Issuu

After years of paying premiums…

Why is it So Hard to Collect On My Disability Policy? No matter where you are in the disability claims process, our firm is here to help. Please visit our website, www.disabilitycounsel.net, to view our dentist resource page. Derek R. Funk, Esq. Direct: 480.685.3638 dfunk@cobelaw.com

If you would like to speak with an attorney about your disability claim, please feel free to call or e-mail Mr. Funk directly.

CONTENTS

OFFICIAL PUBLICATION OF THE UTAH DENTAL ASSOCIATION

CONTRIBUTING WRITERS Dr Mike Smuin Dr Drew Jones Dr Val Radmall Dr Rodney Thornell Dr Mark R. Taylor Derek R. Funk, Esq. Stephanie Sawatzke ODA Today Kimber Solana Dr Bryan Trump Dr Tyler Fix

COVER PHOTO Bear Lake Image Credit: © Kim Lund

PUBLISHER: Mills Publishing, Inc. PRESIDENT Dan Miller

OFFICE ADMINISTRATOR Cynthia Bell Snow

ART DIRECTOR Jackie Medina

GRAPHIC DESIGNERS ADVERTISING REPRESENTATIVES Paula Bell Ken Magleby Paul Nicholas Patrick Witmer

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 2021.

PRESIDENT'S MESSAGE Trust the Process

ASSOCIATION 6 Utah Legislative Efforts Involving Dentistry

Past and Present (including the 2021 Legislative session )

A Boulder to the Ankle Year

New Law Repeals Antitrust Exemption for Health Insurers

COVID-19 Fatigue: Keeping Masks On and Office Morale Up

Give Kids a Smile: "The Need has Never Been Greater"

HPI Poll: Dentists See Increased Prevalence of StressRelated Oral Health Conditions

EDITORIAL 5 Midlevel Providers 11

PRACTICE

Disability Insurance: Do I Really Need It?

What Does it Really Mean When You Hire a "Temporary Employee?"

Oral Pathology Puzzler: Do You See What I See?

Resources at the Ready: You've Got More Help Than You Know

All That Glitters is Not Gold

PRESIDENT'S MESSAGE

TRUST THE PROCESS As we enter the spring my mind seems to be focused on the class of 2021 and the upcoming events preparing them to enter residency or practice. This time period is filled with a vast array of emotions and feelings. We can all appreciate the stress associated with completing academic and clinical requirements, preparing for and taking board examinations, and looking forward to the next step. For most reading this article that next step, as well as the abovementioned events, are a distant memory in the rearview mirror. The fact that so many dental professionals have been able to navigate through these right of passage events should provide the class of 2021 some sense of hope, trust the process. It is true that your process has been “different” than most other classes due to the impact COVID has had on your educational process and lives. None the less the diligent efforts of the dental schools to adapt the educational process to meet the academic and clinical requirements certifies your preparation and readiness to enter the work force. Each of us has a unique and personal story about taking that next step. My next step happened 27 years ago which is hard to believe considering I was 27 when I finished school this gives me half of my life as a practicing dentist, some of my colleagues would say that is a good start. I do recall feeling ready to take on this part of life and being very optimistic about my profession and future. I must admit, as I look back, I was quite naïve about most of what I was hoping to accomplish. I had a good basic understanding of dentistry but beyond that, I was clueless. To be honest that was probably a good thing, I was young and adventuress enough to jump in with both feet and get going. I had many of my senior colleagues, mentors, who were encouraging and reassuring me that I would have success. I trusted the process. Trusting processes could be a topic of great debate. Our society seems to be moving in the direction of questioning everything. We question election results, safety of vaccinations, government responses to nearly every issue, motives of law enforcement, the list is endless. The access to information that each of us possess with just a simple search, is at times mind numbing. Often we have so much information to process it causes making a decision nearly impossible. I have on many occasions found myself in a personal mental debate over when should I restore incipient proximal decay (board lesions-back to our graduates) and if you really want to go insane which isolation techniques, matrices, materials,

