Articulator Volume 24, Issue 4

ARTICULATOR MDDS Connections for Metro Denver’s Dental Profession

2nd Quarter, 2020 Volume 24, Issue 4

PUSHING THROUGH THE PANDEMIC WHERE DO WE GO FROM HERE? 9

The CDC's "Wait at least 15 minutes" Statement: What Exactly Does That Mean?

of an Employment Lawyer 10 Musings On Returning to Working in the Age of COVID-19 Back Into 22 Launching Practice Strong: In Every Crisis Lies an Opportunity

B

Small is huge.

At TDSC.com, we provide consistent, competitive pricing for dental practices of every size, on the highest quality supplies from only authorized sources. This may seem like a small thing, but in fact, giving dentists more negotiating power in a dynamic dental supply market on quality supplies helps not only reduce overhead, but increase control over their entire business. Which is pretty huge.

NEW SUPPLY SAVINGS:

NEW FINANCING OPTION:

Save $50 off your next order of $500 or more with code SAVE50-1*.

Enjoy no payments for up to 6 months and 0% interest with PayPal.**

ENDORSED BY:

* See SAVE at TDSC.com/disclaimer for full terms and conditions. Expires 8.31.20. ** Additional terms and conditions apply. Learn more at TDSC.com/paypal

NEW CE COURSE CALENDAR: Experience the exibility of online courses to earn CE credits from accredited partners.

2nd quarter 2020

what's inside?

10

pg.

9 The CDC's "Wait at least 15 minutes" Statement: What Exactly Does That ..

Mean?

10 Musings of an Employment Lawyer

On Returning to Working in the Age of COVID-19

pg.24

Advertisers Directory 13 Back to Work Resources 20 Building Resilience In Hard Times 22 Launching Back Into Practice Strong In Every Crisis Lies an Opportunity

24 Market Conditions and Practice Transitions

departments

ADS Precise Transitions adsprecise.com................................. 31 Berkley Risk Services of Colorado colorado.berkleyrisk.com.................... 11 Best Card bestcardteam.com............................... 4

Dental Lifeline Network dentallifeline.org............................... 28 Dente Vita denteveita.com.................................. 25

Carr Healthcare carrhr.com........................... Back Cover

Dentists Professional Liability Trust of Colorado tdplt.com............................................ 7

CDA Enterprises cdaonline.org.............Inside Front Cover

Healthcare Medical Waste Services, LLC hcmws.com....................................... 30

Copic Financial Services Group copicfsg.com..................................... 25 CTC Associates ctc-associates.com............................. 27

SAS Transitions sastransitions.com.............................21 Vitality Dental Arts vitalitydentalarts.com...........................5

4 President's Letter 6 Reflections 8 Member Matters

Co-Editors Amisha Singh, DDS; Allen Vean, DMD Creative Manager CT Nelson Director of Marketing & Communications & Managing Editor Cara Stan MDDS Standing Officers President Nelle Barr, DMD

26 Tripartite News

President-Elect Kevin Patterson, DDS, MD Treasurer Pat Prendergast, DDS

29 Event Calendar

Secretary Janie Boyesen, DDS, DMSc

The Articulator encourages letters to the editor, but reserves the right to edit and publish under the discretion of the editor.

Advertising Policy MDDS reserves the right, in its sole discretion,to accept or reject advertising in its publications for any reasons including, but not limited to, materials which are offensive, defamatory or contrary to the best interests of MDDS. Advertiser represents and warrants the advertising is original; it does not infringe the copyright, trademark, service mark or proprietary rights of any other person; it does not invade the privacy rights of any person; and it is free from any libel, libelous or defamatory material. Advertiser agrees to indemnify and hold MDDS harmless from and against any breach of this warranty as well as any damages, expenses or costs (including attorney’s fees) arising from any claims of third parties.

Inquiries may be addressed to: Metropolitan Denver Dental Society 925 Lincoln Street, Unit B The Articulator is published quarterly by the Metropolitan Denver Dental Denver, CO 80203 Society and distributed to MDDS members as a direct benefit of membership. Phone: (303) 488-9700 Fax: (303) 488-0177 mddsdentist.com Š2020 Metropolitan Denver Dental Society Printing Dilley Printing

31 Classifieds

Editorial Policy All statements of opinion and of supposed factare published under the authority of the authors, including editorials, letters and book reviews. They are not to be accepted as the views and/or opinions of the MDDS.

Member Publication

3

PRESIDENT'S LETTER

Giving Unselfishly by Suspending Elective Care

By Nelle Barr, DMD

M

Korinna, Director of Convention and Events, did, and is doing, a stellar job DDS dentists suspended elective care to their patients vetting and planning the virtual CE courses we will give in the future. She is to help stop the spread of COVID-19. This effort working tirelessly on what the 2021 RMDC will look like. Her innovative and helped keep our staff and their families safe. The wonderful ideas will make RMDC happen – different than before - but it will unselfish act was a gift to society and our teams. We gave up happen. our livelihood, our PPE and our ability to pay our extended families, our teams. We put our Cara, Director of Marketing and Communications, was precious relationships with our patients on pause. invaluable help with the webinars and keeping the MDDS These were all very painful sacrifices. Your support of "Thank you to every COVID page updated with the latest information. She worked the ADA guidelines and Gov. Jared Polis’s executive MDDS dentist for this hard and crazy hours to make these happen. Her Byte messages mandate did not go unnoticed. The discontinuation were well-researched and very informative. Cara also had to of elective dental care was given in an unbegrudging huge sacrifice. It makes organize the delay of this Articulator. spirit of generosity. I am not surprised that the me proud dental community has given so much but I felt that it needed to be acknowledged. Thank you to every Your Board of Directors, WOW, what a team! Dr. Kevin to be in the dental MDDS dentist for this huge sacrifice. It makes me Patterson, Vice President, gave several Monday Virtual Town profession." proud to be in the dental profession.

Hall meetings in conjunction with Dr. Jeff Kahl. He was asked tough questions that he handled professionally and with ease.

This was a very challenging time to lead. You know He also answered numerous emails from members helping the saying “teamwork makes the dream work”. Well, that is what we did. them understand COVID-19 and its ramifications. He actively participated in We joined forces with the CDA to provide COVID related webinars, share every work group the CDA/MDDS leadership created. I am not sure how he knowledge regarding the COVID crisis, communicate with DORA and saw his dental emergencies, did all these tasks for organized dentistry and slept! the Governor’s office and disseminate critical information to our members.

I must extend a very special thank you to the CDA officers, Dr. Jeff Kahl, Dr. Pat Prendergast, Treasurer, headed up the PPE Work Group. That was President, Dr. Carrie Mauterer, President-Elect, Dr. Nate Kunzman, Vice a huge commitment. He did a great job collecting PPE and dispersing it to President and Dr. Lindsay Compton, Treasurer and their amazing team, Greg area hospitals. Dr. Prendergast also led by voicing insightful comments on our Hill, E.D., Molly Pereira, Associate E.D., Pam Brockhaus, Associate Associate numerous conference calls.

E.D. of Finance, Erica Carvin, Director of Membership, Kelsey Creehan, Strategic Marketing Specialist, Elisa Llodra, Membership Coordinator, Kelsey Dr. Janie Boyesen, Secretary, helped by vetting back to work protocols. She Currence, Development Manager and Geri Mustain, Office Manager. The worked with me on the Back to Work group. Her input was invaluable. We MDDS Board of Directors, the CDA Executive Committee and our teams met could not have deciphered all the literature without her A+ brain. daily at first and then three times a week for more than a month. Virtually, of course. This strong, brave, visionary and inclusive local dental leadership led Thank you, the MDDS Board of Directors, for all your efforts during the us back to work!

COVID crisis. Dentistry will come out of this continuing COVID crisis united and stronger than ever. We are handling this, like we do all the challenges we Your MDDS team fought tirelessly on your behalf. Shelly Fava, Executive face in dentistry, with dignity, grace and most of all selflessness.

Director of MDDS, was a strong and inspirational force. She went above and beyond! Shelly set up webinars at the last minute, crafted brilliantly written My presidency of MDDS will come to an end soon. I am deeply humbled letters to our Governor, fielded emails from our members, attended three or by the confidence you all placed in me and equally humbled that I had the four virtual meetings every day, kept the MDDS Board informed of all the privilege to help guide the MDDS Board, a group of committed people. I latest COVID news and, yes, she still did all her other E.D. duties as well. She received many supportive text messages and emails from you, the members, worked these long hours with a smile on her face that I could hear through the during the COVID crisis. These kind words fortified me with courage. It has phone. She has a great laugh. Her team was by her virtual side all the way. Jill, been my honor and privilege to serve. From the bottom of my heart, I thank Marlene, CT, Korinna and Cara worked from home without complaining. I you all. must thank our fabulous MDDS team for their efforts during the crisis.

