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ACT ION
THE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION
JANUARY 2012
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VOLUME 32, NUMBER 1 • JANUARY 2012
ACTION
on the cover
ACT ION
THE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION
GDA ACTION (ISSN 0273-5989) The official publication of the Georgia Dental Association (GDA) is published monthly. POSTMASTER: Send address changes to GDA Action at 7000 Peachtree Dunwoody Road N.E., Suite 200, Building 17, Atlanta, GA 30328. Phone numbers in state are (404) 636-7553 and (800) 432-4357. www.gadental.org. Closing date for copy: first of the month preceding publication month. Subscriptions: $17 of membership dues is for the newsletter; all others, $75 per year. Periodicals postage paid at Atlanta, GA. Dr. Jonathan Dubin GDA Editor 2970 Clairmont Rd Suite 195 Atlanta, GA 30329
Delaine Hall GDA Managing Editor 7000 Peachtree Dunwoody Rd NE Suite 200, Building 17 Atlanta, GA 30328
2011-2012 Georgia Dental Association Officers Michael O. Vernon, DMD, President Sidney R. Tourial, DDS, President Elect Marshall H. Mann, DDS, Vice President James B. Hall III, DDS, MS, Secretary/Treasurer Jonathan S. Dubin, DMD, Editor
GDA/GDIS Executive Office Staff Members Martha S. Phillips, Executive Director Nelda Greene, MBA, Associate Executive Director Delaine Hall, Director of Communications Skip Jones, Director of Marketing (GDIS) Courtney Layfield, Director of Member Services Victoria LeMaire, Medical Accounts Manager Judy Lively, Administrative Assistant (PT) Melana Kopman McClatchey, General Counsel Denis Mucha, Director of Operations (GDIS) Margo Null, Property and Casualty Accounts Manager Patrice Williams, Administrative Assistant Phyllis Willich, Administrative Assistant Pamela Yungk, Director of Membership & Finance GDA Action seeks to be an issues-driven journal focusing on current matters affecting Georgia dentists, patients, and their treatment, accomplished through disseminating information and providing a forum for member commentary. © Copyright 2012 by the Georgia Dental Association. All rights reserved. No part of this publication may be reproduced without written permission. Publication of any article or advertisement should not be deemed an endorsement of the opinions expressed or products advertised. The Association expressly reserves the right to refuse publication of any article, photograph, or advertisement.
JANUARY 2012
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010, and since that time many elements of the federal health care reform legislation have been put into motion. Most people are unaware of the broad and far-reaching changes that will be made when the PPACA is fully implemented by 2014. See page 20 for a series of articles discussing the far-ranging scope of the Act; how the Act impacts dentistry; currently active provisions; provisions on the horizon; and Georgia’s Health Insurance Exchange proposal.
other features
sections
10
Give Kids a Smile: Districts Gear Up for February 3
4
Parting Shots
5
Editorial
2012 Checklist: Complying with Regulations and Deadlines
7
News and Views
9
Calendar of Events
27
Classifieds
12 16
Legislative Update: The GDA Sets Four Major Goals
18
Update on Medicaid Issues
25
GDA Annual Meeting Preview: Amazing in Amelia
Member Publication American Association of Dental Editors
index of advertisers Note: Publication of an advertisement is not to be construed as an endorsement or approval by the GDA or any of its subsidiaries, committees, or task forces of the product or service offered in the AA Anesthesia, P.C. . . . . . . . . . . . . . . . . . . . . .23 AFTCO Transition Consultants . . . . . . . . . . . . .31 Atlanta Age Management Medicine / Dr. Ana Casas . . . . . . . . . . . . . . . . . . . . . .29 Center for TMJ Therapy . . . . . . . . . . . . . . . . . .17 The Doctor’s Safety Net . . . . . . . . . . . . . . . . . .22 Elite Dentistry—Dr. Ruth Clemans . . . . . . . . . .11 GDA Dental Recovery Network . . . . . . . . . . . .15
advertisement unless the advertisement specifically includes an authorized statement that such approval or endorsement has been granted.
Georgia Dental Insurance Services . . . . . . . . .32 Georgia Academy of Cosmetic Dentistry . . . .15 Great Expressions Dental Centers . . . . . . . . . . .9 Hinman Dental Society . . . . . . . . . . . . . . . . . . . .2 Law Office of Stuart J. Oberman . . . . . . . . . . .14 Louisiana Dental Association . . . . . . . . . . . . . .10 Officite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19 PDQ Services . . . . . . . . . . . . . . . . . . . . . . . . . .30
Dr. Mark Padolsky—TMD Dentist . . . . . . . . . .13 Paragon Dental Practice Transitions . . . . . . . .26 Professional Practice Management . . . . . . . . .26 Shaul Beckman Paige, LLC . . . . . . . . . . . . . . .30 Southeast Transitions . . . . . . . . . . . . . . . . . . . .28 UBS Financial Services, Inc, . . . . . . . . . . . . . . .6
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editorial perspective
The Cost of Education
Jonathan S. Dubin, DMD
“We must educate consumers as to how to better care for their health, but is it not of even more importance to teach them the value? If we cannot change their mindset on value, how can we expect the statistics to change?”
The biggest threat to dentistry is silent. If you have been out of school for a while, or don’t currently know someone in dental school, you might not be as aware of the threat. It’s the cost of educating a dentist. The cost of dental education is steep. Think about it. The clinic at a school has the same or even higher overhead costs as a private dental office considering technology, materials, and supplies. A clinic can typically accept only a limited number of patients, and students receive reduced fees for the services they provide. Compare that to a teaching hospital that can charge full fees. The cost of education in general has skyrocketed over the past couple of decades. I have two children in college and one in kindergarten. I fully expect I will pay more to educate the one now in kindergarten than I paid to educate my two sons combined. Dental school costs are no different in that they have risen dramatically since I matriculated in 1979. I’m almost embarrassed to say how little my costs were when I attended dental school, but in 1983, I graduated with a debt of $27,000. That was then. A recent American Dental Association survey* reveals that tuition for a first-year in-state resident ranged from a low of $8,091 per year (University of Puerto Rico) to a high of $76,832 per year (University of the Pacific). First-year non-resident tuition ranged from $16,991 to $76,832 (same two schools). Keep in mind that those numbers are only for tuition and not the many associated costs attached to the final bill. The same survey found that mandatory general fees for all students averaged $2,425 per year, while other first year costs (instruments, textbooks, health services, other fixed cost items) averaged $10,377 per year. Add in additional fees and the cost of room and board and then multiply by four years. Is it
any wonder that many of today’s dental students graduate with backbreaking debt? Put that on top of any undergraduate school debt a student may have. I have talked to several students, recent graduates from our state school, who are saddled with debts ranging from $220,000 to over $300,000. That’s a lot of debt to carry just coming out of school. Think of the choices you might have made entering the profession’s workforce with that amount of debt. Think about the choices they will make. What is the final cost then? The Emile T. Fisher Foundation for Dental Education in Georgia, whose sole purpose is to provide scholarship money to dental students in Georgia, has had to dip into its corpus to keep the scholarship dollars given at the same level as years’ past. Perhaps not the most prudent measure, but the urge to help dental students however possible was the motivation. The economic downturn we are experiencing pushed the Foundation’s board to take this exceptional measure, as tuition money sources are becoming more and more difficult to identify. The fact is that the future of our profession, the future of the GDA, and the future of the ADA is reliant on students, on new dentists, on membership, on dues, and on donations. What do dentists value? What do newly graduated dentists value? Where would the profession be without organization? And organization is nothing without membership. Fast forward 20 years. Picture our organizations if new dentists can’t afford to be members or do not perceive value in membership. You, who are reading this, know the value of the ADA, GDA, and Districts. You can go the respective web sites for a refresher if need be.
EDITORIAL Continued on page 6 GDA ACTION JANUARY 2012
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EDITORIAL Continued from page 5
What Are You Thinking?
But our organizations can be compared to a house of cards. Membership is the linchpin card. The stranglehold that debt can place on a student or new dentist is the card leaning against the membership card. Don’t we owe it to the students to help find ways to pay for their education? We owe it to ourselves. The bottom line is we need to do more. At the 2011 ADA Annual Session, one of the resolutions that passed the House of Delegates directed the ADA explore ways to alleviate the debt burden on our new dentists. Perhaps legislators will link loan forgiveness with practicing in dentist shortage areas. And there is a link on the GDA web site where you can pledge to assist the Fisher Foundation. It is easy. Just click.
What Are You Doing?
Do you have an opinion about an article published in the GDA journal or observations about a GDA activity that you would like to share? Please email your comments to Editor Dr. Jonathan Dubin at jsdubin@aol.com or Managing Editor Delaine Hall at hall@gadental.org. Your comments may be selected for publication in the GDA journal. Dr. Dubin’s term ends in July 2012, so if you have been waiting to tell him something, don’t wait too long.
