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Medicaid Update
Deadline Approaching for TamperResistant Prescription Pads
T
he federal Centers for Medicare and Medicaid Services (CMS) announced that, effective April 1, 2008, Medicaid will require all written prescriptions for outpatient drugs, including those sold over the counter, to be on tamper-resistant prescription pads. Congress mandated the new requirement last year but temporarily postponed implementation until April 1, 2008, to allow more time for states to respond. The regulation will apply to all written prescriptions submitted for payment through the Vendor Drug Program, but will not apply to prescription orders sent to a pharmacy via fax, e-prescribing, or telephone. As long as the patient does not physically handle the prescription, the requirement does not apply. For a prescription to be considered tamper-resistant by CMS, the pad must meet all three of the following characteristics: • • •
prevents unauthorized copying of completed or blank prescription forms, prevents erasure or modification of information written on the prescription form, and prevents the use of counterfeit prescription forms.
You can order tamper-resistant prescription pads from SYCOM with the 20 percent discount offered through TDA Perks Program. To receive the discount, mention mail code 56567 when ordering. Order online at www.sycom.com/tda. html, or by calling (800) 356-8141 (Mon-Fri, 7 a.m.–7 p.m.). You can also request a free catalog at the same number. +
It’s Almost Here … Make Plans Now for the 2008 TEXAS Meeting
T
he TDA Council on Annual Session encourages TDA members to make arrangements now to attend The TEXAS Meeting, 138th Annual Session of the Texas Dental Association — scheduled May 1-4, 2008, at the Henry B. Gonzalez Convention Center in San Antonio. Monday, March 31, 2008 — Hotel reservations deadline. After this date, the Texas Dental Association room blocks will be released and reservations may be made at higher rates on a space available basis. Don’t delay booking your hotel room; some hotels are close to selling out.
Dental Workforce Update
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s the date for the TEXAS Meeting rapidly approaches, it’s time to remember what TDA has accomplished before looking ahead to the future. Under the steady hand of your President, Dr. David May, the TDA Board of Directors visited 24 component societies throughout Texas to hear what you — the members — wanted in a future workforce model. The forums informed members about possible policy changes and the consequences of those policy changes. Policy information was also provided to members through a dedicated workforce webpage at www.tda. org. Members who couldn’t attend the workforce forums were encouraged to email TDA at workforce@tda.org or call the TDA central office. Another crucial step in the information gathering process was a membership workforce survey conducted in January 2008. All the information collected was given to the Council on Dental Education, Trade & Ancillaries (DETA) for inclusion in a comprehensive workforce report that will be presented to the TDA Board of Directors this month. At that time, the Board will evaluate the DETA report and any corresponding resolutions to forward on to the TDA House of Delegates in May (HOD).
Tuesday, April 1, 2008 — Register before this deadline and your Annual Session materials will be mailed to you in advance. In addition, you will avoid the $30 on-site registration fee per registrant. Classes are filling up quickly, so don’t delay! Continuing Education — We are pleased to offer the best of dental continuing education taught by leading experts in the dental profession. With more than 90 clinicians and approximately 190 lectures and workshops, there is plenty to choose from for every staff member. The 2008 Exhibit Hall promises to be the biggest and best ever — with the latest in supplies and services to enhance your practice. In addition, you will participate in several cash prize drawings, as well as the ever-popular happy hours in the exhibit hall.
As always, it is you — the members — who drive the process of policy development and it is this democratic process that will conclude with the HOD vote in May. The last installment of this update in April will explain in more detail how to communicate with your delegates. Remember, TDA members shape the future of dentistry in Texas. Let your voice be heard! +
We look forward to seeing you in San Antonio!
