AUGUST JUNE, 2008 2011
VOLUME9,12, ISSUE VOLUME ISSUE 6 8
Dentists Who Care Holds Conference Every Member Matters
AVAILABLE ONLINE ATAT TDA.ORG AVAILABLE ONLINE TDA.ORG
Inside Inside
Rise’ Lyman, DDS, TDA Future Focus Committee
Dentists Who Care held its Medicaid in Smiles My Office? TDA Foundation 15th Annual Charity Dental Membership growth is vital to any thriving organization. The Texas Dental Association (TDA) Board is strongly Yes, I Think So! Texas Mission of Mercy Conference on August 5 and to the Membership goal within the “TDA 2009” strategic plan, which addresses continued growth. committed Richard M. Smith, DDS Texarkana 6, 2011, at Isla Grand BeachIResort am proud to report that, as evidence of that commitment and for the second year in a row, the TDA received in South Padre Island, Texas.the A record following ADA awards in 2008: TDA Smiles Foundation number of 450 people attended • the Greatest Percentage Membership Net Gain: Texas had a net gain of 198 members in the year 2007. TMOM gains ardent advocateHealth Medicaid Electronic event. • Top Constituent Dental Society with Greatest Percentage of Non-Members to Membership: TDA president Dr. J. Preston Represents a conversion of 4.7 percent of non-members into membership at end of year 2007. Record Ask the President Coleman addressed the VIP •luncheon Top Constituent Dental Society to Improve Retention Rate Percentage in 2007: Represents a 97 attendees with a welcome address. Incoming President’s message percent Association retention rate, which is an increase of 7 percent from the previous year. Speakers at the conference touched on Percentage of New Dentist Members: Represents a gain of 111 new dentist members (those TDA Perks • Greatest Hilton Israelson, DDS all areas of dentistry. dentists who are 1-9 years out of school). Dentists Who Care is a grassroots Let’s Talk Another example of the commitment to the growth of our Association is the TDA Externship Program, which builds student awareness Preston’s Press movement of dentists working to Outgoing President’s message of organized dentistry. This innovative program, created in 2007, offers students the opportunity to gain insight into the different components stop childhood decay. Its mission is to of organized dentistry including legislative and regulatory affairs, membership, governance, continuing education, and charitable dentistry and A. David May, Jr., DDS spread the message of preventive care to to gain a better understanding of their role as future leaders of the dental team. The program is open to dental students from each of the three TSBDE Rule Update children. dental schools in Texas. This year the externship program will take place June 20 – June 27 in Austin at the TDA central office. 2008-2009 TDA Board of Directors For more information, please visit As an ongoing effort to enhance the value and benefits ofCare the 2011 Association, the TDA Council on(L-R): Membership developed a survey that wassecretary sent Dr. Grayson Dentists Who Board of Directors: back row president Dr. Larry Balli of Edinburg, dentistswhocare.us. to all members in 2006. The results clearly showed thatofmembers have a high satisfaction rating benefits as the TEXAS Sellers Los Fresnos, immediate past president Dr. with Joe Peralez III such of Edinburg, treasurerMeeting, Dr. NoelTDA Garza of Mission, andMeet Your TDA Staff publications, and the ability to participate philanthropically in the Lalonde TDA Smiles great number of the programs offeredmember to member Dr. Adam of LosFoundation. Fresnos; frontArow (L-R): member Dr.discounted Sergio Guzman of McAllen; Dr. Carlos TDA’s new Finance Director members through the TDA Perks Program also received high satisfaction rating. In with and the strategic plan, Council onofMembership, Garcia ofaWeslaco; and vice president Dr.accordance Ricardo Garcia member Dr. JoeytheCazares, both McAllen. Dee Dee Delagarza will survey members again in 2009. Participation from all members and a collaborative effort between the ADA, TDA, and local component societies are the keys to TDA Membership Directory Congratulations to TDA successful membership recruitment and retention. We encourage every member to get involved whether it is by attending local meetings, Component Societies taking part in Give Kids a Smile! Day activities, volunteering at a Texas Mission of Mercy, or participating in TDA Legislative Day activities in Austin. Each member matters and is essential to the continued growth of our Association and of organized dentistry. Allied Groups Listing This is the seventh and final in a series of articles focused on the TDA’s accomplishments guided by the strategic plan. To view the entire plan, Streamline Your Insurance Claims 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 Speeding up confirmation of benefits Component Societies Listing Molanphy, staff liaison to the Future Focus Committee, at the TDA central office, (512) 443-3675. The Texas Health and Human Services Commission (HHSC) is Only July 27, 2011, the Health and Human Services Commission and eligibility introducing a new system that uses digital technology to streamline (HHSC) announced tentative dental contract awards for Texas Medicaid the Medicaid eligibility verification