Have you won a dental award? Accomplished a dental goal? Participated in a charitable dental event? Conducted an inspiring staff retreat? Recruited a non-member dentist? Generally accomplished something notable and dental related? Let the GDA know! Please email your information to Editor Dr. Jonathan Dubin at jsdubin@aol.com or Managing Editor Delaine Hall at hall@gadental.org. (Dentists with interesting “outside the profession” hobbies are invited to contact the GDA journal as well. You could be featured in Breaking the Mold!)
Where Are You Going? * American Dental Association 2009-10 Survey of Dental Education Academic Programs, Enrollment, and Graduates— Volume 1; and 2009-10 Survey of Dental Education Tuition, Admission, and Attrition—Volume 2.
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Are you planning to attend a LAW Day? District legislative reception? Other GDA or district event? Feel free to share your photos from the event with the GDA journal or on the GDA Facebook closed group page. Please email your photos to Managing Editor Delaine Hall at hall@gadental.org or visit the social networking site and search for “Georgia Dental.”
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general news 2012 Leadership GDA Kudos to the participants in the inaugural GDA leadership development class: Drs. Jason Mann of Central; Brad Hall of Eastern; Evis Babo, Sarabess Baumrind, Ron Cavola, Brook Corbett, Ryan Vaughn, and Lee Whitesides of Northern; Hank Bradford, Casey Hart, Elizabeth Lewis, Freddie Padilla, and Kumar Patel of Northwestern; Cara DeLeon and Matt Rosenthal of Southeastern; and Bo Broadfoot of Southwestern. President Mike Vernon named establishing a leadership pathway as one of his goals during his July 2011 inaugural speech and set up a Task Force on Leadership with Dr. Bruce Camp as chair to help meet that goal. “I want our GDA program to resemble the leadership training that cities and other groups do to help members learn more about the workings of their organizations and be more prepared to guide others,” said Dr. Vernon. “I am excited we have identified dentists who want to be in leadership positions and can give them the opportunity to grow and have their questions answered.” The doctors selected for the initial program have been invited to attend a dinner in January with the holding company and GDIS boards, the January 7 Board of Trustees meeting, the January 8 House of Delegates, the January 9 Dental Health Day at the Capitol, and the February 22 LAW Day followed by lunch and orientation at the GDA office. “We look forward to reporting the progress of our class and seeing them become involved in our Association,” said Dr. Vernon. “Thank you to them and Dr. Camp for working to make this project a success.”
WORKPLACE New Poster As of April 30, 2012, most private sector employers will be required to post a notice advising employees of their rights under the National Labor Relations Act. This requirement applies
to a variety of entities, including hospitals, medical and dental offices, social services organizations, child care centers, and residential care centers with a gross annual volume of at least $250,000. Covered entities are required to post the notice in a conspicuous place, where other notifications of workplace rights and employer rules and policies are posted. Employers also should publish a link to the notice on an internal or external web site if other personnel policies or workplace notices are posted there.
The poster, which is available AT NO CHARGE from the National Labor Relations Board web site, is required to be 11 x 17 inches, in color or in black-andwhite. If printing the poster at full size, set your printer output to 11 x 17. Or, you may print the two 8.5 x 11 pages and tape them together. For further information about the posting, including details of which employers are covered, and to obtain the poster, visit https://www.nlrb.gov/poster. You may also call (202) 273-0064 and request a mailed copy of the poster, again AT NO CHARGE. Don’t be fooled by high pressure sales calls, faxes, or mailers stating that you must buy a special poster to be in compliance with federal law. This poster, like all federal and state workplace posters, is available AT NO CHARGE. All you need is a phone or an Internet connection and a printer! The U.S. government is exceptionally good at producing paper and they are excited to share that paper with you!
GDA EVENT Spokesperson Training The GDA hosted its annual Spokesperson Training event in November 2011 with a brand new format. Crisis communications expert and “Georgia Gang” political commentator Jeff Dickerson was the instructor
for 26 dentists and dental student Bob Wilson. Feedback on the new format was sparkling. Fully 82.3 percent of the participants who completed a survey on the event rated the event as excellent, while 76.3 percent preferred the new format. All participants who completed the survey thought that this training was effective in helping them to understand and to convey the GDA’s messages. Kudos to the following individuals who took part in the training: Dr. Andy Allgood
Dr. Marshall Mann
Dr. Evis Babo
Dr. Donald Nelson
Dr. Jack Bickford
Dr. Kumar Patel
Dr. Bruce Camp
Dr. Kent Percy
Dr. Keith Crummey
Dr. Annette Rainge
Dr. Jonathan Dubin
Dr. Robin Reich
Dr. Nancy Gallagher
Dr. Troy Schulman
Dr. Brad Hall
Dr. Doug Torbush
Dr. Stan Halpern
Dr. Sidney Tourial
Dr. Jay Harrington
Dr. Mike Vernon
Dr. Lindsay Holliday
Dr. Donihue Waters
Dr. Jim Hutson
Dr. Carol Wolff
Dr. Tom Jagor
Bob Wilson (GHSU Student)
Dr. Janice Joyce
GDA President Mike Vernon and Public Relations Committee Chair Robin Reich with Spokesperson Training instructor Jeff Dickerson of the Georgia Gang. The television personality and writer tested GDA members’ knowledge of dental issues and ability to convey GDA messages.
NEWS Continued on page 8 GDA ACTION JANUARY 2012
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NEWS Continued from page 7
ADA Office Manual The American Dental Association (ADA) is offering the newly revised ADA Practical Guide to Creating an Employee Office Manual that is chock full of sample forms, checklists, policies and procedures. Obtain the guide for benefits including: • Updated sample job descriptions and interview questions • New sample policies on using cell phones and social media on and off the clock • New chapter on patient management
MEDICAID Fee Cut Averted The board of the Georgia Department of Community Health voted in December to rescind a 0.5 percent reimbursement cut for physicians, dentists, and other health care providers who treat Medicaid patients. The agency, in recommending that the cut not go through, said it had received financial relief from the state Office of Planning and Budget. The story as reported in the Georgia Health News included a quote from Associate Executive Director and LAW Day coordinator Nelda Greene applauding the board’s move. “Dentistry has already had cuts,’’ she told the news outlet. “We’re thrilled they don’t have to take any additional cut.’’ (From www.georgiahealthnews.com.)
• Updated HIPAA and OSHA policies • New employee performance evaluation forms
WHITENING
• Expanded section on natural disaster preparation
In a unanimous decision handed down in early December 2011 the Federal Trade Commission (FTC) ruled that the North Carolina State Board of Dental Examiners illegally stifled competition by stopping non-dentists from providing teeth whitening services. The dental board’s illegal actions led to higher prices and reduced choices for consumers, according to the Commission. The Commission’s Final Order requires the board to cease ordering non-dentists to stop providing teeth whitening products or services. The Final Order also requires the board to stop informing non-dentist teeth whitening providers and certain other persons that it is illegal for non-dentists to provide teeth whitening products or services. An initial FTC administrative complaint issued in June 2010 alleged that the North Carolina board sent dozens of letters instructing non-dentist teeth whitening providers that they were practicing dentistry illegally, and ordering them to stop. The complaint also alleged that the board sent letters to mall owners and property management companies urging them not to lease space to non-dentist teeth whitening providers. According to the complaint, the board’s actions reduced the availability of teeth-whitening services
The manual is available through the ADA Catalog at www.adacatalog.org or call toll free (800) 947-4746. The book with a CD-ROM is $89.95 for ADA members and $134.95 for non-member dentists. An e-book, available complete or in individual chapter downloads (prices vary accordingly) may be bought from www.adacatalog.org or for the Amazon Kindle or Barnes and Noble Nook. (From www.ada.org.)
EHRs ADA Resources A new resource, Electronic Health Records—A Primer, has been posted in the Dental Practice Hub on www.ada.org. The primer’s purpose is to update dentists on the growth of Electronic Health Records (EHR); provide information on EHR basics; present pros and cons on adopting EHRs, including the eligibility requirements to participate in the federal Government’s EHR incentive program; inform dentists on ADA EHR activities; and to provide sources for information on EHRs. (From www.ada.org.)
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FTC Ruling
in North Carolina and constituted an anticompetitive conspiracy among the dentists on the Dental Board. (From www.ftc.gov.)
TOBACCO Baseball Acts The American Dental Association joined more than 200 organizations in November to thank Major League Baseball Commissioner Bud Selig and Michael Weiner, executive director of the players’ union, for their historic agreement to limit the exposure smokeless tobacco receives during the baseball season. Under the agreement, players, managers, and coaches will no longer be able to carry tobacco tins or packages in their uniforms during games, or any time that fans are in the ballpark. They will be prohibited from using smokeless tobacco during televised interviews, at autograph signings, at team-sponsored appearances, and other events where they meet fans. The restrictions will become effective in the five-year contract to take effect in 2012. The agreement, while significant, does not affect the actual use of tobacco at games or on camera. It does, however, bolster tobacco education programs for players, and creates a new MLBPA center on cessation to help players quit. (From www.ada.org; www.tobaccofreekids.org.)