Jill, Director of MWDI, was instrumental in tackling all the challenges of running the Mountain West Dental Institute (MWDI) during COVID. She had to reschedule events, give advice to our renters and develop a plan for our space under new guidelines.

Marlene, Manager of Finance and Operations, handled the challenge of planning our 2020-2021 budget. She did it and did an amazing job! We should all feel lucky that she works for MDDS. CT, Creative Manger, used his artistic skills to get the necessary information out to our members in a well-designed format. Thanks CT for using your talent to help create our Back to Work Handout. The easy to read layout gives much needed guidance on what PPE is appropriate for which procedures. If you have not seen this, you can find it on the MDDS website and in this issue.

4

I

2nd Quarter 2020 mddsdentist.com

Credit Card Processing

877-739-3952

CDA PRACTICES AVERAGE SAVINGS $3,256 / 24% ANNUALLY•

••

• EXCLUSIVE RATES • EQUIPMENT DISCOUNTS • OUTSTANDING CUSTOMER SERVICE

AUTO POST to dental software available!

Fax or email a recent processing statement to 866.717.7247 or CompareRates@BestCardTeam.com for a detailed no-obligation savings analysis and a $5 Amazon Gift Card!

REFLECTIONS

COVID-19 – Identity, Community and Gratitude

By Amisha Singh, DDS

I

sit staring at the white space on the paper. I am in my last. The indefinite time we have had to sacrifice our routines has impacted home office after having been at home for six weeks, our sense of self. practicing social distancing and watching the world change before my eyes. My children play under the This pandemic, despite impacting us in so many diverse ways, has also been table at my feet. My eldest is tackling remote learning an experience that our entire world has shared. For the first time in my beside me. I am tasked with the challenge of writing life, my day-to-day experiences and challenges are identical to those of my something relevant for you when our world is changing father-in-law living in India, my best friend living in Kenya and my cousin hourly. My heart is filled‌ with fear, with hope, with uncertainty and with living in Canada. This pandemic has united us as a global community in gratitude. I yearn to put words to paper that ease a way few things, if any, have ever done. This experience your worries, encourage you, uplift you... all while has brought profound pride and peace in simply being a "May we also always wondering how life will change in countless ways member of the human race. remember the lessons before this article is printed, before it gets to speak to you and share in your joys, your sorrows and your For me, this experience has also been pivotal in establishing we learned during this triumphs. growth, presence and gratitude. It has shined a light on transformational time. what really matters: the beauty in the present moment May we choose the Our world is different. It has changed so quickly and the profound gratitude for things I previously took and so significantly that it seems surreal. Some have for granted – health, dinner with my family, a glass of wine normal we want to said it feels like a dream. For others, this is closer to with friends. As I write this, I am filled with hope that as return to with intention. a nightmare. Some have been able to find new time you read it, we have all found some normalcy in our lives May our values guide with family or experience a pause and a reprieve. again. I pray that wherever this article finds you, it finds Others have lost loved ones or have struggled with you in health, happiness and prosperity. our choices and our their own mental or physical health. A few weeks decisions." ago, we could never have imagined the way that the But may we also always remember the lessons we learned world has changed. And change, especially when it during this transformational time. May we choose the comes this quickly, can impact the very foundation of our lives. Change can normal we want to return to with intention. May our values guide our impact our identities and that impact brings a world of challenges. choices and our decisions.

As we grow, research identity models generally agree that we start forming our identities in childhood. These identities gain prominence in adolescence and remain fluid and dynamic throughout our lives. They morph based on our experiences, challenges and conflicts. For many, our identities have subtly been uprooted and rerouted during the COVID crisis. We tie our identities to our spaces. College students around the country who were in the middle of discovering their adult selves in their communities, dorms and campuses have been forced to pause that process. Parents across the world who relied on their office and their work culture to create boundaries to fuel their contribution have been handed the challenge of parenting and working at the same time. Children who relied on their classrooms to learn and thrive have lost that outlet of creativity and growth. And in our community, dentists who relied on their practice to be able to live out their calling and help their societies have temporarily lost that space.

Our identities are also dependent on our habits. Everything from the sanctity of the routine of a podcast during a morning commute to a cup of warm coffee while reviewing patient charts to prep for the day help purpose and structure in our lives. A trip to the grocery store, which previously may have been peaceful, rejuvenating or at the very least fulfilling, has transformed into something which violates our physical and psychological safety. Our habits have been replaced with ones perhaps chosen with less intent. We are left wondering how long these new default habits and routines will need to

6

I

2nd Quarter 2020 mddsdentist.com

I know as a community we have been handed a mountain to be moved.

Dentistry, identified as a high-risk profession, was impacted significantly.

But may we also find reminders of our privilege. Our hands are skilled to serve. We are positioned to use our training and our passion to create health, educate and spread a message of safety and unity. We are seen as leaders and in this call to lead, we have a responsibility to those that we serve. Leading in these challenging times is the truest test of leadership and as dentists we are all being called to be true leaders. We are being called to lead when we may be gathering our own footing, fighting our own internal battles. We are being called to lead in our practices, in our teams, in our communities and, most importantly, within ourselves. It is hard but it is also important. It will shape who we will become and, in turn, what our profession will become.

And, although it may be easy to see this as a burden, especially when we are weathering our own internal storms, I encourage you to also see this as a privilege. The health of our communities, the impact on our profession and the influence of our calling lies squarely within our hands. During this time, I am immensely grateful to belong to this community and have incredible people of consequence like you by my side. As a dentist, we belong to a club of caring, passionate people and these are the very people who will rebuild this world. I wake up every day and face the unknown with this fact to give me peace. I am a dentist and I have an incredible professional support system of some of the most amazing people. And for this, I am eternally grateful.

Protect your practice.

Call the Trust today.

There are a lot of differences between being a Member of the Trust and just another policy number at a large, commercial carrier. Both give you a policy the Practice Law requires, but that’s where the similarity ends.

New and Established Dentists Not Currently Trust Members:

$0.00 First Year* *some restrictions apply; subject to underwriting approval.

Convert Now!

Who do I talk to when I have a patient event, claim or question?

The Trust: Local dentists who understand your practice, your business and your needs.

Them: Claims call center (likely in another state).

Besides a policy, what do I get when I buy coverage?

The Trust: Personal risk mitigation training, educational programs and an on-call team that “speak dentist.”

Them: Online support.

Do I have personal input and access to the company?

The Trust: Yes. You are represented by dentists from your CDA Component Society giving you direct, personal access to the Trust.

Them: Yes, via their national board.

How much surplus has been returned to dentists in Colorado?

The Trust: Over $2.2M has been distributed back to Colorado dentists as a “return of surplus” (after all, it’s your Trust, your money).

Them: $0 How long has the company been serving Colorado dentists?

The Trust: We were Established by dentists in 1987.

Them: It’s hard to say... they tend to come and go.

Dr. H. Candace DeLapp · 303-357-2600 www.tdplt.com

MEMBER MEMBERMATTERS MATTERS

New Members, Welcome!

Dr. Jacob Aberle Dr. Jacob Adkins Dr. J. Alverson Dr. Nichole Anderson Dr. Brett Barton Dr. Aaron Bellis Dr. Melina Bjornson Dr. Aarjoo Bk Dr. Stephanie Bont Dr. Marisa Borchardt Dr. Katie Boswell Dr. Brock Brilowski Dr. William Brown Dr. Stephen Bryant Dr. Karissa Burgos Dr. William Cavell Dr. Olivia Chavet Dr. Melanie Chu Dr. Clark Cranfill Dr. Carolyn Cronin Dr. Nicole Czajka Dr. Michael Daetwyler Dr. Katarina Dasbach Dr. Ryan Davis Dr. Lynn Doan Dr. Trey Esplin Dr. Izzy Fayerman Dr. Sarah Forsberg Dr. Alexis Gerry Dr. Chelsie Gritzmacher Dr. Soondis Habil

Dr. Kristie Han Dr. Leeanne Harden Dr. Jake Hauser Dr. Jessica Hazzard Dr. Landon Heckman Dr. Crispin Herrick Dr. Miranda Hicks Dr. Allison Hochwald Dr. Courtney Kaba Dr. Roopi Kattaura Dr. Meenali Khare Dr. Colin Kodama Dr. Kevin Kurtzner Dr. Connie Lan Dr. Chien-Hua Lee Dr. Colleen Leong Dr. Heather Leyva Dr. Mitchell MacGregor Dr. Conor Maguire Dr. Kim Mahoney Dr. Savannah Marston Dr. Alexa McAneney Dr. Hunter McAreavy Dr. Matthew McHugh Dr. Matthew Melcher Dr. Noreen Mian Dr. Benjamin Miettunen Dr. Khoa Nguyen Dr. Lan Nguyen Dr. Tho Nguyen Dr. Audrey Niemchick

Dr. Emily Parsons Dr. Amandeep Pentlia Dr. Angie Perez Dr. Michelle Prather Dr. Nicholas Propp Dr. Patricia Reach Dr. Kyle Richardson Dr. Audrey Riegel Dr. Liz Robinson Dr. Jarrett Romine Dr. Ryan Scheidel Dr. Mackenzie Schumborg Dr. Matt Seiss Dr. Jeffrey Seligman Dr. Vidisha Sharma Dr. Kristin Simboski Dr. Benjamin Sirrine Dr. Tyler Stanley Dr. Wesley Stanton Dr. Grant Stucki Dr. Stephanie Tan Dr. Ramon Tancioco Dr. Jennifer Terrio Dr. Steven Tobler Dr. Minh Trinh Dr. Vikas Trivedi Dr. Andrew Tyus Dr. Jeffrey Varner Dr. Kristine Villanueva Dr. Nikitha Yerram Dr. Jared Zysset

MDDS THANKS YOU! For seeing emergency dental cases during COVID-19 For conserving and donating PPE to hospitals For keeping patients out of emergency departments For social distancing For serving on the frontlines

We stand with you as you reopen and move forward!

