July/August 2019 | Vol. 110, No. 4
University of Oklahoma College of Dentistry Class of 2019
www.okda.org
1
QUA L I T Y C A R E For your patients, and your practice A t th e Pr i vate B ank at Valli a nc e we o f f er a n ar r ay o f tai lored s oluti o n s and speciali zed ser vic e o p ti o n s fo r den tists:
Streamlined banking operations to keep your office running smoothly Convenient access to credit Tools to attract and retain top employees
2019 2 journal | July/August downtown okc
405.792.6400
VBANK.COM
Contents
ADVERTISERS Thank you to these businesses who advertise in the ODA Journal
Oklahoma Dental Association
July/August 2019 | Vol. 110, No. 4
Inside Front Cover Valliance Bank Inside Back Cover Mariner Wealth Advisors Back Cover Delta Dental of Oklahoma
ASSOCIATION 04 Calendar of Events 0 5 Welcome New ODA Members 0 6 What is the Gray Market, and Why Should You Care? 09 ODA Member Benefit Corner
3000 Insurance Group Commerce Bank Corporate Realty Advisors Dallas Dental Symposium Edmonds Dental Prosthetics,Inc. Endodontic Associates Lewis Health Profession Services Lewis Health Profession Services MedPro Group Mid-Content Dental Congress OUCOD Paragon Dental Practice Transitions TDSC UPAL THE OKLAHOMA DENTAL ASSOCIATION JOURNAL (ISSN 0164-9442) is the official publication of the Oklahoma Dental Association and is published bimonthly by the Oklahoma Dental Association, 317 NE 13th Street, Oklahoma City, OK 73104, Phone: (405) 848-8873; (800) 876-8890. Fax: (405) 848-8875. Email: information@ okda.org. Annual subscription rate of $39 for ODA members is included in their annual membership dues. POSTMASTER: Send address changes to OKLAHOMA DENTAL ASSOCIATION JOURNAL, 317 NE 13th Street, Oklahoma City, OK 73104.
10 ODA Rewards Partners 1 2 Oklahoma Mission of Mercy 2020 FAQs
18
2019 Legislative Session One for the Books!
4 4 Finally, Five (not so) FAQs
1 8 2019 Legislative Session Summary
36
New Dentist Corner Mentorship: Paying It Forward
1 9 2019 OKCapitol Club & DENPAC Grand Level Members 2 0 Tobacco Stops with Me News 2 1 ADA Legislative News 2 2 ADA Medicaid Resolutions: Improving Provider and Patient Experiences
SPOTLIGHT 39 What You Didn't Know About Dr. Susan Davis 4 0 Tribute to ODA 50- Year Members
Cover Photo: 2019 OUCOD Graduates posing for the traditional class photo. Welcome New Members!
FEATURES 25 OUCOD 2019 Retirees 2 6 The Difference Between Being Busy or Profitable: Hidden Costs (Part 2 of 3) 2 8 Differential Diagnosis of the Umbilicated Lesion 30 Opioid Prescribing Patterns Among Oklahoma Dentists: A Survey
Subscriptions: Rates for non-members are $56. Single copy rate is $18, payable in advance.
34 Clinical Accuracy of 3-D Printed Casts Compared to Traditional Casts 35 OU ASDA Officers and Award Winners
Reprints: of the Journal are available by contacting the ODA at (405) 848-8873, (800) 876-8890, editor@okda.org.
Copyright Š 2019 Oklahoma Dental Association.
2 1 Meet the Newest ODA Staff Member
LEGISLATIVE LOOP
Periodical postage paid at Oklahoma City, OK and additional mailing offices.
Opinions and statements expressed in the OKLAHOMA DENTAL ASSOCIATION JOURNAL are those of the author and are not necessarily those of the Oklahoma Dental Association. Neither the Editors nor the Oklahoma Dental Association are in any way responsible for the articles or views published in the OKLAHOMA DENTAL ASSOCIATION JOURNAL.
1 4 ODA Marketing Coach
36 New Dentist Corner 38 Hygiene Hotspot
CLASSIFIEDS Is Your Information Correct?
4 2 ODA Classified Listings
Help the ODA keep you informed about legislative actions, CE opportunities, events and other important member-only news. Contact Kylie Ethridge, ODA Membership Director, at kethridge@okda.org or 800.876.8890 to provide the ODA with all of your current contact information. www.okda.org
3
ODA JOURNAL STAFF EDITOR Phoebe Vaughan,DDS ASSOCIATE EDITOR Frank J. Miranda, DDS EDITORIAL BOARD MEMBERS M. Edmund Braly, DDS Mary Hamburg, DDS, MS Somer Heim, DDS Daryn Lu, DDS EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates OFFICERS 2019-2020 PRESIDENT Daniel Wilguess, DDS president@okda.org PRESIDENT-ELECT Paul Mullasseril, DDS presidentelect@okda.org VICE PRESIDENT Chris Fagan, DDS vicepresident@okda.org SECRETARY/TREASURER Robert Herman, DDS treasurer@okda.org SPEAKER OF THE HOUSE Doug Auld, DDS speaker@okda.org IMMEDIATE PAST PRESIDENT Shannon Griffin, DMD pastpresident@okda.org
CALENDAR OF EVENTS Visit the ODA’s online calendar at OKDA.ORG/CALENDAR for all upcoming meetings and events. July 4-5 ODA Building Closed
August 2 OkMOM Steering Committee Meeting ODA Building 8:00 a.m.
July 12 Council on Membership & Membership Services Meeting ODA Building 10:00 a.m. July 19 Council on Governmental Affairs Meeting ODA Building 9:00 a.m.
Annual Meeting Planning Committee ODA Building 10:00 a.m. August 3 ODA Family Zoo Day OKC Zoo 9:00 a.m.- until close
ODA Investments Committee Meeting Teleconference 12:30 p.m.
August 9 RDGP Meeting ODA Building 11:00 a.m.
ODA Board of Trustees Meeting ODA Building 1:30 p.m.
August 16 ODA Medicaid Seminar 9:00 a.m.-12:00 p.m. OUCOD Rm #104 Dentists ONLY August 23 South Central States Leadership Conference Grapevine, TX 1:00 p.m.
ADMINISTRATIVE STAFF EXECUTIVE DIRECTOR F. Lynn Means DIRECTOR OF GOVERNANCE & FINANCE Shelly Frantz DIRECTOR OF COMMUNICATIONS & EDUCATION Stacy Yates DIRECTOR OF MEMBERSHIP Kylie Ethridge Programs & Operations Manager Makenzie Dean MEMBER COMMUNICATIONS MANAGER Madison Douglas SPECIAL PROJECTS MANAGER Abby Sholar
August 25 ADA District 12 Pre-Caucus Grapevine, TX August 27 ODA Student Fall Festival 5:00-7:00 p.m. September 2 ODA Building Closed September 12 New Dentist Seminar ODA Building 5:30 p.m. September 20 Risk Management Seminar Tulsa Community College 8:30 a.m. - 12:00 p.m. Council on Budget & Finance Meeting ODA Building 9:00 a.m. September 27 DENPAC Wine Tasting At the home of Dr. Krista Jones & Rev. Craig Stinson
ODA Family Zoo Day
Saturday, August 3 from 9:00 a.m. until Close Get wild with the ODA! Meet at the zoo entrance by 9:00 a.m. to receive your ticket. After entering the zoo, families are encouraged to enjoy the day and stay as long as they’d like! Entrance for ODA Members and their Immediate Family is courtesy of the ODA. Non-Member Dentists, Staff and Extended Family: $9 per adult & $7 per child
All attendees must rsvp to kylie at kethridge@okda.org
Opportunity to Support Oklahoma Veterans in Need of Dental Care D-DENT is dedicated to helping Oklahoma veterans obtain access to dental care at no cost. This is made possible by raising funds allocated specifically for veterans.
Stay connected with the ODA!
4
journal | July/August 2019
One way D-DENT raises funds for veterans is through its annual Veterans Golf Tournament. This year the 23rd annual golf event will be held on August 12, 2019, at River Oaks Golf Club in Edmond, Oklahoma with a 9:00am shotgun start. For more information on this event, contact D-DENT at 405-424-8092 or visit d-dentok.org for more details.
ODA
ERS NEW m
Welcome, New Members
New Members Joined May 4, 2019 - June 10, 2019
EW ODA NEW ODA
Please join the ODA in welcoming our new members into Oklahoma’s community of organized dentistry
EMBERS MEMBERS
EW ODA NEW ODA
EMBERS MEMBERS
Michael Evans Colin Eliot Aaron Neale Jennifer Chambers Brad Cummings Eric Eakers Jeremy Morris Whitney Rochelle Bruce Tharp Damon L. Johnson George Ballew
NEW ODA NEW ODA
MEMBERSMEMBERS
NEW ODA
Central Northwest Northwest Oklahoma County Oklahoma County Oklahoma County Oklahoma County Oklahoma County Oklahoma County Southwest Tulsa County
MEMBERS
If you're reading this issue of the ODA Journal, it means you've renewed your ODA, local society and ADA membership for 2019 THANK YOU! Non-renewals have now been dropped from the Journal mailing list and have lost all membership benefits. We hope you'll agree that your membership in organized dentistry represents an investment in both your future and the future of your profession. Perhaps that's why close to 100% of all ODA members renew their membership, year after year. Working together, we can preserve the future of dentistry and ensure the highest level of the public's oral health. The Oklahoma Dental Association couldn't do it without you, the members. In 2019, and beyond, we sincerely pledge to do all we can to advance the art and science of dentistry 5 www.okda.org while serving our member dentists.
What is the Gray Market, and Why Should You Care? By Ahmed Shams, SourceOne Dental, Inc. (on behalf of ODA Supply Source) We sometimes receive questions about how ODASupplySource is able to offer such large discounts on dental supplies. Often, dentists wonder if (or are told that) our products might be unsafe gray market items, asking questions like: “Aren’t those products old or expired?” and “Are these products from outside the United States?” or “Are they safe?” It’s clear that many practices don’t know what the gray market is, or how we know that the products you find on ODASupplySource.com are the same quality products from authorized distributors you’re accustomed to – but for a much lower price. So, what is the gray market, and how can you avoid purchasing inferior products? Not to be confused with the black market which typically deals in counterfeit or stolen products and is completely illegal, the gray market deals with different forms of “unauthorized” reselling of products. A simple version of a gray market could be a dentist selling items online. Maybe he/she had bought an item with a buy-one-getone special at a tradeshow and sells the free one via an online auction site. Technically speaking, the dentist is not authorized by the manufacturer to resell this product. This is a gray market resell. The more common contributor to the gray market is when an authorized distributor from another country (who purchases products at lower cost than a U.S.-based distributor) exports those products back to the United States for resale. You can easily find these on large resell and auction websites. A seller might be authorized to sell in Brazil, for example, but once that item is brought back to the United States, it becomes unauthorized for resale and is, therefore, a gray market item. THE RISKS OF GRAY MARKET ITEMS The most important reason to avoid a gray market product is because the warranty is void. You will have no support from the manufacturer if the product does not perform as advertised. 6
journal | July/August 2019
A second risk of gray market products is potentially poor quality control. An unauthorized reseller doesn’t have to ensure any quality control of the products during storage and shipping. Finally, black market (counterfeit or stolen) items often find their way into the inventories of gray market sellers. It can be difficult to know the difference and impossible to know if what you are buying is safe for you and your patients. AVOID THE GRAY MARKET WITH ODA SUPPLY SOURCE There are NO gray market products on ODASupplySource.com. Every company we work with is either an authorized distributor of the products offered on the site, or they are the actual manufacturer of products shipped direct from those warehouses. ODASupplySource is able to offer products at discounted prices to Oklahoma Dental Association members, because we have removed outside sales representatives from the equation and are leveraging the buying power of thousands of member dentists in multiple states. (The ODA is the ninth state dental association to partner with SourceOne Dental.) While a trained outside sales rep can be very useful to a practice, many of the supplies a dental office orders on a regular basis don’t require a commissioned representative’s assistance. Do you need to pay a commission on cotton rolls, patient bibs, gloves, lidocaine, etc.? Some national suppliers have implied that the products offered by SourceOne Dental through ODASupplySource.com are gray market items. This is not true. ODASupplySource prices are lower because of ODA membership power! Additionally, all products include free ground shipping direct from a supplier or the manufacturer. On average, Oklahoma dentists can expect delivery within three to five business days for any in-stock item and typically one to two weeks for any special-order item.
Members who order will save an average of 10 to 30 percent on more than 65,000 brand-name dental supplies without sacrificing quality. Our customer support specialists can answer your questions and provide a custom price comparison based on your recent invoices. Or, you can visit the ODASupplySource page on OKDA.org for a list of frequently asked questions and answers and helpful videos. NOTE: ODA Supply Source is available only to member dentists. Visit ODA.org and click on the Membership link found at the top of each web page or call the ODA Membership Department at 800.876.8890 to join for 2019 and start saving on your dental supplies today! Ahmed Shams is the founder and CEO of SourceOne Dental, a dental supplies marketplace based in Chandler, AZ, and one of the fastest growing companies in the dental industry. SourceOne’s objective is to maximize efficiency in the dental supplies supply chain in order to provide individual dental practices with the ability to purchase supplies for prices typically only available to large group practices. In May 2019, SourceOne partnered with the Oklahoma Dental Association to launch ODASupplySource, the exclusive dental supplies store for ODA members. With over 12 years experience in the US Dental Industry, Shams holds undergraduate degrees in Economics and International Business from the University of Iowa and an MBA in Marketing from Arizona State University.
Turn to page 9 for more details about ODASupplySource and how this exclusive member benefit can save your practice 15-25% on supplies!
EST CONT ENDS ST 31 AUGU
ODA SUPPLY SOURCE CHALLENGE TAKE THE
FOR A CHANCE TO WIN A $100 SOUTHWEST AIRLINES GIFT CARD!
GET STARTED NOW
by emailing, faxing, or calling in your invoices Simply submit four months of recent supply invoices for a free custom side-by-side price comparison showing you the savings on the same products!
Phone: 877-659-7310 | support@odasupplysource.com | Fax: 877-659-5004 * Submit invoices NOW- August 31st for the chance to win a $100 Southwest airlines gift card! *
Phone: 877-659-7310 | suppor t@odasupplysource.com | Fax: 877-659-5004
points
for
purchase Win free registration for the 2020 ODA Annual Meeting with oda supply source Receive one point for every dollar you spend through ODASupplySource! The three ODA members with the most points will win FREE registration to the 2020 Annual Meeting in Oklahoma City. Simply shop, save and earn points! Contest ends December 31st . If you have questions about the contest please contact the ODA at 800-876-8890
www.okda.org
7
Professional Liability... It’s a risk you can’t ignore.
With over 47 years of experience, 3000 Insurance Group protects more dentists in Oklahoma than any other agency. Put your professional liability with the strongest and most experienced brand in Oklahoma.
ODA Highlights •
Claims Defense - Medical Protective provides expert claims defense that wins 95% of all dental trials
•
Pure Consent - No claim will ever settle without your consent, no exceptions.
•
Free Tail Coverage - After 1 year with MedPro, you can retire without any additional cost to you.
•
Cyber and Privacy Liability included - This coverage continues to develop and is no cost to you.
•
New To Practice Discounts - First year is only $50 for a new graduate.
•
Increased Limits - An inexpensive solution for added protection; up to 5M per claim.
•
Occurrence Conversion - Move your Claims Made Policy to an Occurrence for better protection
•
Separate Entity Coverage - Protect your practice with a separate set of limits.