February 3, 2012 www.gadental.org
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General News: Upcoming Dental Events Apr 21 (Sat): GDA Board of Trustees Meeting, Atlanta.
May 26-June 2: GDA President’s Cruise to Canada / New England.
Apr 26-29 (Thu-Sun): GHSU Homecoming Festivities.
May 28 (Mon): GDA Office Closed for Memorial Day Holiday.
MAY 2012
JUNE 2012
Feb 9 (Thu): Northern District CE Meeting, Villa Christina, Atlanta.
May 3-6 (Thu-Sun): Ga. Academy of Dental Practice Meeting, Ponte Vedra.
June 8 (Fri): Finance Committee Meeting, GDA Office.
Feb 15 (Wed): LAW Day— Central District.
May 7-9 (Mon-Wed): ADA Washington Leadership Conference, Chicago.
June 16 (Sat): GDA Board of Trustees Meeting, Atlanta.
Feb 22 (Wed): LAW Day—Western District / Northern District Eastern and Central Branches / Leadership GDA Participants.
May 18-19 (Fri-Sat): GDA Presidents’ Elect Conference, Banning Mills.
JULY 2012
FEBRUARY 2012 Feb 3 (Fri): Give Kids a Smile Day. Feb 8 (Wed): LAW Day—Eastern District / Northern District Southern Branch.
Feb 29 (Wed): LAW Day— Northwestern District.
May 21 (Mon): Northern District Executive Council, GDA Office, Atlanta.
July 4 (Wed): GDA Office Closed for July Fourth Holiday. July 19-22 (Thu-Sun): GDA Annual Meeting, Amelia Island, Florida.
MARCH 2012 Mar 7 (Wed): LAW Day—Southeastern District, Ga Dental Society, N. Ga Dental Society. Mar 14 (Wed): LAW Day— Northern District Northern Branch. Mar 21 (Wed): LAW Day— Southwestern District. Mar 22-24 (Thu-Sat): Hinman Dental Society Meeting, Atlanta. Mar 26 (Mon): Northern District Executive Council, GDA Office, Atlanta. Mar 28 (Wed): LAW Day—Alliance, Northern District Hall County. Mar 30-31 (Fri-Sat): ADA Membership Conference, Chicago.
APRIL 2012 Apr 10-14 (Wed-Sat): Alliance of the ADA Spring Conference, Stone Mountain. Apr 18 (Wed): Northern District CE Meeting, Villa Christina, Atlanta.
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Council on Dental Health Encourages GDA Members to Give Kids a Smile in February Byron Colley, DMD Chair, Council on Dental Health
February is Children’s Dental Health Month (CDHM) in Georgia. While dental offices will conduct volunteer care and education activities all month for children regardless of their economic status, a big focus will be on February 3— Give Kids a Smile (GKAS) Day. This is an annual one-day volunteer initiative to provide preventive and restorative services to children from low-income families. On February 3, the GDA in conjunction with the district dental societies will coordinate free dental care for less fortunate children around the state. Georgia’s program needs the help of GDA member dentists, their spouses, and staff and there are two ways you can help (see below). After you conduct your CDHM and / or GKAS activities, please send information about your accomplishments to Courtney Layfield at the GDA Office (layfield@gadental.org). This information is critical in educating decision makers and elected officials about the efforts of Georgia’s dentists. You are welcome to send photos! However, please ensure that you have signed photo releases for persons in the photos, especially if the photo includes children. The GDA can provide you with a photo release to use at your event. The GDA appreciates all the volunteer efforts of dentists and their staff members in providing care for disadvantaged Georgia children and for helping to call attention to the oral health care needs of this patient population. We hope to see you at an event in February.
Volunteer at a District GKAS Program Over the last couple of years the GDA has moved to broaden its GKAS efforts so that dentists may reach out to lowincome children in their own communities. Districts will hold at least one GKAS event as listed below. The GDA encourages
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members to review the list, pick a location, and volunteer! Bring your staff members and family members as well. Take the first step by calling or emailing the contact dentist listed below for each district and mark February 3 off on your calendar.
Eastern District (Athens) Location: Dental Office of Drs. Erik and Jennifer Wells Contact: Dr. Jennifer Wells docwells8@yahoo.com (706) 548-7373
Central District Location: Several Private Dental Offices Contact: Dr. Shirley Fisher shffish@aol.com (478) 929-0296
Eastern District (Augusta) Location: GHSU Department of Pediatric Dentistry Contact: Dr. John Spratling jspratdawg@hotmail.com (706) 863-7351 This event is at GHSU, but any GDA dentists interested in volunteering are welcome!
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Northern District
Southwestern District
Location: Several Private Dental Offices
Location: Wiregrass Technical College in Valdosta
Contact: Dr. Robin Bingham rtbdds@bdg.fdn.com (770) 602-1138
Contact: Dr. Carly Thomas dds4children@gmail.com (229) 247-3200
Northwestern District
Western District
Location: West Georgia Technical College Hygiene School in Douglasville
Location: Several Private Dental Offices
Contact: Dr. Denise Hall hallortho35@bellsouth.net (770) 321-9494
Contact: Dr. Alex Cranford alex@cranfordbraces.com (770) 251-4444
web site at www.ada.org and download the planning kit you will find on the GKAS page to assist with the logistics of hosting a program in your office. School nurses and the local health department in your area are wonderful resources to identify children who truly need dental care and families that cannot afford it otherwise. Please register your independent program at the ADA’s web site as well so that they are aware of your efforts.
Please send your Children’s Dental Health Month and / or Give Kids a Smile Day activity details and photos to Courtney Layfield at layfield@gadental.org.
Southeastern District Location: Armstrong Dental Hygiene School in Savannah Contact: Dr. Stephanie Skinner skinnerdmd@gmail.com (912) 925-6613
Conduct Your Own GKAS Event Some dentists may prefer to coordinate events in their offices rather than participating in a larger GDA district sponsored event. If you wish to have a GKAS event at your practice, please log on to the ADA’s
This information is critical in educating decision makers and elected officials about the efforts of Georgia’s dentists and may be published in GDA Action.
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Did You Know: “Important Stuff” Checklist for the New Year Happy New Year! The GDA is using these pages to remind you of recent regulatory changes and other important issues to keep track of in 2012. Stay on track with the GDA! And visit the GDA web site at www.gadental.org for more coverage on breaking news and upcoming deadlines.
The One Where Dentists Use Current CDT Codes The 2011 / 2012 ADA Current Dental Terminology (CDT) code book contains 8 new dental procedure codes and 19 revisions to procedure code nomenclatures or descriptors that became effective January 1, 2011. To order call (800) 947-4746 or visit www.adacatalog.org.
The One Where the ADA Dental Claim Form is Updated Beginning on January 1, 2012, the updated version of the American Dental Association’s dental electronic claim form will include a field to report diagnostic codes. Dentists will not have to use diagnostic codes for typical claims. However, some insurers may cover services that require reporting of a diagnosis code (ICD-9-CM) when specific dental procedures may minimize some health risks associated with a systemic condition. Dentists should work with their software vendors to ensure that systems flag these specific claims and auto-populate the record with the appropriate diagnosis code.
The One Where Dentists Comply with CDC Regulations A dentist’s license can be sanctioned for failing to comply with Centers for Disease Control and Prevention recommendations for preventing the transmission of certain diseases. Visit www.cdc.gov to obtain a current copy of the CDC Guidelines for Infection Control in Dental Health Care Settings.
The One Where Dentists Use BMPs The ADA has developed “Best Management Practices for Amalgam Waste” and encourages
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all dentists who use this restorative material to adhere to them. The BMPs include using chair side traps, installing amalgam separators, and proper disposal or recycling. Visit www.ada.org for more details.
The One Where Dental Employees Insult the Practice on Facebook All dental offices should have an employee manual. Recognizing that an up-to-date manual should address matters such as an employee’s use of social media both in and out of the dental practice, the American Dental Association has revised its ADA Practical Guide to Creating an Employee Office Manual to address that issue. This manual is chock full of sample forms, checklists, policies and procedures and is available from www.adacatalog.org or toll free (800) 947-4746.
The One Where Dental Medicaid Gets a Complete Overhaul The Georgia Department of Community Health (DCH) is undertaking a comprehensive assessment and redesign of the state’s Medicaid and PeachCare for Kids programs. In January 2012, Navigant, the company selected by DCH to perform this undertaking, will submit a report that discusses options for service models and their projected savings and costs and assesses federal and state regulatory and operational requirements for the proposed solution(s). DCH’s goal is to begin a year-long implementation of a suggested program in 2013 and debut a fully redesigned program in 2014. The GDA will study this document to calculate the impact on dental Medicaid and will continue to effectively advocate for dental Medicaid and PeachCare patients and dentists accordingly.