process and provides access to Children’s Health Insurance Program (CHIP) — The “Texas TSBDE Rule Update Mission: To be The Voice ofandDthe enTisTry in Texas Medicaid health history. Dental Program” — to the following managed care organizations (MCOs): Requirements for dental office • Delta Dental Insurance Company radiograph machines September 15 – 17 The two main elements of the system are: • DentaQuest USA Insurance Company, Inc. Public Organizational Development Membership • Manpower The Your Texas BenefitsAdvocacy Medicaid card, which replaces the paper • MCNA Insurance Company Austin In the News Image Excellence Medicaid ID letter (Form 3087) that clients receive in the mail TDA members in the news Texas Academy of General monthly. The final awards are contingent upon the Membership Dentistry • Dentists A website Medicaid providers successful negotiation and execution of contracts willfor value membership and participation in the TDA. that supplies up-to-date information between the MCOs and the State. The final Lone Star Dental Conference Objectives on a patient’s eligibility and history contracts between the MCOs and the State should 1.of services Improveand perceived valuepaid andby benefits of membership in TDA. treatments be signed by the first of September. TDA staff will Tooth Whitening: A Clinical Review a. Increase members’ knowledge about the impact and benefits of TDA membership. Medicaid. continue working with HHSC and the MCOs to September 22 & 23 b. Ensure that components are an integral aspect of the membership process. help assist in the transition for participating dentists TDA Historical El Paso Perspectives c. Create awareness benefits. During the firstgreater week of August of the availability of the Peer Review, Ethics & Judicial, and Risk and Management program enrollees. Dentists, dental hygienists, and the d. Actively promotethe adherence to the Code of Ethics. El Paso Dental Conference 2011, HHSC began mailing Your If you are interested in participating in the new dental team e. Enhance Texas Benefit Medicaidcommunication cards to 3.4 with members and non-members. Texas Dental Program, the first step is to contact f. Build student awareness of and interest in organized dentistry and membership in TDA. million Texans covered by Medicaid. the MCOs. Although, as of this writing, the MCOs The 2007 C.T. Rowland g. clients Ensure contact with students throughout dental school. September 23 Award Medicaid canongoing begin using the cards have not finalized contracts with the State, or Orthodontic case report h. Work closely with dental school faculty. immediately. The new plastic card will be established fee schedules, you may wish to sign a El Paso i. everyday EvaluateMedicaid number card of nonmember dentists who attend and participate in TDA activities Letter (TEXAS Meeting, TDA the client’s and of Intent (LOI) toSmiles join each MCOs network. TDA Executive Committee Foundation programs, etc.). will only be replaced if the client changes Signing a LOI does not obligate you to contract The El Paso Dental Conference Metrics Meeting health plans or if the card is damaged or lost. The current paper with an MCO. It is merely the first step in the MCOs credentialing 1. Seventy percent activewill licensed dentists will for be members of process. TDA byParticipating 2009 (baseline of 68.5% increaseproviders Medicaid ID letter (Formof3087) be mailed outintoTX clients the dentists mustinbeJanuary enrolled2007); as Medicaid rateThis to 97paper percent by April 96% in the 2006). months membership of August andretention September. Medicaid ID2007 letter(baseline will with State and credentialed with the MCOs in which they wish to a-d. Increase the number of dentists serving on component peer review and ethics and judicial affairs committees to attain a September 24 discontinue after September 2011. participate. August 14: participation rate of 2-5 percent relative to the total number of component society members by August 2009. Participating Medicaid providers can begin using Bridge City 2. Ninety percent of TX dental school graduates actively licensed in TX will be members of TDA five years after graduation (89% TDA Board Meeting yourtexasbenefitscard.com to verify a patient’s Medicaid eligibility. The MCOs contact information is below: Smiles on Wheels dental student conversion from thesuch graduating of 2005 Austin, Texas • Delta Dental Insurance Company Providers can opt to purchase equipment, as a cardclass reader, to in Texas). 