Access to Oral Health Care
Working Together for Oral Health
Give Kids a Smile in Tyler:
Dentists and dental professionals worked together during Give Kids A Smile Day on February 1, 2008, to help low-income children receive dental care. TDA members in the East Texas (3rd) District Dental Society did their part. A total of 60 families received free dental services ranging from dental cleanings and fillings to extractions as part of national Give Kids a Smile Day. This children’s charitable day resulted in $25,000 worth of donated services for Tyler area children. Children were screened for eligibility and pre-registered by Nancy Jones, R.N. at the Tyler Independent School District, and received treatment at a clinic set up at the St. Paul Children’s Foundation in Tyler. “This was our 5th year to participate in Give Kids A Smile,” said event leader Dr. David Nichols. “It is simply amazing to see how a community can come together to help children in need.”
Charitable Clinic in Weatherford: Weatherford Mayor Pro-tem Clem Lee Smith proclaimed February 18–22, 2008 as “Dental Health of Parker County Week” and officiated at an open house of the Dental Clinic of Parker County, a 501(c)(3) organization. Weatherford Dental Lab owner Darrell Clark was instrumental in setting up the clinic, where area dentists and auxiliary professionals donate time to provide oral health services to those in financial need (reported in Weatherford Democrat). +
For additional information, please visit www.texasmeeting.com or call the TDA Annual Session staff at (512) 443-3675. +
T
he American Dental Association Foundation (ADAF) and the American Academy of Pediatrics (AAP) are pleased to announce a collaborative effort as a result of an ADAF grant that will help improve the oral health of children in a critical age group. The “Working Together for Oral Health” grant will arm pediatricians with the tools they need to assess the oral health of children, particularly those aged 0-3, who can develop dental problems before they see a dentist for the first time. The grant will provide up to $100,000 annually for three years (a total of up to $300,000). The ADA Foundation grant will fund annual “train-the-trainer” oral health summits at which pediatricians will learn to conduct oral health risk assessments (including oral screening exams), teach families about oral health and prevention, and refer children to a dental home. Over three years, all 66 AAP chapters will have the opportunity to send representatives who will return home to lead training in their home states. The grant will also fund an oral health preceptorship program, which provides pediatricians in underserved areas with Continued on page 2
a similar course for strengthening leadership among our members. She is currently working in conjunction with an Austin-based company to establish a first class experience for our TDA members.
TDA 2009
There are numerous opportunities for members to participate in organized dentistry. Too often we think that we don’t have the necessary skills or that someone else could do a better job. In truth, our organization is only as strong as the commitment of its individual members. So, whether you are a new graduate or have been practicing for many years, your society needs your leadership skills!
Strategic Plan of the TDA
Contrary to popular opinion, individuals are not necessarily born with leadership skills, but develop them through education and training. With that in mind, becoming a leader for your local, regional, state, or national society begins by simply agreeing to help when asked. Say, “Yes!” Be a leader and make a difference! For your information, the current leadership development goal is stated below.
The Importance of Leadership Development
This is the sixth in a series of articles focused on the TDa’s accomplishments guided by the strategic plan. To view the entire plan, log in at www.tda.org and click on “TDA 2009” under “Current Issues” on the member homepage. For more information, please contact Lyda Creus Molanphy, staff liaison to the Future Focus Committee, at the TDA central office, (512) 443-3675.