8

INFECTION CONTROL

The CDC’s “Wait at least 15 minutes” Statement What Exactly Does That Mean?

By Kim Laudenslager, R.D.H., M.P.A., Forward by: Allen Vean, DMD

O

ver the last few months, we have seen our profession in turmoil. The issues are well documented and as we return to a new normal for now, new issues arise every day. We have asked Kim Laudenslager, one of our most respected colleagues to comment on a most frequently asked question from our practitioners. Her comments follow. Please be advised that at time of publication, this CDC guideline was in effect.

When the CDC released their May 19, 2020 updated guidelines a new statement was added that reads: To allow time for droplets to sufficiently fall from the air after a dental procedure, DHCP should wait at least 15 minutes after the completion of dental treatment and departure of the patient to begin the room cleaning and disinfection process.3 The CDC repeated the statement again later in the document that reads: Wait 15 minutes after completion of clinical care and exit of each patient to begin to clean and disinfect room surfaces. This time will allow for droplets to sufficiently fall from the air after a dental procedure, and then be disinfected properly.3 Since the CDC released this, I have received numerous calls and emails asking for clarification on what I think the CDC really means by “wait at least 15 minutes”. Below are my thoughts!

1. When the CDC makes the same statement twice in the same document, it’s important.

2. The first statement used the words “at least” which means anything less than 15 minutes would be a violation of the rule.

3. Both statements say after “completion of clinical treatment” and “completion of clinical care” but both statements finish the sentence by stating after “departure of patient” and after “exit of each patient.”

4. Both statements cite a reference to document 3, which is the science and rationale behind why the CDC is recommending this waiting period. To get a full appreciation for why we are being asked to wait 15 minutes, please read the article. To give you a quick idea of the science that went into developing this recommendation, the following concepts and words are used in the article: • • • • • • •

Exponential decay rate Half-life Aerodynamics Stagnant and turbulent air Cascade and virtual impactors Electrostatic effects Air filtration, ventilation systems and complex flow systems

For practitioners who are able to work out of two different operatories, the 15-minute wait period is not a problem. It’s ideal in fact! But for those who work out of one operatory, the waiting period presents what feels like an unnecessary delay and loss of production, hence the numerous questions I’m receiving.

What if we don’t perform an aerosol generating procedure and/or a procedure that create droplets, can we skip the 15-minute waiting period? o Yes. o But remember, using air to gently dry a tooth is considered a procedure that creates droplets and rinsing a tooth with a soft flow of water is also considered a procedure that creates droplets. In short, if the procedure involves using an A/W syringe and/or a handpiece (slow or high-speed) and of course the ultrasonic scaler, you are performing procedures that create both droplets and aerosols which requires waiting 15-minutes to turn the operatory.

What if we perform the aerosol generating procedure at the beginning of the appointment and it’s been at least 15-minutes when we dismiss the patient? o No. o The CDC guidance clearly states the waiting period begins “after the patient leaves and/or has departed”.

Can we start to tear-down the operatory, wait 15-minutes and then complete the set-up? o No. o You must leave all barriers in place for 15 minutes before starting the operatory turn-around process. This way when aerosols settle, they will settle on the barriers (which will be disposed of later) which will leave the surfaces underneath safer for the next patient. o You can however clear the operatory immediately of all instrument trays/cassettes, handpieces, supplies, etc. that need to go to the sterilization area.

Can we shorten the 15-minute waiting period because we are currently using an engineered air filtration system (a fogging system, a UVC light system, an air purifier) which claims to reduce aerosols faster? o No. o While the CDC encourages dental offices to properly maintain ventilation systems (HVAC, HEPA air filtration, etc.), they also state that the efficacy of alternative disinfection methods, such as ultrasonic waves, high intensity UV radiation, and LED blue light against COVID-19 virus is not known. In short, for now, until the FDA and/or EPA approves these systems, we will need to wait 15 minutes.

3. Baron, P. Generation and Behavior of Airborne Particles (Aerosols). Presentation published at CDC/NIOSH Topic Page: Aerosols, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Public Health Service, U.S. Department of Health and Human Services, Cincinnati, OH. www.cdc.gov/niosh/topics/aerosols/pdfs/Aerosol_101.pdfpdf icon

I

2nd Quarter 2020 mddsdentist.com

9

FEATURED ARTICLE

MUSINGS OF AN EMPLOYMENT LAWYER ON RETURNING TO WORKING IN THE AGE OF COVID-19

By Gary Benson, Esq. – Dworkin, Chambers, Williams, York, Benson & Evans, P.C

I

have been representing employers for the last 30 years, and the last three months have included the most surreal moments of my career. For those of you who watch “Stranger Things,” I’m sure you will agree that we are currently living in the “Upside Down.”

At the beginning of March, as COVID-19 was an issue in China and Italy but had not yet become a U.S. problem, I was counseling employers they could not take employees’ temperatures or prevent employees who had traveled to Asia from returning to the office after their vacation, as this would violate the Americans with Disabilities Act. Less than two months later I am not only advising my clients that they can take employee temperatures, but that they are legally required to do so before allowing them to return to the office.

By mid-March, the Families First Coronavirus Response Act (“FFCRA”) was passed. It stated that if employees were unable to work due to a government shelter in place order, they would receive two weeks of paid leave. The language in the statute was clear but the Department of Labor (the agency charged with enforcing the law) said no benefits were owed if employees were sent home due to a lack of work, even if this was because of a shelter in place order.

At the end of March, Congress passed the CARES Act, a two trillion-dollar relief and stimulus bill that, amongst other things, provides a steroidal boost to Unemployment Insurance (“UI”) benefits. Now an employee making $35,000 per year is likely bringing home more money, through July, than before they were furloughed or laid off. Clients complained that employees did not want to return to work, make less money and risk infection.

I

10 2nd Quarter 2020 mddsdentist.com

Had you asked me just three months ago if an employee would be eligible for UI benefits should they reject an offer to return to work, I would have told you “no” as someone typically doesn’t get to collect UI benefits when they are offered a job. Then, on April 27th, Governor Polis issued an Executive Order stating that employees should not lose their right to Unemployment Insurance if they refuse to return to work due to a “demonstrable” fear of catching COVID-19 Don’t we all have a demonstrable fear of catching COVID-19?

Employers can file claims against workers refusing to come back at ColoradoUI.gov, and workers who have received a job offer they don’t want to accept because of health and safety concerns can note that as well when they file weekly or biweekly benefit claim forms. So far, about 150 workers fighting orders to return to work have filed claims with the Colorado Department of Labor and Employment (“CDLE”) to keep receiving unemployment benefits, while employers have filed about 200 claims that could trigger cancellation of payments.

When a claim is filed, the CDLE staff will try to adjudicate it quickly.

Employees will be asked to explain what underlying condition they have that makes it unsafe for them to return to work or why they feel the workplace is an unsafe environment. Employers will be asked if the worker is coming back at the same job and pay rate and if efforts have been made at increased sanitation and social distancing. So far, CDLE officials are coming down on the sides of the workers at a ratio of about 10-to-1.

The CARES Act also includes the Paycheck Protection Program (“PPP”), providing eight weeks of fully forgivable payroll and rent for small businesses.

The program was so popular that it ran out of $350 billion dollars in a matter

of days. Congress began doling out PPP money before it even passed rules and regulations providing clear guidance to businesses on how the loan would be forgiven.

In early April, clients began asking if they should apply for a PPP loan or wait, as it made more sense to get the loan when their practice was actually open.