Visit 3000iG.com/quote to Request a Quote!
405.521.1600 info@3000ig.com 8
journal | July/August 2019
3000iG.com
ODA MEMBER BENEFIT CORNER Why is a membership with the ODA/ADA so valuable? The ODA/ADA supports all members at the national, state and local levels. From helping you manage your practice more efficiently and advocating on your behalf to offering you tools and resources that help you find the answers for which you’re looking, we’re there every step of the way.
Tell Me More About ODASupplySource! ODASupplySource is a member benefit that we launched in May of this year. This new member benefit is something that had been requested by our members for several years and we recognize the value it brings the ODA membership. The ODA Rewards Committee conducted extensive research to make sure they found a partner that not only saved ODA members money but gave members the same quality supplies and customer support to which we know you have grown accustomed. ODASupplySource is not like your typical supply company! Which means things are done a little differently in how items are ordered, delivered and a few other minor differences (like no sales reps!). Although change is sometimes scary, we (the ODA staff) are here to hold your hand along the way and make sure you receive the FULL benefit of this new rewards partner! We encourage you to take the first step by submitting four months of recent supply invoices to support@ odasupplysource.com to get a FREE custom side-by-side price comparison of the same products you currently order.
FREQUE NTLY ASKED QUE STI ONS: Does ODASupplySource charge for shipping? Shipping is FREE for ODA members on every item, regardless of quantity or order volume. How long does it typically take for orders to arrive? Orders will ship directly from the manufacturers and suppliers, located in various parts of the country. This means your order may arrive in several boxes. On average, you can expect delivery within 3-5 business days for any in-stock item and typically 1-2 weeks for any special-order items. What is the return policy? ODASupplySource follows the standard shipping and return policies of each of our vendors. Each vendor's shipping and return policies can be found on every product page under the “Shipping and Returns” tab. If you would like to return an item, simply locate that item in your order history, request the return, and follow the prompts. All returns are subject to vendors’ pre-stated policies.
For more frequently asked questions and helpful videos about ODASupplySource visit okda.org/rewards-program/oda-supply-source.
www.okda.org
9
These are endorsed companies of the ODA that save ODA members money while keeping dues lower by providing royalties to the ODA.
REWARDS
RESEARCHED. PROVEN. ENDORSED. DENTAL OFFICE
Low cost diplomatic collection system (800) 711-0023 www.americanprofit.net
Receive discounts on interpretation services (844) 737-0781 www.cyracom.com/ada
Save 10% and get access to exclusive deals (888) 963-6787 www.healthfirst.com/ada
Save up to 30% on PC products (800) 426-7235 xt. 4889 lenovo.com/ada
Special pricing and a three-year rate guarantee (918) 809-5471 www.heartlandpaymentsystems.com
Setup fee is waived (800) 246-9853 www.demandforce.com/oda
Receive 85-97% of the current market price (800) 741-3174 www.easyrefine.com
Receive e-claims for only .25 cents (866) eclaims (325-2467)
$250 member discount (844) 205-1171
Discounted annual rates (800) 527-7478 www.medjetassist.com
Savings on vehicles for purchase or lease (866) 628-7232 www.ada.org/mercedes
Discount of 15% off all purchases in-store and online. OKC - (405) 755-6600 or Tulsa - (918) 494-7682 www.theuniformshoppe.com
Special pricing for waste pickup (870) 427-6017 www.medicalwasteservices.org
Discounted pricing on dental and office supplies (877) 659-7310 www.ODASUPPLYSOURCE.com Discount of $125 off enrollment (800) 683-2501 www.iaplus.com
Save up to 10% on products and logo applications (800) 990-5407 www.landsend.com/business
Discounts on shipping services (800) 636-2377 www.savewithups.com/ada Preferred pricing and waived set-up fees 855.932.4232 pbhs.com/securemail
25% discount on a new website (888) 433-1747 www.prosites.com/oda
TRAVEL
Free container with recycling with SolmeteX Hg5ÂŽ amalgam separator purchase (800) 216-5505 www.solmetex.com
FINANCIAL SERVICES Sign up for a convenient patient financing solution for only $25.00 (800) 300-3046 www.carecredit.com/dental
Discounts on digital video services & on-hold messaging (800) 460-4653 www.works24.com
INSURANCE
Reduced premiums on a variety of insurance plans (800) 375-8356 www.3000ig.com
Point earning credit card for all your personal & business needs (888) 327-2265 www.adavisa.com
FOR MORE INFORMATION VISIT:
OKDA.ORG/REWARDS-PROGRAM 10 journal | July/August 2019
ODA PARTNERS COLUMN The ODA endorses companies that have been researched and proven to offer products and services that provide real savings. By being an ODA member, you’re automatically eligible for these savings. Below is information about our newest Partner. Learn about all of the Partners at www.okda.org/rewards-partners.
TAKE THE
JOURNEY OF A LIFETIME
Join us in 2019!
Spain~Andalucia May 16-24
Journey along the Elbe May 19-30
Greece ~ Athens and Poros May 30-June 7
Italy’s Lake District June 4-12
Romance of the Douro River July 15-26
Normandy ~ 75th Anniversary of D-Day July 20-28 Canadian Rockies July 25-August 2
Visit us at
www.ada.ahitravel.com
Singapore, Thailand and Angkor Wat featuring the Eastern & Oriental Express Oklahoma Dental Association
AHI Travel programs connect you to the people, places and cultures of the world. Our itineraries take you profound places everyone must see, secret gems only locals know about and built-in breaks for you to realize your own plans. Call us to book your 2019 trip today 1-844-205-1171
September 28-October 11
Grand Danube Passage Cruise September 29-October 14
Croatia & the Dalmatian Coast October 7-18
Sketches of Sicily October 9-18
Cruise the Heart of Europe October 9-24
Endorsed partner, ProSites, just launched a new service called ProSites Select! Now you can get more customization, better security, and cutting-edge features with your website. Learn what’s included here: https://go.prosites.com/webinar-introducing-prosites-select.html www.okda.org
11
OK MISSION OF MERCY FAQS In about six months, the Oklahoma Dental Association and the Oklahoma Dental Foundation, together with the Delta Dental of Oklahoma Foundation, will host the 11th annual Oklahoma Mission of Mercy (OkMOM) in Stillwater, OK. Drs. Daniel Wilguess and Chris Leslie are planning for the 2020 event along with the clinic leads. OkMOM 2020 will be a weekend dedicated to serving the uninsured and underinsured population in need of dental services. Online volunteer registration will open on October 15, 2019 at okmom.org. Please follow OkMOM on Facebook (@oklahomamissionofmercy) and Twitter (@OkDentalMission) for updates. If you plan to volunteer for OkMOM, here are the answers to some of our most commonly asked questions. Where and when is the clinic being held? Payne County Expo Center 4518 Expo Cir. E Stillwater, OK 74075 Clinic Set-up: Thursday, February 6, 2020 Treatment Days: February 7 & 8, 2020 Will there be designated parking for OkMOM volunteers? Yes, free parking will be available at the Payne County Expo Center. Will snacks/meals be provided? We will host a volunteer hospitality room during the event with complimentary food and drinks. What can OkMOM patients expect? Patients will complete a health information form first. Then they will be assessed in medical and dental triage, then receive treatment based on their most urgent needs, with the goal of eliminating pain and infection. Treatments may include cleanings, fillings, extractions, anterior root canals and limited partial dentures. I really want to volunteer, but I am unable to commit to both clinic days. May I volunteer for a half day? Yes! There are several shift options available. You can volunteer anywhere from one half-day shift, to the whole weekend and clinic set-up. Can I earn Continuing Education credit at OkMOM? Yes. Dentists can earn hour by hour up to 10 hours. Hygienists can earn hour by hour up to 5 hours. I have a dental license from another state. Can I still participate?Yes. An out-of-state dentist or hygienist can apply for a temporary license to work at the event. Out-of-state dentists and hygienists need to complete a Special Volunteer License form and send it to the Oklahoma Board of Dentistry to receive their temporary license. This form can be found at www.okmom.org/ volunteers.
12 journal | July/August 2019
What should I bring to the event? • You can bring your own equipment to OkMOM; just be sure to clearly label it. However, since this is a MASH-style event where every chair is needed to be fully operational at all times, there is the possibility that another dentist could use the equipment temporarily while you are on a break. You are responsible for your equipment. • Otherwise, only bring necessities! We cannot store your items, so leave what you will not use during your volunteer hours in your car or at home. • Be sure to bring a smile and a good attitude! What should I wear to the event? All volunteers who register online are provided a t-shirt to wear while volunteering at the event. This helps identify who’s working and in which positions. Volunteers who register onsite are not guaranteed a t-shirt. Scrubs, sweatpants, jeans and casual (comfortable) closed-toe shoes are recommended. Can my assistant be assigned to me during the event?Simply make note of your preference on the volunteer registration form. We cannot guarantee volunteer placement, but we will do our best to accommodate your request. Your assistants must register individually. Dentists who are not paired with their own assistant will be provided an assistant. Are chairside stools provided for dentists and assistants?One chairside stool will be provided for each dental chair. It is intended for the dentists to use during treatment. Assistants who want a chairside stool should bring their own, clearly labeled with their name. Can dental students or hygiene students treat patients? OkMOM is a great learning opportunity, and we encourage students to volunteer in multiple types of shifts. However, only fourth-year dental students are allowed to volunteer in a dentist role, under supervision by a licensed dentist.
Other than dental professionals, will you need additional volunteers? Of course! There are many areas where we need help, such as... -Patient Hospitality -Food Service -Waste Management -X-ray Technicians -Dental Equipment Maintenance -Lab Technicians -EMTs -Patient Runners
-Patient Exit Interviewers -Patient Registrars -Pharmacists/Pharmacy Techs -Translators
Can I bring volunteers who are minors? To ensure everyone’s safety, volunteers must be at least 18 years old. However, 16 and 17 year-olds may volunteer with permission from a parent or guardian. The permission form can be found at www.okmom.org/volunteers. What should I tell individuals interested in obtaining care at OkMOM? Patients will be seen on a first-come, first-served basis. Cleanings, fillings, extractions and very limited replacement teeth will be offered. Because of the expected volume, it is likely we will have to turn people away, so those who want to receive treatment are encouraged to take advantage of our overnight waiting option. Patients who are in pain often have an accompanying infection. OkMOM does not want anyone to wait until the event to seek critical dental or medical attention, as a delay could lead to more serious consequences. And, while the hope is to be able to treat close to 2,000 patients, there’s still a risk volunteers won’t be able to see everyone waiting in line for care. Every attempt will be made to care for those who are present. If I can’t volunteer at the event, is there another way I can help OkMOM? Absolutely! A project of this size requires a substantial budget to cover clinic expenses (equipment and facility rentals, supplies, pharmaceuticals, food costs, etc.). Consider donating money or in-kind products or services. Your contribution will make a difference! Monetary donations may be made at www.okmom.org/donate. In-kind products and services may be made by contacting Abby Sholar at asholar@okda.org.
OKLAHOMA MISSION OF MERCY STILLWATER
FEBRUARY 7 & 8 PAYNE COUNTY EXPO CENTER VOLUNTEER REGISTRATION OPENS OCT. 15
Y
OKLAHOMA MISSION OF MERCY
X
OKDENTALMISSION
a
OKMOM.ORG OKDENTALMISSION www.okda.org
13
ODA MARKETING COACH
Managing Finances | Expenses
Marketing
A good rule of thumb when budgeting for marketing expenses is to allow 3-6% of a new practice’s expenses; 2-3% for mature practices; and about 4% for practices that are in the middle. A start-up practice should plan to spend about $40,000 on marketing during the first year, with those costs incorporated into the overall practice financing. While it may seem like a lot of money, having a solid marketing plan is essential to building a successful practice. As the practice grows, the percentage of expenses dedicated to marketing will drop since more patients will join the practice because of the good reviews they’ve heard from current patients. While newer, smaller practices may want to invest more funds in marketing than established or more mature practices, remember that marketing is essential to future growth at all stages. There are four types of marketing: internal, external, customer service and online. Each type has its own risks and rewards and the options and consumer preferences are always evolving.
Marketing should be considered an essential expense, especially in light of the recent downward trend in consumer spending for dental services. Like many other fields, marketing has become specialized and certain types of marketing work better with certain patient populations. Knowledgeable people in the field advise that you not try to save money by doing it yourself but that you hire a marketing professional who’s familiar with dentistry and knows how it differs from other professions, including medicine. Contact other dentists you know for referrals. Research and interview prospective marketing companies and request samples of their work. Check websites and contact current clients for recommendations. Ask for detailed bids and compare what they can offer and the costs. Once you’ve selected a marketing consultant, you and that professional should work together on a diversified marketing plan that includes each type of marketing. The plan should include testing, making any necessary changes and then testing again. Establish an overall campaign schedule and include dates by which the
consultant should provide analytics that recap the success for each element of the plan. How your practice is promoted is ultimately your responsibility so make certain that you’re involved every step of the way. Dentists who are new to practice, or new to a location should have at least a basic website that introduces the practice and the members of the team to prospective patients. It should also describe the services available, the days and times you’re open, etc. Make sure the overall tone and all images reflect professionalism, quality, customized care, and cleanliness. Other features to consider adding include videos, fact sheets, patient testimonials, etc. Keep in mind that your most effective internal marketing tool is actually your own team. Analyze internal and social media marketing - how your team markets your practice to existing patients, vendors and other contacts - before you start spending on external marketing. Train your team in easy, and natural, ways to promote the practice in almost every patient interaction. The ADA Practical Guide to Internet Marketing and The ADA Practical Guide to Expert Business Strategies provide a number of strategies for boosting your team’s marketing know-how. Both publications also provide suggestions on points to consider when making decisions on marketing. One of the best ways to build a practice is to let current patients know that you appreciate when they recommend you to friends and family looking for a new dentist. These internal referrals, usually called “word of mouth” advertising, are the best and most effective type of marketing. They’re also extremely cost effective. If you’re not comfortable having this discussion with patients, or prefer to delegate training your team in broaching
14 journal | July/August 2019
the topic, research webinars and other continuing education programs that can train your team. These conversations should not be optional and should be required for each team member. Have any of your colleagues had success building their practices through word of mouth advertising? If so, find out what resources or programs helped them achieve that success. Any investment in building your team’s skill set and comfort level in soliciting new business is worthwhile and, while internal marketing is important for any practice, it’s essential for newlypurchased or launched practices. Before launching any marketing campaign, have a team member responsible for learning how prospective and new patients and everyone/anyone on the team can gather this information, with one person being accountable. This data will serve as the baseline for measuring the effectiveness of your marketing program. Have staff continue to ask the question over a five-tosix-month period and compare responses to the initial information. Discuss any changes with your marketing consultant
and reallocate marketing support as needed. Be sure you have a realistic idea of how much new business you can support before finalizing your marketing plan. How you manage your patient base is critical to internal marketing; your efforts could backfire if you receive more patient referrals than you can handle. Schedule a regular review of your marketing plan and use that time to analyze how effective each aspect of your campaign is in attracting new patients. Also take a look at the value that different patients bring to the practice so you can gain an understanding of which types of patients respond to which forms of marketing. Customer satisfaction surveys are a valuable way to get feedback from current patients and can help get a better assessment of your patient base. Information and a sample patient satisfaction survey can be found in the “Managing Patients” module of the ADA’s Guidelines for Practice SuccessTM; see the section on Treatment Recommendations and the article titled "Patient Satisfaction Surveys".