Johnny G. Cailleteau, DDS TDA Future Focus Committee
MISSION: TO BE "THE VOICE OF DENTISTRY IN TEXAS"
L
eadership, a vital management skill, is often defined as an ability to motivate a group of people toward a common goal. While leadership is an essential part of all successful organizations, leadership development must be an ongoing commitment to ensure continued organizational growth and development. Having recognized the importance of this component, the Texas Dental Association (TDA) included leadership development as one of its six primary goals in the TDA 2009 strategic plan in order to ensure that our organization continues to grow and be successful. In 2002, the Future Focus Committee was appointed to determine the feasibility of preparing a strategic plan. Subsequently in 2003, a 3-day statewide retreat was held and a majority of those surveyed were supportive of a leadership development goal. Although the leadership goal has been in place in the strategic plan since its inception, there was difficulty in establishing a direction for accomplishing the statewide training objective within this important goal. However, TDA has been extremely successful in many aspects of leadership development through annual council and committee training, the TDA component society presidents and presidents-elect conference each year, and other programs aimed at working with both the American Dental Association and component society leaders. The direction for broad-based statewide training changed substantially in August 2007, when the TDA set about to revise its strategic plan and better define its goals. At that time, the leadership development goal, referenced at the end of this article, was rewritten and streamlined in collaboration with the Future Focus Committee, a facilitator, and a group of dedicated TDA council members and staff. This has allowed for a better understanding of the best way to accomplish the goal’s objectives. Subsequently, following a presentation to the November 2007 meeting of the TDA Board of Directors, the Board approved financial backing to develop a course for our members that would aid them in enhancing individual leadership skills by partnering with a leadership specialist, rather than developing an in-house program. This approach is thought to strengthen not only the future of our TDA, but is seen as a potential benefit for individual members in their daily lives. Currently, Dr. Lynne Gerlach, who was instrumental in developing a leadership course for the Dallas County Dental Society, has graciously consented to help develop
Manpower
Advocacy
Organizational Excellence
Public Image
Leadership Development
Membership
Leadership Development TDA will ensure its future through broad-based leadership development that encompasses programs designed to recruit, provide leadership skills, and disseminate pertinent information to all constituencies. Objectives 1. Increase TDA leadership development opportunities for all members a. Continue to recruit members that have potential leadership skills at the component society level and dental school level. b. Develop and implement training programs that stress leadership skills. c. Continue TDA Student Externship Program in leadership and organized dentistry. 2. Continue to increase the opportunity for information exchange through council, committee and affiliate training sessions, President/President-elect leadership conferences, and other programs aimed at component society leaders. 3. Encourage leadership participation from our diverse membership base. Metrics 1. Develop a TDA-sponsored leadership skills program by March 2008. 2. Enhance annually all TDA opportunities for information exchange to maintain 100% participation by components (baseline 2007 Pres/Presidents Elect Conference).
ATDA News
Working Together for Oral Health, continued from page 1
Reported by Alys Richards, Publicity Secretary
the support to promote oral health for the most vulnerable children. Ten awards will be given per year. The need is great:
Curtain Up on Dental Health!
T
he Alliance of the Texas Dental Association (ATDA) reports that dental health is center stage with the Dallas Alliance as many members volunteer to present numerous puppet shows in several area school districts. The show provides an entertaining educational opportunity to inform students about the importance of good oral health. As the curtain closes on the show, dental health chair Betty Ball engages the students in an interactive discussion concerning dental health, dental hygiene, good brushing techniques, and good nutrition. As an encore, each student receives a complimentary toothbrush. Members of the Alliance From left: “Gary” (Betty Ball), “Teddy Tooth” (Alys of the Texas Dental AssociaRichards), and “Obie” (Montie Larkin), Alliance of the tion (ATDA) throughout Dallas County Dental Society. Texas were actively involved promoting good oral health during National Children’s Dental Health Month in February. Equally important is that they continue their involvement throughout the year in a multitude of programs that promote good oral health and teach how to achieve it. For example, many local alliances organize dental health fairs at schools, shopping malls, and churches across the state. Still others prepare and distribute pamphlets (English and Spanish) to teach parents how to care for young children’s teeth and coloring books for children that demonstrate how to maintain good oral health. Still other local alliances purchase and distribute complimentary oral health products to school-age children and to nursing home residents as well. In addition to these commendable efforts, ATDA members continue their enthusiastic support for and participation in Texas Missions of Mercy across Texas facilitated by the Texas Dental Association Smiles Foundation. To the members of the ATDA for actively supporting and promoting dental health — applause, applause! +
• • • •
Dental caries (cavities) are the most prevalent infectious disease among U.S. children. While Americans of all ages continue to show improvements in oral health, tooth decay in primary (baby) teeth increased among 2- to 5-year-olds. More than 51 million hours of school are lost each year because of dental-related problems. Caries in primary teeth increase the risk of caries in permanent teeth.