Do you delay filing a PPP application because you don’t want the money yet?

How do you advise clients to delay their application for what is essentially “free money” knowing that there is a high likelihood that the well will run dry and there is no guarantee of a second round of funding? By mid-April, there was a second round of PPP funding announced and those practices who were shut out in the first round were suddenly glad their bank was unable to get their first application approved.

Next employers needed answers to the simplest of questions regarding their PPP proceeds. The CARES Act specifically states that state and local taxes can be funded with PPP loan proceeds. It makes no allowance for a business to use PPP proceeds to fund federal taxes; however, the Small Business Administration (the agency charged with administering and auditing the PPP) provided its interpretation of the law and said that an employee’s payment of Federal Income Tax can be funded with PPP proceeds. It wasn’t until mid-May with the release of the PPP Forgiveness Application and final rules that we were able to confirm that health insurance premiums, retirement plan contributions and an employee’s share of Federal Income Tax can be funded with PPP proceeds.

Our lives are resuming, our businesses are opening. What do the next several months hold in store? The best advice I can give is that you is to remain flexible. We initially were required to take employee temperatures

and conduct a symptom check, then the Department of Public Health and Environment said if that is not practicable then employers can have employees conduct the wellness check at home. Expect many new Executive and Public Health Orders and amendments. Listen to your people and their concerns. Take a deep breath before you move on from a long-term employee who is genuinely concerned about returning to work. Remember that it is not easy to replace departing employees right now. If you were lucky enough to secure a PPP loan, remember that you need to have the same number of Full-time Equivalent (“FTE”) employees by June 30th as you had before the pandemic or you will lose a pro rata share of forgiveness on your loan.

Remember that “temps” hired through a third-party agency will not meet the FTE requirements as your business is not their actual employer.

In talking to many of you, I can anecdotally report that patients are universally returning to your practices and are in a rush to do so. Fear of infection has not resulted in patients pushing off their rescheduled appointment for several months. Your practices have quickly become efficient at disinfecting between patients, maintaining social distance and using PPE. If you continue to adapt as efficiently as you have in just the last three months the outlook for your practices is very bright.

About the Author Gary Benson has been practicing human resources law for more than 20 years.

He is a partner at Dworkin, Chambers, Williams, York, Benson & Evans, PC where he counsels numerous businesses on their employment practices and procedures. In addition to being an experienced litigator he is also a frequent lecturer on issues surrounding employment law and has presented for the Colorado Bar Association.

There’s a

Better Way to Protect Yourself

Berkley Risk of Colorado is dedicated to serving the dental and medical communities with customized, personal insurance services.

• Malpractice Coverage - Administrator of the Dentists Professional Liability Trust • Workers Compensation • Business owners Package • Life Insurance • Medical Insurance - Personal and Group

• Employment Practices Liability Coverage • Disability Insurance • Long Term Care • Flood • Privacy Data Breach 7807 East Peakview Avenue, Suite 350 Centennial, CO 80111 https://colorado.berkleyrisk.com

Phone: (303) 357-2600 Toll Free: (877) 502-0100 denver@berkleyrisk.com

I

2nd Quarter 2020 mddsdentist.com

11

COVID-19 IN COLORADO BY THE NUMBERS

10

+5,550 visitors to MDDS’s COVID-19 update page.

Colorado organizations collaborating daily and weekly on Colorado’s dental industry response to COVID-19.

15

+

9

virtual meetings of Colorado’s COVID-19 Dental Response Task Force.

webinars created with the Colorado Dental Association to help members navigate HR, finance, infection control, PPE and more.

80% of practices in CO reported being open but at a lower patient volume than usual.* 36% of dentists in CO reported a patient volume of 51-75% of their normal volume.* 87% of dentists in CO reported they are paying staff fully.*

47%

of dentists in CO reported having more than 2 weeks supply of N95 or KN95 masks.* *Information provided by the Health Policy Institute as of June 1, 2020.

12

Back to Work Resources As dentists across the metro area and the country are back to practicing under the “new normal� of virtual waiting rooms, screening questions, increased PPE and more, MDDS and the Articulator team have compiled resources to help you safely resume dentistry.

The following pages contain resources, guidance documents and samples that were the latest information at the time of publication.

Please keep in mind the recommendations from the CDC, OSHA, DORA, CDPHE and ADA are frequently updated, sometimes daily, so please note the date on each document and check mddsdentist.com/covid19 for all of these resources, additional information and updates.

Stay safe!

13

Self-Care and Stress Management During the COVID-19 Crisis Increased anxiety is common as we navigate COVID-19 and the broad impacts to our communities. It is a normal, natural response to have increased emotions during this time of uncertainty, including feeling stressed, worried, sad, scared, disappointed, and confused. The more we focus on what is out of our control, the more stressed and anxious we begin to feel. Your well-being and emotional resilience are essential to our patients as we work to help our communities through the COVID-19 pandemic. Here are a few recommendations for stress management during this time.

Self-care is especially important.

• Schedule and take brief relaxation breaks at work. A few minutes of a break during a shift can be calming. Even a 5-minute walk can improve energy and focus.

• Take time each day to do something that brings you joy, even if just for a brief moment.

• Maintain a healthy diet; bring your own meals to work.

• Keep your schedule of daily activities as regular as you can.

• Get some sunlight.

• Try chair yoga or stretching at work.

• Get regular exercise. Try walking or biking to work if you can.

• Avoid or limit use of alcohol and caffeine.

• Monitor yourself for excessive fatigue, irritability, poor focus, or anxiety.

• Pace yourself.

• Take a moment for a slow breath before entering a work area, entering a patient room, or clocking out. This can be difficult while wearing personal protective equipment like a mask, but breathing is calming and helps your body cope with physical symptoms of stress. If you regularly see a mental health professional, video visits or a phone call may be a good idea.

• If you do not regularly see a mental health professional but feel doing so could be helpful at this time, many mental health providers are offering free sessions for health care workers.

• If a spiritual practice is important to you or has been in the past, work it into your regular routine.

Manage the cognitive impacts of stress: • Limit the intake of news; doing so can help manage difficult or upsetting feelings. The constant intake of frightening information can create more stress.

• Connect to reliable sources of information.

• Focus on what is within your power. Wash your hands frequently with soap and water or with an alcohol-based hand sanitizer; try to maintain a 6-foot distance from someone who is coughing or sneezing to prevent the spread of germs; and prevent yourself from touching your face.

• Check in with anxiety-provoking statements and reframe them to be statements that better reflect the evidence. This can reduce stress and increase coping abilities. For example, reframe, “my family will get the virus and die” to “the majority of people who get the virus recover.”

Create networks of social support. Social connections are important to our emotional well-being, especially in times of stress: • Share your concerns and problem-solve with colleagues, family, and friends. Together, plan steps to manage difficulties.

• Lean on each other. You will be there when your colleagues need help, so count on them to be there for you.

• Find ways to connect with friends and family. Meaningful interactions with loved ones are important to our well-being.

14

Reproduced with permission from the National Comprehensive Cancer Network, Inc. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed Month, Day, 2020. To view the most recent and complete version of the recommendations, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.Reproduced with permission from the National Comprehensive Cancer Network, Inc. © National Comprehensive Cancer Network, Inc. 2020. All rights reserved. Accessed Month, Day, 2020. To view the most recent and complete version of the recommendations, go online to NCCN.org. NCCN makes no warranties of any kind whatsoever regarding their content, use or application and disclaims any responsibility for their application or use in any way.

Patient Screening Form Patient Name: PRE-APPOINTMENT

Date:

IN-OFFICE

Date:

Do you/they have fever or have you/they felt hot or feverish recently (14-21 days)?

Yes

No

Yes

No

Are you/they having shortness of breath or other difficulties breathing?

Yes

No

Yes

No

Do you/they have a cough?

Yes

No

Yes

No

Any other flu-like symptoms, such as gastrointestinal upset, headache or fatigue?

Yes

No

Yes

No

Have you/they experienced recent loss of taste or smell?

Yes

No

Yes

No

Are you/they in contact with any confirmed COVID-19 positive patients?

Patients who are well but who have a sick family member at home with COVID-19 should consider postponing elective treatment.

Yes

No

Yes

No

Is your/their age over 60?

Yes

No

Yes

No

Do you/they have heart disease, lung disease, kidney disease, diabetes or any auto-immune disorders?

Yes

No

Yes

No

Have you/they traveled in the past 14 days to any regions affected

by COVID-19? (as relevant to your location)

Yes

No

Yes

No

Positive responses to any of these would likely indicate a deeper discussion with the dentist before proceeding with elective dental treatment. • For testing, see the list of State and Territorial Health Department Websites for your specific area’s information.

