D EC EM B ER 2 0 2 3
Volume 36 • Issue 4
Havens for Pediatric Oral Healthcare NYU College of Dentistry is responding to need for oral healthcare for children in precarious living situations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
NEWS AN OFFICIAL PUBLICATION OF THE NEW YORK STATE DENTAL ASSOCIATION
Following in Distinguished Footsteps UB professor and researcher receives first appointment to endowed chair . . . . . 6 Putting an End to Insurance Nightmare The insurance verification process doesn’t have to be challenging. You just need to know how to handle it . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Out of the Office and Running for Charity
K
NYSDA members tackle the New York City Marathon for health and pet projects.
endra Zappia, D.D.S., and Morgan Fryer, D.D.S., of Albany are sisters, partners in practice and running mates. And while it’s not unusual for them to run races together, this year was the first time they teamed up for the New York City Marathon. CONTINUED ON PAGE 10
Contemplating Selling Your Practice? Consider These First Steps Benjamin P. Malerba; Douglas E. Menikheim; Sean N. Simensky How to start? Let experts guide you through some of the initial steps involved in a sale process, including preparing your practice for sale and finding a potential suitor. YOU HAVE DECIDED it’s time to sell your dental practice and find a potential buyer. Will that buyer be another practice or a dental service organization (DSO)? A sale to a DSO typically involves greater scrutiny into your practice’s financial and operating history than selling to another dental practice. With that in mind, if time permits, one of the most beneficial things you can do is to begin working with your professional advisors early in the process before engaging in any meaningful conversations or negotiations with a potential suitor. Your goal is to prepare the practice for a sale, so that once you have found a potential buyer (whether that buyer is another practice or a DSO), you will be able to obtain the best possible deal. In addition, with early preparation, the transaction process will run smoothly, helping you avoid headaches, stress and additional expenses.
CONTINUED ON PAGE 11
Kendra Zappia, left, and Morgan Fryer celebrate completion of New York City Marathon. The sisters are partners in Zappia and Fryer General Dentistry, Albany.
NYU College of Dentistry Providing Oral Healthcare for Children from Migrant and Asylum-seeking Families MORE THAN 110,000 people seeking asylum have arrived in New York City since last spring—many of them families with young children. These children are facing a range of challenges, from the trauma of a difficult journey to the United States to unstable housing and language barriers in their new schools. One little-discussed challenge is poor oral health and a high prevalence of cavities. Research shows that refugee children experience many barriers to receiving dental care, including cost, different cultural norms and beliefs about oral health, difficulty navigating the healthcare system, and language barriers. NYU Dentistry’s Department of Pediatric Dentistry has been working to remove these obstacles to provide a range of services to meet the oral health needs of children from migrant and asylum-seeking families in New York City—often where they already are. Their approach is three-fold: Outreach events. NYU dental professionals and students take part in outreach events to provide oral health education, toothbrushes, dental exams, and apply fluoride varnish to children’s teeth. Thus far, CONTINUED ON PAGE 13
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Assisting at outreach event in New York City school are Kamen Cheung, fourth-year dental student at NYU COD, and Lorraine Santana, Bringing Smiles Dental Enrichment Program intern.
D E CE M BE R 2 023
NEWS EDITOR
NYSDA OFFICERS
Chester J. Gary, D.D.S., J.D.
Anthony M. Cuomo, President Prabha Krishnan, President-Elect Maurice Edwards, Vice President Paul Leary, Secretary-Treasurer William Karp, Speaker of the House Gregory D. Hill, Executive Director
MANAGING EDITOR Mary Grates Stoll
ADVERTISING & SPONSORSHIP MANAGER Jeanne DeGuire
ART DIRECTOR Ed Stevens
NEWS
Editorial and advertising offices are at Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370. Telephone (518) 465-0044. Fax (518) 465-3219. Email info@nysdental.org. Website www.nysdental.org.