Access to oral health care is critical for the early identification and prevention of childhood caries. Unfortunately, many children in the 0-3 age group never see a dentist, especially economically disadvantaged children and those who live in areas without ready access to a dentist. Because pediatricians see children early and frequently, they can play a role in identifying high-risk children. The AAP has recognized the rise of oral disease in young children and oral health is a key part of its strategic plan. “We’re grateful to the ADA Foundation for recognizing the importance of the role pediatricians can play in maintaining the oral health of young children,” said Renee Jenkins, MD, FAAP, president of the American Academy of Pediatrics. “By arming pediatricians with the tools they need to assess oral health risk, we can begin to reduce the number of children who need but don’t receive dental care and build a solid foundation for their oral health.” “The ADA Foundation is excited about this grant’s potential to broaden the reach of oral health messages to parents. Our alliance with the American Academy of Pediatrics seeks to facilitate pediatrician and dentist collaboration at the national, state and local levels,” said Arthur Dugoni, DDS, MS, president of the ADA Foundation. +
Don’t Donate Used Lead Aprons
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ccording to a brief article in the January issue of the Journal of the Michigan Dental Association, a risk of lead poisoning in special-needs children has prompted the state’s Department of Community Health recently to advise dentists not to donate lead aprons or shields for use in therapeutic weight training. Although well-intentioned, many charity organizations, in constructing weight products for specialneeds children, have inadvertently exposed the lead inside the aprons and shields, creating potentially hazardous items. That state instead asked dentists to dispose of surplus aprons and shields as hazardous waste. According to the article, the Michigan Dental Association recommends that its members contact their local radiographic film manufacturers, amalgam recyclers or hazardous water haulers for proper disposal. +
March 2008 / TDA Today / 2
Let’s Talk By A. David May, Jr., DDS, TDA President, 2007–2008
T
he primary votes have been cast, and I hope everyone took time to exercise one of the greatest privileges of being a U.S. citizen, that of voting. Most are already tired of political ads, and they will be around until November, but we take the process of selecting our leaders for granted. It is one of the most important principles of a democracy.
I ask every dentist to become involved in the political process, and to personally meet the candidates for state representative and state senator in your district. Pick the one that most represents your views, and help them in their campaign. All elected state officials want and need input from the voters back home, and if you have helped with their campaign, they will know you and will value your input on important issues. If you have an elected official — local, state, or national — in your practice, tell them how much you appreciate the time and energy they give for public service. Let them know you are interested in their ideas and views, and that you would be glad to help them in any way you can. We as dentists are looked up to as leaders in our community and we owe it to our profession to help our elected officials make informed decisions. So, let’s talk to the candidates. +
Happy, Healthy Smiles … That’s Our Mission. Bring TMOM Closer to Your Home!
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t 15 dental missions across Texas since 2001, Texas Missions of Mercy (TMOM) has provided almost 12,000 patients with charitable dental care valued at more than $4.1 million. Each event is made possible by hundreds of dentists, dental auxiliaries, and community volunteers who travel at their own expense from all over the state to participate in a 2-day mission. Missions have been held in Tyler, El Paso, Burnet County, Laredo, Dallas, Hereford, and Williamson County. The TDA Smiles Foundation is excited about the three upcoming events we’ve planned for 2008. We’ll hold a TMOM in Tyler on April 19, one in Leander September 5–6, and another in Corpus Christi November 14–15. Next year, we will be heading to Lubbock and El Paso. As you know, our volunteers — both community and dental — drive these charitable efforts. Without generous volunteers supporting the Texas Missions of Mercy through donated hours and funds, this work would not be possible! We want to come to your area. If you are interested in having a TMOM in your vicinity, please contact Dr. Richard Smith at (806) 3534767 or Andrew Robertson at (512) 448-2441, x104, to find out how your area can get on the TMOM calendar! +
Letters to the Editor
I
n the February issue of TDA Today (Vol. 9, Issue 2) appeared a “Quick Pearl from the Board” entitled “Who Can Authorize Prescriptions?” The two letters received regarding that article are excerpted below, along with the TDA response.