15

16 2nd Quarter 2020 mddsdentist.com

I

PROSTHODONTICS

RESTORATIVE

P P P

—

P P

Seating restorations: Try to do crown/bridge adjustments outside of the mouth

Denture/RPD and impressions Repairs/

Stainless steel crowns

—

P

P

Crowns/bridges

Veneers

P

P

Fillings/ restorations

—

—

—

Socially distant patient encounter

—

—

Level 2 or above Level 2

Level 3 or N95

Level 3 or N95

Level 2 or above

Level 3 or N95

Level 3 or N95

Level 1 or above

Level 2 or above

Level 2 or above Level 2 or above

Cloth mask

Level 2

Mask

P

P P

P

P

P

P

—

P

P P

R R

P

P

R

—

P

—

P

P

P

or Plastic Barrier

P

P

Eye protection

R

—

—

—

P P

—

—

—

Booties or dedicated office shoes/bonnet

P

P

P

Gown or jacket

or

—

P P

P

P

P

—

P

P

—

—

Preferred

Face shield

Executive Director Dentists Professional Liability Trust of Colorado

Intra-oral photos

—

—

—

—

FRONT DESK

—

Splatter producing

—

—

Check-in Check-out

SCREENING

New or recall exam Intra-oral radiographs

—

Screening/temp taking

SPECIALTY

DIAGNOSTIC

Aerosol producing

Procedure type

Updated as of May 22, 2020.

COLORADO’S INTERIM GUIDANCE FOR PPE IN THE DENTAL SETTING* H. Candace DeLapp, DDS

— = no

Level 3 or N95

P

—

P P — —

P — —

Retainer checks

Wire changes

P

P

Level 3 or N95

2nd Quarter 2020 mddsdentist.com

I

Level 2

Level 2

Level 3 or N95

Level 3 or N95

Level 3 or N95

Level 3 or N95

Level 3 or N95

Possible

Possible

—

New banding/ bonding De-bonding or de-banding

Bone graft surgery Soft tissue biopsy Hard tissue biopsy

Implant surgery

Level 3 or N95

Level 3 or N95

P P P

P

Level 2, 3 or N95

P

P

Surgical procedures

P

Level 3 or N95

Level 2, 3 or N95

P

—

Scaling/root planing-hand

P

P

—

P

Ultrasonic scaling

Non-surgical extraction Surgical extraction

—

Level 3 or N95

P P Level 3 or N95

Level 3 or N95

Level 3 or N95

or above

Possible

P

P P P P

Rubber cup or tooth brush prophy

Pulpotomies

Apicoectomies

Instrumentation

Endo access

—

—

P P P

P

P

P

P P P

P

P

P

P

P

P P P P

P

P

R

P P P

R

P

P

P

P

P P P P

—

—

—

P

P

P

P

P P P

P

*This document has been prepared by the CDA and the MDDS as a resource for dentists based on our understanding of the current PPE guidance. Dentists should always understand and review the latest CDC, OSHA and any CDPHE requirements that will supersede any recommendation on this chart.

—

—

P —

R

R

P

P P P

R R

P

P

P

P

R

R

—

R

P

P P P P

R R R R —

P

—

Kids In Need of Dentistry Team Dentist

P = yes R = Recommended

ORTHODONTICS

ORAL SURGERY

PERIO/HYGIENE

ENDODONTICS

adjustments

Les Maes, DDS

17

Please remember to practice social distancing and wash your hands regularly.

Upon entering your temperature will be taken.

- Have you been in contact with anyone known to have COVID-19 in the last 14 days?

- Are you exhibiting any symptoms of COVID-19?

(Fever above 100.4, cough, malaise, etc.)

Before entering, please put on your cloth face covering.

STOP!

6 Feet

SOCIAL DISTANCING

FOR

THANK YOU

FEATURED ARTICLE

BUILDING RESILIENCE

IN HARD TIMES

By Laura Brenner, DDS

W

e could all agree that having abounding resilience is the key to a long, successful dental career, right? The ability to recover from challenges and then continue on to thrive is vital. Without that quality, we would not be able to survive the stresses of dentistry.

picking up that hobby or habit that always gets pushed to the side. They may even realize how much less stressed they feel without days in the office. It’s easy to stay positive because things aren’t so bad, or it could always be worse.

We all want more resilience, but some of us aren’t thrilled about doing what it takes to build it. Wouldn’t it be great if we could become more resilient through a lifetime of smooth sailing? I wish that were the case, but unfortunately, that is pure fantasy.

On the one hand, it’s likely that those who are struggling are enduring worse hardships than those who are enjoying this time. That seems logical and fair.

Maybe those who are enjoying this time at home don’t really have that much at stake, so they’re naturally not suffering as much.

The only way to build resilience is to endure hard times.

There might be a different source of their positivity. Perhaps they have endured worse hardships and therefore have a different perspective that is helping them to cope more easily. That is resilience.

Does it seem at all ironic to you that the very thing that builds resilience is the same thing that often makes us want to give up? The very challenges that make us want to crawl into a hole and hide until the problem disappears, are the only keys to growing our resilience.

As we navigate this new world of pandemic precautions, I’m noticing two different reactions to the problem. For some, it has created a catastrophe, and it truly is that. With an abundance of loss all around us: lost wages, closed businesses and, even worse-- illness and loss of a loved one; it’s hard to imagine life could be worse.

For others, it simply feels like an extended staycation. They feel content at home, finding more time for self-care or quality time with their children, or

I

20 2nd Quarter 2020 mddsdentist.com

Regardless of which side of the coin you fall, your reaction is perfectly appropriate for you during this time.

Personally, I fit into the second category of people. As of now, I’m not enduring tragic losses. I’m healthy; I have saved enough money to get through some financial loss; and I have plenty to keep me busy. I have also just finished almost two years of grueling treatments to fight stage three breast cancer. For the past two years, my life was filled with sickness and sadness and constant setbacks that kept beating me down. If something is going to help build resilience, that’s it!

When the fears of the unknowns set in as we were beginning to shut down our country, I thought to myself, “If I could get through that hell, then I’ve got this!” It was amazing for me to experience a natural gratitude for the positives

instead of feeling the anxiety that comes with loss and the unknown.

I didn’t acquire that superpower because I’m better or stronger than anyone else. I earned it by enduring my own personal hell and, as a result, building my own resilience.

In some ways, it was a choice.

"The ability to recover from challenges and then continue on to thrive is vital. Without that quality, we would not be able to survive the stresses of dentistry."

I did a lot of reflection during my year of cancer hell. I allowed myself to grieve properly, and giving myself that space is exactly what allowed me to bounce right back, even before the ordeal ended. It was a choice. I could have decided to be bitter about the world giving me cancer when I had done everything right up until that moment; or, I could have chosen to grow from the experience. I chose the latter, and with that I got to feel the beauty of resilience.

Let’s turn this back to you. If you share my perspective, you would probably agree that you built your resilience by experiencing tough challenges.

If, on the other hand, you are depressed, afraid, angry, or anxious; this moment, right now, is building your resilience. Now is the time to honor and accept those uncomfortable feelings. If you judge and dismiss your discomfort, you’ll only prolong it. Give yourself a break. Anyone would feel anxious in your situation. Validating and supporting your reaction during this time will help you move through it. Judging it and stuffing it down will only make it linger.

We all hate pain. Of course, we do. It’s uncomfortable.

However, that pain builds our resilience. Without it, the smallest problems would put us over the edge. In a way, it can be good for us.

Whether it’s enduring the many challenges of COVID-19, a chronic illness, or even the daily hassles of dental practice, accepting and working through pain makes us stronger. I wish the realities of dental practice meant that teeth didn’t get perf ’d, patients didn’t get angry, or that one team member didn’t miss work all the time. Just think, if that were the case, the smallest of inconveniences might start to feel like huge problems.

It’s those very problems that we often hate to endure, that make us stronger.

It’s those very problems that help us appreciate what’s important. Learning to cope with and manage those problems are exactly what allows us to bounce back from life’s challenges.

When you do bounce back, you’ll be even better prepared to face the next challenge.

About the Author Dr. Laura Brenner worked in private practice in Denver for 10 years until she left clinical dentistry behind for good. As the author of the Lolabees blog and 10 Reasons Your Dentist Probably Hates You Too, she began connecting with other dentists from around the world who wanted more from their careers. This work inspired her to become a Certified Professional Coach who is passionate about helping dentists find joy in their careers again.

Are you ready to WORK LESS and TRAVEL MORE? Is this your year to transition?

Selling or Buying a DENTAL PRACTICE? All practice sales are not created equal. Don’t settle for less than you deserve. Put my experience and expertise to work for you!

trave l more !