While some general information about marketing the practice is covered here, more detailed information is available in the “Managing Marketing” module of the ADA’s Guidelines for Practice SuccessTM. Copyright © 2019 American Dental Association. All rights reserved. Reprinted by permission. For additional resources on how to grow your practice, visit the ADA’s Center for Professional Success at ada.org/success.
Future issues of the ODA Journal will include individual articles from this module, but you can see the module in its entirety at http://success.ada.org/en/ practice-management/marketing
www.okda.org
15
Let UPAL handle the heavy lifting of your 401(k) setup and administration.
Looking For A Rock-Solid Retirement Planning Partner? For more than 30 years, UPAL has been helping physicians take a load off of their retirement and financial planning demands. Specializing in 401(k) administration and planning for the healthcare industry, UPAL offers several flexible management choices for our private practice clients. From a custom 401(k) plan design, easy set-up,and administration, to a self-directed option — leveraging the stocks, bonds, and mutual funds of your choice – UPAL offers our dental practice clients a pain-free solution to retirement planning.
16
Take the first step toward a robust financial at2019 UPAL.com/dental journalfuture | July/August
OKLAHOMA STRONG M E D PRO G RO U P O F F E RS TH E S TRO N G ES T D E NTAL
MALPR AC TI CE INS U R AN CE COVE R AG E I N TH E S TATE O F O KL AH O MA .
400K + MAL P R ACT I CE CASES H AN DL ED N AT I O N AL L Y
A ++ A . M . B E ST FI NA NC I A L ST R E NG T H R AT I NG
9 5 % D E NTA L T R I A L W I N R AT E NAT I O NA LLY
A B ER K SH I R E HAT HAWAY CO MPAN Y
1 1 9 + YE A R S O F SE RV I C E AC R O SS P H YSI C I A N A ND D E NTA L LI NE S O F B U SI NE SS
8 0 % O F NAT I O NA L D E NTA L C L A I M S C LO SE D W I T H O U T PAYM E NT
Why MedPro? • Dental Advisory Board: National dental leaders influence every area of our business. • Pure Consent to Settle: At MedPro no case will ever be settled without your approval. • Policy Options: Coverage types include Occurrence, Claims-made, and Convert to Occurrence® coverage options. • Value: Risk management discounts available. • Strength: The #1 dental malpractice insurance carrier.
Take advantage of our unique coverage options and competitive pricing today. 405.521.1600
INFO@3000IG.COM
MEDPRO.COM
A.M. Best rating as of 7/11/2018. Total number of malpractice claims managed — MedPro Group internal data. All other claims data — internal data (2012-2016). MedPro Group is the marketing name used to refer to the insurance operations of The Medical Protective Company, Princeton Insurance Company, PLICO, Inc. and MedPro RRG Risk Retention Group. All insurance products are administered by MedPro Group and underwritten by these and other Berkshire Hathaway affiliates, including National Fire & Marine Insurance Company. Product availability is based upon business and regulatory approval and may differ among companies. Visit medpro.com/affiliates for more information. ©2019 MedPro Group Inc. All Rights Reserved.
www.okda.org
17
LEGISLATIVE LOOP Legislative Overview & Political Update
2019 Legislative Session Summary One For the Books! Senate Bill 948, the ODA’s pre-authorization bill by Senator Dave Rader and Representative Ryan Martinez, was signed into law and will go into effect November 1. It requires insurance companies to stand by their prior authorization and confirmation of coverage determination. House Bill 1157, the ODA’s Virtual Credit Card Notifications bill by Representative Rande Worthen and Senator John Michael Montgomery, requires insurance companies to notify providers if any fees are associated with a particular payment method and to provide clear instructions as to how to select an alternate payment method. This new law, also effective November 1, will save dental practices 2.5%-5% in credit card
fee charges that were being incurred from these types of reimbursement payments. The ODA received an ADA State Public Affairs (SPA) grant that afforded the ODA the opportunity to contract with an additional lobbyist directed to focus efforts on our two third-party payer bills for the four months of session. Additionally, the ODA hosted Dentist Day at the Capitol in February, which provided a great opportunity to have one-on-one conversations with state lawmakers about these issues. These efforts, coupled with the tremendous number of phone calls and emails our lawmakers received whenever the ODA sent out a Legislative Alert, helped push these bills through to the Governor’s desk.
Yes, this year’s Oklahoma Legislative session was definitely one for the books! One that showed how Oklahoma dentists can come together to make changes that impact their practices, their patients and the dental profession!
Visit the ODA YouTube channel to watch the recap video from this year's session! www.youtube.com/TheOKDentAssoc
SAVE THE DATE
27 WINE SEPT.
TASTING AT THE HOME OF DR. KRISTA JONES & REV. CRAIG STINSON
EDMOND, OK
BENEFITING DENPAC
18 journal | July/August 2019
Why you should join denpac WHYpaying JOINyour DENPAC when dues DENPAC is the political action committee of your Oklahoma Dental Association. DENPAC works hard to make political contributions to dentistry-friendly, state-level legislators. $50 of your DENPAC dues also goes towards ADPAC to support national campaigns. Currently, 20% of the ODA membership funds 99% of the ODA’s legislative and advocacy efforts.
we don’t fundraise... we friendraise!
DENPAC is the political action committee of your Oklahoma Dental Association. DENPAC works hard to make political contributions to dentistry-friendly, statelevel legislators. $50 of your DENPAC dues also go toward Lynn Means at 800-876-8890 or lmeans@okda.org ADPACContact to support national campaigns. Currently, 20% of to join the DENPAC team TODAY! the ODA membership funds 99% of the ODA’s legislative and advocacy efforts. Most of us don’t want a free ride; that’s just not our way. We all know it’s a political world and if our 20% should quit, who will carry the weight?
HOW TO JOIN DENPAC
K
CAPITOL CLUB Dr. Jeffrey Ahlert Dr. Errol Allison Dr. Jim Ambrose Dr. Glenn Ashmore Dr. Douglas Auld Dr. Michael Auld Dr. Tamara Berg Dr. Ryan Brackett Dr. C. Todd Bridges Dr. Matthew Bridges Dr. Steven Brown Dr. Adam Bulleigh Dr. Patricia Cannon Dr. Wuse Cara Dr. John Carletti Dr. Bobby Carmen Dr. Mary Casey-Kelly
WE DON’T FUNDRAISE. WE FRIENDRAISE! THANK YOU TO THESE 2019 DENPAC CAPITOL CLUB MEMBERS!
Dr. Adam Cohlmia Dr. Matthew Cohlmia Dr. Raymond Cohlmia Dr. Susan Davis Dr. Ana Dotson Dr. Brian Drew Dr. Heath Evans Dr. Chris Fagan Dr. Tim Fagan Dr. Barry Farmer Dr. Chad Garrison Dr. Clark Grilliot Dr. Shannon Griffin Dr. Mark Hanstein Dr. Leslie Hardy Dr. Aaron Harman
Dr. Edward Harroz Dr. Richard Haught Dr. Robert Herman Dr. Jeffrey Hermen Dr. Randi Hobbs Dr. James Hooper Dr. Brad Hoopes Dr. Moiz Horani Dr. Donald Johnson Dr. Katherine Johnson Dr. Krista Jones Dr. Michael Kirk Dr. Mitchell Kramer Dr. Larry Lavelett Dr. Robert Livingston Dr. Juan Lopez
Dr. Gary Lott Dr. Kevin Mailot Dr. David Marks Dr. Stephen Mayer Dr. Janna McIntosh Dr. Robert Miracle Dr. Mohsen Moosavi Dr. Robert Morford Dr. Paul Mullasseril Dr. Lisa Nowlin Dr. Sam Owens Dr. Justin Power Dr. Erin RobertsSvob Dr. Brant Rouse Dr. Miranda Ruleford Dr. Andrea Scoville
Dr. Gregory Segraves Dr. Gregory Shanbour Dr. Paul Shadid Dr. David Simon Dr. Lindsay Smith Dr. James Strand Dr. Jim Taylor Dr. James Torchia Dr. Jonah Vandiver Dr. Nathan Villines Dr. Robert Webb Dr. Daniel Wilguess Dr. Rieger Wood Dr. William Yadon
OKCapitol Club is for that “ABC” group of DENPAC members; or those who want to be “ABOVE AND BEYOND CONTRIBUTORS.” OKCapitol Club members truly understand the importance of the ODA’s participation in the political process and want to support candidates who are committed to the state’s oral health and the issues that affect your practice. OKCapitol Club members support those efforts even more by contributing an additional $300 to DENPAC ($470 total) per year. For more information about Capitol Club, contact Lynn Means at 800-876-8890 or lmeans@okda.org.
DENPAC Grand Level DENPAC funds our voice. Without our input, legislators are merely making decisions based on what sounds good, what makes the fewest people angry, or what is easiest for them. Whether you like it or not, the campaign contributions we make to dentistry-friendly candidates are what open those lines of communication. It’s what reminds legislators once they’re in office to go directly to the ODA for information, and not somewhere else. For more information about DENPAC, contact Lynn Means at 800-876-8890 or lmeans@okda.org.
THANK YOU TO THESE 2019 DENPAC GRAND ($1,000) LEVEL MEMBERS! Dr. Douglas Auld Dr. Matthew Cohlmia Dr. Susan Davis Dr. Shannon Griffin Dr. Mark Hanstein
Dr. Richard Haught Dr. Robert Herman Dr. Krista Jones Dr. Mitchell Kramer Dr. Juan Lopez
Dr. Paul Mullasseril Dr. Lindsay Smith Dr. James Torchia Dr. Daniel Wilguess Dr. Rieger Wood
www.okda.org
19
TOBACCO STOPS WITH ME MCCONNELL AND KAINE WANT TO RAISE THE FEDERAL SMOKING AGE TO 21
Senate Majority Leader Mitch McConnell (R-KY) and Sen. Tim Kaine (D-VA) recently introduced a bill to raise the federal minimum age to purchase tobacco from 18 to 21, a measure they say is aimed at reducing teen use of e-cigarettes. The move, from senators representing two tobacco-producing states, reflects growing concern that the popularity of e-cigarettes among teenagers threatens to reverse what had been decades of declining youth-smoking rates. “Today, we are coming together to side with young people’s health,” Kaine said in a statement. “With this bipartisan legislation, Senator McConnell and I are working to address one of the most significant public health issues facing our nation today.” McConnell said smoking should be part of a national debate about children’s health. “We’ve heard from countless parents who have seen the youth vaping crisis firsthand,” McConnell said in a statement. “Together, Senator Kaine and I are addressing this public health crisis head on. By making it more difficult for tobacco products to end up in the hands of middle school and high school students, we can protect our children and give them the opportunity to grow and develop into healthy adults.” McConnell’s backing means the bill, called the TobaccoFree Youth Act, is likely to get a vote on the floor, after vetting by the Senate Health, Education, Labor and Pensions Committee, of which Kaine is a member. Fourteen states and the District of Columbia have already raised the tobacco sale age to 21. The federal law would make it illegal to sell a tobacco product to any person under 21 years old in all states and would include military personnel, a category that is exempted in some states that have raised the legal age. Under the legislation, states that do not comply risk losing federal substance-abuse block grant funding, and a retailer that sells tobacco to anyone under 21 would be in violation of federal law. The CDC reports that the number of middle and high school students using e-cigarettes rose from 2.1 million in 2017 to 3.6 million in 2018. About 20 percent of high school students said last year that they had used electronic cigarettes in the past month, compared with 1.5 percent in 2011.
WALMART TO RAISE TOBACCO PURCHASE AGE TO 21
Walmart recently announced it will raise the minimum age to purchase tobacco products, including e-cigarettes, to 21 across its U.S. stores starting July 1. The retailer will also discontinue the sale of fruit-and dessert-flavored electronic nicotine delivery systems. In March, the U.S. Food and Drug Administration (FDA) had put 15 national retailers, including Walmart, Kroger, Walgreens Boots Alliance and Family Dollar Stores, on notice for allegedly selling tobacco products to minors. Walmart’s announcement was a response to the agency’s move. The retailer said the FDA had conducted approximately 12,800 compliance checks involving minors at Walmart stores and Sam’s Club locations around the country since 2010. Over that period, Walmart stores passed 93 percent and Sam’s Club cleared 99 percent of those checks. In 2018, Walmart stores cleared 94 percent of the 2,400 FDA checks and Sam’s Club passed 100 percent of its 15 checks. “While we have implemented a robust compliance program, we are not satisfied with falling short of our companywide goal of 100 percent compliance,” John Scudder, U.S. chief ethics and compliance 20 journal | July/August 2019
officer, said in a letter to the FDA. “Even a single sale to a minor is one too many.” In the letter, the world’s largest retailer assured the regulator that it will remain focused on improving its compliance rates and any sale-to-minor violation will be dealt with promptly.
ADA EFFORTS TOWARD TOBACCO-FREE YOUTH
The ADA praised lawmakers for introducing legislation that would help prevent tobacco use among youth by raising the national age to legally purchase tobacco products from 18 to 21 years of age. In a letter to Senate Majority Leader Mitch McConnell (R-KY) and Sen. Tim Kaine (D-VA), the ADA commended the lawmakers for introducing S. 1541, the Tobacco-Free Youth Act. This bill would help reduce the number of young people who begin smoking before age 21, which represents 95% of current adult smokers according to the 2014 National Survey on Drug Use and Health. In addition to supporting S. 1541, the ADA has also joined a coalition led by the Campaign for Tobacco-Free Kids supporting H.R. 2339, the Reversing the Youth Tobacco Epidemic Act of 2019. That legislation addresses the e-cigarette epidemic and calls for the Food and Drug Administration to implement the graphic health warnings for cigarette packages (including an oral cancer image) within 12 months. It also would raise the minimum age for purchasing non-traditional tobacco products such as e-cigarettes to 21 and prohibit non-face-to-face sales of all tobacco products, including e-cigarettes and e-cigarette accessories. The ODA is engaged in an ongoing partnership with TSET and supports these healthy initiatives. Learn more at stopswithme.com.
2020 Oklahoma Dental Association
Annual Meeting be interested Oklahoma City April 16 - 18
ADA Legislative News CMS Requiring all Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Providers to Obtain Surety Bond Surety Bonds will be required for dentists who are Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) suppliers enrolled using CMS Form 855S. There are only about 1,800 dentists currently enrolled as DMEPOS suppliers. • The Center for Medicare and Medicaid Services (CMS) is requiring all dentists who are DMEPOS suppliers to obtain a $50,000 surety bond per office location. • Letters from CMS will be mailed to all DMEPOS suppliers (including dentists) the week of June 10. The letter explains the reasoning CMS used to arrive at this requirement.
• Dentists who believe they are entitled to the exception may provide documentation to CMS that they are prescribing the DMEPOS items they are supplying to Medicare beneficiaries as part of their “physician service,” and subject to other Medicare requirements regarding prescribing and filling DMEPOS. However, it is important to note that: CMS has taken the position that the surety bond exception only extends to physicians who are both prescribing and filling the product in the course of their own “physician service.”
• All dentists enrolled in Medicare as DMEPOS suppliers will have to comply within 90 calendar days of receipt of notification from CMS. • The ADA has contacted CMS to voice our concerns and opposition to this requirement. However, CMS has not changed its decision.
Medicare will not reimburse a dentist for supplying an oral sleep apnea device to a Medicare beneficiary unless the requirements of Local Coverage Determination (LCD) 33611 are met.
• Please note that this will not affect most dentists. It will only affect dentists who have enrolled as DMEPOS suppliers. An oral sleep apnea appliance for Medicare beneficiaries is an example of a Medicare DMEPOS-covered device.