Dear Editor: Based on my personal experience, I would not authorize anyone to speak over the phone for the dentist regarding prescription medications. For example, a number of years ago I saw a patient with cervical cellulitis. He was treated with antibiotics and pain medications and rescheduled for extraction. Some days later he called my office complaining of continued discomfort and spoke with my receptionist. Without discussing it with me and without my knowledge she called in a Medrol Dosepak and tetracycline. Of course, he ended up in the hospital, nearly died, and I didn’t know any of this until the physician called me and told me never to give patients Medrol with an active infection (I already knew this). I told the surgeon I didn’t give him any Medrol, and he said, “Your name is on the bottle.” When I pulled his chart I noticed the receptionist had been in conversation with the patient and called in the drugs on her own. When I confronted her with the documentation, she told me she was an “idiot” and it wouldn’t happen again. Of course, I got sued, called before the board, went through a lawsuit, etc. Despite having no knowledge of this incident I was instructed to never let anyone other than myself talk about prescriptions over the phone. She no longer works here, I have an entry in the National Practitioner Data Bank, and years later I am still haunted by this person’s stupidity. Bottom line: tell the members not to delegate this task to anyone and don’t keep or dispense any medications from your office. Sincerely, Larry A. Barry, DDS, Amarillo
Dear Editor: I am not sure whom to ask concerning the article on the front page of the TDA Today. It is titled “Who Can Authorize Prescriptions?” and it encourages us to have a written list of those authorized to call in prescriptions. I looked for more information on the internet and DPS. Can you point me to the regulations or recommendations that encourage this? The article was not clear as to who has jurisdiction over this issue and the penalties for non-compliance. Please let me know if you can point me in the right direction. Vincent Bash, DDS, Midland
TDA’s Response The provision in question is in the Rules of the Texas State Board of Pharmacy. Legally, the cite would be: Title 22 (“Examining Boards”), Part 15 (“Texas State Board of Pharmacy”), Chapter 291 (“Pharmacies”), Subchapter B (“Community Pharmacies”), Rule 291.34 (“Records”). The relevant provision is Rule 291.34(b)(3), which governs “Verbal Prescription Drug Orders” and reads as follows: (3) Verbal prescription drug orders. (A) A verbal prescription drug order from a practitioner or a practitioner’s designated agent may only be received by a pharmacist or a pharmacist-intern under the direct supervision of a pharmacist. (B) A practitioner shall designate in writing the name of each agent authorized by the practitioner to communicate prescriptions verbally for the practitioner. The practitioner shall maintain at the practitioner’s usual place of business a list of the designated agents. The practitioner shall provide a pharmacist with a copy of the practitioner’s written authorization for a specific agent on the pharmacist’s request. (C) A pharmacist may not dispense a verbal prescription drug order for a Schedule III, IV, or V controlled substance issued by a practitioner licensed in another state unless the practitioner is also registered under the Texas Controlled Substances Act.
