year dental students in Utah take this important step in their professional journeys, they join a community of over 163,000 ADA members nationwide who are united in their commitment to advancing the field of dentistry and improving the oral health of individuals and communities. The ADA National Signing Day serves as a reminder of the significance of this commitment and the boundless opportunities that await those who choose to embark on this path.

In conclusion, the ADA National Signing Day at Utah Dental Schools was not only a celebration of achievement but also a testament to the enduring value of ADA membership. As these aspiring dentists transition to full dentist membership, they embrace a wealth of opportunities for continued learning, professional growth, and collaboration within the dental community.

UDA Staff

THE BURDEN OF BURNOUT DENTISTS SHARE WAYS TO LIGHTEN THE LOAD, PRIORITIZE MENTAL HEALTH

Erinne Kennedy, D.M.D., likens feeling burned out to carrying a heavy emotional backpack every day.

Imagine the backpack starts at 5 pounds. Most people could manage that pretty easily. Maybe it increases to 30 pounds for a few days but then goes back to 5 pounds. That is still doable. But what if the backpack weighed 150 pounds every day?

“It would be difficult for most of us to carry that 150-pound backpack around all the time and live life well,” Dr. Kennedy said.

May is Mental Health Awareness Month. The COVID-19 pandemic, which has shaped the world for more than two years, has helped to shine a light on mental health and burnout among health care professionals, including dentists.

The American Dental Association’s 2021 Dentist Health and Well-Being Survey, distributed in March 2021 to a random selection of 20,000 dentists, found 16% had experienced anxiety — more than three times the percentage reported in 2003 — and 13% had experienced depression. Fewer than half of dentists were aware of a state dentist well-being program available through their dental association.

“New dentists face pressures from multiple directions to produce income as associates, provide excellent care, pay off student loans, build a family or spend time with friends, volunteer and more. For new dentists, it might feel like they are wearing that 150-pound backpack and being pulled in multiple directions,” Dr. Kennedy said. “For dental students, it is overwhelming to be presented with and learn the amount of information required for dental school. And the reality is that life doesn’t stop when you are in dental school so that you can have the perfect amount of time to study.”

Dr. Kennedy experienced burnout herself during her educational journey. She found she needed to “declutter” her responsibilities and focus on what mattered most to her, a practice she still follows today as an assistant professor and director of pre-doctoral education at Kansas City University’s College of Dental Medicine. She has spoken about burnout and work-life balance as an ADA Success speaker, on the ADA’s Beyond the Mouth podcast and with student groups such as igniteDDS and the American Student Dental Association.

Bill Claytor, D.D.S., administrative director of the North Carolina Caring Dental Professionals, a nonprofit that helps to monitor and advocate for dentists and dental hygienists who struggle with substance use disorders, stress, depression, burnout and perfectionism, said dentists’ pursuit of perfection may make them more susceptible to burnout. He himself experienced burnout in his early 40s.

Common signs of burnout include emotional and physical

exhaustion, cynicism, negativity, frustration, anger, anxiety, detachment, reduced work performance, insomnia, muscle aches and gastrointestinal upset.

Recovery from burnout begins with taking positive, constructive steps toward freedom, said Dr. Claytor, a consultant to the ADA Council on Dental Practice’s Dental Wellness Advisory Committee, who participated in a Beyond the Mouth podcast episode on burnout. He offers the following seven steps to mitigate burnout while balancing life and work:

Step 1: Define the type of dentistry you want to practice.

Step 2: Control your schedule.

Step 3: Minimize your debt.

Step 4: Stay engaged and don’t isolate.

Step 5: Develop a collegial community.

Step 6: Take care of self and family.

Step 7: Pursue a spiritual life and gratitude.

“Remember that burnout is all about relationships between people,” Dr. Claytor said. “The causes of burnout in the office are endless. We must be proactive as dentists to instigate the changes necessary to mitigate dental office burnout. Dentists should have someone, like a colleague or mentor, with whom they can talk daily to discuss problems and ideas to mitigate the stressors we face as dentists. Solutions to burnout begin with engaging with others and not isolating. Recovery from burnout is a ‘we’ process.”