The One Where Electronic Health Records Come to Play The Medicaid Electronic Health Record (EHR) Initiative is meant to entice all eligible Medicaid professionals, including dentists, who meet certain criteria to
register and potentially receive up to $63,750 in federal funds over six years to participate in “meaningful use” of a certified EHR system. On September 5, 2011, the state Department of Community Health (DCH), in coordination with the Centers for Medicare and Medicaid Services (CMS), opened registration for this initiative in Georgia. There are still many unknowns regarding this voluntary program as it pertains to dentistry. For instance, participants accepted into this initiative must use a certified EHR technology from a vendor approved by the Office of the National Coordinator. At this time, there is only ONE certified dental EHR technology vendor. However, most major dental practice management software companies are expected to pursue certification once the quality measures for dentistry have been defined. The GDA will continue to monitor and report on this issue as appropriate.
The One Where the GDA Loves Address Changes Keep your membership records current by informing the GDA if you move your office or home, or change your phone, email, or fax number. Call (404) 636-7553 or (800) 432-4357, visit www.gadental.org for a change form, or email willich@gadental.org.
The One Where HIPAA Sets a Jan 1, 2012 Deadline for Dentists The Health Insurance Portability and Accountability Act (HIPAA) mandates that the health care industry use standardized formats for electronic claims and claimsrelated transactions. Those formats are being updated with 5010 and ICD-10 coding systems. As of January 1, 2012, all HIPAA-compliant electronic transmission claims and code sets from all providers must be tested and ready for transmission as a 5010 transaction. Visit www.dch.georgia.gov/ ICD10 or www.cms.gov/ICD10 for additional details. The ADA sells a “Practical Guide to HIPAA Compliance: Privacy and Security Kit” with details on 5010 and
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other recent HIPAA requirements. Call (800) 947-4746 or visit www.adacatalog.org.
The One Where the Dentist Loses Insurance Coverage Tell your Business Owner’s and Professional Liability insurance carriers at least two weeks before you move your practice about your move and new location. You will not be covered at your new location until you notify your insurer AND they accept the risk. This happens far more than it should! Georgia Dental Insurance Services clients: Call (800) 432-4357 or (404) 636-7553 with your changes. And if you received additional training in dental procedures or discontinued doing certain procedures, notify your liability carrier, as you just changed the risk the company is insuring. The same goes if you changed from full time to part time or vice versa.
The One Where Dentists’ Insurance Policies are Up to Date Greet 2012 with all of your policies in a secure location. Keep a separate list of policy numbers, renewal dates, and claims department contact details in case you make a claim. Pay your premiums promptly this year. If you have moved, notify all of your carriers so bills arrive at the correct place. Remember to increase your insured exposure limits if the value of your property has increased from last year. And review your medical plan if you recently utilized it so you are aware of any limitations or requirements.
MSDS sheets, ensuring employee medical records are up to date—including Hepatitis B vaccinations and a history of exposure incidents—labeling hazardous chemicals, explaining the Hazard Communication Program to staff, and displaying the proper workplace posters. The ADA sells an OSHA Compliance Kit to assist you with these matters. Buy your kit by calling (800) 947-4746 or visit www.adacatalog.org. Please contact Nelda Greene at the GDA office at greene@gadental.org with questions as well.
The One Where PCI Compliance Fees are Not a Scam The major credit card brands (Visa, MasterCard, Discover, American Express) recently formed Payment Card IndustryData Security Standards (PCI-DSS) to prevent fraud at the merchant level. When you accept credit cards from your patients, you also accept the responsibility to protect and secure their information under PCI-DSS. The payment gateway company you work with should have discussed PCI-DSS with you. If not, talk to them.
Every payment processor is required by PCI-DSS to hire an outside firm to conduct / coordinate a Self Assessment Questionnaire of their merchants. When a client of GDA endorsed processer TransFirst completes their annual questionnaire, they receive a discounted rate on the quarterly PCI fee that TransFirst charges ($18.80 versus $28.80). In general, TransFirst’s PCI fees are much lower than the ones charged by competing processors (and they all charge some sort of PCI fee).
The One Where You Have Until 2013 to Renew Your License The next renewal period for dentists and dental hygienists is December 2013. Renewal happens every two years, which means you should have renewed your license by December 2011. You can verify renewals at http://sos.georgia.gov/plb/dentistry. Remember to maintain your CE documentation for at least three years. You
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The One Where Dentists Don’t Dock Employees for Jury Duty Employees are entitled to receive their salary during the time they are on official jury duty. Georgia law prohibits an employer from discharging, disciplining, or otherwise penalizing an employee for serving on jury duty. For a copy of the Georgia Attorney General Opinion regarding this matter, contact GDA General Counsel Melana McClatchey at mcclatchey@gadental.org.
The One Where OSHA is Still Alive and Kicking Dentists must meet a whole host of OSHA requirements—scheduling annual OSHA updates, documenting training, completing
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CHECKLIST Continued from page 13
now have two years to obtain 40 hours of CE (22 hours for dental hygienists) and ensure you have current CPR certification. You can only obtain online CE for up to one-half of the total hours required for renewal.
The One Where Dentists Need to Buy Security Prescription Paper As of March 31, 2012, health care providers must provide Schedule II Controlled Substance prescriptions to patients on state-approved security paper. This includes providers who use paper prescription pads as well as providers who use software to generate prescriptions. Georgia’s legislature passed this regulation to curb the growth of pill mills, where patients often receive prescriptions for pain medicines without significant scrutiny. All approved paper must be affixed with the Georgia Pharmacy Board’s seal of
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approval. A list of vendors selling approved paper is available on the Pharmacy Board’s web site at www.sos.ga.gov/plb/pharmacy. (The previous deadline was December 31, 2011, but the Board of Pharmacy voted for an extension in mid-December.)
The One Where Use Tax is Still Required The Georgia Department of Revenue requires businesses to pay a use tax on any items purchased from an out-of-state vendor that did not collect Georgia sales tax. You must complete Form ST-3 for payment to comply. Contact the Georgia Department of Revenue at (877)-602-8477 or www.etax.dor.ga.gov for additional help.
The One Where the Feds Issue a (New But Free) Workplace Poster As of April 30, 2012, most private sector employers will be required to post a notice advising employees of their rights under the National Labor Relations Act. This requirement applies to a variety of entities, including dental offices, with a gross annual volume of at least $250,000.
The poster is available for free at https://www.nlrb.gov/poster or by calling (202) 273-0064. Don’t be fooled by high pressure sales calls, faxes, or mailers stating that you must buy a special poster to be in compliance with federal law. This poster, like all federal and state workplace posters, is available AT NO CHARGE. All you need is a phone or an Internet connection and a printer!
The One Where You Must Post Other Fed Workplace Posters In addition to the NLRA poster, the U.S. government requires the posting of these workplace posters: 1) Employee Polygraph Protection, 2) Equal Employment Opportunity, 3) Fair Labor Standards Act, 4) Job Safety and Health Protection, 5) Rights Under the Family and Medical Leave Act (for employers of 50 or more individuals), and 6) Uniformed Services Employment and Reemployment Rights Act. Obtain them for free from the U.S. Department of Labor Web site www.dol.gov/compliance/ topics/posters.htm.
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The One Where Workplace Posters are Required by Georgia Too Georgia requires dentists to post these workplace posters: 1) DOL-154 (Employer Vacation), 2) DOL-4107 (Equal Pay for Equal Work Act), and 3) DOL-810 (Unemployment Insurance for Employees). Obtain these posters at the state Department of Labor Web site www.dol.state.ga.us/em/required_posters.htm. The state also requires you to post two Workers’ Comp notice posters: 1) WC-P1 “Panel of Physicians” with a list of six physicians (one must be an orthopedic surgeon and one a minority, if feasible) and WC-BOR “Bill of Rights for the Injured Worker.” Obtain them at http://sbwc.georgia.gov (click on “Forms” and then “Board Forms”).
The One Where X-ray Certification is Difficult The Health Care Section of the Office of Regulatory Services (ORS) no longer performs routine periodic surveys of x-ray machines, but does perform initial state registration surveys and shielding design
reviews. Dentists must have x-ray equipment inspected by the state before any new equipment may be used. Plan ahead—this process can take months because the state has few inspectors. Dentists may contract with a qualified physicist to complete a shielding design review and initial on-site survey. This physicist submit a report to ORS in support of your application. Regardless of if you choose ORS or a qualified physicist to perform your initial state registration survey and shielding design review, you CANNOT operate your x-ray machines until the initial inspection is successful and you receive a state of Georgia certificate of registration. Visit http://dch.georgia.gov for additional information on registering your equipment.
An expanded version of this “important stuff” article complete with links to referenced agencies is posted at www.gadental.org.