3. the Increase number of member dentists 1 percent a year (as measured by a variety of means utilize card’s the magnetic stripe that contains theactively client’sparticipating Medicaid in TDA by (800) 775-0523 Ext.3066 – participation at TX Meeting, TMOM, TXDDS, FSI programs, DENPAC participations, TDA legislative day) with annual E-mail : PR-Texas@delta.org ID number. However, no equipment is required. Providers also can October 15-19: report to TDA Board by the Council on Membership. continue verifying eligibility through existing channels, which do not • DentaQuest USA Insurance Company, Inc. ADA Annual Session 4. the Establish baseline nonmember participation at TDA activities (CAS, Foundation, Membership) require purchase of anyofadditional equipment. TDA (800)Smiles 685-9971 San Antonio, Texas Established baseline offor members’ and satisfaction with benefits of their TDA membership through Member 5.Additional functionality the Yourunderstanding Texas Benefits of Medicaid the E-mail: dqrecruiters@dentaquest.com Benefits Services Survey (completed Nov 2006), re-evaluate % increase at thatInsurance time for 2009. card project will and roll out in late 2011. • MCNA Company — 6. Sixty-five percent of all full-time faculty will be TDA members by 2009 = 63%). (2006 Davidbaseline L. Brownell, Director of Provider Relations Join us on Facebook New features will: Website: http://www.mcna.net/provider/texas-program/ • Allow to view it’s patients’ claims, prescription, andanother statewide retreat in August of 2008. The TDAproviders will update strategic plan with Updategroups.to/texasdental Profile diagnosis history; immunization details and lab data; and allow The TDA will continue publicizing monthly updates in the TDA tda.org – Membership Info e-prescribing. Today about the commercial administration of the Texas Dental Program. Follow us on Twitter • Give Medicaid clients the ability to view eligibility information, You may view previous updates, starting in November 2010, by accessing Ask a Colleague details about services received, and Explanation of Benefits the TDA Today archives on tda.org. twitter.com/theTDA (EOBs). Clients will also be able to request a card replacement Additionally, the TDA will be sending email announcements as new tda.org – Features online and print a temporary card information becomes available. The TDA is committed to helping dentists Photos Get LinkedIn navigate the new Texas Dental Program and will be creating tools to assistTEXAS Meeting texasmeeting.com/estore For more information on the new Your Texas Benefits Medicaid participating dentists in educating themselves and their patients about the linkedin.com, search “Texas card visit yourtexasbenefitscard.com. Or call, (855) 827-3747. upcoming changes. Volunteer for ‘08 ADA Dental Association” For questions or comments, contact TDA’s policy manager Ms. Diane tda.org/volunteerada08 Rhodes at (512) 443-3675 or diane@tda.org. In 2003, Texas Dental Association members from across the state develop TDA’s first strategic plan, TDA 2009.
September Journal News
HHSC Rolls Out the New “Your Texas Benefits” Medicaid Card
Future Changes to Texas Medicaid Dental Program
Around the State
July Journal News
Around the State
Click & Connect
Click & Connect
TDA Conducts Freshmen Day at UTSD, Baylor
Texas Medicaid Electronic Health Record (EHR) Incentive Program This is the ninth in a series of articles to keep you informed of the Texas Medicaid Electronic Health Record (EHR) Incentive Program and continuing efforts to implement health information exchange initiatives across Texas. The incentive program provides incentive payments to Medicaid providers for the adoption and meaningful use of certified EHR technology. Future articles will focus on helpful reference websites, health information exchange, meaningful use for dentists, certified EHR technology for dental practices, and other relevant topics of interest to dentists. This article is a continuation of last month’s discussion about Meaningful Use (MU) Objectives and Clinical Quality Measures (CQM) for the Medicaid EHR program. Dentists must meet the same eligibility requirements as other eligible professionals (EP) in order to qualify for payments under the Medicaid EHR Incentive Program. This also means that they must demonstrate all 15 of the core MU objectives and five from the menu of their choosing. The core set includes reporting of six CQMs (three core and three from the menu of their choosing). Several meaningful use objectives have exclusion criteria that are unique to each objective. Participating dentists will have to evaluate whether they individually meet the exclusion criteria for each applicable objective as there is no blanket exclusion by type of EP. The Texas Dental Association’s Committee on Access, Medicaid & CHIP recently reviewed and gave recommendations to the Texas Health and Human Services Commission (HHSC) regarding the federal MU objectives and CQMs as they relate to dentistry. It is hoped that HHSC will share this information with the Centers for Medicare and Medicaid Services (CMS) and reference it as they develop the actual data exchange with Medicaid providers as part of the State 2 implementation of the Medicaid Eligibility and Health Information Services (MEHIS) project. MEHIS is a statewide system that replaces the current paper Medicaid identification form with a permanent plastic card, automates Medicaid eligibility verification, provides an EHR for all Medicaid clients, offers electronic prescribing functionality, and establishes a foundation for a future Health Information Exchange for improved efficiency, continuity of care, and health outcomes. MEHIS Stage 2 implementation will occur in coordination with Texas’ Medicaid EHR Incentive Program and the collection of MU and CQMs. CMS has detailed information for the Medicaid EHR program at www.cms.gov/EHRIncentivePrograms. For help in the Texas enrollment process, email HealthIT@tmhp.com or call (800) 925-9126, option 4.