Having a strong support system, including family, friends, colleagues and a therapist, has helped Dr. Kennedy address burnout.

“The key is to be constantly checking in with one another and sharing the load of life,” she said. “If you see someone on your team’s backpack at 150 pounds, ask yourself, ‘How can we divide that load among our team?’ Burnout is never one person’s challenge; it’s the team’s challenge. Check in with one another and have relational pauses. The more you understand about what gives each person on your team energy and what causes them anxiety, the more you can address challenges early on to prevent burnout.”

The ADA offers resources related to mental health and burnout at ADA.org/wellness.

“Dentistry is a journey, not a race,” Dr. Claytor said. “Take care of yourself daily. You and your dental career are only as good as your health and ability to deliver quality care.”

Mary Beth Versaci ADA News Supplement May 2022

PRACTICE

USING THYROID COLLARS DURING RADIOGRAPHIC EXAMS NO LONGER RECOMMENDED BY ADA

Expert panel updates imaging safety guidance

The American Dental Association no longer recommends using thyroid collars on patients during radiographic exams.

Before taking radiographs, dentists should also consider what diagnostic information they need from the images to benefit patient care or substantially improve clinical outcomes, according to updated recommendations developed by an expert panel established by the ADA Council on Scientific Affairs.

The recommendations, published online Feb. 1 by The Journal of the American Dental Association, aim to improve radiation protection in dental radiography and cone-beam computed tomography. Medical physicists with the U.S. Food and Drug Administration supported the development of the recommendations, which are also aligned with recent guidance from the American Academy of Oral and Maxillofacial Radiology. The recommendations are the first on dental imaging safety and radiation protection from the council since 2012.

After reviewing nearly 100 articles, guidance documents and regulations related to radiography, the expert panel determined thyroid and abdominal shielding during dental imaging is no longer recommended, and the use of these forms of protective shielding should be discontinued as routine practice. Evidence indicates modern digital radiography equipment and restricting the beam size only to the area that needs to be imaged better protect patients against radiation exposure to other parts of their body. Lead aprons and thyroid collars can also block the primary X-ray beam, preventing dentists from capturing the image they need.

“When this happens, more radiographs need to be taken, and unnecessary X-rays are what we want to avoid,” said Purnima Kumar, D.D.S., Ph.D., professor of dentistry and chair of the department of periodontology and oral medicine at the University of Michigan School of Dentistry and chair of the ADA Council on Scientific Affairs. “The central point of these recommendations is that clinicians should order radiographs in moderation to minimize both patients’ and dental professionals’ exposure to ionizing radiation.”

The recommendations — which apply to all patients, regardless of age or health status, such as pregnancy — also advise dentists to safeguard patients against unnecessary radiation exposure by:

• Ordering radiographs to optimize diagnostic information and enhance patient care outcomes and making every effort to use images acquired at previous dental exams.

• Using digital instead of conventional radiographic film for imaging.

• Restricting the beam size during a radiography exam to the area that needs to be assessed.

• Properly positioning patients so the best image can be taken.

• Incorporating CBCT only when lower-exposure options will not provide the necessary diagnostic information.

• Adhering to all applicable federal, state and local regulations on radiation safety.

“We encourage dentists and their teams to review these best-practice recommendations, comply with radiation protection regulations and talk with their patients about any questions or concerns before ordering dental imaging,” Dr. Kumar said.

There may be state laws or regulations mandating continued use of certain equipment. Dentists should abide by the laws and regulations where they practice.

To view the complete recommendations, visit JADA.ADA.org. They will appear in the April issue of JADA.

ADA News

CRITICAL CHALLENGES FACING DENTISTRY

The challenges facing dentistry in the United States in 2023 were diverse to say the least. As we enter that 25th year of the first century in a new millennium, the dental care profession and delivery of oral health care will undoubtedly face new challenges while managing those that followed us into the new quarter-century.