Volume 36 • Issue 4
The NYSDA News (ISSN 1531684X) is published quarterly, in February, May, October and December, by the New York State Dental Association, Suite 602, 20 Corporate Woods Boulevard, Albany, NY 12211-2370. It is available in digital form only and accessible online in the members-only section of the NYSDA website, www.nysdental.org, under publications.
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Water Fluoridation Advocate Honored THE NEW YORK STATE ORAL HEALTH COALITION honored Wayne Harrison, D.D.S., of Middle Grove, Saratoga County, with its Dr. Thomas R. Curran Award, recognizing him for his exemplary personal effort to preserve fluoridation in the City of Gloversville. Dr. Harrison received his award in November, presented by Coalition member Betsy Bray, NYSDA Director of Health Affairs. Over the course of several months, Dr. Harrison met with town leaders, attended city council meetings, organized written materials and went to water treatment plants to meet and work with water operators. His award honors oral surgeon Thomas Curran of Elmira, a champion of community water fluoridation.
NEWS
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Corrective Jaw Surgery
When should you consult an OMS for corrective jaw surgery? When a jaw-related problem cannot be resolved through orthodontia alone, the patient should be referred to an oral and maxillofacial surgeon (OMS). OMSs are uniquely qualified and trained to determine the appropriate procedure for each case and to work with the orthodontist and restorative dentist to assure a successful outcome. Visit MyOMS.org for more information.
MyOMS.org © 2019 American Association of Oral and Maxillofacial Surgeons (AAOMS).
AAOMS_CorrectiveJaw_8x10-875in_2019.indd 1
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UB Professor Appointed to Robert Genco Endowed Chair
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atricia Diaz, D.D.S., M.S., Ph.D., professor of empire innovation at the University at Buffalo School of Dental Medicine and director of UB’s Microbiome Center, has been appointed to the Sunstar Robert Genco Endowed Chair.
Patricia Diaz
Robert Genco, SUNY Distinguished Professor of Oral Biology, Periodontics and Microbiology and founder of the Microbiome Center, was a prolific researcher who forged a 40-year collaboration between Sunstar, a multinational healthcare company, and UB. He died in March 2019. In 2020, Sunstar donated $1 million to establish a new endowed fund to honor Dr. Genco. The new five-year position recognizes and supports UB faculty who are not only gifted teachers but also scholars, researchers and applied learning innovators who facilitate medical and dental collaboration in oral biology and periodontal medicine in its dental school. The holder of the chair will also serve as a liaison between UB and Sunstar to continue Genco’s research legacy. Diaz is the first faculty member to be named to the chair. Dr. Genco’s lab was responsible for numerous findings, including the identification of bacteria responsible for periodontal disease and determining that smoking, osteoporosis and stress are risk factors for periodontal infections. His research on gum disease led to the commercialization of 10 oral healthcare products. The formation of the GUM brand of oral health products in 1989 was largely influenced by Dr. Genco’s partnership with the Sunstar Group.
Dr. Diaz came to UB in 2020 from the University of Connecticut, where she served as associate professor of oral health and diagnostic sciences. She is a leader in the study of microbiomes, which are the communities of microorganisms that live on and in human and animal hosts. She aims to understand community dynamics and develop tools to manipulate the microbiome to stop the development of periodontal disease. This month, she was one of 11 fellows selected for the 2024 Hispanic Leadership Institute class for the State University of New York and the only fellow from UB chosen for the class of 2024. At UB, Dr. Diaz served as co-principal investigator last fall for two projects funded by $7.8 million in grants from the National Institute of Dental and Craniofacial Research. In conjunction with Roswell Park Comprehensive Cancer Center and the Albert Einstein College of Medicine, she has been exploring the influence of the oral microbiome on both the risk of developing oral thrush during cancer treatment and the risk of infection with cancer-linked human papillomavirus (HPV) among people with HIV. In May, she published findings in JDR Clinical and Translational Research that she and other UB researchers conducted on the benefits of an antimicrobial mouthrinse for individuals with Type 2 diabetes being treated for periodontitis. Earlier this autumn, Dr. Diaz received a prestigious National Institutes of Health (NIH) grant designed to develop a training program at the University of the West Indies Mona Campus in Jamaica. It is aimed at studying the determinants of periodontitis and associated non-communicable chronic diseases in the Caribbean. Dr. Diaz earned her Doctor of Dental Science degree from CES University in Colombia, her Ph.D. from the University of Adelaide and her Master of Science from the University of North Carolina at Chapel Hill, where she also completed her residency in periodontology.