READ MORE ABOUT THIS AND OTHER ADA LEGISLATIVE INITIATIVES AT ADA.ORG/ADVOCACY.
LCD 33611 includes several criteria, including that the device is prescribed by a “physician.” CMS has taken the position that in this context the term physician does not include a dentist. An address to which all applicable documentation should be sent will be provided in the letter from CMS. The documentation would need to clearly indicate that the dentist is prescribing DMEPOS in accordance with Medicare coverage determinations. For questions concerning the CMS notice, you may contact the National Supplier Clearinghouse (NSC) at 803-735-1034 or the ADA Third Party Payer Concierge at 800-621-8099.
Meet the ODA Programs & Operations Manager Makenzie Dean Makenzie is an Oklahoma native who grew up in Oklahoma City. As the ODA Programs and Operations Manager, she will manage the ODA Rewards Partner Endorsement Program and the Mediation Review Program. She coordinates the annual Dentist Day at the Capitol event along with managing all of the building/grounds services contracts. Additionally, she will provide staff support to the Council on Governmental Affairs, DENPAC, and OkMOM, as well as manage the Exhibit Hall during the ODA Annual Meeting. Prior to joining the ODA team, Makenzie was a full-time student at the University of Oklahoma. While there she had the opportunity to serve as the Development Intern at the Christopher C. Gibbs College of Architecture at the University of Oklahoma and be the Account Lead for Lindsey + Asp. Where is your favorite place to eat in Oklahoma? Eischen’s Contact Makenzie Dean at mdean@okda.org or 405.848.8873
What would your ideal vacation look like? My dream is to spend two weeks in Europe traveling through Great Britain, France, Italy and Greece.
www.okda.org
21
ADA Medicaid Resolutions: Improving Provider and Patient Experiences By: Rhonda Switzer-Nadasdi, DMD and Chief Executive Officer of Interfaith Dental Clinic in Murfreesboro, TN and immediate-past volunteer on the ADA’s Council for Advocacy for Access and Prevention (CAAP) | Dr. Switzer-Nadasd shared her experience as a Medicaid provider in Tennessee with an emphasis on the four Medicaid resolutions approved by the last several ADA House of Delegates. This article appeared in a recent issue of the Tennessee Dental Association News. Reprinted with permission. I love it when I see our new ADA vision statement (“Empowering Dental Professionals to Achieve Optimal Health for All”) being embraced. One way the ADA accomplishes this is by encouraging dentists to participate in Medicaid. As an incentive, the ADA created a Medicaid Provider Reference Guide and Advocacy Toolkit, which serves to educate providers and encourages greater collaboration with state Medicaid agencies to continually improve their programs. Commonsense Medicaid reform must improve enrollee access and quality of care, reduce administrative burdens on dentists, and be cost-effective. If such reforms are successful, it will be a win/win for the patient, the state Medicaid agency, the
taxpayer, the managed care company, and the dental benefits manager, as well as for participating dentists. Often, this entails increasing provider reimbursement rates, but that is not always feasible based on political and fiscal climates within individual states. Incentivizing dentists to become Medicaid providers is not the only approach. Removing disincentives can be equally as valuable. To this end, the ADA’s Council on Advocacy for Access and Prevention’s (CAAP) Medicaid Provider Advisory Committee (MPAC) continues to seek ways to reduce the administrative burdens and perceived risks associated with provider participation in Medicaid and CHIP
Being a Medicaid provider in an era of accountability CE provided by the American Dental Association’s Medicaid Provider Advisory Committee Protecting your practice with efforts related to program integrity, compliance and understanding the importance of documenting medical necessity. This course is for dentist Medicaid providers only . Space is limited to the first 80 dentists to register.
OU college of dentistry
Room #104 1201 N Stonewall Ave Oklahoma City, OK 73117
August 16, 2019
3 ce hours
9:00 a.m. - 12:00 p.m.
Free to attend! Register by August 9 at okda.org/medicaid-ce
22 journal | July/August 2019
(Children’s Health Insurance Program). This article explores four ADA resolutions on Medicaid that do just this. It also provides practical examples of how and why these actions could be game-changers in states that implement these resolutions. The 2015 ADA House of Delegates passed two actions that laid a solid foundation for state Medicaid agencies to support strong dental Medicaid programs (Trans: 2015.275): 1) The American Dental Association encourages all state dental associations to work with their state Medicaid agencies in hiring a Chief Medicaid Dental Officer, who is a member of organized dentistry. 2) The American Dental Association encourages all state dental associations to actively participate in the establishment or continuation of an existing Medicaid dental advisory committee that is recognized by the state Medicaid agency as the professional body to provide recommendations on Medicaid dental issues. My home state of Tennessee is one of about a dozen Medicaid managed care states that have carved out their dental programs. This means that the state contracts directly with a dental benefits manager (DBM) for administering dental benefits versus contracting with a medical managed care company (MCC) that in turn subcontracts for dental services. Benefits of a dental carve-out include greater DBM accountability because of a dedicated dental budget and detailed dental contract provisions, such as scope of services, enrollee access, dental network adequacy, utilization management, utilization review, quality of care and oral disease prevention, program integrity, claims processing, adjudication and payment, enrollee outreach and education. There are also liquidated damages assessed to hold the DBM’s feet to the fire in instances where specific requirements have not been met. Tennessee has had a Medicaid chief dental officer (CDO), Dr. Jim Gillcrist, for almost 17 years. He is both the CDO and the
TennCare dental director, with direct oversight of all Medicaid and CHIP dental contracts. He understands dentistry, has treated patients, has a specialty degree in dental public health, and is an ADA member dentist. I have worked closely with Jim for many years and know him to be a dedicated public servant who understands how to improve the oral health of underserved populations through thoughtful collaboration with dentists and other health professionals. In addition, our state Medicaid agency felt it was important to hire an associate dental director, Dr. Crystal Manners, who is also an ADA member dentist. Tennessee is twice blessed to have these professionals at the helm to work closely with the DBM. A chief dental officer helps establish the overall vision for the Medicaid dental program, which is focused on moving from dental treatment to oral health prevention and value-based care. It is critical to have dedicated dental leadership at the Medicaid agency to hold the DBM accountable for contractual obligations. The chief dental officer can have heightened responsibilities, especially in those states with multiple medical and dental MCCs to ensure proper dental oversight and coordination across multiple stakeholders. Tennessee was one of the first states to establish a Medicaid Dental Advisory Committee, which serves as a forum for participating dental providers to bring forth concerns through their representatives to the committee as a whole. It allows for brainstorming, problem solving, the sharing of ideas, enhanced communication, state updates, and professional input for improving enrollee utilization and quality of care. Although the committee recommendations are not binding on the state, the vast majority of its recommendations over the past 17 years have been adopted, which has improved quality of care and cost efficiency. Committee member seats include representatives from multiple dental associations (e.g. Tennessee Dental Association and Pan Tenn-Dental Association), each of the major dental specialties, a member of the Tennessee Dental Hygienist’s Association, dentists from all three grand divisions of the state, Colleges of Dentistry (University of Tennessee and Meharry Medical College),
the Tennessee Primary Care Association (representing federally qualified health centers), the state Department of Health, faith-based charitable dental care and the DBM. This advisory committee provides critical input and recommendations to increase the use of proven oral disease prevention modalities, medical necessity criteria and periodicity scheduling. Some states include a consumer representative. In Tennessee, this advisory committee is weighted more towards representing dental professionals, rather than member advocacy or politically oriented actions.
the vast majority of reviews concern dentists whose treatment practices deviate significantly from other in-network dentists performing similar procedures based on dental specialty, and where chart audits reveal suspected fraud or abuse. Close professional scrutiny by the dental peer review committee in such instances is a serious undertaking. Everything is conducted with the utmost professionalism. The information is strictly confidential; the committee is not informed of the names of the involved dentists or the area of the state where they practice.
The 2017 and 2018 ADA House of Delegates passed subsequent actions that encouraged fairness and equity within audits conducted via the state Medicaid agency itself or through a contracted entity (Res. 33H-2017 and 69H-2018)
The committee guides the DBM as to quality of care concerns, lack of compliance with the office reference manual policies, and/or medical necessity criteria. The committee reviews the findings presented at each meeting and delivers its consensus findings in writing. Such recommendations may necessitate review of additional enrollee case files from certain dental offices, site visits to certain offices, provider and staff education, recoupment of provider payments, or any combination of these actions.
3) The American Dental Association encourages all state dental associations to work with their respective state Medicaid agency to ensure that Medicaid dental audits are conducted by dentists who have similar educational backgrounds and credentials as the dentists being audited, as well as being licensed within the state in which the audit is being conducted. 4) The American Dental Association encourages all state dental associations to work with their respective state Medicaid agency to create a dental peer review committee, made up of licensed current Medicaid providers who provide expert consultation on issues brought to them by the state Medicaid agency and/or third party payers. In Tennessee, the Medicaid dental contract between the state and DBM requires, as part of its utilization review process, that the DBM have a dental provider peer review committee made up of licensed dentists in good standing with the Tennessee Board of Dentistry, who are well-versed in TennCare’s medical necessity rules and guidelines prior to reviewing cases. I serve on the DBM dental peer review committee along with other Tennessee general dentists, pediatric dentists, oral surgeons, orthodontists, and endodontists, all of whom are Medicaid providers themselves. Our DBM dental peer review committee reviews complaints arising from patients, dental staff or other providers; however,
In particularly egregious cases, the committee has even recommended the removal of a provider from the DBM’s network. Usually provider education is enough to modify a provider’s errant behavior and re-establish them as a beneficial member of the dental provider network. Findings and recommendations of the dental peer review committee are shared with TennCare’s Program Integrity Unit. Though these actions have helped many states improve the oral health of Medicaideligible individuals, there remains an ongoing challenge of recruiting enough dentists to provide the care that is needed and retaining those currently participating. It is important that participating dentists know that when questions about their practice arise, their unique circumstances will be reviewed and evaluated in a fair and equitable manner by their peers. A peer review committee made up of state licensed general dentists, pediatric dentists and other specialists would answer that need. I have served on both my state dental association’s peer review committee and our State Medicaid program peer CONTINUED ON NEXT PAGE
www.okda.org
23
review committee. They are distinctly different entities with each having an entirely different rationale and set of standards. The state dental association’s peer review committee mediates cases between patients and dentists, and tries to satisfy a dissatisfied customer. The DBM peer review committee on the other hand is designed to ensure that participating dentists are following the Medicaid rules, policies, and medical necessity criteria as laid out in the Medicaid reference manual, and to ensure that enrollees receive appropriate dental care. Dentists voluntarily agree to follow these when they sign their provider agreements to become Medicaid providers. Improving Medicaid should involve more than just dollar infusion. It necessitates collaboration among the key stakeholders: the state Medicaid agency, the relevant health plan and the state dental association. If dentists and other health professionals are truly committed to being leaders and advocates for oral health, they must make a concerted effort to work closely with
24 journal | July/August 2019
these stakeholders to implement practical measures that all state Medicaid dental programs could benefit from, such as those presented in these four ADA resolutions. Dr. Rhonda SwitzerNadasdi graduated from the dental program at the University of Manitoba in 1991. Since then, she has spent her career overseeing dental programs for the poor. She served as head of dentistry at a fly-in health center in the sub-arctic location of Churchill, Manitoba. She also worked as a staff dentist for the Department of Health in Hamilton, Bermuda, where she treated children of low-income families, people with mental disabilities, and people in nursing homes and prisons. Dr. Switzer-Nadasdi became the first employee of the Interfaith Dental Clinic in Nashville, Tennessee in 1995 and has served as the CEO. During her tenure, the clinic has grown from a two-chair operation located in a church basement to a ten-chair clinic with a staff of 35, providing more than $4 million in care each year.
ADA’s Medicaid Provider Advisory Committee (MPAC) continues to update the Medicaid Provider Reference Guide and Advocacy Tool Kit, which has a plethora of timely resources related to Medicaid. You can find it online at www. ada.org/en/public-programs/action-fordental-health/strengthening-the-dentalsafety-net/medicaid-provider-referenceguide
2019 University of Oklahoma College of Dentistry Retirees
The following individuals not only made a tremendous impact at the OUCOD through teaching, but invested time into their profession through organized dentistry at the Oklahoma Dental Association. The ODA is forever thankful for their time and commitment!
Johnny L. Siler, DDS
• Served as OUCOD faculty member from 1999 - May 2019 • Oklahoma Dental Association Member for 33 years • Adjunct Faculty for Hygiene Department and AEGD Program, Pre-Clinical Course Director of Fixed Prosthodontics, Associate Clinical Professor for Pre-Clinical Courses, Clinical Professor in Dept. of Prosthodontics, Pre-clinical Instructor in Removable Prosthodontics, Implantology and Occlusion courses • Served as Deputy Commander of the Tinker AFB Dental Clinic and founded and coordinated plan for senior hygiene students to treat patients at the military dental clinic at Tinker AFB, a program which still exists Plans for Retirement Partner with his youngest daughter to design and develop pieces of wearable art using stones and crystals from nature to create one-of-a-kind pieces of hand-crafted, high-quality jewelry in pendants, necklaces, earrings, and bracelets
Dunn Cumby, DDS, MPH • Served as OUCOD faculty member from 1999 - June 2019 • Oklahoma Dental Association Member for 24 years • Division head of Community Dentistry at OUCOD and Taught Introduction to Practice Management, Practice Management, Fundamentals of Dental Practice. Currently teaches Introduction to Ethics • First black man to graduate from OUCOD in 1976
Plans For Retirement Lay groundwork for new masters program at OUCOD, teach ethics and help at former practice 1 day a week
Joy Hasebe, DDS • Served as OUCOD faculty member from 2004 - July 2019 • Oklahoma Dental Association Member for 17 years • Taught Prosthodontics, specifically involved with Implantology-teaching students how to restore dental implants with fixed or removable prosthodontics and how to fabricate complete dentures and partial dentures
Plans for Retirement Going back to school to study art, specifically learning the art of jewelry making and metalsmithing
John Clayton, DDS • • • •
Served as OUCOD faculty member from 1999 - September 2019 Oklahoma Dental Association Member for 36 years Taught Orthodontics Graduated with the third OUCOD class (24 students) in 1978
Plans For Retirement Spending more time with my two grandchildren and more time golfing www.okda.org
25
The Difference Between Being Busy or Profitable: Hidden Costs
By: Craig Dreiling, Founder & CEO, Solutions-101 | Part 2 of a three-part series Something I had to learn quickly was the golden rule, and not the one we learned in kindergarten. When dealing with insurance companies it is vital to remember they have to operate on profit, just as your practice does. It is important for their companies to remain profitable for their salaries, bonuses, company cars, benefit packages, etc. as those are all items on their yearly spreadsheets. Business owners try to control these costs in their operating budgets. Calculating every penny in and every penny out can be a cumbersome task, so those little items here and there fall into the “cost of doing business” category and can often be overlooked. However, they can add up and become pretty overwhelming. So what does this mean to you? Why are we going from TPAs in the last article to
Solutions-101 has helped practices across the United States realize profitability in an ever-changing market environment. Their proven method has allowed them to expand to meet client needs, resulting in a dedicated team to ensure success. They have been referred to offices from multiple sources, allowing them to create networks that can continue to help offices once their services have been completed.