TDA sponsored Freshmen Day at the University of Texas Health Science Center School of Dentistry at Houston (UTSD) and Baylor College of Dentistry – Texas A&M Health Science Center on August 12. Seventy-three UTSD TDA Committee on the Incoming freshmen attend the TDA Freshmen Day at UTSD earlier this month. freshmen and 106 Baylor New Dentist member Dr. freshmen attended the Jeremy Chance speaks to evenys. The students were treated to lunch, had the chance to win door prizes, and learned about the freshmen dental students benefits of organized dentistry and the services offered through the tripartite membership system. at TDA Freshmen Day at UTSD. UTSD Associate Dean for Student and Alumni Affairs Dr. Hugh P. Pierpont, TDA Committee on the New Dentist member Dr. Jeremy Chance, Greater Houston Dental Society (GHDS) president Dr. Karen A. Walters, and GHDS member Dr. Richard Collins hosted the event at UTSD. TDA Council on Membership member Dr. Lynne Gerlach, Committee on the New Dentist chair Dr. Andrea J. Keith, and Dr. Sarah Tevis Poteet hosted the event at Baylor. TDA and local society staff also attended the events. Highlights from the University of Texas Health Science Center at San Antonio Dental School will be featured in a future TDA Today issue. For more information, please contact the TDA Department of Member Services & Administration, (512) 443-3675.
Perks Partner News
TDA Perks Opens Electric Service to TDA Staff, Adds Residential Service
Through its partnership with JLT Energy Consultants, TDA Perks Energy Program is switching to a new retail energy provider (REP) that will allow TDA members and their staff to enjoy exclusive energy savings at their homes, in addition to at the office. More energy choices; faster, easier online enrollment; and program availability to TDA-members’ staff are some of the new features of the updated program. Visittdaperks.com, click on “Endorsed Partners” and “TDA Perks Energy” for more information. *You must live in a deregulated area to be eligible to participate.
Saginaw Dentist Wins Perks’ Latest Giveaway
Dr. Fred Loe of Saginaw (Fort Worth District Dental Society) is the lucky winner of TDA Perks Program’s $200 Visa® Gift Card Giveaway. TDA members who registered their practices for Perks’ Office Depot discount program by July 31 were automatically entered in a drawing for the card. Missed the contest? You can always register for the Perks Office Depot program to save 10 percent on more than 18,000 office supply items. You or your staff can register online at tdaperks. com, or by calling John Listi at: (512) 284-3392. Questions? Call TDA Perks Program at: (512) 443-3675.
TDA Perks’ Advocate Program Launches
Any TDA member interested in becoming a charter member of TDA Perks Program’s new Advocate Program is encouraged to contact the Perks staff immediately. An advocate is a volunteer TDA member who serves as TDA Perks Program liaison at his/her respective local society’s meetings. Advocates will have the opportunity to try Perks programs to help evaluate their quality, join the TDA Financial Services Board at its meetings in Austin, and receive special recognition. Charter members include: Dr. Roland Davies, Capital Area Dental Society; Dr. Lisa Heinrich-Null, Guadalupe District Dental Society; and Dr. William Nantz, Dental Society of Southeast Texas. For more information, contact the Perks staff at (512) 443-3675 or e-mail Josh Epstein at josh@tda.org.
Dallas Seminar Focuses on Attaining Practice Success
Perks partner, Insurance Answers Plus, is hosting “The Key Essentials of a Successful Practice” seminar on Friday Septemer 9 at Park Cities Hilton in Dallas. The 8:30 a.m.3:30 p.m. seminar features speaker Dr. Rhonda Savage, CEO of Miles Global, and will cover the systems of a successful practice, how to attain clinical excellence through comprehensive treatment planning, how to attract and retain the ideal team, the four best scheduling tips, and more. CE credits are available. Download complete information at: http://tinyurl.com/PerksSeminar. Questions? Call Insurance Answers Plus at: (800) 683-2501.
Happy, Healthy Smiles … That’s Our Mission!
Texas Mission of Mercy Texarkana TDA Smiles Foundation (TDASF) held its 24th Texas Mission of Mercy (TMOM) in Texarkana August 5-6, 2011. This event was a huge success, providing 532 patients with $438,691 worth of charitable dental care, including 30 partials! This event ran smoothly thanks to the incredible partnership with CHRISTUS St. Michael. CHRISTUS financially supported the event, and dozens of its employees volunteered, allowing TDASF volunteers to provide care to Texarkana residents. Along with CHRISTUS St. Michael, TDASF offers sincere gratitude to Dr. and Mrs. Milburn S. Haynes of Texarkana for their dental and event support, Crown Dental Lab for the 30 partials provided free of charge to the patients, Henry Schein for X-ray support, Patterson Dental for dental and equipment support, plus many restaurants in the area that provided food for TDASF volunteers. Two more TDASF charitable events remain this year: a Smiles on Wheels in Bridge City on September 24 and a TMOM in Amarillo on October 28 and 29. To register to volunteer at either of these events, please visit tdasf.org.
Questions? Call TDA Perks Program at: (512) 443-3675.