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Since 1996, our team of experts have provided successful transition services exclusively to dentists. Choice prides itself on its reputation for integrity, service and results.
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Alleviating Insurance Verification Challenges If there was a better way to manage insurance verification that improved office operations and your bottom line, wouldn’t you take it? Robert McDermott
T
here are few things that challenge modern healthcare for both the provider and the patient quite like managing insurance. Patients find their coverage difficult to understand, and dental practices struggle to verify coverage and benefits prior to in-office visits. For that reason, patients often rely upon their dentist offices to verify their insurance for care and procedures.
The insurance verification process should be easy but, instead, it’s often lengthy and slow, occupying resources that could be better used to improve office efficiencies and patient services. Still, it’s a necessary task. Insurance verification and pre-approval ensures your dental practice is paid for its services. Finding ways to both improve the process and save resources is, for many dental practices, a top priority. Most dental offices are still relying on manual insurance verification processes. True, you have patient information on file, but must go record-by-record to check any patient on the schedule. Or, you have to wait until a patient completes a form that includes all their insurance information. Most practices dedicate at least one staff member to insurance for at least 20 hours per week. You’re paying a staff member to make phone calls rather than provide support or patient services. Many dental offices are already finding themselves short-staffed.
NEWS
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Buying or Selling a Practice?
Former New York State Dentist Publishes Book on Restorative Dentistry
EXPERIENCE MATTERS
A YEAR INTO WRITING BLOGS for his Online World Academy of Restorative Dentistry
(ONWARD)
Edward
Feinberg,
website, D.D.S.,
realized he had the makings of a book. And, thus, “Open Wide” came to be. Subtitled “Essays on Navigating Challenges in Dentistry to Achieve Excellence,” the 329-page collection of the author’s ob-
Edward Feinberg
servations and experiences, is available on Amazon.com.
Dr. Feinberg, who lives and works in Arizona, practiced dentistry in Scarsdale, NY, for more than 40 years. A good deal of that time was spent working alongside his father, NYSDA past president Elliott Feinberg, to whom he dedicated his book. (Dr. Feinberg served as president in
E S TA B L I S H E D I N 1 9 8 8
1997. He died in 2000.) Edward Feinberg is director of the ONWARD pro-
973-744-4747 212-233-7300 www.practice-broker.com
gram, described as a “unique dental continuing education website…intended to be a valuable resource of dental courses and literature in restorative dentistry.” The program was founded, according to Dr. Feinberg, to educate den-
Let our 30+ years of experience guide
tal professionals on proven concepts and techniques not taught in any dental school.
you through your transition. If you are
Dr. Feinberg is a graduate of Tufts University. He is
are Buying or Selling a dental practice
a nationally recognized lecturer and author of scientific and educational articles for dental publications and
in New York or New Jersey, contact us
the textbook “The Double-Tilt Precision Case for Natural Teeth and Implants.” He is past president of New York’s
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Ninth District Dental Association and currently sits on the Arizona Dental Association Council on Annual Ses-
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sions and as secretary-treasurer of the Central Arizona Dental Society. To learn more about ONWARD, email info@theONWARDprogram.com.