Many of the challenges confronting the oral health care industry are ongoing and must be addressed directly, as they are critical to running a successful dental practice. Dentists often suggest having an adequate patient base and sustaining an optimal level of busyness are hurdles they must continually face.

In addition to these unyielding demands and pressures, we must consider the novel issues that affect the delivery of oral health care. The possibility of a global pandemic always loomed, but we had little idea of the impact such a disaster would have on various aspects of the health care industry. Teledentistry is not a new concept, having been introduced in the 1990s, but its application during the pandemic became increasingly important for filling an important patient communication niche. Using a variety of teledentistry platforms, this technology proved a valuable

communication tool, enabling us to address patient concerns, especially during shelter-in-place mandates.

Dental practitioners frequently find staying abreast of and considering new and emerging technologies to be a challenge. These technological advances range from electronic patient record innovations to diverse social media platforms to a myriad of patient care–focused digital technologies, such as scanners, 3-dimensional printing, 3-dimensional imaging, and tooth aligners, to novel artificial intelligence applications. These technologies are changing the way patients are scheduled, tracked, recalled, communicated with, and treated. For example, social media is increasingly being used in dentistry to communicate information to patients about specific techniques and procedures as well as for dental marketing.

Social media and communication applications on smartphones benefit a variety of situations, such as helping manage preoperative anxiety, improving oral hygiene routines, and improving compliance in orthodontic patients. These diverse platforms allow people across the age spectrum to use social media for communication and information transfer. Disseminated dental

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information varies tremendously in content and quality. Dental care professionals can watch videos on platforms such as YouTube, Instagram, and TikTok that are meant to educate patients about specific dental procedures, or short clips meant to entertain or provide comical value. Given that anyone can post information on these platforms, it is not surprising that the quality and accuracy of information is inconsistent. One poignant example is managing toothache pain with antibiotics; 1 study found that social media was a platform for patients to discuss and recommend antibiotics use to avoid going to a dentist, especially those patients reporting oral health care–related anxiety.

The advent of search engines and consumer-driven sites, such as Google and Yelp, created new hurdles for practitioners, who are forced to monitor these sites for patient posts, reviews, and ratings of their experiences at specific dental practices and to even consider responding to such reviews. A variety of websites that evaluated patient satisfaction indicated that most orthodontics practices received positive reviews. Approximately 50% of studied orthodontic practices, however, received at least 1 negative review, with complaints ranging from quality of care or service and interpersonal interactions to financial issues.6 Orthodontists who posted responses to complaints had higher overall ratings than those who did not respond.6 Patient ratings appear to vary by specialty and other factors, such as sex and time passed since completing specialty training.

The impact of patient reviews on quality improvement in dental offices and how this might influence those seeking oral health care and a dental home is not clear. We can presume that comments posted on the internet, such as “I’m looking for a new dentist and don’t recommend this practice,” would not be the social media advertising that most dental offices want to see.

Having an adequate number of patients remains a key concern for dental practices. In January 2022, the American Dental Association’s Health Policy Institute deployed a survey to glean a better understanding of the operational and economic issues facing dental practices and public health clinics. More than 3,000 practices and clinics participate in the monthly survey. Results from the September 2023 survey revealed a variety of perspectives on the economic outlook and issues identified as challenges when reporting began in 2022. Appointment attendance levels remained a critical issue over the past year.

Dental practices reported having a mean of 83% filled schedules in September 2023 compared with 86% in September 2022. Eighty percent of participating dentists reported patient noshows and cancellations within 24 hours as the primary cause of failing to achieve a full patient schedule, and nearly one-half said they just did not have enough patients. More than one-third of offices surveyed cited personnel recruitment as a critical issue, with most reporting it as being challenging. Numerous experts and consulting firms can provide tips to increase patient volume and retain patients. Improving office reviews, providing notification systems, and offering education using technologies are just a few of the approaches experts suggest can help fill dental practice schedules.