What some past participants are saying:
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“Dr. Sperry really was a blessing to me. I am so very thankful to him! I am also so thankful to God for everyone who has helped me and the others today!” — Ms. Angela Reed, Texarkana (Dr. Fred Sperry, Omaha)
“Dr. Pratt did an amazing job!” — Ms. Roshonda Black, Texarkana (Dr. Steven Pratt, Atlanta)
“Dr. Bunel did amazing work on me!” — Ms. Agnes Guy, Texarkana (Dr. Kirby Bunel, Texarkana)
“Dr. Dickerson is wonderful!” — Mr. Ray Burns (Dr. Rein Dickerson, Mineral Wells)
“Dr. James was a very friendly doctor. He was very quick. Thank you.” — Anonymous (Dr. Joe James, Texarkana)
“Dr. Lathrop was very, very good! All of the workers were great.” Dr. Kent B. Macaulay of Round Rock consults a patient at the TMOM Texarkana earlier this month.
August 2011 / TDA Today / 2
Dr. Frederic G. Sperry of Omaha is pictured with a patient at the TMOM Texarkana earlier this month.
— Mr. Bobby Walker, New Boston (Dr. Colin Lathrop, The Woodlands)
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MK’s Board Notes Mary Kay Linn, TDA Executive Director Below is a summary of actions of the TDA Board of Directors during the May 8, 2011, meeting with TDA president Dr. J. Preston Coleman presiding.
Non-Policy Resolutions Appointments 1-2012-B: Re-appointed Dr. Arthur H. Jeske as TDA historian. 2-2012-B: Appointed to the TDA Holding Company Board: President Dr. Ronald L. Rhea; Vice-President Dr. Michael L. Stuart; Secretary-Treasurer Dr. Ron Collins; Dr. W. Kenneth Horwitz, president of TDA Financial Services, Inc. 3-2012-B: Appointed TDA senior director Dr. T. Beth Vance as chair of the Sunset Review Committee. OUT-OF-STATE TRAVEL 4-2012-B: Approved TDA executive director Ms. Mary Kay Linn, TDA director of member services and administration Ms. Lee Ann Johnson, and TDA executive affairs manager Ms. Donna Cortez to attend the ADA Management Conference in Chicago, Illinois, on July 18-21, 2011. Below is a summary of actions of the TDA Board of Directors during the June 24, 2011, meeting with TDA president Dr. J. Preston Coleman presiding.
Policy Resolutions Appointments 26-2012-B (P): Nominated Ronald G. Presswood, D.D.S. for the Norton M. Ross Award for Excellence in Clinical Research. MISCELLANEOUS 18-2012-B (P): Supports community water fluoridation within the recommended therapeutic levels as determined by the appropriate federal agencies. Rescinded Resolution 88-1972-H.
Non-Policy and Board Policy Resolutions Appointments 5-2012-B (NP): Appointed 2011-12 Board liaisons to the TDA councils and committees. 6-2012-B (NP): Appointed Dr. Victoria A. Vickers (SW) to
fill the unexpired term of Dr. David C. Woodburn (NW) (2014) on the Council on Ethics and Judicial Affairs. 7-2012-B (NP): Appointed Dr. Jean E. Bainbridge, director, to the TDA Assets Management Committee. 8-2012-B (NP): Appointed TDA directors Dr. Gregory K. Oelfke and Dr. David C. Woodburn to the TDA Budget Committee. 9-2012-B (NP): Appointed Dr. Gregory K. Oelfke, director, to the TDA Future Focus Committee. 10-2012-B (NP): Established a Relief Fund work group to review letters of interest received concerning distribution of Relief Fund grants with a report of recommendations to be given to the Board of Directors at its March 2012 meeting. 11-2012-B (NP): Re-appointed the members of the Executive Director Search Committee: Dr. Michael L. Stuart, chair (NE); Dr. Matthew B. Roberts, TDA past president (SE); Dr. Lisa B. Masters, Board (SW); Dr. Rita M. Cammarata, Board (SE); Dr. Michael J. Goulding, Board (NW); Dr. Larry D. Herwig, Board (NE); Dr. David H. McCarley, TDA Council on Constitution and Bylaws chair; Dr. J. Gregory Condrey, TDA House of Delegates (SE); and the following consultants: Ms. DeeDee Delagarza, staff — director; Ms. Diane Rhodes, staff; and Ms. Terry Jordan, human resource consultant. 20-2012-B (BP): Authorized the Executive Director Search Committee to research and prepare recommendations to and resolutions for the Board in hiring an executive director. 21-2012-B (BP): Approved the job description for the TDA executive director. 22-2012-B (BP): Approved the position qualifications for the TDA executive director. 23-2012-B (BP): Approved the timeline for the TDA Executive Director Search Committee BUDGET ISSUES 14-2012-B (NP): Approved items $400 over budget for a total financial implication of $42,630: salaries-temporary, consultants, and human resources. 27-2012-B (BP): Adjusted reimbursement rates for Board members renting automobiles when traveling for TDA business. 28-2012-B (BP): Adjusted reimbursement rates for Board members using taxis when traveling for TDA business. 29-2012-B (BP): Adjusted the TDA travel policy to include reimbursement to members for airline luggage expenses for two bags not to exceed 50 pounds each. Rescinded Resolution 402010-B. 31-2012-B (BP): Approved the TDA out-of-state and instate automobile transportation and surface transportation reimbursement rate for mileage be adjusted concurrently with the business mileage rate adjustments by the Internal Revenue Service. Rescinded Resolution 107-2006-H. OUT-OF-STATE TRAVEL 15-2012-B (NP): Approved TDA legal counsel Mr. William H. Bingham to attend the American Dental Association Management Conference in Chicago, Illinois, on July 18-19, 2011. 16-2012-B (NP): Approved Ms. Cassidy Neal, program manager, to attend the National Dental Benefits Conference in Chicago, Illinois, on August 5, 2011.