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Out of the Office continued from page 1 That’s 26.2 miles through all five boroughs of New York City, a course the sisters finished in a little over six hours. “We had a great time along the way, enjoying the spectators and city,” Dr. Zappia related. The marathon, run on the first Sunday in November (Nov. 5 this year), invites participants to use their outing to raise funds for their favorite charity. Drs. Zappia and Fryer designated the Arthritis Foundation as their beneficiary. Dr. Zappia, who suffers from a form of arthritis known as ankylosing spondylitis, said she put the names of the children and adults she and her sister know who are afflicted by arthritis on her sneakers “to carry them with us.” Elsewhere on the course, running slightly ahead of Drs. Zappia and Fryer, was Tricia Quartey-Sagaille, D.D.S., of Brooklyn. Running in her second NYC Marathon, Dr. Quartey-Sagaille had two goals: to raise funds for Shoe4Africa, an organization that works to empower African women and children through healthcare, and to bring awareness to the need to strengthen Black maternal health. Dr. Quartey-Sagaille, who gave birth to her first child last October, said Black women are fearful of childbirth because they face a higher risk of complications and death than women of other races.
Tricia Quartey-Sagaille in triumphant finish of New York City Marathon. Dr. Quartey-Sagaille is general family dentist in Park Slope, Brooklyn. A new mom, she ran to honor her son, Kendrick Sagaille.
She also managed to best her time, finishing the course in just under six hours. When she ran the marathon in 2014, she finished in 6 hours and 39 minutes after injuring her knee at mile 10 and having to walk most of the remaining 16 miles.
All three women are active members of NYSDA. Dr. Zappia is president of the Third District Dental Society, chair of the NYSDA Council on Membership and Communications and a delegate to the ADA House. Dr. Fryer is a member of the NYSDA Committee on the New Dentist. Dr. Quartey-Sagaille is president-elect of the Second District Dental Society, a delegate to the ADA and NYSDA houses, and a member of the NYSDA Council on Dental Practice and NYSDA Support Services. And all three are dedicated runners. Dr. Quartey-Sagaille grew up doing sports, including track and field, and she has run a dozen or more New York Road Runners races. Drs. Zappia and Fryer run to keep their bodies and minds healthy, Dr. Zappia said, but their outings serve another purpose as well. “Running,” she said, “actually gives us an outlet for the stress of running a dental office and gives us time to discuss what is going on at the office and how we can make changes to keep improving.”
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Selling your Practice continued from page 1 Your first step should be to work with your accountant(s) and financial advisor(s) to ensure that your practice has accurate and comprehensive tax and financial documentation readily available and to address any accounting matters that might be of concern to a potential buyer. Typically, a DSO will provide you with an initial valuation and proposed purchase price after reviewing basic financial information about your practice, including financial statements. In order to ensure that the practice’s operations support the DSO’s valuation and the purchase price they are willing to pay you, a DSO will subsequently conduct extensive financial due diligence about your practice. When the DSO requests specific financial and tax information, you will want to have those documents and information organized in a presentable and readily accessible manner. Working with your accountant(s) and financial advisor(s) early on will also allow them to mitigate any issues arising during the financial due diligence process and/or negotiations. Similarly, you should begin to think about engaging legal counsel to assist you with preparing the practice for sale and advising on any proposed transaction. Now, perhaps you have an attorney who has handled small matters for you in the past, or you remember that your cousin is an attorney (albeit a real estate attorney), and you are thinking to yourself that this individual should be able to handle the transaction. You would be doing yourself a big disservice by engaging this individual. The sale of your practice is one of the most important events in your professional career, and your goal should be to find legal counsel that has experience in both the dental industry and transactional experience with selling a dental practice, particularly with selling to a DSO. By doing so, you are ensuring that you will receive sound legal advice and signal to the buyer that you are taking the process seriously. We have seen attorneys nearly kill deals or not properly advise their clients of certain risks because they did not understand the transactions that they were advising on.