As we enter 2024, I predict patient volume and staff recruitment will remain at the forefront of dental practice improvement. Uncontrollable external factors, such as the overall

economy, will continue to play an important role as well. We can expect new challenges involving emerging technologies, more powerful software applications, and artificial intelligence. Although these innovations can be difficult to adopt and implement, they also represent opportunities to advance our ability to track and analyze patient data and treatment outcomes, improve diagnostics, and improve workflow efficiency and quality. Data collection from social media, office software, and other sources can provide important foundational knowledge useful for improving patient recruitment and retention and for monitoring and improving the quality of delivered care. It is impossible for anyone to clearly forecast the challenges and advances forthcoming in 2024. However, the dental care profession will enter the second quarter of the new millennium’s first century in 2025 seeking new opportunities and innovative technologies to address existing and emerging issues in ways that will advance and improve the population’s oral health.

Tim Wright, DDS, MS JADA

2024-2025 UDA Board of Directors

President Len R Aste DDS

President elect Rodney J Thornell DMD

Treasurer Richard G Fisher DMD

ADA Alternate Delegate Laura Stewart Kadillak DDS

Secretary Randell M Capener DMD

Past President Mark R Taylor DDS

ADA Delegate James H Bekker DMD

ADA Delegate Scott L Theurer DMD

ADA Delegate Darren D Chamberlain DDS

GETTING THE MOST OUT OF YOUR PRACTICE’S WEBSITE

Google Analytics provides valuable data to fine-tune digital marketing efforts.

Any time that you engage in any form of advertising, in order to ensure that it matches your target, it is important to know who your audience is, what their preferences are, and what is important enough to them that they would want to find your practice’s website. This information enables us to make informed decisions regarding where to place our marketing efforts and how to tweak our websites to match our prospective patients’ expectations.

Google Analytics is a free service. Google wants you to have this information because the company makes its money selling advertising. Anything that helps increase their advertising will help their bottom line, which, in turn, will help your bottom line. Your website provider should be well attuned to using Google Analytics. If not, then it may be time for another website company. Only a few lines of code need to be added to your website in order to glean mountains of information about its performance. Make sure that your website company sets you up as a user on the Google Analytics account so that you can access the reports directly. This way, you eliminate the middleman and

put yourself in control. Here are some of the many incredibly useful statistics that you can get from Google Analytics.

The Referral Source

This is how users (who are your prospective patients) have stumbled upon your site. Hopefully, a huge majority of them are coming to your site from organic search engines, such as Google, Bing, Yahoo, etc. this is essentially free advertising, so you’ll want to take advantage of it as much as you can. Google Analytics will also give you the results of any traffic from sites that you had paid advertising on, such as Yelp.com, YP.com, etc.

Keywords Used

This is what users typed into the search box before choosing your site from the listing. This information gives you an indication of what your potential patients are interested in. Using keyword data, you can enhance the web pages that were clicked on to increase your prospective patient’s experience and hopefully nudge them into picking up the phone.

Another thing to look for from the keywords data is what im-

portant keywords are glaringly absent from your details. This means that your web pages with those keywords are not appearing high enough in the listing for those keywords to evoke a click from the users. If that’s the case, it’s time to revamp those pages. Ensure that the keyword or keywords appear near the top of the page and have your web designer place them in text, such as a heading or subheading, with an H1 tag. This renders the text in a very large font, and Google interprets that as being important. In addition, ensure that your web pages have at least 500 to 800 words so that Google considers them to be “unique pages.” If they do not, they will be relegated to the 29th page of users’ search results with little chance of being seen. Take every opportunity to add your important keywords into the text in a readable fashion. Furthermore, plaster your pages with images and place the keywords into their alt tags so that the search engines spiders can detect them. This will help you showcase the different services that you provide that match what users are looking for.

