Issuu

THE

STATE OF DENTISTRY

UTAH

CONTENTS PRESIDENT'S MESSAGE 4 OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS

Changes for the New Year

ASSOCIATION 4

Online Classified Ads at UDA.ORG

Utah Dental Association Legislative Successes – Recent Years to the Present

Professionalism

Dr. Len Aste

Dr. Kim Michelson

Dr. Jerald Boseman

Dr. Val L Radmall

Dr. Cody Calderwood

Dr. Christopher Smiley

Organized Dentistry's Continued Efforts in Our COVID World

Dr. Darren Chamberlain

Dr. Mike Smuin

Continuous Quality Improvement – Don't Miss It

Dr. Kay Christensen

Dotty Tanner

Dr. Gregory Gatrell

Dr. Mark Taylor

ISDA News

Dr. Scott Theurer

Dr. Drew Jones

Dr. Rodney Thornell

Dr. Julie Kellogg

Tracy Thorup

Dr. Brent A Larson

Becky S. Waters, RDH

Larry Marx

UDA Convention Hosting

Planning to Go Live … No April Fools Joke (We Hope!)

GUEST EDITORIAL 5

Why Did You Choose Dentistry

HEALTH

COVER PHOTO Bryce Canyon National Park Image licensed by Ingram Image

PUBLISHER: Mills Publishing, Inc. PRESIDENT Dan Miller OFFICE ADMINISTRATOR Cynthia Bell Snow GRAPHIC DESIGNERS Ken Magleby Patrick Witmer

CONVENTION

ART DIRECTOR Jackie Medina

ADVERTISING REPRESENTATIVES Paula Bell Paul Nicholas

The Utah Dental Association holds itself wholly free from responsibility for the opinions, theories or criticisms herein expressed, except as otherwise declared by formal resolution adopted by the association. The UDA reserves the right to decline, withdraw or edit copy at its discretion. UDA Action is published bi-monthly. Annual subscriptions rates are complimentary to all UDA members as a direct benefit of membership. Non-members $30. Utah Dental Association, 801-261-5315 1568 500 W Ste. 102, Woods Cross, Utah 84010 uda@uda.org. UDA Action is published by Mills Publishing, Inc. 801-467-9419; 772 East 3300 South, Suite 200, Salt Lake City, Utah 84106. Inquiries concerning advertising should be directed to Mills Publishing, Inc. Copyright 2022.

Utah Will Merge the Health Department and the Human Services Department

LETTER 26

Speed Kills

PRACTICE 6 DOPL Update 12

The Elephant in the Room

Radiology Course for Dental Assistants

Inclusive and Not Billable to the Patient … What Now?

Oral Pathology Puzzler: Do You See What I See?

Some Economic Fundamentals

$ Revenue Cycle Checkup

Divorce Can Be a Good Thing

How to Drop a PPO

My Steps to Practice Freedom

Handling Conflicts With Confidence: Tools to Reduce Tension and Risk

This is Not a COVID Story

COVID-19 Perks

PRESIDENT'S MESSAGE CHANGES FOR THE NEW YEAR Another year is upon us and many of you are looking forward to hearing something new from the President this year. We have faced many unusual challenges over the past couple years, but I feel things are improving locally in our profession. As we visited dentists during CQI many dentists reported that they have reduced the number of network PPOs they participate with in their office and that it has unanimously had an improvement on their practice. Another trend we are seeing is a reduction in the number of dentists in the state who are not members of the Utah Dental Association. This is a trend that will have a delayed but profound effect on the future of dentistry. Legislatively we have been very successful at a state level and typically these changes eventually lead to changes at a national level. With the New Year many of us are hoping to make changes in our lives and in our practice. Fortunately, the Utah Dental Association will not come into your office and force you to make changes, but we are working hard to educate our member dentists and we have many resources to help you make these changes. I hope this edition of the UDA Action can help guide you through some of the changes you want to make. According to the American Dental Association Health Policy Institute dental insurance reimbursement in our state decreased close to 1% per year when compared to inflation. Ask your patients how many of them saw a decrease in premiums during this time. The greatest decreases came to operative codes. I’m sure not many dentists even recognized the decrease. We continue to operate blindly, hoping someone will step in and “fix” our reimbursement problem.

Utah and the rest of the nation and world has seen some major changes in the way businesses operate. It is past time for us to make changes to the way we operate too. I feel like many dentists in the state feel like the fees we charge our patients are fair but are unhappy with the amount we write off as PPO providers. As I prepare to leave as President of the UDA I hope each of you understand that signing up with PPO's is a business decision that you have made for you and your practice and it is in no way something that the Utah Dental Association has the ability to negotiate on your behalf. Due to the low dental reimbursement rates in the state, I have felt like eventually there will be a tipping point where something will change either for better or worse. Currently we have a higher percentage of private practice dentists than just about every other state, but we are having a hard time attracting new dentists to our state. Those new dentists who do come to practice in Utah are more likely to work for a DSO since they are unable/unwilling to work in a private practice setting. For private practice owners this will likely lead to fewer private practice sales and declining practice value as you look to retire. The other possible change is that dentists will begin to understand that they need to decrease the amount of dentistry they freely give to insurance companies. This will increase the value of your practice and enable new dentists to move into the state and enjoy the benefits of private practice. Eventually dentists in Utah will take ownership of the problem they have created by participating in too many PPO plans and begin to make changes. Like each of you I look forward to another wonderful year of providing dentistry. I'm sure each of you are too. Dr. Gregory Gatrell UDA President

ASSOCIATION ONLINE CLASSIFIED ADS AT UDA.ORG We appreciate feedback from our UDA members and due to that feedback, we are revamping the classified ads. Beginning January 1, 2022, the word limit will be raised from 30 words up to 75 words so people can include important information. This can include links to apply for the job or request more information. UDA members will be able to post ads at no cost, as a benefit of membership. 4

Non-UDA members will be charged $100 All ads must be submitted to Dotty at the UDA office: dotty@uda.org UDA has the right to refuse to post any ad. The UDA may edit ads as deemed necessary. Dotty Tanner UDA Assistant Director January / February 2022

GUEST EDITORIAL WHY DID YOU CHOOSE DENTISTRY? Earlier this year I had some changes in my employment, which has allowed me to “sub” in multiple dental offices in Northern Utah. This has been an enlightening experience. As a hygienist I spend 40-60 minutes with each patient, which allows me time to talk with a lot of patients. A while ago I was chatting with one of my patients, she asked the question I am sure everyone hears “Why did you decide to go into dentistry?” I told her my usual response, I have always liked teeth, and being a hygienist would be a great job. After this interaction I started wondering why people choose the professions or careers that we choose, especially dentistry. After reaching out to some great dentists in Utah, I have learned there are many and varied reasons people choose dentistry.

Other dentists said they wanted to be involved in healthcare and dentistry offered a better lifestyle than medicine. This “better lifestyle” was mentioned by many dentists I talked to. Some wanted a career that allowed them to be home evenings, weekends, and holidays. Although dentistry occasionally runs late and dentists sometimes have emergencies on weekends or holidays, for the most part the “lifestyle” of a dentist is pretty good.

Many responses included family members encouraged them. One dentist said his mom suggested it when he was nine years old. I am sure that he is grateful he listened to his mom. Another dentist stated his dad was a dentist and he liked everything that went into dentistry, including the clinical decisions and the engineering side. Experiences in the dental office also contribute to going into the dental field. A dentist said he spend a considerable amount of time in a dental chair when he was young and noticed the coordination between the dentist and the assistant. His father worked in plant genetics and had an RN mother, so he was encouraged to get a science degree. We can see that family encouragement is a large part of why some go into dentistry.

The last item I want to cover was the desire to help people and having the ability to change people’s lives. I believe this is a core reason many people choose dentistry as a career.

Dentistry is constantly changing and evolving. This continual change is another reason some choose dentistry as their career. “I didn’t want a career I might become bored with, and I saw, and see dentistry as a field where there is continual change, new innovations and techniques, and opportunities to continue to learn and grow and continue the ‘practice’ of dentistry.” This constant learning and challenging oneself was mentioned by many dentists as well.

So, whatever the reason you chose dentistry, whether it was because of family encouragement, wanting to have your nights and weekends free, or you wanted to be learning new techniques and technology, remember dentistry is a wonderful profession. As the new year has started, I hope you can look back at your reasons and recognize that dentistry is a great place to be. Becky S. Waters, RDH UDA Assistant Director

CONVENTION UDA CONVENTION HOSTING For the upcoming UDA convention, I would like to personally thank all those who have volunteered to host our speakers. Your role in hosting is a big help, and it is much appreciated. We still do have need of more hosts. If you are a current Utah Dental Association member or an affiliate member hygienist and are interested in hosting, please contact me at drcalderwood@gmail.com. I will help assign you to a speaker of your choosing. For hosting, you will receive your convention registration for free as a token of gratitude.

they have any requests or needs for their presentation. The day of the convention you will be the one who stands up before the speaker begins, and you will read their bio, introduce them, and make any announcements for those attending. Pretty easy and straight forward. Having served as a host myself in the past, I can say that it is an easy and rewarding way to get involved. I enjoyed being able to get to know the speaker better.

The duties of a host are quite simple, really. You will be asked to reach out to your speaker before the convention and see if

Thank you! Dr. Cody Calderwood

And as I mentioned, this goes for member dentists and hygienists as well. So, if any of you are interested in having your registration fee waived and would like to host, please reach out to me.

UDA Action

PRACTICE

DOPL UPDATE

In March 0f 2020 the Utah Dentist and Dental Hygienist Practice Act Rule was amended to update many parts of the rule. The most significant portion of the update was to change the anesthesia and sedation classifications from four levels to five. The premise for the change was to follow the ADA Guidelines for the Use of Anesthesia and Sedation. Some minor changes will be made in 2022 focusing on a class C anesthesia permit. Class C permits currently allow minimal sedation using local anesthesia, nitrous oxide and a single enteral medication. This will be modified to simply allow for minimal sedation in accordance with the ADA Guidelines. Class D will allow moderate sedation and Class E will allow deep sedation or general anesthesia. The method will not be critical, the result or level of sedation is critical. During the Legislative session of 2017 House Bill 142 establish requirements for the use of IV sedation and anesthesia. Informed consent, disclosure of personnel and licensure, reporting of adverse events as well as a crash cart are required. HB 142 will sunset July 1, 2022. It is likely that legislation will be put forth to continue these requirements and expand regulations in a manner similar to the dentistry rules. Dentist have been good about reporting adverse events and the requirement is likely to continue. Effective January 1, 2022 controlled substances must be prescribed electronically (also known as e-prescribing).