26 journal | July/August 2019
overhead? Simple. That expansion can have hidden expenses down the line. RECAP: In the last issue we talked about a network expansion that absorbed an existing patient base already in the practice. We ran through a scenario that outlined 100 patients being absorbed into a lower paying contract, which in turn reduced your profitability. The simplistic math of the example was just to give an outline, but the underlying truth has a much larger ripple effect. Not only are you seeing the same patient base at a reduced rate, you are faced with new business decisions. Let's say that your 100 existing patients were absorbed into a contract that has a 30% “write off.” (A “write off ” article is coming soon.) Essentially you see the same 100 patients but get paid for 70 of them. What happens if the network that absorbed those patients falls into a new overhead influencer? With all of the diligent work trying to understand the networks, alliances, and leases, now comes another variable, the Virtual Credit Card. I have seen an onslaught of insurance companies jumping on this trend, especially on the leased network side. This is probably the biggest and most overlooked “cost of doing business” category we see, so let’s break it down. First question, does it even matter? YES! Virtual credit cards are implicating your practice in a way most don’t even consider. It’s safe to assume that as a business in the 21st century you take credit/debit cards. Diligence in business and controlling overhead by staying current with your credit card processor can help alleviate some of the expense, but it truly is a cost of doing business. Depending on which virtual credit card you get paid under, we have seen processing fees as high as 8%. So here is where this ripple effect continues to make its way through your practice.
Back to the 100 patients that got absorbed into a 30% write off category. You already had those patients without the network expansion but now you are part of a leased network and are getting paid by a virtual credit card. Taking the average credit card processing fee of around 4%, that is an extra four patients that go into the “See For Free” category as they have now been absorbed into an operating expense. Why even take the virtual credit cards? There is some simplicity to keying in a number for the practice as well as the time factor of a quicker payment. As we’ve all heard throughout our careers, time is money. Is that time worth the money, though? In some cases yes, in some no. Fully evaluating all the factors producing or reducing revenue, even when it’s hidden a few layers down, can have a dramatic effect on the overall practice. I’ll leave you with this question: Who benefits from the processing fees of those virtual credit cards? TURN TO PAGE 18 FOR MORE DETAILS ABOUT VIRTUAL CREDIT CARDS. When Craig was completing courses and chairside hours in anticipation for attending dental school, he discovered the effects insurance can have on a practice. With that discovery, he also realized a need for something that can help practices stay ahead of the data and continue to focus on the more important aspect of dentistry, patient care. Passionate about helping, Craig and his team have been able to assist offices in recapturing revenue that was either unknown or thought to be lost. In his free time, Craig loves to spend time with his three kids and wife. Anything outdoors, or at the lake, is where you will find him relaxing and laughing with friends and family. Grateful for an amazing group of doctors to work with, Craig and Solutions-101 make sure that they provide a service that is beneficial for each case that they take on.
You Demand the Best for Your Patients. We Demand the Best for YOU. Quality/Products We hold ourselves to a higher degree of excellence in our products and our services.
Fine Craftmanship Our technicians go through continual training to be the best, giving you and your patients the esthetics you both expect and deserve.
If you haven’t tried us yet, why the delay?
Partnership We want to know you and your needs, then meet those beyond your expectations. We want to help you grow your business.
Sounds like we have the same goals: your success and your patients’ happiness!
Value-added We take pride in our high level of customer service and work hard to bring you educational programs, case planning, and resources for you and your patients.
Made in the USA We know others may claim it, sowe invite you to visit our lab to see exactly where your restorations are made.
Quality you can trust, from people who care.
SM
PROUD MEMBER OF
800-462-3569
www.EdmondsDentalProsthetics.com
© 2019 Edmonds Dental Prosthetics, Inc.
www.okda.org
27
ODA FEATURE
DIFFERENTIAL DIAGNOSIS OF THE UMBILICATED LESION By Glen D. Houston, DDS, MSD (gdhdds@heartlandpath.com) CASE HISTORY A 56-year-old male presents for an initial evaluation. During the oral examination, an umbilicated lesion involving the left nasolabial fold, medial canthus of the eye area is observed. The patient notes that the area is not painful, has been present for "a couple of weeks", and tends to "come and go". QUESTION #1 Your differential diagnosis based on the clinical presentation should include (multiple answers):
Basal cell carcinoma (c) is also observed on sun-damaged skin, particularly the upper face, including the lip. This neoplasm is found in males more often than females. Basal cell carcinoma usually presents as a crusted ulcer with an elevated, smooth, rolled border.
ANSWER #2 Consultation with a dermatologist or other related specialist (b) is necessary in order to determine optimal treatment and management of the patient. Biopsy of the lesion (c) is also essential in order to establish a definitive treatment format.
The traumatic ulcer (e) is usually observed as a shallow ulcer with a raised, rolled border as is noted in this current case. The non-healing ulcer is easily mistaken for squamous cell carcinoma which commonly occurs in the same areas and exhibits a similar clinical appearance.
Exfoliative cytology (a) and following the closely for 3 - 4 months without surgical intervention (d) would be of little or no benefit in the management of a non-healing ulcer that is indurated and exhibits a rolled border.
ANSWER #1 Your clinical differential diagnosis should include:
The intradermal (intramucosal) nevus (d) is one of the most common lesions that occurs on the skin. The nevus is usually an asymptomatic, pigmented, black-to-brown, slightly elevated papule or flat macule. Based upon the clinical appearance in this case, it is not considered in the present clinical differential diagnosis.
QUESTION #3 An incisional biopsy is performed and the following microscopic features are noted: an ulcerated lesion with a central crater exhibiting a raised, rolled border; islands of cytologically bland epithelium invading the underlying dermis; and peripheral cells of these islands exhibiting polarized, palisaded nuclei. The correct diagnosis is:
a. Squamous cell carcinoma b. Keratoacanthoma c. Basal cell carcinoma e. Traumatic ulcer
QUESTION #2 Based on this differential diagnosis, the following should be accomplished (multiple answers):
a. Basal cell carcinoma b. Keratoacanthoma c. Trichofolliculoma d. Squamous cell carcinoma
Squamous cell carcinoma (a) arising on actinically damaged skin is usually observed in males in the fifth to eighth decades of life. Most lesions occur on the upper lip following a prolonged period of sun exposure. Squamous cell carcinoma begins as a recurring ulceration with encrustation. Eventually, this non-healing ulcer develops a rolled border that is indurated.
a. Exfoliative cytology b. Consultation with Dermatology (or other related specialty) c. Biopsy d. No surgical intervention; follow closely for 3-4 months
ANSWER #3 The correct answer is (a) basal cell carcinoma. (See "Discussion" section.) Choices (b), (c), and (d) are incorrect.
a. Squamous cell carcinoma b. Keratoacanthoma c. Basal cell carcinoma d. Intradermal nevus e. Traumatic ulcer
The keratoacanthoma (b) also occurs on sun-damaged skin, especially the face and lower lip. This benign lesion has a domeshaped pimple-like clinical appearance, rapid growth, and microscopic features that are similar to squamous cell carcinoma. However, this lesion usually undergoes spontaneous regression without any type of treatment.
28 journal | July/August 2019
The keratoacanthoma (b) resembles a welldifferentiated squamous cell carcinoma. However, because of a central keratin plug which is surrounded by a "buttress" of normal surface epithelium, cells with minimal nuclear pleomorphism, infrequent mitotic figures, and an absence of atypical mitotic figures, the keratoacanthoma can usually be distinguished from squamous cell carcinoma. The trichofolliculoma (c) is a benign adnexal tumor that microscopically exhibits a keratin-filled cyst (primary hair follicle). Numerous "secondary" hair follicles are also noted. These histologic features are not observed in the present case. Squamous cell carcinoma (d) reveals numerous sheets and islands of neoplastic squamous cells that arise from the surface stratified squamous epithelium and invade into the underlying fibrous connective tissue. Again, these histologic features are not observed in the present case. DISCUSSION Basal cell carcinoma was originally reported in the literature by Krompecher in 1903. This malignant skin tumor develops most frequently on sun-exposed
surfaces of the skin. Over 90% of all cases are encountered on the upper face and forehead. It has an extremely low potential for metastasis; for this reason, it has often been called a "benign" carcinoma. Cotran, in his series of over 9,000 cases of basal cell carcinoma of the skin, found the incidence of metastasis to be approximately 0.1 percent. If not treated, however, the neoplasm may kill the patient by direct invasion. People with a fair complexion who have spent much of their lives out of doors are often the victims of this lesion. Basal cell carcinoma occurs in middle-aged and elderly adults with a definite male predilection. It may be solitary or multiple and typically begins as a small, slightly elevated area which ulcerates, heals, and then recurs. The tumor slowly enlarges with repeated episodes of attempted healing. Eventually, a "crusty" ulcer, which appears superficial, develops a smooth, rolled, raised, indurated border (umbilication) representing tumor spreading laterally beneath the skin. Untreated, the lesion will continue to enlarge, infiltrate adjacent and deeper tissues, and may eventually erode or invade deeply into the underlying cartilage or bone.
Microscopically, a variety of histologic types of basal cell carcinoma are recognized, but in general the disease is characterized by nests of cells "dropping off " from the overlying basal cell layer of the surface epithelium. The periphery of the cell nests is composed of a layer of cells which exhibit polarized, palisaded nuclei. Each lesion must be considered separately when contemplating the choice of therapy. Complete surgical removal, cryotherapy, electrocautery, radiotherapy, and chemosurgery (Mohs technique) with area-by-area frozen section control have all yielded successful results. In general, the prognosis of basal cell carcinoma is good since it grows slowly, does not tend to metastasize, and responds well to treatment. REFERENCES Epstein EH. Basal cell carcinoma: attack of the hedgehog. Nat Rev Cancer. 8:743-754, 2008. Firnhaber JM. Diagnosis and treatment of basal cell carcinoma and squamous cell carcinoma. Am Fam Physician. 86:161-168, 2012. Kwasniak LA and Garcia-Zuazaga J. Basal cell carcinoma: evidence-based medicine and review of treatment modalities. Int J Dermatol. 50:645-658, 2011.
www.okda.org
29
Opioid Prescribing Patterns Among Oklahoma Dentists: A Survey By Amanda Akkari 2019 Ishmael Award Winner As the current opioid crisis intensifies, it is even more crucial that we take a closer look at the effects of opioid prescribing patterns and how they are contributing to this epidemic. Dental practitioners in particular are responsible for prescribing 12% of all immediate-release opioids; the most commonly misused of prescription opioids.1 Additionally, approximately one third of opioid prescriptions written by dentists are associated with nonsurgical dental visits.2 According to one study, each year more than one million opioid pills prescribed by dentists remain unused following third-molar extractions.3 Dental professionals hence play a big role in the opioid epidemic; their prescribing practices can be modified to alleviate some of the associated burdens. The National Academy of Medicine recommends that dentists use the Prescription Monitoring Program (PMP), monitor patients and counsel them about risks and benefits.4 However, the PMP only lists the number of prescribed opioids by dental practitioners, not the types of procedures for which opioids are being prescribed. In March 2018, the American Dental Association announced its new policy on opioid prescribing practices5 that specifically supports limiting opioid prescribing and requiring continuing education for dental practitioners who regularly prescribe opioids. The purpose of this study was to investigate opioid prescribing patterns of Oklahoma practicing dentists as well as their knowledge of guidance for known addicts, neither of which has been previously investigated in Oklahoma. A questionnaire was sent to all currently active Oklahoma Dental Association members (as listed in the 2018-19 ODA member dentist directory) whichrequesteddata about clinical situations for which they would prescribe opioids, whether or not they provide guidance to their patients on opioid use and abuse, and the degree of correlation between prescribing habits and current ADA guidelines.
30 journal | July/August 2019
METHODS A questionnaire was developed for use in this study and sent via email to a total of 1076 dentists (excluding retired dentists). The invitation to participate in the study was extended twice over a two-month period. The analysis methods were as follows: categorical data were summarized as counts and percentages of each response. Continuous data were summarized using medians and interquartile ranges. Survey questions were divided into eight categories. The first pertained to practice information: year of graduation, type of practice (general or specialty), type of practice setting (urban, rural, etc.). The second category focused on pain management strategies, including what medications (opioid or otherwise) were prescribed for pain management and which procedures most often prompted the use of opioids. Another category covered opioid prescribing behavior, including the identification of patients during the last 12 months with a prescription drug abuse problem and any action(s) taken if opioid abuse or diversion was suspected. This led to a section on patient education and whether or not the risks of opioid addiction were discussed with patients. Another category inquired whether and how often Oklahoma’s Prescription Monitoring Program (PMP) was accessed, and if the information therein was helpful. Participants were also asked their viewpoints on whether continuing education on prescribing opioids should be mandatory, and if patients should be required to sign a consent form when prescribed pain medications. The last part of the survey inquired about participants’ level of education and training in pain management, prescribing controlled drugs, and identification of patient drug abuse and/or addiction.
RESULTS A total of 161 dentists (15% of those invited) completed the survey. Nonparticipants either did not access the survey (83%), refused to participate (0.6%), or provided an inactive email address (1.4%). Table 1 presents a description of participant characteristics, including gender, practice location and type, and length of practice. The majority of respondents were male, in general practice in urban locations, and in practice longer than 15 years. Eighty-two percent of participants prescribe opioids for pain management; 19.1% of those no longer prescribe them. Of those who currently prescribe opioids, 57.4% reported at least one adult patient with a prescription drug abuse problem, 8.5% reported an adolescent patient with the same problem, and the majority (90.1%) reported no such issue. Of those suspecting opioid abuse or diversion, the vast majority (95.4%) reported documenting the incident. Only 24.7% offered education materials, while (13%) contacted a family member and 5.3% created a drug contract/agreement with the patient. With suspected abuse/ diversion 60.4% provided a prescription without refills, while 97% prescribed non-opioid analgesics. On the frequency of explaining the risks of opioid addiction when first prescribing the medication, 23.5% of respondents answered “Never”, and 20.6% answered “Most of the time.” A significant number of participants (89.4%) have accessed Oklahoma’s Prescription Monitoring Program. Of those who have accessed it, 74.2% said they always do so prior to prescribing any opioid for pain management, 87.6% report always checking it prior to initial prescribing to “high-risk” patients, and 79.5% always do so prior to initial prescribing to new patients. Most dentists (73.6%) found PMP information to be very helpful. Table 2 presents the attitudes and behaviors of study participants regarding opioid prescription. Slightly more than half (55%) do not believe continuing education for prescribing opioids should be mandatory
to obtain their DEA license. The same percentage said that patients should not have to sign a consent form for prescription pain medication. A similar number (55.6%) do not think there are sufficient community or state resources available for dentists to treat addicts safely; 55.8% know of abuse counseling services in their area but only 7.2% felt very qualified to assess/screen for prescription drug abuse/addiction in their patients, with 42.4% feeling somewhat qualified. Most (84.5% and 83.6%) reported receiving instruction in pain management and prescribing controlled drugs, respectively; 48.3% indicating CE as the source of their training. The five procedures most often prompting opioid prescription included surgical tooth extraction (69.6%), emergency pain management (39.7%), simple tooth extraction (27.9%), impacted teeth removal (27.3%), and root canal therapy (24.8%). DISCUSSION Oftentimes in dentistry, pain management can be accomplished with the use of non-opioid analgesics. It has been well established that the best management of acute pain is through the use of NSAIDs.7-9 Many dental procedures are atraumatic
and don’t require prescription opioids for post-operative pain. However, results from this study suggest that a large majority of Oklahoma dentists currently prescribe opioids for pain management despite the ADA’s recent recommendation to use NSAIDs as a first-line treatment option for dental acute pain.7,10 A significant number of study participants have at some point accessed the state’s Prescription Monitoring Program. Previous studies6,10 have shown otherwise, even through the website offers invaluable information that could help ameliorate the clinical care provided to patients presenting with acute pain. Clinicians can identify patients with recently dispensed opioids, and more easily recognize those who are potentially diverting medications. It affords dentists the opportunity to better manage these patients and open discussions on how to best approach their acute pain. When confronted with a patient suspected of opioid abuse/diversion, over 95% of respondents said they would document the incident, but only 63% would counsel
TABLE 2 ATTITUDES AND BEHAVIORS REGARDING OPIOID PRESCRIPTION Do you prescribe opioids for pain management?