Be Proactive Once you have chosen competent legal counsel, you should work with them to help ensure that all of the practice’s policies and procedures (e.g., HIPAA and data privacy policies) are up-to-date and documented. You and your counsel should also review the practice’s operations to identify and address any potential compliance deficiencies. As you are aware, the healthcare industry is highly regulated and compliance matters can often be confusing and costly, so it is important to have competent counsel guiding you. Addressing these matters early on will allow you to provide diligence materials and responses to a potential buyer in a timely and efficient manner. In addition, if the buyer identifies a compliance defect during the diligence process, it will help to show that you are already aware of it and you either have corrected it or are in the process of correcting it with the advice of legal counsel. You do not want to learn about an operational/compliance deficiency for the first time during the due diligence process or negotiations because it could stifle any leverage you had with the buyer or, if serious enough, scuttle a transaction entirely. Even worse would be for a buyer to uncover it after the closing and look to you for indemnification for damages. Finally, you can work with your legal counsel to identify and compile documentation that a buyer will likely request during the due diligence process, such as third-party contracts and leases. Again, the overarching idea with engaging your professional advisors at this point in the process is that you want to be “proactive” rather than “reactive.” From the buyer’s perspective, it shows that you are serious and committed to the sale process. For you, it means saving yourself time, money and headaches during the transaction and, potentially, after the transaction has closed.
Finding a Buyer In years past, a dentist might only need to look to his/her associate dentists as a potential means to transition the practice or sell to any number of other local practices interested in expanding their footprint. Today, those opportunities are becoming scarcer, and practice owners are looking more and more to the growing number of DSOs that frequently bombard them with letters of interest and cold calls regarding a potential sale. However, it’s important to identify the “right” suitor, and there are different ways of doing so. One approach is to research and reach out to potential buyers on your own. If you have an established practice, it is likely you have received a number of unsolicited letters or calls from various DSOs. Often, DSOs will send prac-
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Selling your Practice continued from page 11 tice owners marketing materials highlighting their track record, the expected operational synergies when affiliating with the DSO, how they approach transactions and the type of practices they are looking to affiliate with, and what a practice owner can generally expect following a transaction. A first step is to contact one or more of these potential suitors to begin preliminary discussions about a sale. Another resource to utilize is other local dentists who have already undergone the process of affiliating/selling to a DSO. This is a particularly useful approach because you will have someone facilitating an introduction to the DSO and, more importantly, you will have the ability to gain insight from a peer about their experiences with the DSO during the transaction and quality of life following the transaction.
Another approach would be to engage a business broker or investment banker to help you market your practice and find a buyer who would be the best fit for you.
Another approach would be to engage a business broker or investment banker to help you market your practice and find a buyer who would be the best fit for you. Both a business broker and an investment banker can provide immense assistance in preparing a confidential information memorandum regarding your practice (i.e., a slide deck summarizing the operations of the practice and highlighting its financial performance, which is provided to potential buyers), identifying potential buyers, evaluating multiple offers, and assisting with compiling necessary due diligence materials that potential suitors will request, particularly financial due diligence materials and information. Another significant service that both offer is assisting you with reviewing and negotiating a DSO’s valuation of your practice (e.g., adjusted EBITDA calculations) and any negotiations relating to the financial terms of the transaction. This latter service is often a key differentiator between a business broker and an investment banker. As you might guess, these services come with a fee, which is often based on a mix of a fixed fee and “success fee” (i.e., a percentage of the sale price). Investment bankers typically seek larger percentage-based fees and will only take on transactions that cross certain purchase price thresholds. Your job is to evaluate the fees associated with engaging a business broker or investment banker to determine whether they are warranted in relation to the services that they will provide to you. Regardless of the approach you take, when evaluating DSOs, you will want to perform some of your own basic diligence and ask the following preliminary questions:
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Is this an organization (both the DSO and its affiliated dental practice) I want to partner with and be employed by?
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Will this organization help to enhance my reputation or tarnish it?
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What is the organization’s track record with other sellers?
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How is the DSO viewed in the market?
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Will my patients receive an enhanced level of service?