TSBDE Rule Update
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. This TSBDE Update will address Texas State Board of Dental Examiners (TSBDE) Chapter 110 — 22 TAC §110.4 — Minimal Sedation (Level 1) permit. The TSBDE defines Level 1 Minimal Sedation as, “Nitrous plus one enteral drug (1).” A dentist holding an active Enteral Sedation permit before June 1, 2011, will automatically have his/ her permit reclassified as a Level 1 Minimal Sedation permit in accordance with §110.4 (a) (3). A Level 1 Permit automatically qualifies an applicant for Nitrous Oxide and Level 1 privileges (1). As a reminder, although Chapter 110 became effective June 1st, the TSBDE will not start enforcing requirements until January 1, 2012. This delay is intended to allow ample time for dentists to become compliant with all facets of the new regulations such as standards of care and monitoring. The TSBDE defines Minimal Sedation as, “A minimally depressed level of consciousness, produced by a pharmacological method, in which the patient retains the ability to independently and continuously maintain an airway and responds normally to tactile stimulation and verbal command (2).” The summary below is taken directly from Chapter 110 — 22 TAC §110.4 — Minimal Sedation. A dentist applying for a Minimal Sedation permit must meet one of the following educational/professional criteria: §110.4 (a) (1): satisfactory completion of training to the level of competency in minimal sedation consistent with that prescribed in the American Dental Association (ADA) Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students, or a comprehensive training program in Minimal Sedation that satisfies the requirements described in the ADA Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. This
includes a minimum of sixteen (16) hours of didactic training and instruction in which the competency in enteral and/or combined inhalation-enteral minimal sedation technique is demonstrated; or §110.4 (a) (2): satisfactory completion of an advanced education program accredited by the ADA Commission on Dental Accreditation (CODA) that affords comprehensive training necessary to administer and manage minimal sedation, commensurate with the ADA’s Guidelines for Teaching Pain Control and Sedation to Dentists and Dental Students. Additionally, a dentist performing minimal sedation must adhere to standard of care requirements (§110.4 (b) (1-4)) and clinical requirements (§110.4 (c) (1-8) (d)) including maintaining under continuous direct supervision auxiliary personnel capable of reasonably assisting in procedures, problems, and emergencies incident to the use of minimal sedation as well as maintaining current certification in Basic Life Support (BLS) for Healthcare Providers for the assistant staff by having them pass a course that includes a written examination and hands-on demonstration of skills. The dentist is responsible for the sedative management, adequacy of the facility and staff, diagnosis and treatment of emergencies related to administration of minimal sedation, and providing the equipment and protocols for patient rescue. In addition to the dentist, at least one additional person trained in BLS for Healthcare Providers must be present. The patient’s baseline vitals must be obtained in accordance with §§108.7 (Minimum Standard of Care, General) and 108.8 (Records of the Dentist). A focused physical evaluation must be performed as deemed appropriate, and pre-procedure dietary restrictions must be considered based on the prescribed sedative technique. Pre-procedure verbal and written instructions must be given to the patient, parent, escort, guardian, or care-giver.