TABLE 1 PARTICIPANT CHARACTERISTICS Dental specialty
Practice setting
Gender
Years of practice
the patient on the dangers of opioids; this suggests that the dentist may find it difficult to approach the patient with such a sensitive subject. While 97% of dentists would prescribe a non-opioid analgesic as an alternative, an alarming 60.4% would provide a prescription for opioids without refills. This is especially startling if the patient is suspected of opioid abuse/ diversion; one would logically expect the provision of alternative pain management solutions. Further, the frequency of explaining the risks of opioid addiction ranged from 20.6% (“most of the time”) to 23.5 (“never”). Considering that many patients, especially adolescents, are opioidnaïve, it would be especially necessary to discuss those risks. It would also be prudent to make sure that patients are made aware of the possibility that their unused medications could be diverted or misused, and that dentists are discussing proper and appropriate ways to dispose of unused opioids prior to dispensing. This is something that almost half of dentists never do. CONTINUED ON NEXT PAGE
General Practice
119 (75.8%)
Pediatric dentistry
12 (7.6%)
Endodontics
3 (1.9%)
Oral/Maxillofacial surgery
10 (6.4%)
Periodontics
5 (3.2%)
Orthodontics
7 (4.5%)
Other
1 (0.6%)
Urban area
59 (37.6%)
Suburban area
36 (22.9%)
Small town
37 (23.6%)
Rural area
21 (13.4%)
Other
4 (2.5%)
Male
92 (66.7%)
Female
46 (33.3%)
Less than 5 years
15 (10.8%)
5-10 years
31 (22.3%)
11-15 years
21 (15.1%)
15+ years
72 (51.8%)
How often do you explain the risks of addiction associated with taking opioids when you first prescribe the medication?
Yes
114 (82.0%)
No
25 (18.0%)
Always
29 (21.3%)
Most of the time
28 (20.6%)
Sometimes
27 (19.9%)
Few of the times
20 (14.7%)
Never
32 (23.5%)
Do you think continuing education courses for prescribing opioids should be required to obtain your DEA license? Yes No Do you think patients should have to sign a consent form for prescription pain medication? Yes
63 (45.0%) 77 (55.0%)
63 (45.0%)
No
77 (55.0%)
Yes
59 (44.4%)
No
74 (55.6%)
Yes
77 (55.8%)
No
61 (44.2%)
Very qualified
10 (7.2%)
Qualified
29 (20.9%)
Somewhat qualified
59 (42.4%)
Not very qualified
35 (25.2%)
Not at all qualified
6 (4.3%)
Do you think state or community resources are available for dentists to treat addicts safely?
Do you know of any abuse counseling services in your area?
How qualified do you feel to assess/screen for prescription drug abuse/addiction in your patients?
www.okda.org
31
Only 49.6% of respondents felt very qualified or somewhat qualified to assess or screen for prescription drug abuse/ addiction among patients. Considering that over half of the respondents have been in practice for 15+ years, it is somewhat disconcerting that such a large number of practitioners do not feel confident in screening for high-risk patients. Since 63.3% of respondents reported that their training on identifying and assessing for drug abuse was through CE courses, this begs the question of whether mandatory CE needs to be implemented in order to better educate the practitioner, despite the relatively high numbers that disagree with mandatory CE courses or requiring patients to sign a consent form for prescription medication. Evidence has shown that implementing mandatory policies significantly affects the prescription pattern of dentists, leading to lower rates of opioid prescriptions and a higher percentage of practitioners using the PMP website.10 This study did not explore whether dentists are prescribing opioids post-operatively out of habit or because of a lack of education on alternative pain management options. However, it is clear that to decrease the percentage of dentists prescribing opioids, more extensive education must be implemented in dental school, residency programs, and/or CE. The main limitation of this study was the small sample size. More participants and a more diverse pool (females, younger dentists, etc.) would capture a more accurate representation of the dental profession and provide a better perspective on the issue at hand. Current ADA guidelines are aimed specifically at minimizing opioid prescribing patterns. Oklahoma dentists are following those guidelines by checking the PMP website. However, the rate of opioid prescription is still high. It may take some time for more dentists to start shifting towards using non-opioid analgesics to manage acute pain. Continuing education aimed specifically for the dental professional could be very beneficial in teaching ways to recognize a drug-seeking patient and how to confront known addicts, as well as learning the proper ways to dispose of opioids in order to better educate patients. Additionally, more state and community resources are needed to help dentists treat addicts safely. 32 journal | July/August 2019
Amanda Akkari is a 4th-year dental student at the University of Oklahoma College of Dentistry. Originally from Austin, TX, she received her Bachelor’s degree from the University of Texas at Austin. Amanda served as the 2018-19 president of the National Student Research Group and is the recipient of the Donald L. Mitchell Excellence in Prosthodontics award. This article is based on her Don M. Ishmael Essay Contest submission “Opioid prescribing patterns among Oklahoma dentists: A survey,” which was awarded second-place honors during the OUCOD’s 2019 Scientific Day.
4. First, Do No Harm: Marshaling Clinician Leadership to Counter the Opioid Epidemic. Nat'l Acad Med, Washington, DC., 2017.
REFERENCES 1. Lutfiyya, MN, et al. A scoping review exploring the opioid prescribing practices of US dental professionals. J Am Dent Assoc 149(12):1011-1023, 2018.
9. Becker, DE. Pain management: Part 1: Managing acute and postoperative dental pain. Anesth Prog. 57(2):67-79, 2010.
2. Gupta, N, Vujicic, M and Blatz, A. Opioid prescribing practices from 2010 through 2015 among dentists in the United States: What do claims data tell us? J Am Dent Assoc 149(4):237-245, 2018. 3. Maughan, BC, et al. Unused opioid analgesics and drug disposal following outpatient dental surgery: a randomized controlled trial. Drug Alcohol Depend 168:328-334, 2016.
5. American Dental Association announces new policy to combat opioid epidemic. Available from: https:// www.ada.org/en/press-room/news-releases/2018archives/march/american-dental-associationannounces-new-policy-to-combat-opioid-epidemic. 6. McCauley, JL, et al. Opioid prescribing and risk mitigation implementation in the management of acute pain: Results from The National Dental Practice-Based Research Network. J Am Dent Assoc 149(5):353-362, 2018. 7. Statement on the use of opioids in the treatment of dental pain. American Dental Association, 2017. 8. Hersh, EV, et al. Prescribing recommendations for the treatment of acute pain in dentistry. Compend Contin Educ Dent 32(3):22, 24-30; quiz 31-2, 2011.
10. Rasubala, L, et al. Impact of a mandatory prescription drug monitoring program on prescription of opioid analgesics by dentists. PLoS One. 10(8):e0135957, 2015. 11. McCauley, JL, et al. Dental opioid prescribing practices and risk mitigation strategy implementation: identification of potential targets for provider-level intervention. Subst Abus. 37(1):9-14, 2016.
2020 RESIDENCY IN
IMPLANT DENTISTRY Module I: January 17, 18, 19 Module II: March 6, 7, 8 Module III: April 3, 4, 5 Module IV: June 12, 13, 14 Module V: July 17, 18, 19 Learning Objectives • Basic understanding of anatomy and physiology as it relates to implant dentistry • Learn surgical and prosthetics principles as it relates to implant dentistry • Hands-on experience with surgical placement and restoration of implants on live patients • Diagnosis and treatment planning for the edentulous arch • Proper case selection for the beginner implant practitioner
Continuing Education Credit: 115 hours of CE credit (75 hours of lecture, 40 hours of hands-on participation) Tuition: $15,000 A $5,000 deposit will be required at registration. Monthly payment plans are available for the remainder of the tuition. A $1,000 discount will be given to recent graduates of the OU College of Dentistry. If you graduated in 2019, 2018, 2017, 2016, or 2015, please mention this to the Manager of Continuing Education, when you are establishing your payment plan. A $1,000 discount will also be given to new members of the Oklahoma Dental Association. For more information, please call Kylie Ethridge, Director of ODA Membership at (405) 848-8873. Once you have joined the ODA, ask them to send us a confirmation.
Register Today
bit.ly/ResidencyInImplantDentistry (Limited Enrollment)
For more information, please call the Office of Continuing Education at (405) 271-4050, or email Deanna-Foster@ouhsc.edu.
The University of Oklahoma College of Dentistry is a CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry. Concerns or complaints about a CE provider may be directed to the provider or to ADA CERP at www.ada.org/cerp.
A banking relationship to grow your dental practice. Commerce Bank can help lay the financial groundwork to meet the needs of your growing dental practice. Customized, small business banking, with big growth in mind.
commercebank.com/dental Š 2019 Commerce Bancshares, Inc.
www.okda.org
33
CLINICAL ACCURACY OF 3-D PRINTED CASTS COMPARED TO TRADITIONAL CASTS By Neeral Patel & Caytlin Eidson, 2019 Ishmael Award Winners MATERIALS & METHODS noted between the mandibular intraoral As in many areas of society, technology Ten subjects between the ages of 18 and crown width measurement and the same plays an increasingly important role in 50 and having Class I dentitions were parameter as measured on fabricated dental the practice of dentistry. Its use in the selected for evaluation. Using a digital casts (regardless of technique), but not with fabrication of master casts of dental arches caliper, intraoral measurements were maxillary crown width comparisons. is a case in point. One traditional method taken on each subject. These included of taking dental arch impressions for A larger sample size in any future study three measurements of first molars #3 fabrication of a master cast uses polyvinyl would more readily reveal minute and #30: mesiodistal crown length [A], siloxane (PVS), which has advantages of deviations. Further, more definitive resiliency and re-pour accuracy. While PVS cervical-occlusal crown height [B] and comparisons might be gained from a buccolingual crown width [C], and two is considered the gold standard for certain study standardized on one subject, using arch measurements: arch width [D] and dental impressions, its disadvantages him/her over a number of impressions arch perimeter [E]. (Table 1) For each include patient discomfort, dry field and re-scanning and re-printing their subject, PVS impressions of the maxillary requirements, polymerization time, casts repeatedly to better compare the and mandibular arches were taken using technique sensitivity, and additional lab reproducibility of stereolithographic and 1 Aquasil XLV in ultra-fast set, light and work needed for cast fabrication. Another traditional techniques. Other factors that medium body (Dentsply Caulk), and modality for recording dental arches on should be considered in future studies traditional casts were prepared using Silkya cast is use of a digital intraoral scanner include time and temperature variability, Rock Violet (Whipmix). Intraoral scans of to produce a stereolithographic cast; its the amount of saliva present during scans the dental arches were also taken and sent advantages include time efficiency and and impressions, and researcher accuracy .2 out for printing using Vida (EnvisionTEC) less materials cost Because no studies with intraoral and cast measurements. for the DLP technique and Form 2 (Form have been done on the various methods 3 labs) for SLA. The same five measurements Despite the limitations of this study, it of stereolithographic cast manufacturing (commonly known as 3-D printing), there taken intraorally were then applied to the does show that the variability between is little evidence to support the use of some casts obtained from all three methods. traditional and digital printing techniques digital technologies for printing casts of is negligible in terms of clinical accuracy. teeth. This study compared the dimensional Mean values of differences in A, B, D While the statistical differences were and E were not statistically different accuracy of stereolithographic casts and negligible, the relative advantages of among cast types or arches. The mean PVS-fabricated casts by evaluating both improved time efficiency and reduced values of differences in C (buccolingual techniques against measurements taken materials costs associated with digital crown width) were statistically higher for directly from the patient’s oral cavity. applications in dental cast production mandibular casts, but were not statistically Two different stereolithographic methods (as examined in this study) suggest that different among cast types. were evaluated: digital continued research into the benefits light-processed (DLP) and of digital dentistry deserves strong TABLE 1. MEASUREMENT SPECIFICATIONS stereolithographic laserconsideration. MEASUREMENT SPECIFICATIONS based apparatus (SLA). ABOUT THE AUTHORS DLP, the older of the two Teeth #3 & 30: from mesial anatomical contact point to A – Crown Length Neeral Patel is a third-year dental distal anatomical contact techniques, uses a digital light Teeth #3 & 30: from center portion of occlusal table to most student at The University of processor to cure one layer of B – Crown Height apical portion of mucogingival margin Oklahoma College of Dentistry. material at a time to build an Teeth #3 & 30: from facial height of contour to lingual height C – Crown Width Born and raised in Oklahoma of contour object. SLA uses a two-motor Maxillary: from mesiolingual cusp of tooth #3 to City, he attended Westmoore system (with X and Y axes) to mesiolingual cusp of tooth #14 D – Arch Width High School before attending The Mandibular: from mesiolingual cusp of tooth #19 to laser-cure resin at a specific mesiolingual cusp of tooth #30 University of Oklahoma, where location and build an object Maxillary: from distal of tooth #3 to distal of tooth #14 (at he earned his Bachelor of Science with incremental additions height of interdental papilla) E – Arch Perimeter Mandibular: from distal of tooth #19 to distal of tooth #30 (at in Biology. Prior to enrolling in of resin. Because the SLA height of interdental papilla) dental school, he worked for a year method has the ability to as a dental assistant in OUCOD’s cure individual resin points DISCUSSION Advanced Education in General Dentistry at a specific time and is not affected by Dental casts fabricated from traditional (AEGD) program. After graduation, he temperature, both of which are limitations PVS impressions or either of the additive plans to pursue an AEGD or GPR program of the DLP method and traditional stone stereolithographic printing methods before settling down and practicing in the casts, it is anticipated that SLA would be the demonstrated no statistical differences in Oklahoma City area. most accurate cast-fabrication technique. accuracy when compared with intraoral measurements. A statistical difference was
34 journal | July/August 2019
Caytlin Eidson is also a third-year student at the OU College of Dentistry. She was born and raised in Sapulpa, attended Cascia Hall High School in Tulsa, and is a graduate of Villanova University in Philadelphia, PA (Bachelor of Science in Biochemistry with a Minor in Mathematics). She worked as a dental assistant for two OUCOD graduates and conducted research in Chemistry for the University of Tulsa before enrolling at OUCOD. She plans to continue her education after graduation and eventually practice in Tulsa.
Patel and Eidson conducted this research project with the guidance of their OUCOD faculty advisors Dr. Sharukh Khajotia, Associate Dean for Research, and Dr. Phoebe Vaughan, Director of the Advanced Education in General Dentistry (AEGD) program.