Because of the challenges involved in identifying appropriate software to work with health records and pharmacies DOPL will be allowing extensions for prescribers who cannot afford software, have connectivity challenges or other extenuating circumstances. Medicare and Medicaid reimbursement policy requires pharmacies to document why the prescription was not submitted electronically. Prescribers who obtain an extension will need to notify pharmacies that they have an extension on the prescription. The extension request form is available on the DOPL website and the dental page https://dopl.utah.gov/dental/. DOPL will have representatives at the 2022 UDA Convention March 31-April 1st. We will be there to answer questions about license classification, CE, laws and rules and renewals. We hope you will stop by to talk or vent. Look for us near the UDA Information desk. Since the past 20 months have been ruled by Covid-19 there have been questions and concerns about continuing education. Due to cancellation of most in person continuing education DOPL has been allowing more CE to be completed online. We recommend attending the UDA Convention and getting as many live CE hours as you can. Larry Marx Division of Occupation and Professional Licensing

UP TO 6,500 SQ FEET AVAILABLE

MEDICAL/DENTAL PROFESSIONAL SPACE FOR LEASE IN CACHE VALLEY UTAH CALL

JOHN KARTSONE 435.512.3379

January / February 2022

PRACTICE

UDA Action

CONVENTION PLANNING TO GO LIVE . .

NO “APRIL FOOLS” JOKE (WE HOPE!) After being forced to cancel the last two UDA Conventions due to the pandemic we are once again looking forward to gathering for a two day live meeting on Thurs/Fri March 31 – April 1. Our exhibitors are eager to be back, our speakers having tired of virtual presentations are looking forward to being back and we hope you are too. Our convention planning committee has been working hard to make sure that this upcoming convention is special and has something for everyone. Let me provide just a sample of what is in store. Presentations will include Gordon Christensen giving an update on stable esthetic dentures, Janet Press providing answers and dispelling myths about the use of diode lasers for dental hygiene procedures, Lois Banta helping the front office rise to new heights, Dale Miles teaching how to take better radiographs and how to interpret CBCT images, and David Rice teaching our assistants how to help make chair time more fun and efficient, just to mention a very few. An anesthesia and sedation course will also be held for those of you that still need the required hours for your license renewal. This will provide 2 hours. If anyone on your team needs their BLS renewed there is an opportunity to do it during the meeting. Don’t want to spend 3 hours in a course? Take advantage of the 1 hour presentation format available in the Local Speakers Series and receive practice “pearls” on many different topics. Earn 2 days worth of CE credit during the meeting toward your license renewal requirement of 30 hours every 2 years, while learning with your office team. Take your entire staff to the annual Team Luncheon in the Marriott Grand Ballroom this year and learn how to pull together as a team from the very popular and entertaining Matt Townsend, who will also be doing an all-day session on building better relationships. We anticipate having over 200 exhibitors on our exhibit floor where you and your office can browse the latest in dentistry, learn about products and services then take advantage of convention specials. We encourage you to support our exhibitors by stopping by their booths and purchasing your needed dental supplies while at the meeting. Most importantly we hope you will come and mingle with colleagues from around the state and draw from the energy that is present at our meeting. The Utah meeting is recognized as one of the greatest values in continuing dental education in the US. For a relatively small registration fee you can essentially attend any of the offered courses without paying additional individual course 8

UTAH DENTAL ASSOCIATION

CONVENTION

2022

SALT LAKE CITY Salt Palace Convention Center 100 S. West Temple Salt Lake City, Utah

MARCH 31–APRIL 1, 2022 fees that can add up to hundreds, if not thousands, of dollars. For the few workshops that have limited attendance requiring registration only very modest fees are in place to insure that those who sign up for the available slots remember to show up and use them. We try to keep it this way as a benefit of your membership in the UDA. Peruse the printed convention program that you should have received in the mail, or go online to the UDA website www.uda. org to view the program then register your entire team to attend with you. Our goal is for you and your entire staff to come away with valuable information that you can implement in your office on Monday! I will be there, and I hope to see you there as well. Dr Jerald Boseman UDA Convention Coordinator

January / February 2022

ASSOCIATION UTAH DENTAL ASSOCIATION LEGISLATIVE SUCCESSES – RECENT YEARS TO THE PRESENT (Reprinted from Earlier edition of the UDA Action) From listening to dentist’s and their dental team members across the nation year after year, there is always a particular theme that surfaces to identify the most common #1 frustration in a dental office. That frustration is generally a frustration with dental insurance companies. More correctly identified as third-party payer companies. They are usually the #1 frustration in dental offices nationwide. Utah dentists and their dental team members definitely agree, third-party payers are their biggest frustration. Although the ADA nor UDA cannot dissolve the contracts a dentist has signed to be a PPO provider and accept lower reimbursements, the organization is still actively engaged in finding some resolve to the issues. Recognizing the dentist’s frustration, the ADA expanded the attempts a few years ago, to get involved with Insurance Reform across the nation. Several key topics began to surface, and efforts were put forth to see where changes or improvements could be made. Lots of effort was made to communicate state to state with successes and wording to initiate legislation in each state in regards to insurance reform. One of the early topics was Non-Covered services.

Non-Covered Services:

In 2016, the UDA with the help of Senator Allen Christensen and the ADA, proposed a bill that would be presented to the 2017 Utah Legislature. This bill passed the 2017 legislature and became law (statute) and went into effect Jan 1, 2018. Similar Non-Covered Services laws were passed in over 40 states. Showing the US Congress the importance and the need to address this in the US Congress and make this applicable to federally regulated third-party payers. For Utah, passing this bill in 2017 means: • A dental insurer is prohibited from setting fees for dental services that are not covered services under the dental insurance. • A contract between a dental plan and a dentist to provide covered services may not prohibit a dentist from offering or providing noncovered dental services to a covered individual at a fee determined by the dentist and the individual who will receive the noncovered services. • This does not apply to a dental plan that is regulated by federal law. • For exact language of the law, see Utah statute 31A-22646. • The state laws only apply to state regulated insurance plans. There are many dental plans that are under federal regulation.

More Recent Insurance Reform:

In the years since 2017, the ADA has been working on other third-party payer issues that continue to be a frustration to the dental team. The ADA identified several key frustrations and formed Dental Insurance Reform messages to assist states in achieving legislation that could ease some of the frustrations of the dental team, in regards to third-party payers. Four of those key topics developed with the help of the ADA, are: • • • •

Retroactive Denials of Coverage Prior Authorization Virtual Credit Cards Network Leasing

Let’s go over the significance of each of these areas and how the UDA has been able to make progress in Utah for dental offices on each of these common frustrations.

Retroactive Denials:

For those that may not understand what this term means, you all may be familiar with the actions that occur that are defined as Retroactive Denials. I myself, have been a victim of these efforts by third-party payers. Retroactive Denials are when an insurance company tries to require dentists to repay claims already paid to them when insurers discover they paid a claim mistakenly, even if the claim was processed years prior. In other words, an expected covered treatment is performed on a patient and the claim is processed and paid by the third-party payer. Then years later, the dental office receives a letter saying the office was overpaid and the office now owes the third-party payer a certain amount determined by the insurance company. It’s my understanding that often, the third-party payer strips out the “overpaid” balance out of other pending claims from other patients. This alleged overpayment notice comes at a time when an office can no longer legally go back to the original patient to bill for the performed services. In my case, the letter of “over payment” was received three years after treatment was performed. There is now a law in Utah that prevents this. The current recoveries language on Retroactive Denials applies to healthcare and is found in UCA 31A-26-301.6(14). This law is already on the books and does not allow an insurance company to come back years later to try to reclaim overpayments or claim disputes long after the date of service. The state Representative we have been working with, says the third-party payers only have 1 year from date of payment to try to reclaim the money. This time period is doubled for Medicaid claim overpayments.

UDA Action

Prior Authorizations:

In discussing Prior Authorizations, we should explain the difference between Prior Authorization and Pre-Treatment estimates. Usually, Pre-Treatment estimates occur when an office staff calls the third-party payer and tries to find out the extent of coverage, if certain procedures are performed. This pre-treatment estimate is not technically a Prior Authorization. A Prior Authorization means the thirdparty payer has agreed to make payment for the services being sought prior to treatment (usually this is done in writing, and possibly after dental consultant review). The concern with dental offices is an increasing number of insurers are denying claims for services previously authorized, reversing their agreement with both patients and dentists. In 2019, SB 264 regarding to Prior Authorizations passed. The Bill was sponsored by Senator Evan Vickers and Representative Suzanne Harrison. This Legislative bill spelled out that a Prior Authorization, if done correctly, would be more like a commitment or contract by the third-party payer for payment. When a dental office has received a prior authorization and the third-party payer elects to not honor that prior authorization, the office should appeal to the third-party payer company citing the Utah law, reminding them the law states they are committed to the payment they acknowledged in the prior authorization. See statute UCA 31A22-650 .

Virtual Credit Cards:

This is a term given to the process where an insurance company reimburses a dental office through a virtual credit card, which can include a per-transaction fee of as much as five percent. In some cases, insurance companies even share in the revenue generated from these fees. You likely have seen this as a letter that contained a credit card number that your office is to run the number through your credit card services as if you were being paid with an actual credit card. This results in an additional loss of income since a percentage was removed by the credit card services company. In the 2020 Utah Legislative session, the UDA advocated for language in HB 37, that would allow a dentist to opt out of Virtual Credit card payment methods. Thus, saving the office from the credit card fees associated with credit card payments. Representative Jim Dunnigan and Senator Curtis Bramble sponsored an insurance Amendments bill and worked with the 10

Photo: Image licensed by Ingram Image

UDA to give dental offices an option to accept or opt out of Virtual Credit card payments methods. The dentist needs to notify the third-party payer that they want to opt out of Virtual CC and receive payment by check. The Utah law says they can request the opt out for the dentist from that particular third-party-payer company. The dentist would have to repeat this notification for every third-party payer company they participate with. It is not automatic. The dental office will have Utah law backing them when they request to opt out. See UCA 31A-26-301.6 Some insurance companies were making the dentist specify each patient they were opting out on. The new law says they can tell that Insurance company they opt out for all their payments from that company. The dentist should clarify, they want the Ins Co to pay them by check rather than Virtual Credit card. This applies to state regulated insurance plans. This may not apply to federally regulated plans.