(D) A pharmacist may not dispense a verbal prescription drug order for a dangerous drug or a controlled substance issued by a practitioner licensed in the Dominion of Canada or the United Mexican States unless the practitioner is also licensed in Texas. Note that there is another, fairly similar, provision governing “electronic prescription drug orders.” That provision is 291.34(b)(4), which also includes language requiring practitioners to designate “agents” who are authorized to transmit electronic prescription drug orders. Unlike the provision governing “verbal prescription drug orders,” however, 291.34(b)(4)(C) prohibits a pharmacist from dispensing an electronic prescription for a Schedule II controlled substance unless it is faxed in accordance with Section 481.074, Health and Safety Code. Use this link to access all of the Board of Pharmacy Rules: http://www.tsbp.state.tx.us/rules/ Also, from the rules of the Department of Public Safety, Texas Administrative Code, Title 37, Part 1, Chapter 13, Subchapter1, Rule 13.205, “Practitioner’s Designated Agent”: (a) Prohibitions. A practitioner may designate another individual as an agent of the practitioner unless the designation is a subterfuge intended to circumvent materially the effect of a denial, suspension, revocation, or similar disciplinary action taken by the director, DEA, or a related health regulatory agency. March 2008 / TDA Today / 3
(b) Other rules apply. A practitioner who designates another individual as an agent must comply with each relevant provision of a federal regulation or rule of a state health regulatory agency governing the conduct of the practitioner. (c) Requirements to be designated. A designated agent must be: (1) a registered nurse licensed in this state; (2) a licensed vocational nurse licensed in this state; (3) a physician assistant licensed in this state; or (4) an employee who is: (A) located in the practitioner’s office; and (B) a member of the health care staff of the office. (d) Current list. A practitioner must maintain in the practitioner’s usual place of business a current written list of each individual designated as an agent under this section. (e) List provided. When a practitioner adds an individual to or deletes an individual from the list, the practitioner must provide upon request the current list to a pharmacy or pharmacist, the director, a member of the department, or an investigator listed in the Act, §481.076(a)(1). +
This recurring section is designed to help TDA members keep up with important Texas State Board of Dental Examiners (TSBDE) rules, other regulations, and state law affecting their practices.
TDA
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uestion: I’m a dental specialist practicing in San Antonio. Recently, a patient tried to insist that I “guarantee� the results of a particular procedure. Isn’t that prohibited by state law or a Dental Board rule?
nswer: Yes. TSBDE Rule 108.50 — “Objectives of Rules� states that “[a]s professionals, dentists have the duty to communicate truthfully and without deception to the public and should not misrepresent their training and competence in any way that would be false or misleading in any material respect.�
Moreover, Rule 108.52 — “False or Misleading Communications,� specifically prohibits Texas dentists from communicating with patients in a way that “create[s] an unjustified expectation about results the dentist can achieve� or that “guarantee[s] that a dental patient will be satisfied with the services and/or products received.� The full text of Rule 108.52 reads as follows: Rule 108.52 “False or Misleading Communications� Examples of communications to the public that may be false or misleading in any material respect include but are not limited to those that: 1) (2) (3) (4)
contain material misrepresentation of fact; omit a fact necessary to make the statement considered as a whole not materially misleading; create an unjustified expectation about results the dentist can achieve; contain a representation or implication that the announced services are superior in quality to those of other dentists which is not subject to reasonable verification by the public. (5) guarantee that a dental patient will be satisfied with the services and/or products received. +
Register for the 2008 TEXAS Meeting online! Go to www.texasmeeting.com and click on “Registration� then “Online Registration.� The deadline for online registration is April 1, 2008. To sign up for housing online click on “Travel & Housing� then “Hotel Information� then “Online Housing.� The deadline for online housing is March 31, 2008. Contact Donna Musselman with any questions at (512) 443-3675 or donna@tda.org. Active, full dues paying members can pay 2008 dues online! Join the hundreds of members who have paid their member dues online. Go to www.tda.org and click on “Pay Dues� on the member homepage. Contact Lee Ann Johnson with any questions at (512) 443-3675 or leeann@tda.org.
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News You Can Use
Special Perks Issue! What are TDA membersâ&#x20AC;&#x2122; favorite Perks Programs? What are your newest discounts and EHQHĂ&#x20AC; WVÂłDQG KRZ GR \RX DFFHVV WKHP" Interesting and informative, the special April issue of â&#x20AC;&#x153;Texas Dental Journalâ&#x20AC;? will contain all you ever wanted to know about your TDA Perks Program.
www.tdaperks.com