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Message from the President Dr. Alonzo Bell

As i sit down to write this message, it is a sunny fall afternoon. The leaves on the trees paint a beautiful tapestry of red, yellow and gold. My 2 and 6 Redskins have just beaten the Denver Broncos. Yes, Thanksgiving is certainly upon us!

During this season, I am reminded that we as members of the Virginia Dental Association have much to be thankful for. Despite what has been a very challenging year for all, our association continues on sound footing.

The VDA enjoys:

• A strong financial condition • An efficient and dedicated staff • A visionary leader in our Executive Director Dr. Terry Dickinson • A great record of service thanks to our M.O.M. Projects

By the time you read this message, the holidays will be over and a new year begun. A new year brings the new commitment that we cannot afford to rest on our successes of the past. As leaders, we must constantly look to and plan for the future so that we are able to preserve all that we hold dear about our profession for those that follow us.

As we look to the immediate future, the one issue that will dominate our effort is advocacy.

In the national arena, the ADA has several legislative actions that directly affect dentistry. First, the ADA has actively lobbied in support of an amendment of the health care reform legislation to repeal the McCarran-Ferguson Federal Antitrust Exemption for the “business of insurance”. Enforcement of the “red flags rule” has been delayed again until June 1st and the ADA Washington office continues to coordinate the effort to bring the FTC and congress in agreement to exempt dentists.

In Virginia, we have just witnessed a huge change in the makeup of our General Assembly, and the total party change of our state administration. This change comes as we are about to undertake our biggest legislative initiative in recent memory with our bill on MANDATED FEES FOR NON-COVERED SERVICES. We need to harness all of our resources to prevail in this effort.

The issue that this bill addresses is that some dental insurance companies are amending their contracts to seek to mandate fees for procedures that they provide no coverage. If the dental insurance companies are successful in achieving these contract changes, the fees for non-covered services will be controlled by the insurance companies and not by the treating dentist.

MAKE NO MISTAKE ABOUT IT - THIS WILL BE A BATTLE AND OUR SUCCESS OR FAILURE WILL DEPEND ON YOU!

Here’s what you can do to show our legislators that we have the political will to determine our own future:

• Make a generous contribution in support of our VADPAC.

• Become familiar with the language of the bill and with the information about the bill provided by our lobbyist. If you have not received a copy of the bill, contact our VDA office.

• Contact your legislators to get their support and get your friends and colleagues to do the same. As they say, all politics is local. You can find the name and contact information for your Delegate and Senator by clicking on the following link: http://conview.State.Va.Us/whosmy.Nsf/main?Openform.

• Show up in Richmond for our lobby day January 15, 2010.

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Dr. Charles Norman • 16th District Trustee

“Does the ADA speak for you?”

A recent online issue of Dental Products Report asked the Question “Does the ADA Speak for You?”. The implication of the question is that maybe there is a better voice for dentistry, but if not the ADA then whom. The article goes on to question how the ADA can represent both the dentist members and the public that we serve. Many critics feel that there are policy issues that are either good for the profession or good for the public with little room for common interest. Personally, I have always believed that policy that is based on sound science and a proven track record will ultimately be mutually beneficial to both the dentist we represent and the patients we serve. However, sometimes our policies may conflict with those within our profession, as well as, policy makers who may have an agenda that is pragmatic with no concern for science or best practices. A good example of this disconnect would be the use of midlevel providers. In fact, the DPR article goes on to mention that there are three areas commonly mentioned by discontented members as weaknesses of ADA policy, midlevel providers, national licensure, and favoritism of specialist over generalist. Let’s examine each of those issues separately.

As a background for the first two issues, you have to also recognize that the organizational structure of the Association, the tripartite, has an effect on the relevance of ADA policy. Sometimes individual states have internal conflicts or political pressures that mandate a departure from long standing policies which create a conflict with the parent organization. That is both the advantage and the conundrum of being a confederation of state associations. Therefore, if you practice in Alaska or now Minnesota, your state dental practice act may be in conflict with ADA policy on midlevel providers. The current policy developed by the HOD restricts the delegation of diagnosis, treatment planning, and irreversible procedures to anyone other than a dentist. That stand is based on the educational requirements necessary to provide those services, as well as, a long standing track record of public safety. In addition, there are no similar uses of auxiliaries in the healthcare arena. Proponents of midlevel providers often compare them to the Nurse Practitioner in medical practice, but the training is significantly more stringent for Nurse Practitioners and they are not allowed to perform surgical procedures as is the case with DHATs. There are many questions about the effectiveness, safety, long affects on public dental health of this type of delivery system. It is not enough to point to the use of DHATs in Europe and New Zealand as evidence of their validity. The last time that I looked the US is still considered the model for dental care throughout the world, and until we see an objective, peer reviewed, scientific evaluation of the long term effectiveness of the DHAT programs, the ADA is taking the responsible position on this issue.

Similarly, licensure is ultimately the responsibility of the individual state licensing agencies, and is not within the statutory mandates of the ADA. For many years, ADA policy has encouraged states to accept a common content dental licensing exam, and to recognize the results of other testing agencies. In addition, current policy also calls for the elimination of live patients when a proven alternative is available. As recently as this past HOD, a resolution passed that asked the ADA to study a written exam alternative to the clinical exam as a means to eliminate live patients. If you were a member from a state like New York, you might think that the ADA policy on licensure does not go far enough to foster mobility; however, if you were a member from one of the independent states, you would consider the ADA policy to be meddling. In the end, the people with the fiduciary responsibility for the protection of the public will decide what form of examination is appropriate for their needs, regardless of ADA policy.

Finally, regarding the concern that the ADA represents specialists at the expense of GPs, I think we have to admit that we all view an issue based on our own experiences. Therefore, if you are a specialist, you will tend to evaluate policy from a specialist point of view, and the same would be true of GPs. Remember that our profession is about three quarters’ generalists and one quarter specialists. The House of Delegates tends to mimic those percentages, so it is unlikely that policy would pass that specifically favors the needs of a specialty group at the expense of another or GPs. More commonly, good policy is the one designed to be relevant to all the practice communities. With a years experience as your Trustee, I can say without hesitation that the ADA speaks for the entire the profession and dental health of the public.