Network Leasing:

Many may not recognize the term Network Leasing. Network Leasing is when third-party payers sell dentists to a different January / February 2022

insurance network often without the dentist’s knowledge or consent. Basically, when a dentist signs up with a third-party payer to be a provider for them, the third-party payer leases that contract to other third-party payers. This can result in the dental office being contracted with additional PPO plans. The dentist may not even be aware of all the dental plans of which they are then contracted. This can significantly impact the insurance benefits available to the patients. This also erodes patient/dentist trust, which can lead to assumptions in treatment plans and costs based on a false understanding of patient coverage. In preparation for the 2021 Legislative session, the UDA was working with Representative Jim Dunnigan to craft a bill creating transparency and options for a dentist in regards to Network Leasing. The National Council of Insurance Legislators (NCOIL) and the ADA had been working on model legislation that would help solve many dentist’s frustration with Network Leasing. The ADA, various State Legislators, and many Insurance Companies had already vetted this topic for months and had come to several agreements for transparency. The result was the NCOIL Model Legislation. The UDA used this model legislation in initiating a bill for the 2021 legislative session (HB 359 sponsored by Representative Jim Dunnigan and Senator Karen Mayne). See UCA 31A-22-646.1 Since the Fall of 2020, the UDA has worked with Dr Rob and Tracy Thorup of “My Practice, My Business”, in specifically creating legislation regarding HB 359. Their additional ideas presented included two topics that were included in HB359. Many hours of work with Representative Jim Dunnigan, the UDA and Dr Rob & Tracy Thorup were put in to finally create the final version of HB 359. The Thorups, UDA Representatives and Rep Dunnigan virtually met weekly for several weeks and brought in many representatives of the larger insurance companies. The discussions resulted in some understanding of the dentist’s frustrations caused by these third-party payers in regards to Bundling and Downcoding. As part of 2021’s HB 359, An insurer may not maintain a dental plan that: • based on the provider’s contracted fee for covered services, uses downcoding in a manner that prevents a dental provider from collecting the fee for the actual service performed from either the plan or the patient; or • uses bundling in a manner where a procedure code is labeled as nonbillable to the patient unless, under generally accepted practice standards, the procedure code is for a procedure that may be provided in conjunction with another procedure. Also, an insurer shall ensure that an explanation of benefits for a dental plan includes the reason for any downcoding or bundling result. See UCA 31A-26-301.7. or HB 359 (2021) There had been a great deal of significant effort made to negotiate and resolve conflicts with third-party payer companies during all aspects of the crafting of this bill. As a result, HB 359

was placed on consent calendar for both the House and Senate. This essentially means, enough debate and crafting took place before the writing of this bill, that it sailed through legislation unopposed. This was a great “Win” for Utah dental offices on insurance reform topics made possible by the efforts of the UDA and My Practice, My Business (Dr Rob and Tracy Thorup).

McCarren-Ferguson Repeal:

The US Senate on Dec. 22, 2020 voted to repeal the McCarranFerguson antitrust exemption for health insurance companies by passing HR 1418, the Competitive Health Insurance Reform Act. The ADA has been a “longtime advocate of this bill that would reform the McCarran-Ferguson Act of 1945 to ensure that health insurance companies are subject to the same federal antitrust laws that nearly all other industries must comply with in the U.S.,” the ADA wrote in an email to dental leaders. ADA News reported: “Our bipartisan bill will allow for greater transparency and oversight into the health insurance industry and help make health insurance more affordable [for Americans] across the country. This is a commonsense bill being signed into law,” said Sen. Daines R-Montana in a news release. According to the release, the bill “amends the McCarranFerguson Act to restore the application of federal antitrust laws to the health insurance industry, but does not otherwise interfere with or impact the authority of state authorities to regulate health insurance provided under the act.” “This bill will help address instances of artificially higher premiums, unfair insurance restrictions, and harmful policy exclusions,” the release concluded. “For leaders and contributors to ADPAC, this was a culmination of years of dentists lobbying and participating in high-level political activity,” ADA said. “Most importantly, dentists engaged in grassroots activism, recently sending over 21,000 communications to legislators” on this issue. In Summary, although legislation intends to improve and sustain what is best for the public and professions such as dentistry, there are always plenty of groups out there trying to disrupt the status quo. Legislation that will only contribute to sustaining and maintaining the dental profession as we currently know it, is not likely. Between the DIY dental companies, the trend toward mid-level providers, and growing aspects of DSO’s, the profession we love of dentistry is gradually and significantly changing. The UDA is constantly defending and encouraging dentists and their dental team members to provide the best oral care for the public. If we remain united and do not become a fragmented profession, we will be better able to direct Legislative and Congressional successes, maintain public safety and improve sustainable oral health care. Dr Val L Radmall UDA Executive Director

UDA Action

PRACTICE

as PPO providers. It’s a basic supply and demand principle. The more providers willing to take a cut in reimbursement rates, the more the rates get cut. Rates will only go up if there is a drop in the number of willing network providers. As long as network provider numbers are healthy, reimbursement rates will continue to drop. As The American Dental Associations Health Policy Institute (HPI) has recently shown, the trend of reimbursement decline has been steady for several years. Inflation and Cost of living haveTHE increased, yet dental reimbursement ratesROOM continue to decline. ELEPHANT IN THE

There has been a lot of discussion and social media chatter recently, in regards to dental office frustrations with dental insurance companies. There has been hope that some entity can come in and rescue them from compromises they have agreed to over the years by signing up as PPO providers. With inflation and COVID caused increases to overhead, dental offices are finding themselves at the crossroads, where expenses can no longer be met at the reimbursement rates currently of dentists sign up a PPO provider has been The rates. willingness of dentists to signThe up willingness as a PPO provider hastobeen theasmain cause of overall offered by many PPO reimbursement the main cause of overall dental reimbursement decline. Not all dental reimbursement decline. Not all dentists are willing to sign on for a cut in reimbursements. dentists are willing to sign on for a cut in reimbursements. On Oncan thebe graph below, it is known that Montana Dentists traditionally do not sign on with PPO The decline in reimbursement rates directly attributed to the graph below, ithave is known that Montana Dentists traditionally plans. reimbursement rates in Montana increased while most of the nation has the number of dentists signed up as PPOTherefore, providers. It’s a basic do not sign on with PPO plans. Therefore, reimbursement decreases supply and demand principle. Theexperienced more providers willingintodental reimbursement. Utah is well below the national average in rates in decline Montanaoccurring have increased while most the nation to the therates amount of reimbursement over the past fewofyears. This is take a cut in reimbursement rates,regards the more get cut. has experienced decreases in dental reimbursement. Utah is related to aofhigh number of dentists on PPO plans. Rates will only go up if there is adirectly drop in the number willing well below the national average in regards to the amount of network providers. As long as network provider numbers are reimbursement decline occurring over the past few years. This is healthy, reimbursement rates will continue to drop. directly related to a high number of dentists on PPO plans. Our state has one of the highest percent of solo practitioners in As The American Dental Associations Health Policy Institute the nation. The number of dentists per 100,000 population is (HPI) has recently shown, the trend of reimbursement decline has dropping in Utah. Young dental students have a huge debt load been steady for several years. Inflation and Cost of living have coming out of dental school. Dental income in Utah needs to increased, yet dental reimbursement rates continue to decline. improve going forward, or we will have a hard time keeping a young dentist that decides to practice in Utah. One way to increase dental income is by decreasing PPO dependence. Dental incomes will increase if PPO participation decreases. See the current national dental earnings graphic below. This is the Elephant in the room. If you want to improve your individual position and help contribute to an overall effort to improve dental reimbursement, take a look at which PPO plans you are contracted with. Evaluate if it is wise for you to continue the downward trend with this PPO. Ask your Office manager, they

Our12state has one of the highest percent of solo practitioners in the nation. The number of dentists per 100,000 population is dropping in Utah. Young dental students have a huge debt

January / February 2022

can tell you which plans are hurting your practice. Then have the courage to act. It will only change if YOU take action. Start dropping plans, especially the ones causing you frustration and stress. Those reporting to have begun this process, unanimously claim less stress and more profit. Ultimately, they are happier!! If you seem to be unhappy with insurance companies, take hold of your own future and listen to sound advice. At the same time,

you will be doing your part to help improve the overall situation in our state. Be a part of the solution rather than participate in the cause of the decline. Together, we can get rid of the elephant in the room and eat it up, a bite at a time! Dr Val L Radmall UDA Executive Director

PASSING A LEGACY

IS OUR SPECIALTY.

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We have all of the experience, tools, and resources necessary to help you transition your practice into the right hands. We provide expertise on appraisals, practice sales, and everything you might need for a fulfilling practice transition.

UDA Action

PRACTICE RADIOLOGY COURSE FOR DENTAL ASSISTANTS One of the all time challenges we face in dentistry is finding good, well trained dental assistants. This is especially true since the onset of Covid19. Those of us who practice in rural areas have an even more difficult time finding trained assistants due to the lack of assistants available in the general area and inaccessibility of training programs. Fortunately dental assistants in the State of Utah do not need to be licensed to work in a dental office. They can obtain their training either by completing a dental assistant course or be trained in a dental office. Regardless of their training, in order for dental assistants to expose radiographs on patients, they must successfully complete an approved radiology course. Dental assistants who receive training through a licensed and certified dental assisting course, approved by DOPL and accredited by the ADA Commission on Dental Accreditation, will have the approved course included in the curriculum. Those who are trained in a dental office will need to pass a the Dental Assisting National Board Radiation Health and Safety Examination or a radiology exam approved by the Board that meets the criteria established in Section R156-69-6039(11) of the Dentist and Dental Hygiene Practice Act Rule for the State of Utah. For years, those of us in my office looked forward to the annual UDA convention at the Salt Palace Convention Center. It was an opportunity to bond as coworkers. It was also a great opportunity to have our new assistants take the radiology course offered to obtain their certification. Up until 2003, the convention ran from Thursday to Saturday. The radiology course was offered on the Saturday, along with other valuable convention courses. From 2004 until 2007 the convention was scaled back and the radiology course was the only course held on Saturday. It was great to have the course available, but taking the course meant staying an additional night in a hotel. In 2008 the UDA moved the radiology course to Friday and made it available along side the other convention courses. This was a big help to those of us who had to travel long distances to attend. This format continued until 2018. Offering an annual course was helpful, but it failed to meet the needs of dental offices who hired dental assistants throughout the year. Sensing a need to provide the course on an as needed basis, Dr. Val Radmall, the executive director of the UDA met with Larry Marx, the DOPL Bureau Manager for the Dentist and Dental Hygiene Board to get an online radiology course approved. In 2019 the Utah Dental Association produced a Radiology Course that met all the DOPL requirements and is continuously available for those who need certification. This is a member benefit that has greatly helped dental offices train assistants to legally to take radiographs.