You’ve worked hard to build a successful practice, so it may not always make sense to select the buyer offering the highest purchase price. It often involves evaluating which buyer is the best fit for continuing what you have built. The authors are attorneys with Rivkin Radler Attorneys at Law, Uniondale, NY (www.rivkinradler.com), a member of NYSDA’s Legal Services Panel, specializing in contract analysis. Inquiries should be directed to Joel M. Greenberg at Joel.Greenberg@rivkin.com. Benjamin P. Malerba, Esq., is co-chair of the Health Services Practice Group and a member of the Cannabis and Privacy, Data & Cyber Law practice. His practice also covers data breach and response, cybersecurity and data security, with a particular focus on security breaches related to HIPAA. Douglas E. Menikheim, Esq., focuses his practice on representing and advising healthcare clients in connection with corporate transactions, including entity formation, private equity investments, mergers and acquisitions, divestitures, joint ventures, private placements and other strategic transactions, as well as corporate governance matters and commercial contracts. Sean N. Simensky, Esq., concentrates his practice on general corporate representation of private and international companies, not-for-profit corporations, physicians, group medical practices and other health services clients, including dentists, as well as representing financial institutions, private lenders and borrowers in loan transactions.
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NYU continued from page 2 they’ve provided dental exams and fluoride varnish to approximately 300 children and have shared oral health information and resources with approximately 1,200 families at Open Arms Resource Fairs at The Shed, a community event organized by the Department of Education to provide resources to families living in NYC’s temporary housing. School-based care. NYU Dentistry provides dental screenings and care in New York City public schools and Head Start centers. School-based care has been shown to lower the barriers to dental care by bringing care to children. In several high-need schools, including those with large numbers of migrant children, students are seen twice a year for cleanings, fluoride, sealants, X-rays and even filling cavities and extractions, serving as the children’s “dental home.” An estimated 200 children from asylum-seeking families are receiving ongoing dental care in NYC schools. Follow-up care at NYU Dentistry. Children who are screened at outreach events and those who are seen in schools but need more in-depth care that is best provided in a dental office are invited to schedule appointments at NYU Dentistry. Care is provided at no cost to families, with funding from the New York City Council covering the cost of basic oral healthcare for children who are uninsured. A grant from the Mother Cabrini Health Foundation provides additional funds for dental care, as well as transportation to and from NYU, as getting children to appointments is a significant barrier to care. For many of these children, these interactions mark the first time they are seeing a dentist, says Dr. Rose Amable, clinical assistant professor of pediatric dentistry at NYU and one of the dentists caring for migrant children both in schools and at NYU. Beyond cleaning and fixing teeth, Dr. Amable, a native Spanish-speaker, is often communicating directly with migrant parents to educate them about oral health and help them to get their children to appointments at NYU Dentistry.
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Alleviating Insurance continued from page 8 The last thing a dental practice or patient wants is to impede this process any further or have a claim denied. Denied claims not only delay care and frustrate patients, they also interrupt cash flow to your dental practice. How can dental practices simplify and improve the insurance verification process? 1. Verify early Whether it’s staffing constraints or patient delays, waiting until the day of or day before a scheduled appointment can be a mistake. For instance, it limits staff to checking only new patients or patients with known insurance changes. If there are miscommunications, or other unexpected errors or delays, it may lead to a canceled appointment, unscheduled treatments or worse. 2. Create a thorough, but simple process First, consider online forms. Manual data entry is one area with potential for human error to complicate the process. When emailed a form or a form is available online, patients can quickly fill it out. Further, many online forms will integrate with your existing practice management system to facilitate the process and improve accuracy. 3. Get a full breakdown of insurance benefits Keeping dental insurance benefits thorough and updated means you can quickly verify whether certain dental services or procedures are eligible through the patient’s insurance. 4. Consider leveraging technology to remove the burden from staff The newest automated insurance verification software can offer considerable advantages such as: •
Verification in seconds for every patient on the schedule each week (rather than one patient at a time)
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Built-in error reporting for quick resolutions
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More accurate estimates and higher acceptance rates (fewer denials)
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Real-time benefit information and remaining coverage data
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Robust reporting and revenue updates
Any effort that can streamline the process, help the patient and support your bottom line is an effort worth making. Mr. McDermott is president and CEO of iCoreConnect, a NYSDA endorsed partner. iCoreVerify completes automated insurance verifications - up to seven days in advance - for every patient on the schedule. Book a demo now at iCoreConnect.com/NY12, or call (888) 810-7706. NYSDA members receive substantial discounts on iCoreVerify by iCoreConnect.
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