REFERENCES 1. Chee WWL and Donovan TE. Polyvinyl Siloxane Impression Material: A review of properties and techniques. J Prosth Dent 68:728-732, 1992. 2. Ting-shu S and Jian S. Intraoral Digital Impression Technique: A Review. J Prosthodont 24:313-321, 2015. 3. SLA vs DLP: A 3D Printing Technology Comparison. Formlabs (Somerville,MA), published July 5, 2017. https://www.formlabs.com
Annually, the senior student body recognizes OUCOD teaching and staff services. Congratulations to the following: Outstanding Full-time Faculty Dr. Nanay Shadid
Outstanding Department Division of Comprehensive Care
Outstanding Staff Person Mr. Kevin Hoang
Congratulations to the 2019-20 OU ASDA Officers President Edith QuiĂąonez
Treasurer Amanda Tran
Publications Editor Hadley Finley
Vendor Coordinator Hannah Kraemer
President-Elect Jamie Watson
Secretary Brooke Korkames
Historian Kelsey Kramer
Vendor Coordinator Christian Contreras
Vice President Caytlin Eidson
Membership Coordinator Nick Keeling
Legislative Liaison John Corbett
Vice President- Elect Treyon Grant
Congratulations to the ASDA Award Winners High Noble Award Recipients Mary Temple-Goins Dylan Droege Tendai Dandajena Jacy Glover Berlian Jeffrey Cheryl Fleming Kate Littlefield Gabe Duffy Ashely Long
National Award of Excellence Will Seibold
Delta Dental Distinguished Leader Award Brittany Hand
Michael E. Lindley Award Lynna Van
American Student Dental Association
www.okda.org
35
New Dentist Corner
Mentorship: Paying It Forward By: Daulton Roberts, DMD, a 2016 graduate of the LECOM School of Dental Medicine in Bradenton, Florida. Since graduation he has been practicing general dentistry at TLC Dental in Enid, Oklahoma. In my short career in dentistry I have found that there are few things that can be as beneficial as mentorship. It is in my opinion an often greatly underrated aspect of dentistry. During my pre-dental days at the University of Central Oklahoma, I was fortunate enough to meet Dr. Randy White, who was then an instructor at the OU College of Dentistry. Through Dr. Jordon Smith (Breathe Modern Dentistry, Broken Arrow, Oklahoma) I met Dr. White in the OUCOD Mentorship Program. I was a senior Business Management major at UCO at the time, but I had decided the previous year to pursue a career in dentistry. From the first time I assisted Dr. White at his office in Norman, clumsily helping during a simple procedure, I knew this man would make an impact on my future dental career (although I could never have known then how significant that impact would be). Dr. White taught at OUCOD Monday through Thursday each week, and then “worked”
Friday mornings in his Norman practice. I say “worked” because I later realized that he probably rarely collected what was required to cover his overhead for the day, or whatever lab bills he may have incurred. He used this time to see his favorite patients and to let awkward, unsure, pre-dental students (up to 10 at times) assist him. All the while he would quiz us about materials he was using, or procedures we had observed the previous week. Unfortunately, I attended dental school out of state. I only received the benefit of learning from Dr. White through my frequent phone calls asking him to explain some portion of restorative materials, going with him to OU basketball games and concerts, or just meeting up for a burger and a beer. The man impressed upon me the importance of always doing your very best for the
Save the Date ODA New Dentist Seminar Ce chosen by new dentists, for new dentists!
Thursday, September 12 at 5:30 p.m. ODA Building, Oklahoma City
For more information visit okda.org/education
36 journal | July/August 2019
patient, accepting that you are human, and to always “know enough to know you don’t know enough”. He was quoted as saying, “The value of failure is vastly underrated. If you don’t have the opportunity to fail, then you go on thinking you’re something special. If you think you’re perfect all the time you can never learn anything.” Dr. White passed away on January 1, 2018 after a tough battle with cancer. It was a devastating loss to all who knew him, but especially to the Oklahoma dental community. The legacy he left will forever be improving dentistry for the better through all those students that he affected throughout his career. Without Dr. White and my many other mentors and heroes, I know I would not be where I am today. No matter how far along we are in our careers we all have the ability to help others who are where we once were. So I encourage us all to never underestimate the positive impact of taking a moment from our busy schedules to assist, encourage, or mentor someone from the future dental community. I applaud all those who take the time to share their knowledge with us young dentists, and I hope someday we may all be somebody’s Dr. White.
OKLAHOMA DENTAL ASSOCIATION
MENTORSHIP PROGRAM
GET INVOLVED NOW ACCEPTING APPLICATIONS! APPLY TO BE / A MENTOR AT OKDA.ORG/MENTORSHIP-FORM MENTORS SERVE AS TEACHERS, ROLE MODELS, ADVISORS, PROFESSIONAL PARTNERS AND MOST IMPORTANTLY, FRIENDS! WE MATCH YOU BASED ON YOUR LIKENESS, SPECIALTY AND LOCATION. THERE IS NO TIME REQUIREMENT TO BE IN THE PROGRAM. YOUR TIME IS, DETERMINED BY WHAT WORKS BEST FOR YOU AND YOUR MENTOR S SCHEDULE. www.okda.org
37
HYGIENE HOTSPOT
The Dental Hygienist's Relationship with Patients Influences Treatment Acceptance By: Shelly Von Short, RDH, MS, PhD At the end of the day do you reflect on the relationships you have built through your service and patient care? In any business, the relationship component is crucial and must be established before a product or service is offered to a client or patient. Once this relationship is in place, the benefits of a proposed product or service will be more readily accepted by the client/patient. Our dental patients have to understand how the treatment we offer will benefit them, and what the risks can be if they choose not to move forward with recommended treatment. It is critical that the dental hygienist answers the WHY for the patient! It is not enough to say, “This will be great for you….” The patient will rightfully want to know why the treatment you recommend will be good for them. Classic health promotion follows the Health Belief Model (HBM), a psychological health behavior change model developed to explain and predict health-related behaviors, particularly in regard to the uptake of health services. It is a guide for one’s readiness to move forward with recommended health care. First, the patient must understand and accept that they are susceptible to disease, and that disease can have a range of severity. Second, the patient must
You may be closer to achieving your financial goals than you think. Discover what many of your colleagues are already talking about.
Enjoy the retirement you deserve. Call today. Your local PARAGON dental transition consultant James Avdoyan
38 journal | July/August 2019
Hygienists often fall short in communicating the benefits of treatment to their patients. When this message is not delivered and clearly received, their ability to help the patient by providing services that would be in their best interests is limited. Building a healthy relationship and providing the “why” for treatment are the key ingredients to helping a patient move forward with dental care. How does one establish a healthy relationship with the patient? It is through the building of trust -- a process that may take some time to truly anchor. Because of the relative frequency of the care they provide, hygienists have a ready opportunity to foster trust and build relationships. The time spent in educating the patient and delivering care positions the hygienist as a great patient advocate with significant influence in guiding patients forward with dental treatment recommendations. Having healthy patient relationships is both meaningful and rewarding, knowing that the patient is taking action not only for improved oral health, but also for improving their overall health and well-being. Zum Wohl! (To your health!)
Your future. Your practice. Our trusted expertise.
866.898.1867 info@paragon.us.com paragon.us.com
be able to justify that the time and money invested in care will have a positive impact on their overall well-being. Without a clear understanding of the benefits of care, the patient will not accept the recommended course of action.
Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 4/1/2016 to 3/31/2020 Provider ID# 302387.
Shelly V. Short is the founder and owner of Zum! Group (www.zumgroup.us), a dental practice management consulting company started in Oklahoma in 2009. A 1985 graduate of the OU College of Dentistry’s dental hygiene program, Shelly has been active in the dental field for over 34 years, both as a practicing dental hygienist and, since 1996, as a practice management and clinical efficiency consultant for both general and specialty practices. In addition to her bachelor’s degree in dental hygiene, she has also earned a master’s degree in nutritional sciences and a correspondence Ph.D. degree in holistic nutrition. Shelly is a past-president of the American Dental Hygienists’ Organization of Switzerland, where she practiced clinical dental hygiene for six years. She is also a former faculty member in the OU College of Dentistry’s Department of Dental Hygiene. An accomplished speaker and writer, Shelly has consulted extensively throughout the United States and Europe. She currently works and lives in Oklahoma City.
ODA MEMBER SPOTLIGHT
What you didn't know about Dr. Susan Davis By Abby Sholar, ODA Special Projects Manager
Dr. Susan Davis has received countless accolades for her involvement in the Oklahoma Dental Association and for her commitment to charitable dentistry throughout Oklahoma. However, one honor that many do not know about is her involvement in the prestigious Medical Music Group (MMG) that travels the world! This award-winning organization is the world’s “premier integrated medical chorale and symphony orchestra.” Each member of the group is, or was prior to retiring, a health care professional. Among the ranks are dentists, physicians, nurses and volunteers from medical centers all over the country. This group is also open to family members of health care professionals and students studying in the medical field. MMG states that its mission is to perform “Music with a Message” that promotes “healing, hope, inspiration and patriotism.” In the past five years, this organization has had the opportunity to perform in South Africa, London, Costa Rica, Poland and in cities across the United States. Living in Laverne, OK, there are not many occasions where one can showcase their musical talents and passions alongside their peers. When asked why she chose to be a part of the Medical Musical Group, Dr. Davis simply said that she didn’t have much opportunity to play trombone and this group gave her the opportunity to play while supporting a mission that inspires
individuals around the world. Since joining, Dr. Davis has remained in the group because at its core, the group is all about honoring veterans. On Veterans Day in 2018, they performed a joint concert with Texas Medical Center Orchestra in Houston, “A Musical Salute to Veterans.” One of Dr. Davis’s favorite memories of traveling with MMG was getting to meet Darryl Haley of the New England Patriots. Haley is dedicated to serving veterans and their families and he was the narrator at the Veterans Day concert. Another favorite memory has been getting to perform with singer Deana Davis for multiple performances. If musically-inclined dentists are interested in joining this chorale and symphony orchestra, visit medicalmusical.com. This year, MMG will perform in Washington D.C. and Taiwan. To find videos of past concerts, look for the Medical Music Group channel on YouTube.
www.okda.org
39
Honoring Oklahoma Dental Association's
Year Members
Each year, the ODA honors dentists who have been members of the Association for a significant amount of time. Dentists who have maintained their membership for 25, 35 and 50 years are gifted pins to celebrate these milestones. The 50-year members are invited to attend the ODA House of Delegates meeting in April to be honored by their peers and receive their pin from the ODA President.
2019 Oklahoma Dental Association 50-Year Members Dr. Denton Anderson Dr. William Glasgow Dr. William Gray Dr. Richard Haught
Dr. Shannon Griffin with Dr. Richard Haught
Dr. Shannon Griffin with Dr. William Wynn, III
40 journal | July/August 2019
Dr. Robert Hughes Dr. Richard Powell Dr. Daniel Slanker Dr. William Wynn, III
Dr. Shannon Griffin with Dr. Daniel Slanker
Dr. Shannon Griffin with Dr. William Wynn, III and his son Dr. Bernie Wynn, IV
The following 50-year members are those who we were able to reach ers are those who we Journal were able to reach deadline. by the ODA publication on deadline.
How has organized dentistry shaped your dental career? Except for my Navy dental corps service, I had a solo practice until retirement. The ODA was a s organized dentistry shaped your dental career? great resource learning, networking, camaraderie and all things required to keep a dental for my Navy dental corps service, I had a solo practicefor until retirement. The ODA was a practice thriving. esource for learning, networking, camaraderie and all things required to keep a dental e thriving. What is your favorite part of dentistry? All aspects, but especially the friendships developed with patients and with staff. your favorite part of dentistry? ects, but especially the friendships developed with patients and with staff. What are some of the biggest differences in dentistry from when you began practicing to now? from when you began practicing to re some of the biggest differences in dentistry Expanded duties, improved materials and equipment, digital imaging, computer-generated restorations, and the listcomputer-generated goes on. ed duties, improved materials and equipment, digital imaging, ations, and the list goes on. What is your favorite memory, moment or accomplishment in your career? So many good in memories. Notable was the time I was away from the practice for two months your favorite memory, moment or accomplishment your career? recovering health-related Several Durant dentists organized to keep my ny good Dr. memories. Notable was the time I was awayfrom froma the practice forsetback. two months Denton Anderson practice going by seeing the patients already scheduled. They provided treatment and ring from a health-related setback. Several Durant dentists organized to keep my College Station, TX emergency care, and kept my staff working and the practice viable until I returned. It was an e going by seeing the patients already scheduled. They provided treatment and Baylor College of Dentistry, example of fellow dentists being friends and colleagues, not competitors. ency care, and of kept my staff working and the practice viable until I returned. It was an Class 1966 e of fellow dentists being friends and colleagues, not competitors.
What do you believe is the biggest membership value that your Oklahoma Dental Association membership has given you? Dental Association o you believe is the biggest membership value that your Oklahoma The people you get to meet and work with! It has been very beneficial for me to have met so ership has given you? many dentists in CE courses and ople you get to meet and work with! It has been very beneficial for me tomeetings. have metTo sorealize you are not alone in this profession is comforting. There is in always someone you entists in CE courses and meetings. Tovery realize you are not alone this profession is can call on for advice, and someone to help better in your omforting. There is always someone youdeliver can call on forcare advice, andpractice. someone to help better care in your practice. What do you see as the biggest challenge that today’s new dentists are facing? choices in establishing how they want to practice. Always seek advice from o you see as the biggest challenge that Making today’s the newright dentists are facing? yourwant colleagues and instructors, business the right choices in establishing how they to practice. Always seektake advice from courses and continue taking CE courses. olleagues and instructors, take business courses and continue taking CE courses. What is your favorite part of dentistry? Helping patients achieve/improve their oral health so they may improve their overall health. your favorite part of dentistry? g patients achieve/improve their oral health so they may improve their overall health. What is your favorite memory, moment or accomplishment in your career? Establishing a treatment plan, following through with that plan and then seeing the results, your favorite memory, moment or accomplishment in your career? Dr. Richard Haught knowing thatplan youand helped someone’s shing a treatment plan, following through with that thenimprove seeing the results, life. It was also very memorable being elected Tulsa, OK American Dental Association President. Knowing your peers have elected you for that g that you helped improve someone’s life. It was also very memorable being elected Baylor College of Dentistry, position is both an honor and humbling. can Dental Association President. Knowing your peers have elected you for that Class of 1967 n is both an honor and humbling.