Preston’s Press J. Preston Coleman, D.D.S., TDA President 2011-12
Green Lights! Organizational excellence is one of the goals for TDA 2014, covering a wide range of objectives from increasing the non-dues revenues to enhancement of the TDA facilities. I will briefly focus on objective four: maximize the effectiveness of all TDA management and governance. Last year, there were concerns that our financial reports needed reevaluating / redesign to simplify the information. This spring, an independent auditing firm praised our financial reporting system. The firm suggested that additional training might help the Board see the big financial picture. As a result, the August board meeting included a 2-hour presentation by Mr. Matt Kouri, president and executive director of Greenlights for Nonprofit Success. The presentation covered roles and responsibilities shared by all non-profit boards, fundamental board roles and responsibilities, advanced board practices, and financial oversight. Kouri also presented on the Non-Profit and Texas Business Organizations Code. He also explained that the most important duties of a director are loyalty, care, and obedience. Loyalty requires a director to perform his or her duties in good faith, always acting in the best interest of the organization. Care requires directors to use sound judgment in decision-making on behalf of the organization, devoting a reasonable amount of time and attention — “ordinary care” — to understand the matters before them. Obedience requires a director to act in the best interest of the non-profit, setting policy and making decisions that are consistent with the mission of the organization. Kouri also pointed out that in the TDA Bylaws and Board Manual, Board responsibilities include monitoring the management of the Association’s property and paying taxes. The documents state, “… during the term of office on the Board of Directors, each member has the duty of considering not only the interests of the members of their particular division or geographical area, but also the welfare of this Association, the dental profession as a whole and the public we serve.” This is borne out by the fact that Board members are nominated by one of the four divisions and are also elected by a vote of the House of Delegates. The TDA Board of Directors must be strategically engaged in the operation of the Association, walking a fine line between micromanagement and hands-off neglect. There are three modes of governance: fiduciary, strategic, and generative. When the Board works well across all three modes of governance, leadership is the result. Financial oversight is everyone’s job, but the treasurer is most often the leader. Effective oversight requires good reports, questions, and actions. The TDA Board receives a 16-page financial report at each meeting. One page shows the big picture of cash flow, budget progress (and comparison with the previous year) as well as revenue over expenses for the year to date. There are five pages of detail supporting the summary report and four reports to explain other areas that are not a part of the summary, but require oversight. Three pages have recently been added to provide the Board members with greater details of transactions in the TDA reserve funds. Our budgeting process is thoughtful and realistic, taking into consideration that adequate resources are needed to support the programmatic and administrative plan. This process is carried out by the Budget Committee under the guidance of the treasurer. The Audit Committee and the director of finance work diligently each year to provide accurate and complete information for the annual audit of the financial statements. The results in the auditors’ reports and comments have always reflected positively on our staff and organization. Reviewing the points of Kouri’s presentation, I feel that we are financially sound both in regards to our fiscal condition and the Board’s function for financial oversight. Nevertheless, there are improvements to be made to better tier the financial roles of the TDA, allowing the Board to concentrate more on the big picture and of what lies ahead in the future.
Continued on page 4
August 2011 / TDA Today / 3
TSBDE Update, continued from page 3 Post-procedure verbal and written instructions must also be given to the patient, parent, escort, guardian, or care-giver. Post-procedure, patients should be accompanied by an adult caregiver for an appropriate period of recovery. Patients considered for minimal sedation must be suitably evaluated prior to the start of any sedative procedure. In healthy or medically stable individuals (ASA I, II), this may include a review of their current medical history and medication use. However, patients with significant medical considerations (ASA III, IV) may require consultation with the patient’s primary care physician or consulting medical specialist. The patient, parent, guardian, or care-giver must be advised regarding the procedure associated with the delivery of any sedative agents and must provide written, informed consent for the proposed sedation. Monitoring during the administration of sedation must include oxygenation wherein the color of mucosa, skin, or blood must be continually evaluated. To that end, oxygen saturation monitoring by pulse-oximetry should be used when a single drug minimal sedative is used. The additional use of nitrous oxide has a greater potential to increase the patient’s level of sedation to moderate sedation, and a pulse oximeter must be used. The dentist (or appropriately qualified individual) must observe chest excursions and must verify respirations continually. Blood pressure and heart rate should be evaluated pre-procedurally, post-procedurally and intraprocedurally as necessary. Documentation must be made in accordance with §§108.7 (Minimum Standard of Care, General) and 108.8 (Records of the Dentist) and must include the names and dosages of all drugs administered and the names of individuals present during administration of the drugs. A time-oriented sedation record may be considered for documentation of all monitoring including: pulse oximetry, heart rate, respiratory rate, and blood pressure may be documented at appropriate intervals of no more than 10 minutes. Permitted dentists under this section shall not supervise a Certified Registered Nurse Anesthetist performing a minimal sedation procedure unless the dentist holds a Minimal Sedation permit issued by the TSBDE. The dentist shall determine that an adequate oxygen supply is available and evaluate equipment for proper operation and delivery of adequate oxygen under positive pressure.