Susan A. Spear

Licensed Broker/Business Intermediary susan@sastransitions.com

CONTACT SUSAN AT 303.973.2147 WWW.SASTRANSITIONS.COM

I

2nd Quarter 2020 mddsdentist.com

21

FEATURED ARTICLE RMDC SPEAKER

LAUNCHING BACK INTO PRACTICE STRONG In Every Crisis Lies an Opportunity

By Kim McGuire, CPCC

"U

nprecedented,” “New Normal,” “Uncertain.”

These are the overused phrases and words describing this time. Certainly you and your business have been through a lot the last few months: applying for a PPP loan, working with creditors to delay payments, procuring Personal Protective Equipment (PPE) and keeping your team apprised on the new systems when returning back to work. As an Executive Coach, my focus has been to coach clients to not only come back to work successfully, but to up their game and thrive in this new environment. My hope is that you take some of these ideas and implement them so you can serve your patients, strengthen your team culture and actually increase your profitability.

Throughout this process we have reminded dentists that they wear three hats as an owner: a Leader, a CEO and a Clinical Director. As the CEO, you have been busy obtaining your PPP loan, temporarily laying off some or all of your team and focusing on cash flow analysis. As a Clinical Director, you have procured your PPE, created new protocols and outfitted your practice to comply with the current standards. Now, let’s move into what will sustain you long term, as the leader.

Leadership is about influencing those around you - your patients, your team and your community. Patient relationships and engagement are not new, yet effort will have to be significantly increased to not only survive but thrive in this environment.

Right now, there are headlines in the media that are not always positive for the dental industry. Rather than trying to control the media, focus on what you can control - the narrative inside your practice. What are the communications and messages that you send to your patients and community? You have an opportunity to strengthen your relationship and the trust they have in you

I

22 2nd Quarter 2020 mddsdentist.com

as a healthcare provider - encouraging your patients to take care of their oral health as it is connected to the rest of their body.

While we don't have a crystal ball, there may be a “gap” in the patients who are ready to come back to see you. The “early adopters,” those who trust you and were ready to see you once you opened your practice, have already been in for their appointments. The next phase of patients to come back are the “early and late majority” (up to 70% of your patient base). These patients may be more hesitant and will require more engagement to get them back to your practice. What we do today can greatly reduce the effect of that gap.

Before we get into some tactical strategies on increasing patient engagement, let us focus on leadership. It starts with a “Culture Calibration.” Calibrating one's culture means to have everyone aligned in the result and the actions taken to achieve the ideal outcome. Once there is consistency in your culture and everyone is clear on the expectations of each other, they can begin to focus on the desired results from every interaction. If every employee understands that each interaction with patients either encouraged them to come in and experience the office influences them to reschedule their appointment, we would see an increased level of importance and concentration on each interaction. Our conversations matter, our word choice is essential and their experience matters.

What is the consistent message you want your patients to feel when they engage with your office? Whether it’s calling the office and speaking to someone over the phone, visiting your website or social media channels or coming in and interacting with your team, what should a patient feel? In a time like this, you want to focus on words like trust, safety, reassurance, confidence, knowledgeable, etc.

In your team meeting, gather the team and ask them two questions: 1) What do we want our patients to feel?

2) How will we ensure they feel that?

Once you have your Culture in place, focus on the different ways you will engage your patients. For a detailed guide with scripting for all modalities listed, see the link at the end of this article to download.

The most obvious one would be the telephone. Do you have "Patient relationships a script for pre-screening your and engagement are patients before they come in? It not new, yet effort will is important to communicate to the patients all of the protocols have to be significantly the office follows to keep the increased to not only team and the patients safe and survive but thrive in this healthy. Whoever is making the environment." phone calls should also reassure all patients that the dental office is making every effort to be safe and you have been diligent about infection control for decades. In addition, a post-appointment check in is a great time to ask for reviews and referrals.

Next is email. Many practices have a patient communication system that automatically communicates with the patients such as RevenueWell or SolutionReach. Take a look at emails that are going out and customize them to the current times. There are five different types of emails that are important to customize and send out.

1) Reactivation: This email should be sent to patients who are past due for an appointment.

2) What to expect during your visit: This email should be sent 2-3 days before the patient’s appointment.

3) Follow up: This email should be sent after the appointment.

4) Weekly emails to all patients: A weekly email should be sent to the entire patient base.

5) Personalized: This email is for patients who you’ve called and not heard back. Send them a personal email including some of the verbiage above.

Weekly emails to patients should include items such as patient written and video testimonials.. They may also include team videos about what to expect, fun team videos on what is happening in the practice, personal stories of team members, information on PPE / patient safety, inspiring messages and health and dental tips.

Text messages have also become an effective tool. Are you customizing and getting creative with your texts? Use texting to communicate availability

and hours, to schedule appointments, to confirm appointments and to send post-appointment thank you notes. In addition, you can use customized giphy images that reflect your brand and image. By customizing your texts, you are differentiating yourself and strengthening the personal connection.

Engaging your community using social media is more important than ever! People are spending more time on social media and here is your opportunity to engage with your patients and greater community. Even if you were not focused on this before COVID, this is your chance. One of the most valuable tools you can use is getting video patient testimonials.

If someone else says it, it must be true! Ask your early adopter patients to take a short video on how great their experience was and post on Facebook, Instagram in addition to using in your weekly emails.. Don’t forget to boost posts on Facebook.

Social Media Ideas: • Post photos of your happy and friendly team members • Conduct a Facebook Live to answer patient questions • Scheduling - when and how they can visit the practice • Promote your In-Office Discount Plan Video Ideas: • Patient testimonials showing your “wow” factor • Create selfie videos to speak to your patients from the heart • Virtual office walkthrough video on the “new” patient experience • “Behind the scenes” video of cleaning instruments, door handles...etc.

• New PPE and equipment to keep patients and team members safe • Team member videos sharing what will be different for patients Patients and potential patients will be looking at your online presence. Your website should be updated with new hours, videos of the doctor and team explaining new protocols, video testimonials and welcome back message. I’d also suggest utilizing Live Chat.

Last, it is time to turn your online advertising back on! Focused Facebook ads and Google Adwords are important to keep that steady stream of new patients flowing into your practice. We are seeing the following keywords be effective: “Emergency dentistry,” “Implants,” “Safe Dentistry,” “Senior Dentistry” and “Same Day Dentistry.”

For a detailed 17 page Engagement Guide, and many other free resources, please visit https://tinyurl.com/y9vsxly6.

About the Author As an Executive Coach for Fortune Management, Kim brings over 18 years of Dental Executive Coaching and practice management knowledge to the Colorado Dental community. Kim advises doctors and teams to implement strong systems for maximum effectiveness. Her leadership coaching enhances communication, relationships and accountability. Kim also has a deep understanding of the Business of Dentistry. Passionate about personal growth and professional development, Kim's coaching has people be their best self!

I

2nd Quarter 2020 mddsdentist.com

23

RMDC SPEAKER PRACTICE MANAGEMENT

MARKET CONDITIONS AND PRACTICE TRANSITIONS

By Marie Chatterley

W

e just experienced a traumatic event and are now all working towards recovery. The last few months have produced sleepless nights and a few meltdowns. We exhausted ourselves with webinars, podcasts, blogs, news updates and tried to manage the chaos of empty store shelves and homeschooling. We are getting back to work and hoping to quickly move to full productivity. We have experienced financial loss and a lot of emotional stress within our business and personal life. In the midst of this trauma, I am feeling optimistic about the future of our industry to recover. As I contemplate these recent events, I am reminded of a time I experienced great financial and personal failure. At the time, all I could see was the great losses I was experiencing. Now, years later, I have tremendous gratitude and a profound sense of accomplishment for my resilience during that trying time. My hope for our dental community is to gain strength from this experience and stay resilient as we rebuild our businesses.

continues to increase each year and has increased over the last two months.

On average we have 30 new buyers contact us each month regarding practice opportunities. We saw the same number of new active buyers inquire in March and April of this year.

Can I still get a loan to purchase a practice?

Yes, lenders are currently approving new deals and scheduling closings in May, June and July. Some banks have paused funding new loans for a few months, some have added additional conditions to close, such as proof of postCOVID production numbers and others are lending as usual. The lending approval process is taking much longer and additional closing conditions are extending closings currently.

Will the Seller need to carry a promissory note for a portion of the purchase price?

Since things change daily, I will try to provide some insight into what is happening currently with practice transitions. You may be contemplating how recent events could impact your ability to transition in or out of practice ownership this year or next year. Below are the most common questions we are being asked regarding transitions and current market conditions.

Most of the lenders are approving 100% of the purchase price and working capital but we have seen occasional approvals that request a Seller carry back.

Conditions for a Seller note vary depending on the practice cashflow and the financial strength of the buyer. If the Seller’s office production quickly jumps back to normal, there should be little reason to see lenders asking for the Seller to carry a note.

Have practice values been impacted?