How has organized dentistry shaped your dental career? Having mentors like Dr. Jim Saddoris and Dr. Bob Bartheld was extremely beneficial. s organized dentistry shaped your dental career? mentors like Dr. Jim Saddoris and Dr. Bob Bartheld was extremely beneficial. What are some of the biggest differences in dentistry from when you began practicing to now? from when you began practicing to re some of the biggest differences in dentistry Improvements in technology in so many phases of dentistry. ements in technology in so many phases of dentistry. What do you see as the biggest challenge that today’s new dentists face? dentists today are under great financial pressure just out of school. The burden of o you see as the biggest challenge that New today’s new dentists face? student loans is enormous. entists today are under great financial pressure just out of school. The burden of t loans is enormous. What is your favorite memory, moment or accomplishment in your career? Having both ofin my sons and my oldest daughter involved in dentistry has been so wonderful your favorite memory, moment or accomplishment your career? to involved see. My daughter, Sheila Todd,so is awonderful sales rep with Hu-Friedy in Edmond. My son, Dr. Bernie both of my sons and my oldest daughter in dentistry has been is a periodontist in Tulsa, andDr. myBernie son, Dr. Michael Wynn, is a general dentist in Tulsa. My daughter, Sheila Todd, is a sales repWynn, with Hu-Friedy in Edmond. My son, III Dr. Michael Wynn, is a general dentist in Tulsa. Dr. William Wynn, s a periodontist in Tulsa, and my son, McAlester, OK University of Tennessee College of Dentistry, Class of 1969 entistry, Class of 1969
www.okda.org
41
CLASSIFIEDS Looking to fill an open position in your office, need to sell dental equipment or a practice? Check out the latest listings below and visit okda.org/classifieds for additional listings. JOB OPENING GENERAL DENTIST NEEDED IN MUSKOGEE The Dental Care of Muskogee, a locally owned thriving private practice in Muskogee, has a full-time position available for a compassionate and caring Dentist. Competitive compensation and lots of patients to work on. New grads will be considered and mentorship is available as well. We do everything from simple restorative, ortho, to implant cases. We have Cone Beam CT on site as well as an intraoral scanner. Come join our happy family and our fun loving staff!! Please check out our website at www.muskogeedentist.com. Must be a team player that always has the patient's best interest at heart. If interested, please send resume to moizhorani@gmail.com or text/call me at (918) 280-8309. Pediatric Dentist Thriving private practice in Sallisaw is looking for a Pediatric Dentist starting a few days a month. This is a great need for this rural area and would help many children. If interested please contact 918-775-4431. TULSA MIDTOWN DENTAL ASSISTANT WANTED Dental Assistant Needed: Are you looking for a well established Midtown Tulsa dental office with good energy and low staff turnover to be your new work home? Would you like to work with an experienced dentist that is great with people and easy to get along with? If so, and you are experienced, hard working, friendly, dependable and organized, please email resume to KevinBurleson@cox.net or fax to 1-877-710-0167. THRIVING PRIVATE PRACTICE IN LAWTON/GREAT MENTORSHIP OPPORTUNITY My dad/partner will be retiring soon and I need your help! 2004 OUCOD graduate, 2008 Young Dentist of the Year, looking for an associate and/or space sharing partner. 4500 square feet, 11 operatory, newly remodeled practice, ready for move in! Please call or email me if you are interested in this once in a lifetime opportunity! Also, you can check out my website to see what we are all about. mylawtondentist.com Andrea Montgomery | 580.536.3313 | montgomerydentistry1@gmail.com HYGIENIST-STILLWATER, OK Hygienist wanted now– Stillwater, OK. Established two doctor practice. 1-2 days per week with strong potential for more days. Call (405) 624-3880 for more information.
Dentists Needed - Signing Bonus Available We are GROWING! We need Dentists in Muskogee and Collinsville! ********$20,000 SIGNING BONUS********** We offer career growth, modern office and equipment, huge patient base, a positive culture, and a trained team. Our office is very active and offers an excellent opportunity for you to provide all aspects of general and specialized dental care for your patients. Whether you are fresh out of school and need mentorship or a seasoned veteran looking for a change, we match you with practice opportunities that meet your long-term goals while providing you with support along the way. We offer relocation assistance, CE reimbursement, malpractice insurance, guaranteed salary, health insurance and a team of doctors and staff to help you reach your goals. If you want to know what sets us apart from other group practices, please feel free to contact me! Candice Davis, RDH cdavis@thespringdental. com or 405-365-1448
Pediatric Dentist Job Opening Pediatric Dentist Opportunity in the Oklahoma City and Tulsa area. Great career opportunity for a compassionate and energetic Pediatric Dentist who is interested in joining a dynamic team. Work with modern equipment, a huge patient base, and a friendly trained staff. Our office is very active and offers an excellent opportunity for an enthusiastic, self-starting production oriented individual who is dedicated to providing superior patient care. Benefits include: sign on bonus, relocation assistance, CE reimbursement, malpractice insurance, guaranteed daily minimum or production based compensation which is higher, health insurance, and a team of doctors and clinical/ adminstrative support staff to help you reach your goals. Please feel free to contact me with any questions: Candice Davis, RDH cdavis@thespringdental. com or 405-365-1448.
Place a Classified Ad SUBMIT A LISTING Submitting a classified ad is easy with our online form. Find the form and more information at okda.org/classifieds. 42 journal | July/August 2019
QUESTIONS? Email: advertising@okda.org Call: 800.876.8890.
PRICE ODA Members Online - Free ODA Journal - $40 for first 50 words
PRACTICES FOR SALE Small Town. BIG OPPORTUNITY! Elite Practice for Sale SE of OKC This stunning practice features hard working staff, loyal patients, and an incredible growth opportunity! This practice is so seamlessly ran and has impeccable procedures in place, you will be up and running from the start – what more can one ask for? Not only is this practice perfectly located on one of the busiest streets in town, it is also in a stand-alone building. Even more exciting, you can also buy the real estate if you are interested! Based on the fact this office offers such amazing visibility, it is easy for all new patients to find you in addition to fantastic organic marketing! Due to the highly loyal patient base, impeccable reputation and amazing staff, there is immense goodwill within the practice. Similarly, as a result of the perfect layout, well established procedures and diligent staff, you are guaranteed to make money from day one! To learn even more details about this wonderfully designed practice, please read more below: • 5 Fully Equipped (and certainly expansive) dental operatories • Expansion Opportunity by building expansion • More than 2200 Active Patients
• Nearly $550k in Collections
• Practice Valued at $369k • Furthermore, there is great growth opportunity with extended hours, offering more services in house and additional marketing efforts This opportunity certainly won’t be available for long. For that reason, we recommend you contact us soon! To learn even more about this undeniably incredible practice, please contact Kaile Vierstra with Professional Transition Strategies either by phone at 719.694.8320 or certainly by email at kaile@professionaltransition.com. PRACTICE FOR SALE • Motivated owner of established profitable dental practice in Tulsa, Ok area. • Stand alone, self-owned building with dental practice on bottom floor next to periodontist. • Highly visible: located on busiest street in fastest growing town in the state. • Centrally located in high acclaimed Broken Arrow school district. • Plumbed four exam rooms, 3 fully equipped rooms. • Fully equipped lab, private office, 2 bathrooms • Furnished waiting and break room
PRACTICE FOR SALE- SUBURB OF TULSA LISTING CODE: OKTJSPT18 Great practice currently collecting $442,826 on 4 days/ week, 1208 active patients with an average 20 new patients per month. Hygiene growth potential of $318,975, 5 ops equipped, 1 plumbed, digital x-ray and pano. For more information, contact Jaquay Enterprise at 833-238-4777 or email info@transition-advisors.com.
Call for more information 918-810-3011 PRACTICE FOR SALE -CUSTER COUNTY Practice Code: OKTJWU17 This is a great satellite office or merger opportunity! The office has 4 ops with lots of growth opportunity. Senior doctor is referring out endo, oral surgery, implants, most ortho and some perio. Active pt count of 1289 and averaging 17 new pts per month. As a merger opportunity you can expect a 56% return on your investment the first year and to make 36% on every dollar you produce AFTER paying your loan note. Why do a startup when you can start with a healthy patient base who need treatment now!?!? Call TODAY for more information 833-238-4777 or email Tabitha@transition-advisors.com Sm File mcdc full page ad2.pdf 1 4/10/2019 2:28:51 PM
S T. C H A R L E S C O N V E N T I O N C E N T E R
November 14-15
SOUTHERN OKLAHOMA GENERAL DENTAL PRACTICE FOR SALE
{ g r e a t e r s t l o u i s d e n t a l s o c i e t y. o r g }
If you are looking for the perfect practice, in the ideal location in Southern OK- look no further! Half way between major metropolitan areas of Oklahoma City and Dallas, TX- this practice boasts a small town feel with easy access to large cities. With a mixture of 'southern gentility and western informality' (per Dallas Morning News) this town features rapid business development and cutting edge research: UCSO, the Noble Foundation and the Industrial Airpark. Not to mention, only minutes away from the largest employer in Southern OK- the Michelin facility! This practice has GREAT goodwill through the upstanding reputation from the existing doctor, the longevity of the staff, and furthermore, the loyal patient base. Above all the location of the practice can’t be beat – it is located in an ideal spot in the city. If you're tired of dealing with rush hour, check out this practice- most commutes are less then 15 minutes! • 5 fully-equipped operatories
C
M
Y
G R E AT E R
S T.
LO U I S
D E N TA L
S O C I E T Y ’ S
7 8 T H
A N N UA L
CM
MY
CY
CMY
K
• Over 9000 Active Patients, with another 1100 in Recall • 22 Average New Patients a Month • Amazingly diverse patient base • Lots of specialty work outsourced • Collections over $665k • Net to Doctor after loan payment nearly $270k To learn more about this opportunity please contact Kaile Vierstra at: kaile@professionaltransition.com or 719-694-8320.
F E AT U R I N G Karen Baker, BS, MS | Beth Burns, DDS, RYT 200, CLC | Stephen J. Chu, DMD, MSD, CDT | Nancy Dewhirst, RDH, BS Brett E. Gilbert, DDS | Cathy Stewart, RDH, MS | Kevin Henry | Baron Grutter, DDS | Uche Odiatu, DMD | Wayne Kerr, DDS Hygiene CE Express | Parag R. Kachalia, DDS | Stanley F. Malamed, DDS | Judy Kay Mausolf Carrie Webber | Howard S. Glazer, DDS | Alex Touchstone, DDS & Crystal May Corky Willhite, DDS | Richard Williamson, BS, ACE, CPT | Shannon Brinker, CDA | Connie Fisher, LCSW Preventative Maintenance Workshop | Judy Bendit, RDH | David Meinz, MS, RDN
REGISTRATION OPENS THIS SUMMER
www.okda.org
REGISTRATION IS FREE FOR GSLDS MEMBERS & AFFILIATES (ADA dentists outside our boundaries)
43
Finally, Five (not so) FAQs! Dr. Matt Bridges Duncan, OK
1. If you were a Microsoft Office program, which one would you be? Excel 2. When was the last time you had a hard cry? When Dr. Mullasseril helped me finish the RPD case I needed to graduate. 3. When was the last time you belly laughed? All the time. Kid logic is quite entertaining! 4. Always on time or always late? Mostly on time - I have 4 kids, so cut me some slack! 5. If there was a movie produced about your life, other than yourself, who would play you? Dolph Lundgren
Let’s Work Together. Because when independent dentists work together, it can lead to big savings on dental supplies for practices of every shape and size. Built to serve members of organized dentistry, TDSC is saving members more on supplies than they pay in dues. SHOP ONLINE AND S TA R T S AV I N G TO DAY
44 journal | July/August 2019
One solution. Priceless hours saved. Tired of endless paperwork for credentialing with multiple plans? The ADAÂŽ credentialing service, powered by CAQH ProViewÂŽ is a digital solution to help streamline the process so you and your team can spend more time on patients and less time on paperwork.
Learn more at ADA.org/credentialing www.okda.org
45
4.5 Million visits and counting
Don’t miss out on this FREE marketing channel for ADA members. Complete your ADA Find-a-DentistŽ profile today. ADA.org/completemyprofile
46 journal | July/August 2019
AACREW CREWTHAT THATISISFOCUSED FOCUSEDON ONYOUR YOUR PERSONAL PERSONALFINANCIAL FINANCIALDESTINATION DESTINATION
Meeting Meeting your your financial financial goals goals takes takes a partner a partner who who is as is committed as committed to to reaching reaching them them as you as you are.are. Because Because there there is nothing is nothing more more important important
BARRON’S BARRON’S S TOP S TOP RIA FIRMS* RIA FIRMS*
to us to than us than your your vision, vision, Mariner Mariner Wealth Wealth Advisors Advisors willwill help help youyou chart chart a course a course to navigate to navigate your your financial financial future. future.
Joe Hendrix, Joe Hendrix, CFP®, CFP®, CPA CPA Nicholas Nicholas Harroz Harroz III, JD, III,CPA JD, CPA Senior Senior Wealth Wealth Advisor Advisor Senior Senior Wealth Wealth Advisor Advisor 405-353-1550 405-353-1550 405-698-3715 405-698-3715 joe.hendrix@marinerwealthadvisors.com joe.hendrix@marinerwealthadvisors.com nicholas.harroz@marinerwealthadvisors.com nicholas.harroz@marinerwealthadvisors.com Barron’s Barron’s awarded awarded the 2018 the 2018 #3 Top #340 Top RIA 40Firms RIA Firms ranking ranking to Mariner, to Mariner, LLC dba LLCMariner dba Mariner Wealth Wealth Advisors Advisors based based on data on data compiled compiled for Mariner for Mariner Wealth Wealth Advisors Advisors and the and2017 the 2017 #2 and #2 2016 and 2016 #1 rankings #1 rankings in theinTop theRIA TopFirms RIA Firms to Mariner to Mariner Holdings Holdings based based uponupon data data compiled compiled for Mariner for Mariner Holdings’ Holdings’ registered registered investment investment adviser adviser subsidiaries. subsidiaries. Barron’s Barron’s has transitioned has transitioned the name the name of theof2016 the 2016 inaugural inaugural award award of Top ofIndependent Top Independent Advisory Advisory FirmsFirms to thetoTop theRIA TopFirms. RIA Firms. EachEach year year sincesince inception, inception, Barron’s Barron’s has increased has increased the number the number of firms of firms including including in theinrankings the rankings fromfrom 20 (2016), 20 (2016), 30 (2017) 30 (2017) and in and 2018 in 2018 the list theincludes list includes 40 firms. 40 firms. Barron’s Barron’s publishes publishes thesethese lists based lists based uponupon a number a number of criteria of criteria and the andfirms’ the firms’ filings filings with the withSEC the were SEC were usedused to cross-check to cross-check the data the data provided provided to Barron’s. to Barron’s. The listing The listing includes includes the firms’ the firms’ numbers numbers of clients, of clients, employees, employees, advisors, advisors, offices offices and state and state locations. locations. The award The award is notisindicative not indicative of future of future performance performance and and therethere is no is guarantee no guarantee of future of future investment investment success. success. Registration Registration of anof investment an investment advisor advisor doesdoes not imply not imply a certain a certain level level of training of training or skill. or skill. Mariner, Mariner, LLC dba LLC Mariner dba Mariner Wealth Wealth Advisors Advisors (“MWA”), (“MWA”), is anisSEC an SEC registered registered investment investment adviser. adviser. Registration Registration of anofinvestment an investment adviser adviser doesdoes not imply not imply a certain a certain level level of skill of or skill training. or training. MWAMWA is in compliance is in compliance with with the current the current notice notice filingfiling requirements requirements imposed imposed uponupon registered registered investment investment advisers advisers by by 47the www.okda.org thosethose states states in which in which MWAMWA maintains maintains clients. clients. For additional For additional information information about about MWA, MWA, including including fees and fees services, and services, please please contact contact MWA MWA or refer or refer to the to Investment Investment Adviser Adviser Public Public Disclosure Disclosure website website (www.adviserinfo.sec.gov). (www.adviserinfo.sec.gov). Please Please read read the disclosure the disclosure statement statement carefully carefully before before you invest you invest or send or send money. money.
earn 7 ce credits in Just 1 day with
Join us for a day of training at our headquarters in oKlahoma city schedule for friday, september 6 8:30 a.m. - 4:00 p.m. ▪▪8:15 a.m.
— Light Breakfast served
▪▪8:30 a.m. — HIPAA: ‘Basics and Beyond’ ▪▪11:30 a.m. — Lunch served ▪▪12:00 p.m. — OsHA: ‘safety Doesn’t Happen by Accident’
Category B CE Credits
Price per person
hipaa course
3 HOuRs
$75
osha course*
4 HOuRs
$100
7 hours
$157
both courses save time and money by registering for both
* fullfills your annual requirement
For more information or to register, contact our Provider Relations team at 405-607-2137 (OKC Metro), 800-522-0188, ext. 137 (Toll Free) or pr@deltadentaloK.org 48 journal | July/August 2019