UDA members can access the online webinar type course for their assistants at no charge from the homepage at www.uda. org by clicking on the Online Course & Events – Radiology Course-Assistants banner. By clicking on the UDA Members Free Access. A page will populate that will allow the dentist or assistant to enter the dentist’s ADA number. It is then checked with the ADA Database and allows them to proceed without paying the fee. Non ADA-UDA affiliated individuals interested in taking the course will be charged $35, which is a real bargain for the money. The course is for individual participants and not intended for groups. It is approximately 60 minutes in length, followed by a short quiz. After completing the quiz the participant will be able to print a certificate that states they have completed the approved radiology course. One thing to note, the UDA does not keep a record of the participants that take this course. It is the responsibility of the participant to keep the certificate to prove their certification in radiology. If the certificate is lost the course will need to be completed again. This radiology certification course is just one of the many benefits offered by the Utah Dental Association to save it’s members time and money. Organized dentistry is the backbone of our profession. It provides the support that makes us, year in and year out, one of the most trusted and respected professions. The UDA is always searching for ways to improve dentistry. They do this by sponsoring legislation that is profession friendly, providing tools for practice management and offering continuing education courses. The results of which makes dentistry in the United States the envy of dental world. Dr Len Aste UDA Secretary

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I nc l ud e y o ur Fi rs t a nd La s t N a m e Yo ur i nt e re s t s t o ge t i nv o l v e d : a) b) c) d) e)

House of Delegates - Governance UDA Action Committee- Publications UDPAC Committee – Legislation I know my legislators – Name them & connection I’d be willing to be a Collaborative Dentist

January / February 2022

ASSOCIATION PROFESSIONALISM We are members of a wonderful profession, Dentistry. It is full of learning opportunities, technical advances and meaningful relationships with patients, colleagues and staff. We live in a time when we can bless the lives of others, with our dental skills, better than ever before. We stand firmly on the solid ground set by those who came before us and were willing to contribute and make our profession a better place than they found it. As professionals we have certain values that we ascribe to that have lead us to the wonderful position we are in today. If we abandon those values, we will have missed the boat and will contribute to a decline in our professional standing. Dr Raymond A. Cohimia DDS, the new executive director of the American Dental Association mention these in an article sent out a few weeks ago. These values were taught to me by, among others, my father who was a dentist and served in many professional organizations including the UDA and the International College of Dentist. ● Professionals must have a higher level of education than the general public. ● Professionals must advance the art and science of their field for all people everywhere. ● Professionals must possess the ability to self-govern Take anyone of these three values away, and we lose our blessed and earned title of “professional”. Education comes in many forms. Advanced degrees and certificates, that are to be used to benefit others, come at much sacrifice in terms of time and money. We also learn from experience, continuing education, and from our mistakes (the school of hard knocks). To love learning is one of our great goals. As we become more proficient in our chosen field, “the art and science of dentistry” we need to lift others. That can be our colleagues, patients, students or the disadvantaged of our society. Sharing our knowledge to help the common good is an obligation we should take willingly. Our patients deserve to be first in our priorities. The Doctor/Patient relationship is almost sacred. It allows us into the inner circle of peoples lives and can last for lifetimes, even generations. Putting others first will not only make us worthy of the title “professional” but also make us happy and allow us to love our work. Helping the underprivileged should be an area that every professional participates in, one way or another.

We need to protect our doctor/patient relationship. It is one that should remain direct, unobstructed, and must not be dictated by any interferences of any kind. In order to govern ourselves we must have those willing to represent us. If we don’t effectively govern ourselves others will do it for us. We must be organized and have an “association” that advocates on our behalf and gives us a standard to live by and practice by. We all do things a little differently but there are many issues where if we stand together we can be much more effective in advancing our profession. We can better control our circumstances and keep our chosen profession honored and highly respected. Our code of ethics, given to us by our American Dental Association and which are part of our legal statutes and DOPL Rules, is a great start in protecting our Dr/Patient relationship and maintaining the trust of society. Our involvement in our dental associations is about governing ourselves and preserving a tradition of excellence and caring in a world of “What’s in it for Me”. Thank you for doing your part, even if at times it is just being a supportive member. Free loaders, who love the benefits of our dental association and self-governance, but are not willing to support or help, are missing the boat. They are a part of life but if we have to many of them it is like having the proverbial albatross around our necks as we fight to protect our patients and our profession from outside interferences. Maintaining the values of a “profession” is a cost of doing business. I pay my dues to the ADA/UDA with a smile because of how necessary it is and what our association does for me. When you can, get involved. Be a part of: staying educated, advancing the art and science of dentistry and self-governance. Together we have a bright future that I look forward to. Thank you for protecting the profession that over the last 45 years I have grown to love. Dr Brent A Larson ADA Delegate

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PRACTICE INCLUSIVE AND NOT BILLABLE TO THE PATIENT…WHAT NOW? Your patient comes in to the office for their regular cleaning and you find yourself billing for panoramic and bitewing x-rays on the same day. Why? Well, because the patient needed them and you are following the “standard of care” that your dentist is held accountable for. However, you (once again) receive that dreaded EOB that combines those services to a “full mouth series” (FMX). The EOB alludes that you should be writing off the difference. Sound familiar? Yes, it’s easier to simply write-off the balance due from the patient and follow the EOB verbiage…but what are you telling your patients when you back down? That you don’t know your job? That you will write things off if they “bully” you to do so? That the insurance companies care about them? That you need constant “oversight” so you don’t overcharge them? And my favorite, “We do free dentistry here”. There are four issues with these unethical and regular protocols done by almost all insurance companies in our state: 1. Have you looked at your contract to see if you are required to write off the downgrade or bundle the services? As of right now, we have only seen one insurance company continue to promote these philosophies. 2. The ADA considers “bundling” to be potentially fraudulent. Heck, they even give the above example of downgrading x-rays in that statement!1 3. Our wonderful, amazing new Utah law, now to be called the “Network Leasing, Downcoding and Bundling Protections” Law, PROHIBITS insurance companies from using “Bundling or Downcoding” as a way to change a covered code to “non-billable” to the patient. Oddly, by regularly downgrading x-rays in the example above, the insurance companies are both downcoding and bundling. 4. As all of you know, it’s not just x-rays. There are many examples of downcoding and bundling that we are currently confronted with. So... how do you fight back? The first step is to check and see if the insurance plan is “selffunded” or not. Unfortunately, the only way to check is to call the insurance company directly. Once you’ve established the plan as being “self-funded”, flag it for all current and future patients with that plan so you’re not “duplicating the work”. Like it or not, self-funded plans are not required to follow state law, and in those cases, follow your contract. I emphasize again to read your dental contracts…you’d be surprised to see what’s not in there. The next step is to simply collect the difference from the patient and stop writing it off. Yes, the EOB is wrong. We’ve

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Photo: Image licensed by Ingram Image

seen it before with other CDT codes showing “zero” patient responsibility, yet we collect, knowing it’s wrong (Fluoride, anyone?). Many times, I simply pick up the phone and let the patient know that the insurance paid all but a little bit from their x-rays and collect over the phone. Most patients sigh, tell us how much they hate their insurance, and ask if we can take their credit card. “But what if they use their EOB against us?”, you ask. Yes, there will be a few patients that wave their EOBs in your face as though it is the “foremost authority” on proper billing. You know…those patients are the ones that think you don’t know how to do your job. The ones who question everything you charge out on the ledger. For those ones, there’s something “extra” for you to do, and if you want to make the rest of your future interactions with those patients better, you’ll want to do this immediately. First thing to do: pick up the phone and call the insurance company directly. Before we start “the battle”, let me emphasize that the first person you talk to will be a “tier-1” representative, whose job is to read their “general policy” and get you off the phone as fast as possible. They do not know state laws. You do now. Teach them. Step One: “Hello, my name is_______ and I’m calling from Dr. _____’s office and I would like to know WHY I’m being told to write off this downgrade or bundle this procedure.” Step Two: “You consider it to be ‘Inclusive’/not billable? That’s fine, but where in my contract does it state that I’m supposed to write the service off?” Make them show you. Step Three: Let them know that there is a new Utah Law that contradicts the verbiage on the EOB and they are breaking the law. State law supersedes contractual agreements. Explain what part of the law is being broken. Examples are: January / February 2022

Down-coding with the EOB stating to write off the difference. Let them know the new Utah Law allows them to still down-code, but they can not force you to write off the down-coded portion, nor should the EOB allude to such. Bundling and the EOB stating you have to bundle your procedures and write them off by including them. Build-ups with crowns, bitewing x-rays and panograph to a full-mouth series, diagnostic codes with a limited exam are just a few where you no longer have to write them off. The verbiage of a. and b. above needs to be corrected on the EOB.

Step Four: Often times, the insurance company will not change the EOB. Is this right? No. However, the goal of the call is to enforce the law and get the representative to agree that they are wrong/ misinformed, and to correct the issue with you and your patient. Step Five: If a dental insurance company instructs you to “APPEAL” the charges with a narrative, and other such timewasting protocols, you should: a. Tell them you DO NOT need to “APPEAL” the charges, THEY need to forward it for REPROCESSING with a note referencing the new Utah Dental Law, “Network Leasing, Down-coding, and Bundling Protections” Law b. Let them know they have 30 days to process. c. If they try to state they, the dental insurance company, are determining “GENERALLY ACCEPTED PRACTICE STANDARDS” regarding the claim, let them know that “generally accepted practice standards” do not reflect “their views” in Utah. Those are, and have been, determined by the “licensed dentists” in our state, and tell them that if they do not change it, you will be filing a complaint with the Utah State Insurance Commission.

4. 5.

Your EOBs in the future will likely be wrong as well. Our office will take any concerns you have seriously and follow up on them because WE care about you and your oral healthcare.

Let me teach all of you what we teach during our Front Office/ Office Manager training here at My Practice My Business: “Do NOT fear the beast”. Remember, the insurance companies have rules and regulations they need to follow. They cannot break the law or come between the doctor/patient relationship. They cannot “kick you out of the network” if you simply remind them that they are not above the law or if you file a complaint with the Utah State Insurance Commission. So many offices do not understand contractual law and state law and all the ways we have to increase net revenue. We’re more protected than you think. Tracy Thorup CEO, My Practice My Business www.mypracticemybusiness.com

PRACTICE ORAL PATHOLOGY PUZZLER: DO YOU SEE WHAT I SEE? Which of the following represents the best diagnosis for the Oralradioraphic Pathologyfindings Puzzler:inDo see what I see? theyou anterior mandible?

Step Six: Thank them for their help, GET A REFERENCE NUMBER AND THEIR NAME, and ask when you can expect a) Periapical cemento-osseous dysplasia Which of the following represents the best diagnosis for the radioraphic findings in the anterior mandible? the outstanding claim to be reprocessed and fixed, and then b) Periapical granulomas a) Periapical cemento-osseous dysplasia YOU follow up on it. Even better: try to get them to call the c)Periapical Odontogenic granulomas keratocysts patient and apologize for the misleading EOB. Have I had them b) c) Odontogenic keratocysts Lateral Periodontal Cyst do it before? Absolutely. And I loved every minute of it. d)d)Lateral Periodontal Cyst Step Seven: Now, to address that wonderful patient of yours. Call them back, give them the reference number and name of the agent you spoke to, and tell them that it was confirmed that the EOB was incorrect and any balance due is their responsibility. I often follow up with, “I’m so glad that you were comfortable enough with us to voice your concerns. As I mentioned before, this is an issue that happens often with your insurance company, and unfortunately, we expect the issue to continue to occur with them. I’m sorry that your insurance company lied to you, but please know that we will continue to be transparent with you.” Why do I do this? To re-establish control. By following the above steps, I’m telling the patient quite a bit with that conversation: 1. Don’t tell me how to do my job. 2. I know the tricks that those insurance companies play. 3. Your insurance company will do anything to save themselves money and make me look like a “bad guy”.