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GDA Legislative Priorities for 2012: Practice Freedom, Third Party Issues, and Volunteers Michael Vernon, DDS, President Jack Bickford, DDS, Governmental Affairs Chair Martha Phillips, Executive Director
Your GDA will pursue numerous legislative objectives this year—see the full list in the box on page 17. However, your Governmental Affairs Committee and GDA leadership have identified four items of primary focus for the Association: • Advocating for an appropriate dental Medicaid budget for children and adult dental services. • Lobbying for 12-month eligibility for Medicaid, which will allow children to have uninterrupted dental care and lessen the administrative burden for dentists. • Supporting legislation that would allow dentists licensed outside Georgia to practice for a specific volunteer program approved by the Georgia Board of Dentistry. • Advocating for autonomy of a dentist from being required to participate in any specific insurance plan as a condition of licensure. “Conducting the Georgia Mission of Mercy in 2011 helped us realize the importance of enabling as many dentists as possible to provide care in a volunteer capacity in our state,” said President Mike Vernon. “So the GDA has chosen to support a bill that will allow dentists licensed in other states to provide care at Board-approved volunteer programs. We have many non-Georgia dentists who are eager to take part in GMOM and volunteer at our charitable clinics, but who are relegated to nonprimary care functions due to our laws.” “Members have watched the GDA lobby on Medicaid issues for many years,” said Dr. Jack Bickford, Chair of the Governmental Affairs Committee. “Not all
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of our dentists participate in this program, but hundreds do. If health care reform moves forward, this program will expand tremendously in our state. Not paying close attention to the financing and structure of Medicaid could have consequences for all dentists, and Georgia’s poor children. So, the GDA will lobby for an appropriate dental Medicaid budget for children and covered adult services. We will also lobby for 12-month Medicaid eligibility, which keeps kids on the program to access care, and makes keeping up with patients easier on dentists.” Both doctors also say the GDA will support legislation to support the autonomy of a dentist from being required to participate in any specific insurance plan as a condition of licensure. For additional information on these issues, consult the GDA Position Papers as approved by the House of Delegates and posted on the GDA web site www.gadental.org.
Take Part in a LAW Day— Despite Butterflies Even if you get tongue-tied thinking about relaying dental viewpoints face-to-face with a legislator, a LAW Day is an eyeopening, don’t miss, amazing experience for dentists, and dental spouses. This award-winning GDA advocacy activity features breakfast (usually everyone is good at breakfast), an “extreme insider” issues overview from GDA Executive Director Martha Phillips (usually everyone is good at enjoying the behind the scenes news), and a visit to the Capitol (always cool to see the state museum artifacts and the historic building). LAW Day visitors are welcome to stay in a group of volunteers designated to communicate with a particular legislator, and allow a LAW Day veteran to actually
talk. Please note that your presence—you standing inside the Capitol on a workday to carry a patient-friendly message—speaks VOLUMES. Maybe you can even work up the gumption to speak to your own legislators, even if they are not on a dentalcentered committee. Despite the presence of LAW Day veterans, your actual voice will be put to use if you want to speak! Don’t miss your chance to see Georgia law being made. Contact Nelda Greene at greene@gadental.org to sign up for any of the 2012 LAW Day dates:
February 8: Eastern District / Northern District Southern Branch. February 15: Central District. February 22: Western District / Northern District Eastern, Central Branches / Leadership GDA. February 29: Northwestern District. March 7: Southeastern District, Ga Dental Society, N. Ga Dental Society. March 14: Northern District Northern Branch. March 21: Southwestern District. March 28: Alliance, Northern District Hall County.
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GDA Sets Numerous Objectives for 2012 Legislative Session Medicaid and PeachCare: The GDA Supports • Legislation that provides access to dental care for adults, the elderly and the developmentally disabled either through inclusion in the Medicaid budget or other means. • Maintaining an appropriate Medicaid budget for dental care. • Legislation to carve out the dental portion of the Medicaid and PeachCare programs. • 12-month eligibility for Medicaid. Access to Care: The GDA Supports • Legislation for a student loan forgiveness program for dentists and dental hygienists who agree to serve in underserved areas.
and pay for medical benefits for their employees. • Maintaining tort reform provisions enacted with SB3 in 2005. • Pursuing insurance reform whereby dentists can compete fairly by requiring full disclosure of insurance ratesetting information and whereby persons reviewing insurance claims are licensed in Georgia in the same field. • Autonomy of a dentist from being required to participate in any specific insurance plan as a condition of licensure.
Patient Care: The GDA Supports • The dental team concept and opposes efforts to remove the delivery of dental hygiene services from the direct supervision of dentists and continue the administration of local anesthesia by dentists. • Oral health education and prevention programs that enable Georgians to be informed about optimal oral health and children to access basic prevention services, such as sealants and fluoride.
• Legislation that would provide transparency and regulation of so called “silent PPOs” and rental networks.
• Legislation that would allow state tax credit for dentists who provide documented charitable care in excess of $5,000 annually. • Revitalizing the dental public health program so that oral health is a priority in the Department of Public Health, the fluoridation monitoring and surveillance program is funded, and dentists’ and dental hygienists’ salaries are increased. • Amending Georgia law to allow dentists licensed outside Georgia to practice for a specific volunteer program approved by the Georgia Board of Dentistry. Dental Practice: The GDA Supports • Legislation that would allow any provider who is willing to abide by the terms of an insurance plan to participate in that plan. • Legislation to allow a tax credit for small business owners who provide GDA ACTION JANUARY 2012
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Update on Medicaid Issues from the GDA Medicaid Task Force Dr. Jimmy Talbot Task Force Chair
Our Task Force* continues to monitor the activity taking place in and around the Medicaid and PeachCare programs. With the rollout of federal health care reform, and the re-design of the state Medicaid program, there is a great deal of activity to track.
Georgia Medicaid Re-Design The Department of Community Health (DCH) is studying a re-design of the state Medicaid and SCHIP (PeachCare) programs in partnership with its hired consultant Navigant. Here is a timeline of major activities: • DCH has completed its “Assessment Phase” after holding a series of stakeholder focus groups, including two dental-only groups. (GDA members and staff participated in these focus groups.) • DCH is now moving into the “Recommendation Phase.” Navigant is expected to submit a report in January that will include options for service models and projected savings / costs of any proposed models; an assessment of federal and state regulatory and operational requirements for the proposed solution(s); a consideration of how to accommodate the PPACA-created Medicaid expansion slated for 2014; and some contractual provisions to consider for new CMO contracts. • For the “Procurement Phase,” by June 2012, DCH plans to finalize all documents and post them for public review and submission. On or about July 1, 2012, DCH expects to issue RFP(s) for the redesign procurement. • By January 2013, DCH anticipates awarding contracts to selected vendors and moving into the “Implementation Phase.” DCH is planning a yearlong implementation phase and expects to fully implement redesigned Medicaid and SCHIP programs by February 1, 2014. (Note: these dates and details were taken from the DCH web site www.dch.georgia.gov and are subject to change by the Department.)
managed care system in Georgia as part of the DCH redesign mentioned above. Molina Healthcare and Aetna Better Health are looking to enter the Georgia Medicaid market, develop a dental provider network, and offer services statewide. Both companies have hired public affairs firms to assist them with the DCH contract bidding and procurement phases.
Electronic Health Records The Medicaid Electronic Health Record (EHR) Initiative is meant to entice all eligible Medicaid professionals, including dentists, who meet certain criteria to register and potentially receive up to $63,750 in federal funds over six years to participate in “meaningful use” of a certified EHR system. On September 5, the state Department of Community Health (DCH), in coordination with the Centers for Medicare and Medicaid Services (CMS), opened registration for this initiative in Georgia. There are still many unknowns regarding this voluntary program as it pertains to dentistry. We do know that eligible professionals must have at least 30 percent patient volume attributable to Medicaid, which includes fee-for-service and managed care patients. However, PeachCare for Kids enrollees do not count toward the Medicaid patient volume which may disqualify many dental offices. “Meaningful Use” measures an eligible professional’s use of EHRs to improve the quality, safety, and efficiency of patient care. One criterion is the use of EHRs to report clinical quality measures; however, no dental clinical quality measures have been established.The American Dental Association is working with the Office of the National Coordinator to define the framework for EHR clinical quality measures. The ADA has also provided comments to CMS regarding proposed rules defining meaningful use. Participants accepted into this initiative must use a certified EHR technology from an approved vendor list. At this time, there is only ONE certified dental EHR technology vendor. Most major dental practice management software companies are expected to pursue certification once the quality measures for dentistry have been defined.
CMO Provider Network Expansion The GDA has confirmed that the Medicaid Care Management Organizations Peach State and Amerigroup both plan to expand their network of providers statewide starting in January 2012 upon approval by DCH. The contract has been re-negotiated between DCH and the CMOs and is awaiting signatures by all parties involved. This Task Force will monitor the expansion and report as new developments are made public next early next year.
New Companies in Medicaid? Over the last few months we have met with representatives from two companies that are interested in expanding into the Medicaid
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Meetings and Monitoring In addition to tracking all of the above issues, the Task Force continues to monitor GDA staff reports from regular DCH, DentaQuest Advisory Board, SCION Dental Advisory Board, and HP Enterprises MMIS meetings. The GDA offers input at each of these meetings as necessary. * Task Force members are Drs. Jim Hall, Alfred Peters, Annette Rainge, Kaneta Lott, Alfred Wyatt, Jason Oyler, Antwan Treadway, Byron Colley, and Ed Green.