Landing Page and Pages Visited

From which page did users enter your site? This data can provide you with a good indication of what a prospective patient’s interests and concerns are. Some may enter more generally through your homepage, whereas other may enter more specially through pages about your offerings or your blog. Once users are on your site, you can see what other pages they are clicking on, so even if they arrived through a simple search for a dentist in their area, you can learn what services they are interested in.

Time Spent on a Page

This data allows you to gauge how much interest users have in any particular page. If users are attracted to a page, but they only spend a few seconds looking at it, it may be time for a redesign – anything to keep their attention focused on their site.

This is extremely important data that you can use when making marketing decisions. Let’s say that you are getting a lot of traffic from one particular site. You can now look at the uses that come from that site and see what their bounce rates are. The bounce rate is the percentage of users who only view a single page without clicking anything and then go elsewhere. If the traffic that you receive from one particular site has a high bounce rate, especially if the average time spent on the page is only a few seconds, then this is obviously not a quality referral source. If this particular site is one on which you are paying for advertising, then it is probably a good time to drop them.

Alternatively, when users from a particular source not only spend enough time on a page that you know that they are reading your content but also visit multiple pages, that is considered a quality referral source. For those sources, it may be a good time to consider ramping up more advertising to increase the quality traffic even further.

Keep It Real

When looking at statistics from Google Analytics, remember to keep in mind that there are bots lurking in the shadows of cyberspace. These bots can visit your website multiple times and skew your statistics so badly that you become excited about how wonderful the source website is that is sending you all of these visitors who need to get their teeth fixed. Unfortunately, these bots have no human teeth – just statistical ones. You can easily identify them by the fact that their bounce rate is 100% and that their time spent on your page is 0 seconds. If you identify any of these bots, you can have your website provider filter them out for you, but even then, there will always be a few that get through, so try to weed them out of your statistics before making any marketing decisions.

Google Analytics can be an absolutely wonderful tool to keep track of your web marketing results. But remember, it is important for you to be able to access it directly so that you can get the real data, not stats that have been manipulated or watered down by your webmaster. Monitoring your website traffic will enable you to make marketing decisions that will increase your return on investment as well as the amount of new patients who are coming in the door.

Dr Richard P. Gangwisch

PRACTICE

THE TEN COMMANDMENTS OF CYBERSECURITY

Thou Shalt Believe it Can Happen to You!

Most people believe it will never happen to them. Ransomware attacks are occurring with greater frequency. The health care sector is particularly under threat. Private health information is 50 times more valuable than credit card data on the dark web. Last year, the American Dental Association was impacted.

Thou Shalt Use Strong and Unique Passwords for Each Account

Compromised passwords are one of the greatest threats to your cybersecurity. A common practice is using the same password for everything. One of your passwords gets compromised, and now the bad guys have access to all your other accounts. Your passwords are being bombarded daily with programs designed to crack them. Don’t believe me? Go to haveibeenpwned. com, type in one of your email addresses, and look at how many times your account has been breached. It will make you want to change all your passwords.

Thou Shalt Enable Multi-factor Authentication

Whenever Possible

Multi-factor authentication (MFA) is no longer a suggestion but

a must. MFA works with your password to have a code sent to you or some other form of authentication (face, touch, authenticator app, etc) before anyone gains access to your account, email, etc. I know it seems annoying and excessive, but without it, you are making yourself an easy target for cybercrime.

Thou Shalt be Careful What You Click on!

Ninety percent of cybercrime is still started via a phishing email. The email has links or a button and because it seems urgent, vital and important, you click on it and do whatever it says. Phishing emails have cost companies billions, forced some to close and destroyed lives. Take time to think before you click that link!

Remember to Back Up Important Data Regularly and Securely

Backups are still one of the best ways to beat cyber crime and save you from paying the ransom to regain your data. It does not fix everything, but it at least provides a way for your business to get back up and running quicker.

(continued on page 22)

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PRACTICE

EMOTIONAL INTELLIGENCE CAN HELP DENTISTS RETAIN A STRONG TEAM

Emotional intelligence (EI) is understanding and managing emotions constructively. Dentists who operate with high EI can significantly impact their teams by effectively fostering healthy, happy and productive work environments.