(continued onLateral pagePeriodontal 19) Correct answer: (d) Cyst

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PRACTICE SOME ECONOMIC FUNDAMENTALS There is great power inherent in the directional flow of money. Insurance companies understand this. Banks understand this. Politicians understand this. As dentists, we often do not understand this. Failure to comprehend this fundamental economic principle has consequences, and they are not good. Several years after graduating from dental school, we purchased a building lot on a quiet cul de sac. We bought this lot directly from the builder, with an agreement that is often referred to as a build-job. This means that as part of the purchase agreement, we were also agreeing to use this same contractor to build our home. This contractor had built quite a number of nice homes in this area. We closed on the lot, with the plan to wait until the following spring to begin construction. During the ensuing months, we started hearing horror stories from some of our soon to be neighbors. They went something like this: “We cannot clean up the title on our new home because of all the liens levied against our property.” My gut-level reaction was, “What, you have a brand new home that is already encumbered by liens?” That was precisely the situation in which many of these people found themselves. Similarly, they had all purchased build-jobs from this same contractor. This well-meaning contractor was using draws on home A to pay the sub-contractors on home B, and he was getting a little behind… Essentially, he was robbing Peter to pay Paul. I was horrified. What had I gotten myself into? I spent many sleepless nights fretting over this problem. In the end, I consulted with a real estate attorney. His advice was simple: First, stipulate to the builder that every bank draw, and subcontractor payment must be authorized by me. Second, no subcontractor is to be paid without first providing a lien waiver. We simply redirected the flow of money, and removed the general contractor from the middle-man role. By following this simple advice we took control of the situation, and had a much different outcome from our new neighbors. When our home was finished, we had a clean, unencumbered title. Everyone was happy, including our general contractor, and all of the subcontractors. I learned an important lesson from that experience: Whoever cuts the checks calls the shots. Ultimately, the final destination of the money did not change. What changed is the path it took to get there. Another way to look at this is, whoever pays you, controls you. That is precisely why dental insurance companies much prefer to have patients assign their dental benefit over to you, the health care provider, than to have the patient pay the health care provider directly, and then be reimbursed. It all has to do with redirecting the flow of money, and the effect it has on who controls whom. 18

The patient, either directly, or indirectly through their employer, pays premiums to the insurance company. Consequently, the insurance company must answer to the patient and their employer, but not to you. So, when it comes time to either settle a dispute, or pay on a claim, the patient is in a much better position than you are in to get results. The same is true with the other side of this three-way relationship. If the patient pays you, and is reimbursed by the insurance company, then you are accountable to the patient, which is as it should be. On the other hand, if the insurance company becomes the middle-man by paying you directly, and bypassing the patient, you are not only accountable to the patient now, but also to the insurance company as well. By agreeing to accept the assignment of benefit, you have invited the insurance company into the driver seat position in the relationship. At times, we can be our own worst enemy. In many ways, when we are dependent upon them for payment, we are at their mercy. The mistaken notion that patients who do not sign over the insurance benefit to you, will spend that benefit on their new patio furniture instead, is shortsighted. And, quite frankly, if the patient has already paid you, what does it matter how they spend their insurance benefit. Part of the solution to that problem lies in better financial arrangements with the patient in the first place. Many years ago, my partner, who happens to also be my brother, and I decided that we were no longer going to accept assignment of benefit from any insurance company. I must admit that we approached the idea with some fear and trepidation. However, once implemented and in place, we never looked back, nor regretted the decision. In fact, it was one of the single most beneficial practice management decisions that we made together. It was liberating. A side benefit was the complete elimination of a front office position in our practice. Gone were the days of statements going out, followed by endless phone calls from patients wondering if we ever received payment from their insurance company, or if that periapical x-ray had ever been sent, or any number of other insurance related questions. Suddenly, our patients were demanding accountability from their insurance carrier directly. They were the ones spending time on the phone with the insurance company, not us. We became allies with our patients, working together for insurance company accountability, and fairness. We did not do this on a whim. We carefully planned out our approach. We tried to anticipate problems in advance. We rehearsed the plan with our staff. And voilà, it worked. Suddenly we were completely out from under the thumb of dental insurance companies. We loved it. Our patients loved it. The only party not loving it, was the insurance companies themselves. They did everything they could to pay us directly, and circumvent the system we had created. But we persisted, and finally they relented. January / February 2022

PRACTICE Whenever an insurance benefit payment came to us by mistake, we responded with letters to both the patient and their insurance carrier, drawing attention to this thoughtless mistake. It really became quite fun. We took advantage of every opportunity to make the insurance company appear foolish. After all, is not that tactic frequently used against us? We also discovered that insurance companies pay those who pay the premiums much more quickly than they pay the health care provider. Who are we anyway? We deceive ourselves if we really think we have that much clout with insurance companies. We do not. And, it is because we do not pay the premiums.

ORAL PATHOLOGY PUZZLER: DO YOU SEE WHAT I SEE? (continued from page 17) Correct answer: (d) Lateral Periodontal Cyst

At the end of the day, who pays whom, and the power derived from controlling the directional flow of money is real. Make it work for you, not the insurance company. If you really want to liberate yourself from insurance companies, stop accepting assignment of benefit. Dr Mark Taylor UDA Treasurer

HEALTH UTAH WILL MERGE THE HEALTH DEPARTMENT AND THE HUMAN SERVICES DEPARTMENT On July 1, 2022 the Utah Department of Health and the Utah Department of Human Services with merge and become the Utah Department of Health and Human Services. Currently Nate Checketts is the Interim executive director for the Department of Health. Tracy Gruber, current executive director for the Department of Human Services has been named to be the new executive director when the two departments merge. Currently the state dental direct in the health department is Dr. Kim Michelson servicing in the position 0.20 FTE. Historically the position has been full-time, however starting in July 2013 it was changed to 0.50 FTE when the previous state dental director retired. In October 2018 the positon was reduce to 0.25 FTE due to reduced funding for the positon. In addition to the state dental director, the Oral Health Program staff in the health department have also seen reductions. In 2018 the program had two full-time dental hygienist that helped with program activities and currently there is one. As plans are being made for the merger there are discussions about elevating the importance of oral health going on. The Utah Oral Health Coalition has been involved in efforts to pursue this.

A lateral periodontal cyst is a developmental odontogenic cyst which typically occurs along the lateral root surface. It arises from rests of dental lamina. Under the microscope, the lateral periodontal cyst has a thin, usually non-inflamed, fibrous wall A lateral periodontal cyst is a developmental odontogenic cyst which typically occurs with cystic epithelium that rests is thin most areas.Under However, lateral root surface. It arises from of in dental lamina. the microscope, the la nodular thickenings of the lining are often noted (image It epithelium periodontal cyst has a thin, usually non-inflamed, fibrous wall with2). cystic is the intrabony counterpart of the gingival cyst of adult in most areas. However, nodular thickenings of the lining arethe often noted (image 2). I intrabony the gingival cyst ofages the adult andItishas commonly found in patie and iscounterpart commonlyoffound in patients 40-60. a striking 40-60. It has a striking predilection to occur in the mandibular premolar-canine-latera predilection to occur in the mandibular premolar-canine-lateral areaincisor (75%-80% in this region). Anthis important finding is that all adjacent teeth ar areaoccur (75%-80% occur in region). An important Radiographically, it appears as a well-circumscribed radiolucency that is typically un is that all adjacent teethare arenotvital. Radiographically, it keratocyst th The finding radiographic features of this cyst diagnostic; an odontogenic appears as a well-circumscribed radiolucency that is typically between the roots of adjacent teeth may look identical (image 3). Most lateral periodo unilocular. The radiographic features of this cyst are not are less than 1 cm in greatest diameter. Occasionally, the lesion may appear polycysti lesions are termed odontogenic cysts (botryoid meansbetween “grapelike”). They ap diagnostic; anbotryoid odontogenic keratocyst that develops multilocular and this lesion variant of the rootsvia ofradiograph adjacent teeth may lookrepresents identicala(image 3).the lateral periodon Conservative enucleation is treatment. Recurrence and/or malignant Most lateral periodontal cysts are less than 1 cm in greatesttransformation is exceedingly rare. diameter. Occasionally, the lesion may appear polycystic. These lesions are termed botryoid odontogenic cysts (botryoid means “grapelike”). They appear multilocular via radiograph and this lesion represents a variant of the lateral periodontal cyst. Conservative enucleation is treatment. Recurrence and/or malignant transformation is exceedingly rare. Works Cited

Dr. Kim Michelson State Dental Director Utah Department of Health

Neville, Damm, Allen, Chi (2016). Oral and Maxillofacial Pathology, 4th Ed. St. Louis: Elsevier.

UDA Action

Works Cited

PRACTICE

$ REVENUE CYCLE CHECKUP Running a dental practice isn’t easy. Successful practices have owners who are financially astute, track expenses, monitor their revenue cycles and ensure that the business is profitable. Recent surveys have reported that significant and lasting shifts have occurred in consumers’ spending patterns, especially when it comes to healthcare. Consumer demand for dental care has leveled off and caused dentists across the country to see an increase in capacity and a drop in earnings; making it even more challenging for dentists to maintain the right balance between revenue and expenses. Critical factors include establishing internal controls to prevent fraud and embezzlement and setting up patient payment systems that provide a positive patient experience and maintain their loyalty to your practice. Having a clear, documented financial protocol and getting buy-in from your dental team members is important, as they likely have the day-to-day responsibility for the office’s revenue cycle. If you accept assignment of benefits from patients with some type of dental benefit coverage, make sure you collect the anticipated amount the patient is responsible for, at the time of service. Don’t wait to collect the private-pay portion of the bill until after the third-party payment has been received. Sometimes, there might be a balance due from patients after you receive the payment of benefits, even though patients have paid their estimated portion of the bill at the time of service. When that happens, immediately communicate with the patient, indicating the balance which is due. It is important to note that the Payment Card Industry Data Security Standard (PCI DSS) is a set of requirements to ensure that all merchants that process, store or transmit credit card information, maintain a secure environment. Compliance with these standards is generally required in the agreement between the dental practice and the credit card company or processing entity. PCI DSS requires that merchants satisfy twelve different elements of a program aimed at maintaining the security

of credit card information. The requirements include many technical components such as maintaining data encryption, firewalls, and anti-virus protection. It also includes team training and maintaining a list of service providers who have access to the dental practice’s payment card data. Remember, if you store data such as a patient’s credit card number – you are responsible for its security. Credit card disputes and chargebacks are a complex discussion for another time. Since most patients don’t budget for dental treatment, concern about costs may cause them to postpone treatment or to decide against it. Many practices offer internal or external programs to help patients finance treatment without maxing out their personal credit cards. Knowing there are options to financing treatment often increases case acceptance rates and can significantly reduce the amount of time a patient needs to decide about proceeding with treatment. When managed properly, financing programs make good business sense for your patient and your practice. Regardless of which approach you take, it’s important to be selective about which options you offer to which patients. It’s also important to be aware that certain financing programs could result in the practice being considered a “lender,” especially if in-office payment plans offer patients more than 90 days to settle accounts. Complying with Truth-in-Lending regulations, which exist at both the federal and state levels, can be a very arduous process. For these and other reasons, many practices opt to out-source financing and payments to a third party such as CareCredit. While you might want to do everything you can to help each patient cover the cost of treatment, in-office financing should not be offered to every patient. Criteria to consider before discussing this option includes your relationship to the patient, the patient’s ability to pay, payment history, the type of work being done, and the value of the treatment plan. Managing a financing program can require a significant amount of time, so make sure your designated team members have sufficient time to be certain that payments are credited to the correct accounts. Increasingly, the regulatory environment for this option, is demanding. For example dental offices are considered “Creditors” as they seek to comply with Regulation Z of the Federal Truth in Lending Act (TILA) Regulation Z. Required compliance with this regulation includes offices who extend consumer credit regularly and those where the payments are initially payable to the practice, either by written agreement in more than 4 installments or are subject to a finance charge. Need to review the 317 TILA pages? (http://files.consumerfinance. gov/f/201503_cfpb_truth-in-lending-act.pdf)