Should I consider selling my practice now or should I wait until next year?

We have seen no impact to practice values. Practices on the market currently have gone under contract for the appraised value or higher. However, current practices under contract are experiencing a delay in closing times due to lenders requiring the office be back up to at least 80% of usual production before they will fund. Most lenders anticipate offices will rebound quickly once open. If some offices experience a longer period (6-12 months) of lower production, that will likely have an impact on practice value. The perception of value, however, in the mind of some buyers is being influenced by the uncertainty of the broader impact the pandemic may have on the economy moving forward.

This is the most common question we have received over the last two months.

The answer is not simple, as some of the reasons to sell now or wait may be unrelated to COVID. We recommend contacting your trusted transition company to discuss your situation so appropriate advice can be provided based on your circumstance. In the last three weeks we have placed practices on the market, many are going under contract quickly and closings are being scheduled. For now, transitions are moving forward, and the only change is extended time frames for financing.

Have any transitions taken place since business closed?

We had three closings the week after business closures and two closing midMay. Are there more practices on the market now and is it turning into a buyer’s market?

In Colorado we historically have far more buyers than opportunities available.

This has not changed in the last two months. The number of active buyers

I

2424 2nd Quarter 2020 mddsdentist.com

If you are considering buying or selling this year, please reach out to discuss current challenges and opportunities. A qualified transition specialist can help establish your objective and determine an ideal transition plan.

About the Author Marie Chatterley is a partner at CTC Associates, a practice transition consulting company that has helped facilitate over 1,500 practice transitions in the last 29 years. You can reach her at info@ctc-associates.com.

We’re here to help.

Improve your patient care without adding overhead expense – by partnering with DenteVita and the Practice of Dr. Aldo Leopardi, Prosthodontist. You can trust that you’ll receive the impeccable service you would expect from a seasoned specialist like Dr. Leopardi.

Our goal at DenteVita is to do everything possible to build your confidence and exceed your expectations.

Together, we will work with you to provide the highest level of individualized care. Consider Dr. Leopardi’s expertise as an extension of your professional practice. The level of experience and precision that his Practice offers makes it easy for you to refer your patients with complete confidence.

Call our office at

About Dr. Aldo Leopardi Dr. Leopardi is the founder of DenteVita Prosthodontics. His focus is to provide functionally driven aesthetic solutions to patients requiring tooth borne fixed, removable, aesthetic and implant supported dentistry. With over 30 years of experience, from single tooth to complete rehabilitation, you can be assured that your patients are in the care of a skilled professional.

7400 East Crestline Circle, Suite 235 Greenwood Village, Colorado 80111 P. 720.488.7677 // F. 720.488.7717 Visit our website: www.dentevita.com

720.488.7677 to speak to Dr. Leopardi and find out how we can build a successful partnership.

Don’t forget to ask about our referral packet!

Life is

better with DenteVita

I

2nd Quarter 2020 mddsdentist.com

25

TRIPARTITE NEWS

What’s the CDA Doing About ________?

By Greg Hill, JD, CAE, CDA Executive Director

T

his question has come in our emails, across

The CDA took the lead through this crisis the same way we have led

social media feeds, through text messages and

for the past decade. We brought the entire profession together: dentists,

by telephone calls hundreds, if not thousands,

dental hygienists, state regulators, public health experts, suppliers,

of times over these past few months. Sometimes that

insurers, our lobbying team, component leaders (including your MDDS

question continued with a sincere appreciation for the

leadership) and national ADA representatives. Some have criticized this

work we are doing. Other times the email was followed with anger and

approach and feel we should not have engaged these stakeholders in the

spite and words I cannot print.

process—that leading this way showed the CDA is weak and ineffective. I would argue quite the opposite. This approach was a big part of the reason

Early on, we learned quickly that we would never be able to please everyone during the early spring months of COVID-19. It started with dozens of phone calls and emails demanding a recommendation to close practices. Once we made the difficult decision to recommend practices close to non-emergency treatment to preserve PPE for hospitals, a decision that aligned with the ADA and the other fifty states, we found ourselves on the wrong end of angry emails and phone calls demanding we do just the opposite. We

that Colorado dentists were the second state in the

"Like everyone, we were thrust into this pandemic without an instruction manual. Learning as we went, sometimes making an error, but always trying to do 'the right thing.' "

had emails saying that the “majority of CDA members

country to reopen to be able to perform elective procedures. For some of you, we know this is not good enough. Your practice, your career, your legacy is being threatened by a force that you can’t control. We sympathize with you but no business in Colorado or anywhere has gone through this unscathed. Tens of thousands of business owners across this country will never have the opportunity to do what most of you have already done—walk back into your business and restart it.

think you guys are doing an excellent job and appreciate your leadership. This is why I am a member of organized dentistry. You

Has the process and the communication from the state government been

should be proud of yourselves.” Minutes later, we would receive an email

flawless? Absolutely not. But have we “lobbied” DORA, the governor,

that said, “the majority of CDA members think you are inept and are not

CDPHE (Colorado Department of Public Health and Environment)

going to renew their membership. You should be ashamed of yourselves.”

to open dental practices? To answer that question, we not only lobbied on your behalf with these groups, we recruited them on to our team;

The CDA staff has been yelled at, screamed at, cussed out and had

we included them in our decision making. They were able to take the

members question whether they should even be employed. We have

recommendations from the CDA directly to the ultimate decision makers.

even had lawsuits threatened against us. Next, we had members who

That is the reason the recommendations we put forward were adopted in

were outraged: “Why is the CDA collaborating with Delta Dental?” Our

the executive order, incorporated in the public health order, and allowed

answer to that was simple—because members were calling and asking,

for the reopening of dental practices before most states were able. We

“Why isn't the CDA working with Delta Dental so that they will help

brought Delta Dental onto our response team, and when claims were

dentists by returning money for PPE, like they are doing in Washington

delayed for clarification as to whether the treatment was done according

and Ohio?”

to the requirements of the executive order, we were able to call Delta Dental directly, explain the concern and within an hour, have the issue

Like everyone, we were thrust into this pandemic without an instruction

resolved on behalf of our members. When there was confusion around

manual. Learning as we went, sometimes making an error, but always

the scope of practice for dental hygiene, we collaborated with the hygiene

trying to do “the right thing.” None of us have had to lead through a global

association who "lobbied” DORA to expand the hygiene procedures in

pandemic that has killed more than 100,000 Americans and shut down

a way to safely protect their members. Because of our proactive action,

the entire U.S. economy overnight, resulting in more than 40 million job

and team-centric approach, we did not experience the substantial rift

losses—a half million in the dental profession.

between most hygiene associations and their dental counterparts.

I

26 2nd Quarter 2020 mddsdentist.com

Hopefully, this is not news to you, but life and the practice of dentistry will

and to reprioritize its programs and services to meet our member’s needs in

likely never be the same as it was a few months ago and there is nothing anyone

this uncertain future. In five years, I expect COVID-19 will still be affecting

can do. No amount of lobbying, standing up for the profession or pushing back

decisions we make as an organization.

against regulators or the governor is going to make COVID-19 go away. At some point, hopefully in the near-future, reliable testing will be made available

I promise you this, we have never worked harder on your behalf and we will

and dental offices may be able to relax the PPE requirements on confirmed

continue to do so until this virus is eradicated and this crisis ends. We are here

COVID-negative patients. There will likely be a COVID phase 2, and even

for our members and my door is open to your comments. You can email me at

a phase 3 and 4. We want you to be able to remain open during these future

greg@cdaonline.org or call me at (303) 996-2846.

outbreaks and are working to make sure that happens.

About the Author

Unless and until there is a vaccine developed, this is going to be a part of your

Greg Hill, JD, CAE has served as the Executive Director of the Colorado

everyday life and practice. But you won’t be alone.

Dental Association since June of 2014. Prior to joining the CDA, Greg was employed by the Kansas Dental Association for 15 years and served as

So, what is the CDA doing about _______? The answer is everything we can.

the Assistant Executive Director of the CDA and Executive Director of its

You should know that dozens of your colleagues stepped forward during this

Foundation. Mr. Hill is a 1999 graduate of the Washburn University School

time of crisis and, while managing the same professional and personal struggles

of Law in Topeka, KS and a 1994 graduate of Kansas State University with

that all of you have faced, volunteered an estimated 5,000 hours to this response

a Bachelor of Science in Economics. He became a Certified Association

and to the decisions that have been made. I ask that you thank them.

Executive (CAE) in 2016. In addition, he serves as Co-Chair and Treasurer of Oral Health Colorado; on the Board of Directors for the Colorado Dental

COVID-19 will have a long-lasting impact on the CDA and our members

Lifeline Network and the Colorado Mission of Mercy; and is a member

for a considerable time. We are already developing a comprehensive “Restart”

of the Denver Tech Center Rotary Club. He and his wife, Gwen, are the

plan that outlines how the CDA plans to rebuild itself as an organization

parents of daughter, Haven, and son, Camden.