Daniel Goleman, the famous researcher who brought EI to the leadership forefront in the 1990s, stated:

“IQ, cognitive abilities are basically hardwired. They don’t really change that much through life. On the other hand, emotional intelligence (EQ or EI) is learned and learnable and you can upgrade it at any point in life.”

What Leading with EI Looks Like

If we break down Goleman’s summary of EI, there are five key components:

1. Self-awareness

2. Self-regulation

3. Motivation

4. Empathy

5. Social skills

Let’s dive deeper into each component to identify characteristics shown in dentists with strong EI.

• Self-awareness: confident, realistic about their self-assessment and can laugh at themselves

• Self-regulation: redirects disruptive impulses in moods, thinks before acting, is trustworthy and has integrity

Cybersecurity (continued from page 19)

Honor Your Software by Keeping it Up-to-date.

Updates for software are being pushed out daily for your phone, tablet, computers and other technological devices. Why? Because bugs or exploits have been identified. You are putting yourself at risk by not updating. Using old or outdated technology adds to the threat and can leave your systems vulnerable to attack. The “Internet of Things” is full of devices that can be exploited. Updates can help.

Thou Shalt Only Download and Install Apps From T rusted Sources

Have you ever stopped to read any of those agreements that come with apps you install or software you put on your computer? No. You click “ok” and move on. Then you have little idea what risk you are taking so you best trust the source you are getting those apps from. Even the Apple Store is susceptible to apps that misuse your data. Ensure you know what access you are giving before doing it.

Thou Shalt Use Caution Accessing Public Wi-Fi Networks

Free Wi-Fi is everywhere. All you have to do is connect, plug in, click a box and boom, you are on the internet. You

• Motivaion: works for reasons beyond money, power or status and is optimistic even in the face of failure

• Empathy: understands the emotional makeup of others and builds strong relationships

• Social skills: networks easily, builds rapport with people and relates with others

The Positive Result of EI-Driven Dentists

Dentists who excel in EI often produce high impact results, including:

• Faster team productivity

• Higher team engagement

• Stronger trust and transparency with colleagues

• Healthier conflict resolution

• Better ability to hand work pressures

In my leadership coaching and training experience, I see all types of dentists with unique challenges. Outstanding leadership starts with you and your authentic self-awareness.

Becoming a great dentist evolves – this is hard in practice and needs to be a part of your proactive growth to leadership excellence. It’s important to grow as a dentist and continue practicing EI because it significantly affects leadership and team performance.

Bobi Seredich

Southwest institute for Emotional Intelligence

might be opening up shop for your data to be stolen by doing so. Even charging you phone is a risk now. Take precautions. Use virtual private network software that protects data on your device.

Thou Shalt Not Share Your Personal or Sensitive Information Online.

The hackers sometimes do not even need to hack you. We are handing them all the information they need via social media. On vacation? Facebook knows. So does everyone else. Do you play those silly games that ask you questions? Doing so can provide information that hackers can use when trying to guess your security questions. If you would not tell a stranger who shows up at your house, why tell the world that information?

Thou Shalt be Aware of your Weakest Link

Your best defense is only as strong as your weakest link. If I have a secret, I have one daughter I can tell to keep it and another daughter if I want everyone to know what it is. If you can’t identify your weakest link, then it very well may be you. Education and training can go a long way to helping other know the risk and avoid costing you and your business greatly.

Larry Darnell

• What is the current local dental practice transition marketplace like?

• What are the best transition options for my practice?

• What impact does the makeup of insurance have on the sale of my practice?

• Any suggestions for improving my practice image and real estate?

• What potential practice investments to increase value could I make or avoid?

• What might present and future staffing integration look like?

• What might present and future associate integration look like?

• How does my new patient flow and patient turnover analysis stack up?

• How is my promotion and marketing of the practice? What basic ideas should I consider?

• What about my lease or transfer of the real estate?