January / February 2022

PRACTICE DIVORCE CAN BE A GOOD THING!! In late December Congress passed the “No Surprise Medical Billing Act of 2022” which establishes new federal protections against surprise medical bills effective January 1, 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. It requires dentists to disclose that their practice is out-of-network with the patients’ dental benefit plan prior to treatment and includes specific patient rights for disputing out-of-network balances. And, if patients are self-pay or choose to pay for care without using their benefits plan; the new rules make sure patients receive a “good faith” estimate of how much their care will cost - before they get care. (https://www.cms.gov/ nosurprises/Ending-Surprise-MedicalBills) Feelings of frustration with patients who ignore your teams’ efforts to collect delinquent balances can initiate actions to “get even by ruining their credit”. You should be aware of changes in 2020 to Utah Code requiring creditors to receive a notice of a “negative credit report” which they would reasonably expect to adversely affect their ability to obtain or maintain credit. This notice must be delivered to a creditor within 30 days of submitting a negative credit report. If you assign past due accounts to collection agencies or attorneys, you should be aware of their procedures for submitting negative reports to a credit reporting agency. The Statute can be found: (https://le.utah.gov/xcode/Title70C/ Chapter7/70C-7-S107.html?v=C70C7-S107_2020051220200512)

Why am I talking Divorce in a dental publication? Sometimes a divorce is the best option to maintain sanity and dignity. I’m specifically talking about a needed divorce in your dental practice. Divorce by definition is, “separate or dissociate (something) from something else”. Some of the other words used to describe a divorce are: dissolution, separation, disunion, break up, part company, sever, repudiate and many more. It has become more apparent (especially since the pandemic has increased overhead in dental practices) to look at your practices and decide where a Divorce is needed. As we discuss dental concerns with dentists across the state, there is almost always one common area of frustration and complaint. This is especially true for Utah dentists and their dental team members. This is a common concern across the entire dental community nationwide. The complaints stem from dealings with insurance companies and their handling of a patient’s dental benefits. Almost universally, the most frustrated dentists are those that have signed up to be Preferred Providers for various dental benefit companies. As a PPO provider, you have agreed to accept lower reimbursements for your dental services to your patients that have that particular dental benefit plan. You have signed a contract to “play by their rules” and policies. You have given the insurance company the power to decide what you receive in reimbursement for your dental services. Since this is the #1 frustration nationwide, why do we not more often “Divorce” ourselves from this frustrating and sometimes abusive relationship??? Many frustrated dentists look to the ADA or UDA to solve their insurance company complaints. Although the UDA and ADA continue to do many things to fight insurance interference, the organization cannot prevent you from signing up for an abusive or frustrating relationship. The ADA and UDA has worked on several pieces of legislation in recent years to help ease the frustration of dental offices on the dental benefit plans frustrating behavior. But really the best solution to your dental benefit frustrations is to “File for Divorce”. Obviously, I’m talking about divorcing from PPO plans. Divorcing all the PPO plans you have signed on may be an end goal. But dropping them all at once might be too much adjustment to a single practice. But dropping your most frustrating plans will almost automatically bring you less stress and frustration and most likely you will see increased profits from your dental services provided. We have seen this unanimously across the state, those that have dropped a few plans have been happier and more profitable. It has been 100% unanimous for the past several years. A patient or two may be lost in the process, but the majority of patients want to stay with their dental office choice. Especially, when you discuss with the patient, how they would want you to do your best dentistry and use the best materials. And explain that is not possible with some dental benefit plans.

Bottom Line: A new year is a good time to review and update your practices’ financial policy and revenue cycle process.

If you suffer from frustrations due to PPO plans in which you have signed on to be a provider, maybe it’s time you consider “Filing for Divorce”. It is time for you to realize the problem cannot be solved by an outside organization. It needs to be solved by not agreeing to participate in the fee reimbursement reductions and to the “rules” of the game they dictate. Since you have signed the contract to be a PPO provider, only you can get out of the contract terms. The ADA and UDA cannot change the legal and binding contract you signed.

Dr Scott Theurer ADA Delegate

Dr Val L Radmall UDA Executive Director

UDA Action

PRACTICE HOW TO DROP A PPO So, if I am interested in dropping PPO plans, how do I go about it? Below is a step by step approach and includes sample letters of how to make the process successful in your practice. Try it with your most frustrating PPO plan company. Then repeat it with other frustrating PPO plans. Sign and date a termination letter. Attached is an example termination letter you are welcome to use. Submit your termination letter directly to the insurance carrier’s provider relations department. It is recommend sending it via email, mail, and fax if possible. You will receive a response from the insurance carrier in writing to indicate your official termination date. Insurance contracts require a 60 to 90 day termination window so the response you receive from the insurance carrier will reflect the termination timeline listed in your contract. Prepare a notification letter for your patients. Let them know that you will be terminating your contract with their insurance plan. Attached is an example letter. This letter is best given to patients in person (when they come in for treatment) so that you can make an attempt to explain the letter and let the patient know that they can continue coming to your office. For all other patients who have not been in your office during the termination window, send the letter to them 2 weeks prior to your actual termination date. If your intent is to retain those patients it’s recommended that you follow up with each patient by calling them to let them know that they can continue coming to your office for dental treatment. On your termination date, delete the fee schedule you have on file for that insurance and begin treatment planning using your standard office fees for patients of this network. When terminating a PPO contract, if the intent is to retain as many patients as possible it’s best to have meetings with your team to prepare them for the out of network changes. It is very common for team members to drive patients away if they are not fully prepared or fully believe that going out of network is in the best interest of the practice. When everyone believes that, it’s much easier to drop an insurance plan and retain the majority of your patients. Dear Provider Relations, Date: I hereby tender my resignation as a participating provider of your PPO Network effective on the date of this letter. Per my contractual obligation to provide written termination notice please accept this letter as my intent to terminate my agreement with you. I request that you respond to me in writing to let me know the final date of my participation with your PPO network. I will remain active in practicing at my current location but only wish to discontinue my PPO participation. Here is our office and contact information: 22

Doctor’s Name: Business Name: Tax ID: Address: Phone: Fax : Respectfully, Dr. ____________________________ Dear (insert patient name), I’d like to personally thank you for choosing me as your preferred provider of dental services. While I’ve been practicing dentistry for __ years I’ve invested countless hours in receiving ongoing continuing education in an effort to provide you with the best and most advanced dental treatment. Quality of Dental Care is at the forefront of my mission, vision, and values and I truly hope your experience with my team is nothing but the best. I am writing you to let you know about a change in my participation status with your insurance plan. I have elected to not participate with (enter name of insurance) as a contracted provider. However, I am pleased to inform you that you will continue to receive your insurance benefits at our practice and we will continue to process and submit all of your claims for any dental treatment we provide. My decision to discontinue participating as a contracted provider with your insurance plan was largely due to the restrictions that insurance carriers place on those that contract with insurance. Because those restrictions interfere with our mission to provide the advanced quality clinical care, changing my participation status with your insurance plan will ensure that you will receive the best care we can offer. We will have no restrictions in proving you with the type of advanced treatment we feel you deserve. We believe in excellent quality clinical care and not policy driven or restricted dental care advocated by the insurance industry. On behalf of my entire team, we look forward to continue providing dental care to you and your family and we thank you for choosing us as your dental care providers. Despite the change in our participation status with your insurance plan we will still be here to provide the high quality dental services you need, and you will continue to receive any benefits your insurance plan offers. Thank you for your time and attention and I personally look forward to seeing you during your next visit with us. Sincerely, Dr.________________________________ Edited by Dr. Kay Christensen UDA President Elect

January / February 2022

PRACTICE MY STEPS TO PRACTICE FREEDOM This year is my 10th anniversary of going out-of-network with all but one insurance plan. Ten short years ago, I was contracted with 15 dental insurance plans. Taking decreased fees didn’t only affect my business, it affected me personally too. Some dentists are able to juggle being in network with multiple insurances while having financial success and a happy life. I wasn’t one of those. I was getting burned out and was loosing my passion for my profession. I was struggling to make ends meet and finally had enough. I told my wife that I wanted to go out-of-network. I knew I would have to accept whatever consequences would come, even if that meant moving to seek greener pastures. But I hoped for greener pastures, financial success and personal happiness in my own backyard. Fast forward ten years. I’m still here and doing quite well. This past year 2021, was the highest collection year we have had in all my 18 years of practice. Collections are up over 50% from when I was in-network, we are working less hours per week than we were ten years ago as well. For the rest of this article, I want to walk you through a Cliffs Notes version of how we went out-of-network and what we are doing to continue our progress. If you find yourself in a similar circumstance to myself ten years ago, I hope that these steps will encourage you to transition to an exciting and fulfilling dental career. Step #1. I realized that something needed to change. I realized that I wasn’t happy and I needed to do something differently. It was my fault for signing up on the insurances, I had no one else to blame other than myself for the situation. It was worth it for me to do something about it. Step #2. I hired a consultant and did what the consultant told me. Thanks to a UDA recommendation, I hired a consultant that had experience and a proven track record helping dentists go out of network. I was determined to make the leap and follow their advice. Step #3. I told my team about going out-of-network and we made a plan. I got the team onboard with what I was trying to accomplish and why. Step #4. I trained my team to be better at customer service. If we charge more, we need to have incredible customer service. I followed that up with weekly trainings and education on improving our patient interaction for better patient experiences. Step #5. We found out how to properly end our insurance contracts. We contacted each insurance company learned the protocol to follow to properly terminate our contract. Step #6. We lightened the patients’ financial burden during the transition. The cost of recall hygiene seems to be most important

to patients so this is where we identified ‘minimum amounts’ to collect that would soften the impact on our patients. Though lower than standard fees, the ‘minimum amounts’ allowed patients to ease into paying a little out-of-pocket for their hygiene visits, while allowing us to collect a fee closer to standard levels. Step #7. We let patients know about the change. Don’t do this how we did. We sent a letter about the change, but in hindsight it would have been better to contact them personally when they were due for recall to explain our new insurance relationship and what it would mean to them financially, if anything. Sometimes the impact to them was negligible. This also created an opportunity for patients to tell us why they liked our practice and why they didn’t mind changing along with us. Step #8. We studied EOB’s religiously to determine how much more each insurance was reimbursing us as an out-of-network provider. We tracked this for each patient and noted what they would pay for copays in the future. This was the most challenging part as we didn’t want to undercharge copays which would force us to make collections calls. We ended up sending a lot of refund checks in the beginning, which patients didn’t mind at all. Step #9. We sat back and watched what happened and didn’t listen to the voices that said it couldn’t be done in Utah. Step #10. We used the extra collections to reinvest in the practice and CE. I had passion again to continue improving our patient experience, my skills, and to grow the practice. The results speak for themselves, I have a practice of which I am very proud. I do dentistry I feel comfortable doing at a comfortable pace I enjoy. I have a family life I love. And I have a practice that continues to grow through word-of-mouth referrals and google reviews. If there was ever a year for dentists to make a change, this is the one. With inflation at almost 7% and insurance reimbursement declining, it will only become more difficult to negotiate with insurance plans wanting to control treatment and reimbursements. We, as dentists, undervalue our services too often. I invite you to value yourselves more. I want you to see how much you could help your patients if you better enjoyed what you do and were reimbursed what you are worth to do it. Patients will choose to afford what they value. If you 1) create a positive experience and 2) perform quality work that lasts, your patients will stay with you even when their insurance plan tells them to go elsewhere. If any of you would like help with an out-of-network transition, we at the UDA office are more than happy to help. Contact the office and ask for recommendations for consultants that can help you. I am more than happy to talk to anyone interested in hearing more of my experience. Have a successful year! Dr Rodney Thornell ADA Delegate