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New Year, New Developments in Federal Health Care Reform Martha Phillips, Executive Director
The Patient Protection and Affordable Care Act (PPACA) was signed into law on March 23, 2010, and since that time many elements of the federal health care reform legislation have been put into motion. Most people are unaware of the broad and far-reaching changes that will be made when the PPACA is fully implemented by 2014. This article and its sidebar articles will attempt to show the far-ranging scope of the Act; how the Act impacts dentistry; currently active provisions; and provisions on the horizon.
Academy of Pediatric Dentistry (AAPD) offered recommendations to IOM on the dental services the essential dental benefit package should cover. The AAPD’s written statement supported their Model Dental Benefits policy which delineates the diagnostic, preventive, and restorative services that are essential to children:
PPACA and Dentistry: Essential Benefits
• Restorative and endodontic services to relieve pain and infection and restore and maintain function.
PPACA laid out 10 general areas of health care services that should form what was termed an “Essential Benefits Package” (EBP). The areas mentioned were ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental health and substance use disorder services, prescription drugs, rehabilitative and habilitative services and devices, lab services and devices, lab services, preventive and wellness services and chronic disease management and pediatric services, including oral and vision care. This EBP, PPACA directed, must be offered beginning in 2014 as part of any health plan providing coverage in the individual or group market. However, the reform bill kept its language very general. Instead, the bill directed the U.S. Department of Health and Human Services (HHS) to define the details of what services will be offered within the EBP. HHS requested that the Institute of Medicine (IOM) recommend a process that would help HHS define the benefits that should be included in the package. IOM was not to decide what was to be covered, but rather propose a set of criteria and methods that should be used in deciding what benefits are most important for coverage. The American Dental Association (ADA) and the American
• Orthodontic services to prevent, intercept, and treat malocclusions – including management of children with cleft lip or palate and/or congenital or developmental defects – consistent with program criteria for medically necessary services.
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• Diagnostic procedures, which only a dentist can provide. • Preventive services, including fluoride varnish, sealants, prescriptions.
Some children, especially those with early childhood caries, special health care needs, or medically compromising conditions are more likely to require additional services such as: • Behavior guidance services, including both pharmacologic and non-pharmacologic management techniques. • Dental and oral surgery under sedation / general anesthesia, in outpatient or inpatient hospital facilities.
The IOM also said that HHS should lead an effort to limit the growth of health costs. The IOM panel suggested that HHS finalize the benefits list by May 1, 2012, after seeking extensive public input. Since the IOM was not to decide what was covered and what was not, no specific coverage recommendations were included in the report. However, the indexes delineated dental services typically included and excluded by established health care plans. The report may be read at www.iom.edu/Reports/2011/EssentialHealth-Benefits-Balancing-Coverage-andCost.aspx. In a somewhat surprising December 2011 move, HHS elected to move decisions on covered essential benefits to the states. An HHS memo stated that the agency intends to define essential health benefits using a benchmark approach and give states the flexibility to select a benchmark plan that reflects the scope of services offered by a “typical employer plan.” According to HHS, states would choose one of the following benchmark health insurance plans: • One of the three largest small group plans in the state by enrollment; • One of the three largest state employee health plans by enrollment; • One of the three largest federal employee health plan options by enrollment; • The largest HMO plan offered in the state’s commercial market by enrollment.
• Periodontal services. • Prosthodontic services, including implants to restore oral function. The IOM released initial guidance for HHS in October 2011, directing HHS to choose an essential health benefits package that costs about the same as an average small group health plan would in 2014, provides a range of services backed by evidence of their medical effectiveness, and balances the competing needs of health plan affordability and covered benefits.
If states choose not to select a benchmark, HHS intends to propose that the default benchmark will be the small group plan with the largest enrollment in the state. To prevent federal dollars going to state benefit mandates, the health reform law requires states to defray the cost of benefits required by state law in excess of essential health benefits for individuals enrolled in any plan offered through a Heath Insurance Exchange. These bench-
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marks are generally regulated by the state and would be subject to state mandates applicable to the small group market. Thus, those mandates would be included in the state essential health benefits package if the state elected one of the three largest small group plans in that state as its benchmark. Essential health benefits must include coverage of services and items in all 10 statutory categories. HHS intends to require that a health plan offer benefits that are “substantially equal” to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories. Health plans would have the ability to adjust benefits, including both the specific services covered and any quantitative limits, provided they continue to offer coverage for all 10 statutory categories and the coverage has the same value. Insurers would also define the cost sharing features of the plans such as deductibles, copayments, and coinsurance. (From www.pnhp.org.)
PPACA and Dentistry: Medicaid Expansion PPACA would expand Medicaid eligibility to include all individuals and families with incomes up to 133% of the Federal Poverty Level as well as provide for a simplified SCHIP (PeachCare for Kids) enrollment process. This expansion would add more than 600,000 Georgia residents to the Medicaid program by 2014 if health reform is fully implemented. The dental component of Georgia’s Medicaid program has been beset by administrative red tape, service cuts, and fee schedule upheavals since becoming part of the Care Management Organization system in 2005. The state is currently planning for a re-design of the Medicaid program, with an eye towards the expected influx of new enrollees. The GDA has testified at the state’s focus groups on the re-design process, and has prepared a long list of improvements that should be made to the dental component if this safety net for Georgia’s poor children is to survive.
FEDERAL HEALTH CARE REFORM Continued on page 22
Health Insurance Exchanges: How They May Look in Georgia Despite opposing PPACA, and filing a federal lawsuit to stop its implementation, Georgia’s leadership established a Health Insurance Exchange Advisory Committee in June 2011 to determine how the state wants to proceed with a Health Insurance Exchange as mandated by PPACA. The committee is due to issue a report about Georgia’s exchange structure in January 2012. If PPACA is not overturned by the Supreme Court or repealed, Georgia has two choices: comply with the law and formulate a customized exchange, or wait for the federal government to force an exchange system on them. Georgia’s decision to establish parameters for a state exchange instead of waiting for a federal exchange to be forced on them appears to acknowledge that in some form, PPACA and health care reform is here to stay. No one knows what exchanges will look like. States have a great deal of flexibility in establishing an exchange once they meet required basic settings. Exchanges will serve as clearinghouses and some will have some quasi-regulatory functions. They will help facilitate the purchase of private insurance and will serve as the vehicle for enrolling Medicaid and SCHIP (PeachCare) eligible individuals. In general terms the market will be divided into three segments: (1) State public programs (Medicaid, CHIP, and State Health Benefit Plan); (2) Exchanges (individual and small groups); and (3) everyone else. The exchanges may make dental benefits available to more individuals, but also may require dentists who want to participate as providers sign contracts for fees much different than they have charged previously. According to a 2005 ADA-funded dental economics analysis, “carriers with greater levels of concentration in a local area effectively depress reimbursement fees to general practitioners.” A 2011 paper by the Deloitte Center for Health Solutions listed among its projected implications of heath care exchanges for hospitals and physicians that “payments by Qualified Health Plans might be lower than traditional commercial rates, reducing margins for providers.” How a single powerful entity can easily control dental fees may be shown by the actions of Delta Dental of Idaho in November 2011. According to Kym Browning, spokeswoman for Delta Dental, Delta cut their reimbursement fees to dentists on a regional basis by an average of 8%. Dr. Greg Bengtson, President of the Idaho State Dental Association, said the cuts will range from 4% to 13%. Ms. Browning stated, “We are making PPO fee adjustments to remain competitive in a changing market and to respond to concerns from employees about the rising cost of employee health benefits. By making changes to our PPO fee structure, we can help ensure employers are able to continue offering access to quality, affordable dental benefits for their employees and our members receive optimal savings when covered by Delta Dental of Idaho.” Dr. Bengtson said, “The dentists’ relationship to Delta Dental is similar to that of David and Goliath. Delta says it’s the largest stand-alone dental benefit carrier providing employer coverage in Idaho, with about 380,000 members statewide. With that market share, it’s hard to contemplate dentists not accepting their plan.” Quality reporting requirements will likely be a part of the exchanges’ quasi-regulatory authority. Insurance companies will be required to provide data on outcomes and it is not hard to imagine that this could lead to pay-forperformance initiatives. The National Association of Dental Plans reports that currently 30% of consumers get dental coverage through small groups with 2% obtaining coverage via individual markets. They state that more than 44% of households with dental benefits have incomes below $50,000 and could potentially benefit from the subsidies offered in the exchanges.