AUGUST 2011
VOLUME 12, ISSUE 8
A positive–pressure oxygen delivery system suitable for the patient being treated must be immediately available. When inhalation equipment is used, it must have a failsafe system that is appropriately checked and calibrated. The equipment must have either a functioning device that prohibits the delivery of less than 30 percent oxygen, or, an appropriately calibrated and functioning in-line oxygen analyzer with audible alarm. An appropriate scavenging system must be available if gases other than oxygen or air are used. The dentist administering the sedation and must remain in the operatory room with the patient until the patient meets the criteria for discharge to the recovery area. At that time, the dentist may delegate monitoring to a qualified dental auxiliary. Oxygen and suction equipment must be immediately available in the recovery area if a separate recovery area is utilized. The dentist must determine and document that the patient’s level of consciousness, oxygenation, ventilation, and circulation are satisfactory prior to discharge. The dentist shall not leave the facility until the patient meets the discharge criteria and is discharged from the facility. A dentist holding a Minimal Sedation permit shall not intentionally administer Moderate Sedation, Deep Sedation, or General Anesthesia. Because sedation is a continuum, it is not always possible to predict how an individual will respond. If a patient enters a deeper level of sedation than the dentist is qualified to provide, the dentist must stop the dental procedure until the patient returns to the intended level of sedation. A dentist must be able to rescue patients who enter a deeper state of sedation than intended. The dentist, personnel, and facility must be prepared to treat emergencies that may arise from the administration of minimal sedation. For children twelve (12) years of age or under, the dentist should observe the American Academy of Pediatrics/American Academy of Pediatric Dentists Guidelines for Monitoring and Management of Pediatric Patients During and After Sedation for Diagnostic and Therapeutic Procedures. For more information, please contact TDA policy manager Ms. Diane Rhodes at (512) 443-3675, diane@tda.org. References 1.
2.
TSBDE Webpage: New Anesthesia Permit Regulations to be Enforced January 1, 2012!: Http://www.tsbde.state.tx.us. TSBDE Chart: Anesthesia Rules – Summary of Requirements: http://www.tsbde.state.tx.us.
AVAILABLE ONLINE AT TDA.ORG
EDITORIAL STAFF Stephen R. Matteson, D.D.S., Editor Nicole Scott, Managing Editor Lauren Oakley, Publications Coordinator Barbara Donovan, Art Director Paul H. Schlesinger, Consultant BOARD OF DIRECTORS J. Preston Coleman, D.D.S., President Michael L. Stuart, D.D.S., President-elect Ronald L. Rhea, D.D.S., Immediate Past President Vice Presidents Lisa B. Masters, D.D.S., Southwest Robert E. Wiggins, D.D.S., Northwest Larry D. Herwig, D.D.S., Northeast Karen E. Frazer, D.D.S., Southeast Senior Directors T. Beth Vance, D.D.S., Southwest Michael J. Goulding, D.D.S., Northwest Arthur C. Morchat, D.D.S., Northeast Rita M. Cammarata, D.D.S., Southeast Directors Yvonne E. Maldonado, D.D.S., Southwest David C. Woodburn, D.D.S., Northwest Jean E. Bainbridge, D.D.S., Northeast Gregory K. Oelfke, D.D.S., Southeast Ron Collins, D.D.S., Secretary-Treasurer Glen D. Hall, D.D.S., Speaker of the House David H. McCarley, D.D.S., Parliamentarian Stephen R. Matteson, D.D.S., Editor Mary Kay Linn, Executive Director William H. Bingham, Legal Counsel TDA Today (USPS 022-007) is published monthly except for December by the Texas Dental Association, 1946 S. IH-35, Ste 400, Austin, Texas 78704-3698, (512) 443-3675. Periodicals Postage Paid at Austin, Texas and at additional mailing offices. POSTMASTER: Send address changes to TDA TODAY, 1946 S. IH-35, Ste 400, Austin, TX 78704-3698. Annual subscriptions: Texas Dental Association (TDA) members, $5. In-state American Dental Association (ADA) affiliated, $15 + tax. Out-of-state ADA affiliated, $15. In-state non-ADA affiliated, $30 + tax. Out-of-state non-ADA affiliated, $30. Single issue price: TDA members $1. In-state ADA affiliated, $3 + tax. Out-of-state ADA affiliated, $3. In-state non-ADA affiliated, $6 + tax. Out-of-state non-ADA affiliated, $6. Contributions: Manuscripts and news items of interest to the membership of the Association are solicited. Manuscripts should be typewritten, double spaced, and the original copy should be submitted. Please refer to Instructions for Contributors in the annual September Directory of the Texas Dental Journal for more information. The Information for Contributors is available at tda. org. All statements of opinion and of supposed facts are published on authority of the writer under whose name they appear and are not to be regarded as the views of the Texas Dental Association, unless such statements have been adopted by the Association. Articles are accepted with the understanding that they have not been published previously. Authors must disclose any financial or other interests they may have in Member Publication products or services described in their articles. Advertisements: Publication of advertisements in this publication does not constitute a guarantee or endorsement by the Association of the quality of value of such product or of the claims made of it by its manufacturer.
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