UDA Action

ASSOCIATION ORGANIZED DENTISTRY’S CONTINUED EFFORTS IN OUR COVID WORLD

Photo: Image licensed by Ingram Image

I know, I know, you have heard enough about SARS-CoV-2. You’re sick of hearing about the sleepless nights and many hours put in by UDA and ADA leadership in order to get dentists back to work locally, and nationally. You’ve read and reread the ADA’s return to work toolkit, and memorized the safety protocols for when you or an employee contract the dreaded Coronavirus. You’ve had enough of the out-of-pocket expenses for, and uncomfortableness of, additional PPE including face shields, gowns, N95/KN95 masks, and protective barriers. You’ve filled out more government forms than you ever thought possible in the hopes of obtaining unemployment, HHS, or PPP money. You’ve had enough conversations with patients, family members and friends about the pros and cons of masks, and vaccines to last a lifetime. You’re done. I know, because I am too. We’re ready for life to return back to normal. I’m writing this article so that you know that the UDA and the ADA understand what we are going through and are doing everything in their power to return our lives back to normal. They are continuing to work with local and national governments to let them know that Dentistry, as it has been performed for the 24

last 30 years, is safe for the dentist, their employees, and patients. They have done and are continuing to do the research to prove this point. They have data to back us up. They continue to lobby “the powers that be” to allow dentistry to continue in an unobstructed manner. As a member of the ADA’s Council of Government Affairs, I am privy to some of the ADA’s governmental efforts and I’d like to share one of their recent letters to OSHA which was considering mandating vaccinations in all dental offices. Here is a portion of that letter… “OSHA posits that a COVID-19 emergency vaccination and testing requirement is necessary due to a grave danger of workplace exposure to the virus that can lead to COVID-19. The requirement, which is being litigated, applies only to large employers (100 employees or more), regardless of industry or level of community transmission. The agency is presently considering whether and how smaller employers should also be subject to the rule. Requiring dental practice owners to institute a mandatory vaccination and testing policy will have little impact on the safety of dental office workers and the patients they serve. January / February 2022

Infection rates in dentistry are already low and vaccination rates are already high. However, it could have the unintended effect of exacerbating dental team shortages and impeding access to essential health care. Research indicates that infection rates among dentists and dental teams are very low—far lower than for other health care workers, such as nurses and physicians, and even lower than in the general population. The cumulative COVID-19 infection rate was just 2.6 percent for dentists and 3.9 percent for dental hygienists, in November 2020 and October 2020, respectively. Those data were collected before the COVID-19 vaccines were available. Vaccination rates in dentistry have also been exceptionally high. As of June 2021, at least 89.8 percent of dentists had been fully vaccinated and another 3.6 percent had received at least one dose. At least 73.7 percent of dental hygienists had been fully vaccinated as of August 2021, and another 5.0 percent had received at least one dose. We strongly support the Centers for Disease Control and Prevention’s recommendations for the public to be vaccinated against COVID-19, including every member of the dental team. Our concern with a vaccination and testing mandate is that it could exacerbate dental team shortages and, as a result, impede access to essential health care—even in parts of the country where infection rates are decelerating. Compared to before the pandemic, dentists are facing major challenges in recruiting dental team members. The vast majority of owner dentists who are recruiting team members report being “extremely” or “very” challenged to fill vacancies for dental hygienists, dental assistants, and administrative staff. Over 40 percent of dentists report that staffing shortages are limiting their ability to see more patients.

Again, requiring practice owners to institute a mandatory vaccination and testing policy will have little impact on the safety of dental office workers and the patients they serve. Infection rates in dentistry are already low and vaccination rates are already high. However, it could have the unintended effect of exacerbating dental team shortages and impeding access to essential health care. Thank you for allowing us to share our perspective…” This letter was written on December 1st 2021. As you can see, the ADA is continuing to fight for the freedom and rights of dentists to practice how we best see fit. No matter where you stand on the vaccination front, you can see that the ADA is doing their best to allow dental practices and their employees to make a decision about what is best for them in their current situation. I’m proud to be a UDA/ADA dentist and I’m honored to serve on your behalf in the American Dental Association. The ADA needs your support. These types of letters are only effective if the ADA represents the large majority of dentists nationwide. With all the efforts the UDA and the ADA have performed on our behalf, if you are not a member, please consider renewing your membership, or joining for the first time. We are more powerful if we’re united with you. Dr Darren Chamberlain UDA Past President/ADA Council Representative

Staff shortages pose a distinct risk for smaller practices, where the departure of a single hygienist, dental assistant, or office manager can severely limit (or even halt) the flow of business. Photo: Image licensed by Ingram Image

UDA Action

LETTER SPEED KILLS I worked and lived at the Multnomah County Medical Examiner’s office from 1976-1980. Those are the four years I attended dental school at The Oregon Health and Sciences University. It wasn’t easy toe tagging a body at 2 AM and then taking a neuroanatomy test six hours later. With my job experience you would have thought I would have done well in gross anatomy, but I passed with a 2.0. Of course, this was before grade inflation and a 2.0 was the class average. I will never forget my first night on the job. The bell to the morgue rang about 1AM on a Saturday morning and I went down to check the body in. What I saw is etched in my mind. A motorcycle rider had hit a telephone pole head on at about 80 mph smashing his helmet through his head. Right then I knew I was not going to be riding motorcycles and I wasn’t going to speed. Speed Kills. On Friday September 11, 2020 I went to the hospital to have my foot repaired. Over 40 years earlier I had blown out my left lateral peroneal tendons when I was tripped running to first base in a city league softball game in. I underwent surgery but my ankle had deteriorated over time. My general experience with surgeries are only do them if they are absolutely necessary. A general rule is if God made it then it will work better than if man made it. My appointment was scheduled for 1 PM and it was a three-hour surgery. At about 4 PM they finally came to get me. I told the doctor we should probably reschedule as being three hours late on a Friday would not be good. He insisted that he would not rush the surgery and that everything would be fine. When I woke up at about 6 PM I had never been in such pain. My foot was on fire. For the next eight months the pain was unbearable. On a scale of 1-10, I gave it an 8 (intense, limited physical activity, even making conversation difficult). After visiting five more surgeons, two pain clinics, two chiropractors and five physical therapists, I was no better. I had tried almost every medicine I could find, but oxycontin was not a long-term option and gabapentin put me in a suicidal brain fog. After hours, days and months of searching for relief (pain will do that to you), I found a neurosurgeon who said he could help. No one else in the state could do peripheral nerve repairs. Unfortunately, he was booked out for 5 or 6 months, yet with some persuading, I was able to get an appointment in a few weeks. Dr. Mahan performed the surgery on May 26, 2021. What he found was the deep peroneal nerve had been completely obliterated by the foot surgeon. It looked like a chopped-up piece of cooked spaghetti. The deep peroneal nerve is the largest nerve to the foot, so it is fairly easy to locate and see. Dr. Mahan had to repair the nerve using a graft and suturing it with 9-0 suture. The pain 26

went away immediately. Unfortunately, about a third of my foot is numb. It will take 6-24 months to see how much the nerve recovers. How could the first surgeon not have seen the nerve and just botch the surgery? I think I know. He is supposed to be the best foot and ankle surgeon in Utah. I am sure he is normally really good. But when you are three hours behind schedule on a Friday afternoon, you tend to rush things. The nurses want to go home, the anesthesiologist wants to go home. The surgeon wants to go home. The hospital wants the surgical room. There is lots of pressure to get it done fast. He did my three-hour surgery in two hours. Everything turned into a nightmare. I know that dentistry has a lot of stress. Maybe the biggest stress factor is keeping on schedule. Unless you have a practice that only sees one or two patients a day you are going to get behind. I hate being behind. Even for twenty minutes. But I must control myself and never lose sight of doing things right. Don’t short cut and don’t rush. It is a lot easier to reschedule a patient than it is to repair a damaged lingual nerve or a broken jaw. It is easy to perforate a root or overfill a canal. In your hurry to catch up you might look at an impression with a bubble on the margin and just let it go. Don’t do it! Dentistry takes a certain type of personality to survive and thrive. Never sweat. Never loose your cool. Stop and take a break if you need it. Hire good people around you. People who know how to stay calm. Just remember, Speed Kills—especially if you are on a motorcycle going 80 miles an hour at 1 AM in a rainstorm. That is how I feel when a pedo patient is screaming and I am an hour behind, but just put your mask on and slow down. Dr Drew Jones

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January / February 2022

ASSOCIATION CONTINUOUS QUALITY IMPROVEMENT – DON’T MISS IT At the annual meeting of the House of Delegates of the Utah Dental Association Spring of 2017 I was elected to serve as Secretary of the UDA. I understood this would mean that over the next 5 years I would be a worker/servant for that organization and its members. Each successive year my responsibilities would change, my learning and understanding of the organization would increase and ultimately, I would serve as President of the UDA. As with most opportunities there was a lot more there than I anticipated but I can honestly say I have enjoyed it all and appreciated the chance to learn so much more about the UDA/ADA. The deeper knowledge and understanding of this organization pales however in comparison to the friendships gained across the country but more importantly here in our great state. The UDA staff, Val, Dotty and Becky, and Board of Directors, past and present, are a wonderful dedicated group of friends whom I admire and appreciate. I first started to realize the value of the UDA back in 1996 when a program was instituted called CQI (Continuous Quality Improvement). I was a young solo practitioner in Vernal, Utah and I really learned to love the annual trips of the UDA leadership and guest speakers to my community. These individuals were willing to come to us and share ideas, topics and information that were timely and relevant to practicing dentistry in this state. Initially attending this meeting was required for licensure and so of course these meetings had great attendance. Over time attendance to these meetings was no longer required but for me this did not change the value of the meeting itself. Not only do I value getting to know the UDA leadership and learning from them but I deeply enjoy getting together with my local colleagues, who I consider my friends. In Vernal our meeting is traditionally held at a local restaurant; we order off the menu and each individual is responsible to pay for themselves and most years we have good attendance. As I interact with current and former leaders of the UDA I have come to realize that the trip to Vernal was memorable for them as well, despite the “long” drive. When I was elected into UDA leadership, I knew the day would come when I would be traveling the state as part of the CQI. It was hard to imagine that I could take that much time away from the practice and all the other responsibilities of life and travel the state to attend and participate in CQI meetings. We have CQI meetings from Logan to St. George and everywhere in between and let’s not forget Vernal and Moab. As a UDA leader it is anticipated that you will attend these meetings for at least 2 years of your tenure.