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FEDERAL HEALTH CARE REFORM Continued from page 21
PPACA and Electronic Health Records (EHR) The move toward mandatory use of Electronic Health Records (EHR) by all health care practitioners is a part of the PPACA and is well into being implemented. Billions of dollars have already gone into this process. The federal government is subsidizing the EHR transition of Medicaid and Medicare providers whose practices provide care to at least 30 percent Medicaid or Medicare recipients. The move to EHRs is a necessary part of the overall reform of the delivery of health care. The government will have access to data it can use to drive policy and payment decisions. The data will also provide necessary information in the evaluation of “best practices,” evidence-based care, and other changes to benefits and payment practices.
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PPACA and New Methods of Health Care Delivery The use of EHRs and other sorts of health information technology (HIT) to achieve certain health reform goals is emphasized in PPACA. The phrase “health information technology” or “HIT” is used more than 40 times in PPACA pertaining to measuring and enhancing quality, establishing new methods and models for delivering care, and achieving other goals. And new methods of coordinating and delivering care are on the drawing board throughout the health care field. For instance, telemedicine is an emerging model to deliver care in rural areas that are deemed to have a shortage of health care providers. In response to requests from the American Medical Association and others, the Centers for Medicare and Medicaid Services (CMS) has announced that it intends to eliminate outdated quality measures and standardize reporting methods by aligning the federal electronic medical record incentive program with other initiatives. CMS will allow for more access to telemedicine services for patients in
rural and critical access areas. CMS has already published a rule permitting hospitals to use telemedicine to obtain services from a “credentialed practitioner” at a distance hospital as long as the hospital also is participating in Medicare and a written agreement between both facilities exists.
PPACA and Dentistry: The Future It is difficult for me to believe that the PPACA will be repealed in whole no matter who is sitting in the White House in January 2013 or which party is in control of the House and Senate. Too many of the policies relating to the PPACA have already been put into place (see the sidebars on pages 21 and 23) and many of the provisions of the Act are supported by Democrats and Republicans. If the Republicans are in control of the White House and the Senate, the most contro-
FEDERAL HEALTH CARE REFORM Continued on page 30
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Selective Overview: Provisions of the PPACA The Act requires: • Insurers to offer the same premium to all applicants of the same age and geographical location without regard to most pre-existing conditions (excluding tobacco use). • That nearly all persons not covered by Medicaid, Medicare, or other public insurance programs purchase an approved private insurance policy or pay a penalty, unless the applicable individual is a member of a recognized religious sect, exempted by the IRS, or waived in cases of financial hardship. This provision is commonly called the individual mandate. • Medicaid eligibility to expand to include all individuals and families with incomes up to 133% of the poverty level along with a simplified SCHIP enrollment process. • The creation of state Health Insurance Exchanges— marketplaces where individuals and small businesses can compare policies and premiums, and buy insurance (with a government subsidy if eligible based on Federal Poverty Level incomes).
• The establishment of minimum standards for health insurance policies and prohibition of lifetime coverage caps. • That firms employing 50 or more people but not offering health insurance pay a “shared responsibility” requirement if the government ends up subsidizing an employee’s health care. • Insurance companies to spend a certain percentage of premium dollars on medical care improvement and issue rebates to policy holders if failing to meet this requirement. • Elimination of co-payments, co-insurance, and deductibles for select health care insurance benefits considered to be part of an “essential benefits package.” (Pediatric vision and dental care are considered as part of the essential benefit package, but specific services for pediatric patients have yet to be defined).
PROVISIONS OF THE PPACA Continued on page 24
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PROVISIONS OF THE PPACA Continued from page 23
PPACA Provisions in Force and Upcoming Provisions Currently Effective • Insurers are prohibited from imposing lifetime dollar limits on essential benefits; excluding pre-existing medical conditions for children under the age of 19 except in grandfathered individual health plans; charging co-payments, co-insurance, or deductibles for certain preventive care and medical screenings on all new insurance plans; and dropping policy holders when they become sick. • Insurers’ abilities to enforce annual spending caps are now restricted, and will be prohibited by 2014. • Insurers are required to reveal details about administrative and executive expenditures, and non-profit Blue Cross insurers are required to maintain a loss ratio (money spent on procedures over money incoming) of 85% or higher to take advantage of IRS tax benefits. • Insurers are required to spend 85% of large-group and 80% of small-group and individual plan premiums (with certain adjustments) on health care or to improve health care quality, or return the difference to the customer as a rebate. (Georgia applied for and received a waiver that will allow state insurance companies on a sliding percentage up to three years to meet this requirement.)
Provisions Effective in 2012 • Starting January 1, employers must disclose the value of the benefits they provide for each employee’s health insurance coverage on the employees’ annual Form W-2.
Provisions Effective in 2013 Income from self-employment and wages of single individuals in excess of $200,000 annually will be subject to an additional tax of 0.9%. The threshold amount is $250,000 for a married couple filing jointly (threshold applies to join compensation of the two spouses), or $125,000 for a married person filing separately. In addition, an additional tax of 3.8% will apply to the lesser of net investment income or the amount by which adjusted income exceeds $200,000 ($250,000 for a married couple filing jointly; $125,000 for a married person filing separately.)
Provisions Effective in 2014 • Insurers will be prohibited from discriminating against or charging higher rates for any individuals based on pre-existing medical conditions. • Two years of tax credits will be offered to qualified small businesses. To receive the full benefit of a 50% premium subsidy, the small business must have an
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average payroll per fulltime equivalent (FTE) employee, excluding the owner of the business, of less than $25,000 and have fewer than 11 FTEs. The subsidy is reduced by 6.7% per additional employee and 4% per additional $1,000 of average compensation. • Chain restaurants and food vendors with 20 or more locations will be required to display the caloric content of their foods on menus, drive-through menus, and vending machines. Additional information, such as saturated fat, carbohydrate and sodium content, must also be made available upon request. • Health Insurance Exchanges and subsidization of insurance premiums for certain individuals will be in place. • Members of Congress and their staff members may only access health care plans through the exchange or plans otherwise established by the bill (instead of the Federal Employees Health Benefits Program that they currently use.) • An excise tax goes into effect on pharmaceutical companies based on market share of the company. • Most medical devices will become subject to a 2.3% excise tax collected at the time of purchase. • Health insurance companies will become subject to a new excise tax based on their market share; the rate gradually rises between 2014 and 2018 and thereafter increases at the rate of inflation.
Provisions Effective in 2017 A state may apply to HHS for a “waiver for state innovation” provided that the state passes legislation implementing an alternative health care plan that meets certain criteria established by PPACA.
Provisions Effective in 2018 • All existing health insurance plans must cover approved preventive care and checkups without co-payment. • A 40% excise tax on high cost (“Cadillac”) insurance plans will be introduced. The tax is on the cost of coverage in excess of $27,500 (family coverage) and $10,200 (individual coverage), and it is increased to $30,950 (family) and $11,850 (individual) for retirees and employees in high risk professions. The dollar thresholds are indexed with inflation; employers with higher costs on account of the age or gender demographics of their employees may value their coverage using the age and gender demographics of a national risk pool.
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classified ads Dental Related Services How GDA members can place classified ads AD FORM: Submit all ads on a GDA Classified Advertisement Form. To obtain a form, call Skip Jones at (800) 432-4357 or (404) 636-7553, or email jones@gadental.org. (Note: The GDA may accept or reject any ad for any reason and in its sole discretion.)
AD DEADLINE: Ads and ad check payments are due by the first of the month before the publication month (i.e., Dec. 1 for January).
AD RATES: ADA member dentists pay $75.00 per 60-word ad per month. There is a 25 cents per-word charge for each word over 60. Non-dentist-owned companies (real estate firms, etc.) pay $195 per 60-word ad per month (additional word charges as above). Non-member dentists may not place ads.
LATE FEE: Ads for which full prepayment is not received by the first day of the ad’s publication month (i.e.; Nov. 1 for a November ad) will incur a $25 late fee in addition to the ad rate.
FORMS OF PAYMENT: Submit a check or money order with the ad form. (Make checks payable to GDA.) Credit cards are not accepted as payment.
WEB SITE PLACEMENT: Prepaid ads will appear on the GDA Web site www.gadental.org for the month the ad appears in print. Non-prepaid ads will NOT be placed online.
X-RAY SAFETY CERTIFICATION for assistants is required by Georgia law. This up-to-date take-home course has effectively certified thousands of x-ray machine operators. Send $149.99 per registrant with name(s) to: Dr. Rick Waters, 385 Pinewood Circle, Athens, GA 30606. Visit www.gaxray.com for credit card payment or to use the immediate-access online version. Call (706) 255-4499 for more information. Supplies for sale—Dentist retiring! Everything 20% below retail. Dispersalloy Amalgam 500 2-spill capsules $1,000; 2x2 gauze, 5000 / case $46.00; Bibs 13x19, 500 / case $22.40; Disposable Prophy Angles, 144 / box $48.00 or case of 8 boxes $360.00. Too many to list here. To request complete list with prices, call (770) 4562550 or email fmooredmd@bellsouth.net. All products guaranteed or full refund.