SELLING your DENTAL PRACTICE? Appraisals • Practice Sales • Partnerships • Buyer Representation • Post-Transition Coaching Start-Up Coaching • Associateships

Your Dental Practice Is Your Legacy.

Larry Chatterley

Marie Chatterley

Randon Jensen

As dental practice transition specialists, we guide you through the complex process of selling your practice to ensure everything goes smoothly with the legacy you have built.

Operating since 1988.

Complimentary Consultation

303-795-8800

“I sold my practice to my associate and Larry and his team were wonderful to work with. They handled the endless details beautifully and made the transition a really easy one for all of us. I highly recommend them and am so thankful they were there to guide us though the process!” - Dr. Naomi Jacobs

I

2nd Quarter 2020 mddsdentist.com

27

EVENT CALENDAR September 16 CPR & AED Training -American Workplace Safety Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700 September 26 MDDS Shred Event Rocky Mountain Orthodontics 650 W Colfax Ave Denver, CO 80204 9:00am – 12:00pm (303) 488-9700 October 2 Navigating the World of 3D Imaging -Dr. Michael Moroni Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 3:00pm (303) 488-9700 October 3 HANDS-ON Er:YAG and Nd:YAG Laser Training – Take Your Practice to the Next Level -Dr. Terry Alford Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

SIGN UP NOW BEFORE IT’S TOO LATE!

BENEFITING

October 23 – 24 HANDS-ON Dental Laser Certification: Utilize Today’s Dental Lasers in Managing Periodontal/Soft Tissue Conditions -Dr. Sam Low Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 5:00pm October 23 8:00am – 12:00pm October 24 (303) 488-9700 October 30 Botulinum Toxins (Xeomin, Dysport, Botox) and Dermal Fillers Training, Level 1 -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700 October 31 Botulinum Toxins (Xeomin, Dysport, Botox) and Dermal Fillers Training, Levels 2 & 3 -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700

October 31 Frontline TMJ & Facial Pain Therapy, Level 1 -American Academy of Facial Esthetics Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 5:00pm (303) 488-9700 November 6 Connecting Technologies: The Key to Digital Workflows -Dr. Bryan Limmer Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 11:00am (303) 488-9700 November 10 CPR & AED Training -American Workplace Safety Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 6:00pm – 9:00pm (303) 488-9700 November 13 HANDS-ON Zirconium Crowns for Primary Teeth, Simplified -Dr. Nelle Barr and Dr. Sean Whalen Mountain West Dental Institute 925 Lincoln St Unit B Denver, CO 80203 8:00am – 11:00am (303) 488-9700

Sat., September 26, 2020

MDDS

SHRED EVENT 9:00am – 12:00pm Rocky Mountain Orthodontics 650 West Colfax Avenue, Denver, CO 80204 29

STAY TUNED FOR

A REIMAGINED RMDC EXPERIENCE! Visit rmdconline.com for updated information.

JANUARY 21-23

Founded by a team of industry professionals who have been providing waste management services to Colorado for over 18 years, HCMWS proudly serves hospitals, clinics, laboratories, blood banks, dentists and funeral homes, as well as any facility that is looking for a safe and cost-effective way to dispose of their medical waste.

I

30 2nd Quarter 2020 mddsdentist.com

PO Box 1385 Colorado Springs, CO 80903-1385 info@hcmws.com 719-445-5044 720-319-9419 www.hcmws.com

CLASSIFIEDS For Sale IMMEDIATELY AVAILABLE for build-out, 2075 sq. ft. build-to-suit space at Lincoln Avenue and Oswego Street, Beautiful Custom Professional Building, total building size 8000sq. ft., two of three suites already leased to general dentists, common entrance with private back entrance, High visibility from Lincoln Avenue, half mile from the I-25 and Lincoln interchange, adjacent to the Master Planned Lone Tree Retail and Town Center, Plentiful and easy walk-up parking, Lone Tree/Meridian population demographic outstanding, across the street from SkyRidge Hospital complex and Charles Schwab Corporate campus, close to light-rail stop, Compressor and Vacuum shared, Triple Net lease and terms negotiable, please call 303/877-9226 Well established general dentistry practice for sale. For over 30 years in the same location, our practice has served the community as a cornerstone of this outdoor shopping area. Located in a high traffic district in central Denver, we benefit from established patient families and name recognition within the community. Contact david@clanclark.net or (303) 358-7529.

Office Features: • Two operatories featuring independent chairs, rinse sink, lights and a shared x-ray.

• Standalone Panoramic X-Ray • Lab • X-ray processing room • Back office with break area • Remodeled entrance exterior and interior • Patient waiting area for 9 Medical Office Building for sale (CO 2007) in Federal Heights, 4,700 sqft, built in 2010, custom alder woodwork and granite throughout, fireplace in upper lobby, could subdivide for multiple organizations. For more information, please contact us at frontdesk@adsprecise.com or call 303.759.8425 and use the listing reference number CO 2007.

GP and free-standing Building (sold with practice) for Sale in Woodland Park (CO 1803) Dr retiring, annual revenue $275K, 5 OPS. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com.

Listing Reference Number: CO 1803 GP in West Denver for sale with Building (CO 1706) Purchase Price $630K for practice + $1.28M for building, $810K collections, 5 OPS, 2,000 sqft office + 800 sqft basement, Dr retiring. . For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1706 GP for Sale: North Eastern CO (CO 1735) 4 Ops, approx. $900K in collections, Standalone bldg. sold w/practice. Dr. retiring. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1735 GP for Sale near Aspen CO (CO 1613) Well established Gross $660K. Net $212K 4 + 1 ops., attractive lease. 4 MONTHS FREE RENT 3 1/2 days/wk. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www. adsprecise.com. Listing Reference Number: CO 1613 OMS practice, western mountains near Vail and Aspen, (CO 1350) Annual Collections $840K, 3 ops, 1260 sqft. For more information contact ADS Precise: 303759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1350 GP for Sale: Pueblo, CO (CO 2006) 4 Ops, 1900 sqft office, $393K in collections. Dr. retiring. For more information contact ADS Precise: 303-759-8425, email: frontdesk@ adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 2006

General Practice for Sale: Southwest Colorado Springs (CO 2010) Annual Revenues $319K, 3 Ops fully enclosed, 1682 sqft – Dr. Retiring. Sale price $239K. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 2010 Perio practice for Sale: Colorado Springs, CO area (CO 1914) Annual Revenues $630K, 3 Ops, 1,542 sqft. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1914 GP for sale in Central Denver (CO 1910) Sales Price $489K 6 OPS, 3,600 sqft, $740K collections, Dr retiring. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1910 ` Perio practice for Sale: Denver Metro area (CO 1909) Annual Revenues $500K, 3 Ops, 1,323 square feet. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1909 GP for sale in CO Springs (CO 1908) Collections $465K, 2,043 sq ft, 5 OPS. Sales price $250K. . For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1908 Endo for Sale in Southern Colorado (CO 1907) 5 DTR, $475K in collections, Dr Retiring. . For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1907 GP for sale in Denver (CO 1906) Beautiful 5 Op in Denver Metro Sales price $125K, Dr moving out of the area. . For more information contact ADS Precise: 303-7598425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1906 GP for sale in Colorado Springs (CO 1904) 4 Fully Equipped Ops, $250K in collections, 2540 sqft, Dr Retiring. For more information contact ADS Precise: 303-759-8425, email: frontdesk@adsprecise.com, www.adsprecise.com. Listing Reference Number: CO 1904

DENTAL PRACTICE BROKERS

KNOWLEDGE • EXPERIENCE TRUST • CREDENTIALS • Practice Sales Since 1986 • Practice Appraisals • Partnerships • Transition Planning • Dental Building Sales • Buy Ins/Buy Outs

Pete Mirabito DDS, FAGD • Jed Esposito MBA, CVA

Call us - 303-759-8425 Visit us - adsprecise.com

All ADS companies are independently owned and operated

I

2nd Quarter 2020 mddsdentist.com

31

Does your lease expire in the next 24 months?

If so, allow our team of expert brokers to save you a substantial amount of time and money.

CARR Healthcare is the nation’s leading provider of commercial real estate services for healthcare tenants and buyers. Our team of experts assist with start-ups, lease renewals, expansions, relocations, additional offices, purchases and practice transitions.

DENVER METRO Dan Gleissner 303.748.7905 dan.gleissner@carr.us NORTHERN COLORADO Phillip Redmond 970.409.0307 phillip.redmond@carr.us SOUTHERN COLORADO Kent Hildebrand 719.440.0445 kent.hildebrand@carr.us CARR.US