Once again as I traveled and participated in these meetings, I gained a greater appreciation for them. I got to spend some valued talking time with my beautiful wife, Holly, who travel with me. When possible, the UDA leadership carpools as we travel which was a great time to build friendships and discuss business. Each and every meeting I met new colleagues, rekindled friendships and gained new and diverse perspective of the issues we face. Most meetings were under attended which does cause some degree of frustration. I don’t feel like it is wasted time because those who attend receive valuable information and we receive valuable feedback. For those who do not attend it is a missed opportunity. A missed social gathering with friends and colleagues, missed education on matters that seem to be on the forefront in the state, and a missed chance of sharing ideas and opinions with the leaders who are representing our profession on the local, state and national level. As this is the member benefit issue of the “UDA Action”; after our annual convention I vote CQI as the most valuable member benefit provided by the UDA. After 20+ years of attending and 2 years presenting, I plan to continue to attend each year. Don’t miss out on this valuable meeting, watch for the CQI schedule to come out, put it on your calendar and go to learn and be a voice in our profession. I hope 2022 is a wonderful year for all of you. Dr Mike Smuin UDA Past President

UDA Action

PRACTICE HANDLING CONFLICTS WITH CONFIDENCE: TOOLS TO REDUCE TENSION AND RISK action and the impact to the schedule. The employee judges their own intentions and everything they have done -fighting traffic or skipping breakfast – to try to make it to work on time. While the intention doesn’t excuse the action attempting to see both sides facilitates productive, solution oriented discussions. Empathy also extends to thanking employees for positive contributions of every size and sincerely apologizing when you are wrong. 3. Be Patient Living with unresolved conflict is stressful, but rushing to a solution rarely bears long-term gain. When a patient or employee makes a tough demand or offers an unideal solution, explain that you need time to consider their request and return your decision. Understand that they need time to consider their answer to your proposed solution. However, if a demand is unreasonable, such as never scheduling a specific staffer on the days that they come in for appointments, answer at the time. Give a measured response that keeps the discussion open to reasonable demands, such as, “I understand you are unhappy, but I don’t believe this is a fair assessment of the situation,” or “I don’t feel it’s reasonable to ask me to make adjustments that would create a disruption for my practice, other employees and patients.”

Photo: Image licensed by Ingram Image

Here are five proven principles to de-escalate conflict: 1. Be Clear Overgeneralization can increase drama. “You’re always late to work,” is a broad statement that invites defensiveness. “I’m concerned that you’ve been about 30 minutes late the past three Fridays” is more specific. Alternately, communications may be so vague that both sides are left with different interpretations. If the dentists remarks on the lateness without specificity or follow through, they may feel like they have addressed the issue and the employee may feel like they’re off the hook. Lack of clarity means future conflict is likely.

4. Be Objective How the message is being delivered and who it is delivered by often determines how we engage. Take a calm, respectful approach and find a private place to talk. When struggling, start with the facts. Don’t disparage others’ character or values or bring up past conflicts unless there is an established pattern. Rather, analyze the point of conflict, share your observations and listen to their perspective before pursuing a resolution. 5. Be Curious Making assumptions about others isn’t empathy. Listen first, asking questions to understand their point of view. Curiosity can de-escalate conflict. For the late employee, it could be, “I’ve noticed you’re on time for most shifts, but not for the last few Fridays. Is something going on that day that we can talk about?” After hearing their side, invite their input in finding a solutions.

With patients, clarity means listening to concerns first-hand, not deflecting nor delegating issues to staff. Patients want to feel heard. Allow them to voice concerns without interrupting or speculating. Listen attentively and then repeat back their concerns so there is no misunderstanding about the source of conflict.

Conflicts are inevitable and pandemic pressures have amplified disagreements about finances, scheduling, employment and clinical protocols. By addressing conflicts early and reframing them as opportunities to address unresolved issues, you can better protect your practice.

2. Be Empathetic We tend to judge others by their actions and ourselves by our intentions. When an employee is late, the dentists judges the

ISDA News

January / February 2022

PRACTICE THIS IS NOT A COVID STORY As dentists, we pride ourselves in our tough immune systems and our ability to work through pain and minor illness. But sometimes we find ourselves in the position of receiving care instead of providing it. The experience of being a patient with an unusual disease is both eye-opening and humbling. On Friday, May 14, I stepped into the office seemingly healthy and excited. By 10 am, I started feeling lethargic and I couldn’t think clearly. That night I developed horrible chills. On Saturday, it became difficult to talk without coughing and by afternoon my fever spiked close to 103. Thus began daily cycles of debilitating temperatures spikes from 97-104. I couldn’t sleep and I coughed constantly. Walking to the bathroom or kitchen felt like a half marathon. My speech was staccato and labored and my head felt like a chef’s knife was being thrust into my brain every five seconds. On the eighth day, after another tortured night, I laid in my dark bedroom and cried with exhaustion. Despite two negative Covid-19 test, the primary and urgent care options for a patient with cough and fever are limited. A good friend who is a physician assistant finally insisted it was time to go to the ER. In the waiting room of the ER, she held up the back of my head with her hand while I kept a wet washcloth over my face to cool the fever and block the light. Having someone take the lead and lend a steady hand brought unbelievable comfort. When the ER doc examined me, he said, “I’m really glad you came here today.” Those words were reassuring in the moment of crisis. I received a battery of tests and images, IV fluids and a differential diagnosis list. For the next week, test after test came back negative, and discouragement set it. I developed lymphadenopathy and secondary tonsillar abscesses. On day 16, when the fevers finally abated, I received a positive test result for coccidioidomycosis, or Valley Fever. But none of my providers seemed confident if antifungal medications were indicated. It would take another frustrating 10 days of feeling poorly before the referral trail led me to an infectious disease specialist. He confirmed that I did have Valley Fever and my continued symptoms were not complications but rather autoimmune activity.

Reflecting on my experience, here are six recommendations for patient and healthcare professionals: For patients: 1. Find an advocate. Ask a friend or family member to be a healthcare advocate for you in the case of illness or medical treatment. This advocate is a second set of eyes and ears and assists in evaluating your options and making decisions. 2. Be nice and be persistent. Navigating the medical system when you don’t feel good is frustrating, and you need to be nice and persist to get the right care. Ask about expected timelines. I found it helpful to utilize the chart apps to views test results and communicate directly with providers. 3. Make a recovery plan. Our medical system does acute care well --- then often leaves the patient on their own. It was up to me to figure out how to treat my lingering symptoms, rebuild my deconditioned body and ease back into work. For medical professionals: 1. Patients want to be heard. As patients it often feel that our story, our symptoms and the big picture aren’t hear in the rush to make a diagnosis or provide treatment options. Pull up your chair, close your computer and look in your patient’s eyes, and really listen. 2. Touch is powerful. The touch of the human hand is meaningful. Even if the diagnosis is obvious, put on your gloves and perform a thorough exam. 3. Offer reassurance. When the ER doc said he was glad I came in, that provided me a lot of reassurance that I made the right decision. In the end, I am deeply grateful to my friends and family who cared for me and encouraged me every day. Small acts of kindness really do go a long way, especially when you are sick. Dr Julie Kellogg WSDA

In total, I was off work of over a month. Recovery continues slowly. I still struggle with fatigue, body pain and brain fog. UDA Action

PRACTICE COVID-19 PERKS It is not my intent to dismiss the tragedy of the loss of more than 700,000 American lives from the pandemic or the devastation it has caused in our society and economy. Yet, even in the darkest clouds, it is possible to catch the faint glimmer of a sliver lining. In this season, I pause to consider what I will call “COVID-19 Perks.” My inspiration comes from remarks by Dr Natasha Lee, president of the San Francisco Dental Society, published in the Journal of the California Dental Association this past September. In it, she shared how patients confide in us that isolation has taken an emotional toll. Although they are healthy and earning a living working from home, going to the dentist has become a social event and a welcome break from the stress of a COVID-19 imposed quarantine. Patients have always trusted us to address their dental needs. Dr Lee points out they have now demonstrated confidence in our infection control protocols as we mitigate the spread of the virus. They further trust us to listen empathetically as they share the struggles they face. As dentists, we are well-positioned to identify more than dental disease, and as compassionate listeners, we can help those in need find the assistance they need. Our patients’ trust is a perk that comes from being a member of our profession.

Photo: Image licensed by Ingram Image

Some consider Zoom conferencing a curse, but it has been an essential conduit for many. Zoom kept me connected with my daughters, family and friends who live far away. It is also a perk that overcame my hearing limitations. In regular times I struggle to hear and function effectively at many in-person gatherings. With Zoom, I put on my headphones and I am fully engaged. The pandemic further revealed what is best about our colleagues. Networking to cope with the latest regulation or simply checking in with each other has built strong community bonds. My perk is a group of professional friends who text to commiserate about bad officiating during a Michigan game, discuss how to apply for PPP loan forgiveness or just share a joke. They have been more than a perk, they’ve been a lifeline.

Importantly, we dentists are fortunate to have figured out how to safely interact with people up close, in person. We get to leave the house each day and interact with coworkers and patients. We’ve maintained human connectivity as very few have – the ability to socialize with patients and team members has been an invaluable perk that has sustained us in the darkest of times.

The availability of vaccines has allowed us to emerge and connect in society cautiously. The promise of safe social gatherings is a perk that must be tempered with continued indoor masking. The threat of breakthrough infections and evolving variants require us to lead by example.

The resilience and resourcefulness of our profession is a perk provided us through ADA and its return-to-work guidelines to comply with OSHA and CDC requirements. Guidance on navigating government financial assistance programs and countless webinars are perks that emphasize the value of our association in preserving the viability of dental practice and create a sense of community.

Christopher Smiley, DDS JMDA November 2021

It’s really about the importance of human connection threatened by the pandemic. Our ingenuity finds ways to persevere. We are lucky to be dentists.

January / February 2022

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