Dentists Available for Locum Tenens Dentist will fill in for illness, vacation, or continuing education. Licensed, insured, DEA #. Call (404) 786-0229 or email breighard@gmail.com. Dentist Available Daily (DAD): Dentist available during vacations, emergencies, and CE courses. Leave your practice in well-trained hands. I am licensed, insured, and have a DEA registration number so I can write prescriptions. Call Dr. Richard Patrick at (770) 993-8838. DENTIST: Need Part Time Fill In? Vacation, Illness, Maternity? GENERAL DENTIST SOLD LONG ESTABLISHED PRACTICE. GA & DEA LICENSED. (Available Expanded Atlanta Area.) Cell: (404) 219-4097. Home: (404) 842-1196. Jesse Hader, DDS.
For sale or assumable loan—2 year old E4D crown milling machine, excellent condition with three year warranty remaining. Great investment, inquiries call (229) 344-5636.
Dentist available during emergencies, vacation, CDE courses. I have a current license, DEA certificate, and insurance. Contact me at (706) 291-2254 or cell (706) 802-7760. I hope I can be of service to you. Patrick A. Parrino, DDS, MAGD.
Dental Staff Candidates Available
Positions Available
Looking for a new dental staff? Email dentalstaffschool@gmail.com and we can help you place a great match for your office! Whether you are looking for a recent graduate or one who has been out working already, we have extensive files of qualified dental staff from all over the state who are looking for work. All have training in Dentrix, Eaglesoft, digital x-ray certification, and crown and bridge training. Some candidates have also formal front desk training. There is no fee for placement service. Also available are current students willing to work short-term pro bono in sterilization, doctor and hygiene assisting, making radiographs, answering phones, etc. Email or call (678) 819-3919!
A Brand New Busy Private Marietta Practice is looking to bring in a pediatric dentist & an oral surgeon who is looking to establish and grow with our Practice. Currently have about 500 pediatric patients and 4,000 adult patients. Looking for a competent, proficient, and energetic doctor to add to our team to take care of the large pediatric and adolescent patient pool that we have in our community. Rewarding compensation packages with additional pay as you grow the practice. Feel free to contact Dr. Mansouri if you have any further questions at (267) 4412565, mansouridmd@comcast.net, or visit our web site to see both of our office location at www.NaturalSmile.biz. CLASSIFIEDS Continued on page 28 GDA ACTION JANUARY 2012
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Associate Dentist: Buford / Sugar Hill. State of the Art digital practice in busy Gwinnett Co. Full-time. Fax resume to (770) 945-1449 or email info@dentistgwinnett.com or call (770) 845-9159
Busy Pediatric Practice seeking associate, either pediatric dentist or general dentist that specializes in children. Ownership potential. High income area in West Cobb with great growth. Please send CV to dentalservice@bellsouth.net or fax to (770) 952-0199.
Dentist Jobs: Aspen Dental offers tremendous earning potential and a practice support model that empowers dentists to achieve goals. We eliminate obstacles for dentists to own their own practice. To learn more about our compelling proposition and to apply, please call (877) 332-9154 or visit www.AspenDentalJobs.com. EOE
Georgia—Cartersville, Hiram and East Point: Opportunity available for general dentist in an established family practice. We are a multi-specialty group providing quality patient care. Locations in the Atlanta area. State-of-the-art offices. Excellent incentive packages. Requirements: One plus year of experience and active Georgia license. Email resume to HR@asmile4u.com.
Delta Dental—Dental Consultant (Alpharetta, Georgia): DDS / DMD degree from a dental school accredited by the ADA; minimum of five years in clinical practice of dentistry; active and unencumbered license issued by the Georgia Board of Dentistry. For full job details visit www.deltadentalins.com and click on Careers. To apply, submit resume to www.RanchoHR@Delta.org.
Dentist Jobs Columbus / Albany / Macon / Valdosta. FT/PT base salary over $100K per year with tremendous commission and profit share upside. No HMOs. Join our network of affiliated private family practices. Benefits include medical, vacation, 401K. Call Dr. Todd Christie at (321) 432-5922 (confidential) or email tchristie@dental-partners.com; fax (321) 254-6800.
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Exceptional Opportunity for Associate Dentists. Join Dr. Mark Shurett’s Associate Team to provide treatment to children throughout Georgia. Well equipped and maintained offices. Positions include F/T, P/T, and Locum Tenens. Multiple locations available. Friendly staff with no daily office / overhead challenges. Contact Tina Titshaw at ttitshaw@hcsga.com, call (678) 413-8130, or fax resume to (770) 760-1375.
Practices / Office Space Available STOCKBRIDGE: DON’T WAIT! Five operatory, bread-and-butter general dentistry practice for sale. The practice is on track to collect $620K this year For more information call (678) 482-7305, email info@southeasttransitions.com, or visit www.southeasttransitions.com.
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Smyrna / Cumberland Mall / Vinings area. Completely equipped dental office for rent. 3 operatories, Panorex, new equipment. Present dentist uses the office one day a week. Great place to start a practice with no equipment to purchase. There has been a Dental practice at this location since 1978. Free standing building. Go to www.Pickrondental.com to see building. (770) 265-0201. DULUTH: All FFS practice on track to collect $400K this year. Beautiful office with 4 equipped operatories loaded with technology. Practice has great visibility! For more information call (678) 482-7305, email info@southeasttransitions.com, or visit www.southeasttransitions.com.
NORTH OF GAINESVILLE—North GA MOUNTAINS: This practice has consistently collected $1M for the last 5 years. No Recession here! 5 operatories, updated equipment, Digital X-Rays. The seller would like to retire. The building is also for sale. For more information call (678) 482-7305, email info@southeasttransitions.com, or visit www.southeasttransitions.com. TIRED OF THE RAT RACE? Wellestablished practice and building in the mountains for sale. 10,000 sq ft building is a great investment—high image glass architecture and well located for public awareness. Friendly patients who appreciate what you do for them. Motivated cross-trained staff. Modern equipment. Computers in all operatories. Ideal for solo or group practice. Growing community. NO long commute and NO 8-lane freeways. Excellent school system. Low crime rate. Tons of family / sportsman outdoor recreational opportunities. Close enough to larger towns to go to the mall, but far enough away to avoid all the big city hassles. (706) 745-6848.
FLOWERY BRANCH / HOSCHTON / BRASELTON, GA: 20,000 square foot dental office building for lease in the #4 most economically developing area in the country! Now Leasing and Interior Build Out Can Begin Immediately! Great lease rates & TI allowance available. Looking for PERIO, ENDO & ORAL SURGEON. In a highly visible area where NO specialists are located at this time! Be the first in the area for a promising long term career location. Whether you want 1,500 or 5,000 square feet, space will be tailored to each individual’s needs. Perfect location for a new practice startup or a 2nd satellite location! Close to the newly approved satellite location for Northeast Georgia Medical Center. Demographics are off the charts and schools are unbelievable … literally one of the most sought after locations around! Priority will be given on a first come / first serve basis. Please e-mail: SpoutSpringsProfessionalPark@gmail.com for more information or call (678) 6122277.
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FEDERAL HEALTH CARE REFORM Continued from page 22
versial portions that are likely to see some type of change or total repeal would be the provisions that deal with individual mandates and government subsidies. As it stands now, a majority of the states, and numerous organizations and individual persons, have filed actions in federal court challenging the constitutionality of PPACA. As of October 2011, the constitutionality of PPACA has been upheld by three out of four federal appellate courts, with the fourth declaring the law’s individual mandate alone as unconstitutional. The Supreme Court has agreed to review the suits and has scheduled over five hours for oral arguments on the matter in March 2012. It would appear from this that we could have a ruling on the constitutionality of the PPACA before the November 2012 election. Many believe that the system is transforming itself and that the outcome of the court challenges or the elections will be anticlimactic to what will have already happened in the marketplace. Insurance companies have already taken hits on some of the most contested elements of the PPACA legislation and have begun to adopt policies to adapt to the changes. One such change involves agent reimbursement. Agents’ commissions will no longer be automatically included in the premium. Instead the premiums will be minus any commissions and agents will have to sell their services to the consumers as consultants and have the consumers agree to pay them for their services. Many hospital administrators, insurers, and doctors are counting on federal subsidies and coverage expansion that would result in a surge of patients with insurance to offset cuts in government programs. Consolidations of health care providers and new delivery models will have more of an impact on the way health care is delivered in the future. Large health systems (hospitals and large monopoly providers) could use their newfound clout to demand higher prices from private insurers even as federal and state governments pay less. Specific PPACA provisions may fall by the wayside, but our future is definitely a PPACA-influenced one.
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Inside This Issue • 2012 Legislative Update: GDA Sets Major Goals • Gear Up For Give Kids A Smile Day February 3
DATED MATERIAL PLEASE DELIVER AS SOON AS POSSIBLE
ACTION
Suite 200, Building 17, 7000 Peachtree Dunwoody Road Atlanta, Georgia 30328-1655 www.gadental.org