and polishing products should I use. Obviously to keep from having to make these decisions on every single patient we develop personal philosophies and processes, which we trust. Occasionally you will adjust your process to keep up with advancements in technology and science. I feel confident for our new graduates that our profession has good processes in place to help as you move into your next step. Trust it. Certainly you have many more choices that any class proceeding you, which could cause you to question yourself to the point of paralyzation. Look to your senior mentors who have been down the road before and follow their lead. Look to the ADA/UDA and local dental society to be a resource to help you in your process. In time you will make adjustments to meet your personal needs and you may even forge out into uncharted waters creating a whole new process. I am confident you have what you need to start down the road to a long successful career. For those of us working along the career path look for these new graduates, look for opportunities to help them succeed, you have much to offer. Look for ways to adjust your process to make it more enjoyable and profitable. Education and involvement are two ways I have found that help me enjoy my profession and career choice more. Our careers will last much longer than we ever imagined constant evaluation and adjustment are necessary for continued success. 2021 will bring a whole new set of opportunities and challenges. I am confident in our ability to succeed as new graduates, seasoned practitioners, and an association. I trust the process. Dr Mike Smuin UDA President

Utah Dental Association Fall CE Event For Dentists & Hygienists September 24, 2021 Salt Palace Convention Center 6 CE Hours Available

March / April 2021

EDITOR'S MESSAGE

MIDLEVEL PROVIDERS In 1980 I was getting ready to graduate from the Oregon Health Science University School of Dentistry. At the same time, a 31-year-old lawyer by the name of Ron Wyden was campaigning to win a congressional seat from Portland. He was promoting the “gray panthers”, a term he used to describe the elderly. Part of his platform to support the “gray panthers” was to legalize denturism in the state of Oregon. His proposal was to allow technicians who had been trained in providing the laboratory side of making dentures to provide dentures directly to the public without supervision by a dentist. They would not need to go to school but would-be grandfathered in. The reason he gave to support denturism was that it would be cheaper and improve access to care. Sound familiar? At the same time Portland was trying to pass a law to allow the fluoridation of its public water supply. The results of the elections were denturists could provide dentures directly to the public, but fluoride was not added to Portland’s water. Portland is still the largest city in America without water fluoridation. Dentists lost in both cases. Ron Wyden won his election and like most politicians has never left. Now he is a bald headed, old man who looks a little weird (to use his own term) and is in the U. S. Senate. Denturists can now practice indirectly in Oregon, Idaho, Montana, and Washington. They can practice under supervision in Maine, Arizona and Colorado. I learned early on that one politician can have a huge impact on dentists, that the slogan of “rich dentists need to be cut down to size by providing cheaper alternatives and allowing more access to care” could win votes.

What is the scope of practice for a dental therapist? There are over thirty procedures that they can perform. They can provide all preventive and diagnostic procedures. They are allowed to administer nitrous oxide and prescribe certain drugs. They can perform cavity preparation and restoration of primary and permanent teeth. They can prep and place crowns on primary teeth and place temporary crowns on permanent teeth and recement permanent crowns. They can extract primary teeth and do “simple” extractions of permanent teeth. They can perform pulpotomies on primary teeth and pulp cap permanent teeth. They can reimplant and stabilize a fully avulsed tooth. They can make space maintainers and do denture relines. In my mind they are coming close to being general dentists. They use high speed hand pieces and elevators and forceps.

Today we are facing a much bigger attack on our profession. They are called midlevel providers or dental therapists. The idea of having less trained individuals providing expanded dental care began in New Zealand in the 1920’s. Today 54 countries have dental therapists. As of August 2019 Alaska, Arizona, Connecticut, Idaho, Maine, Michigan, Minnesota, Nevada, New Mexico, Oregon, Vermont and Washington have authorized the practice of dental therapists. Minnesota seems to have been the most aggressive state in promoting dental therapists. They have a program to educate and license dental therapists and over a hundred of these midlevel providers are working in Minnesota. The only other school of dental therapy is in Utqiagvik (Barrow) Alaska, that is at least what was reported. Vermont is expecting to open a school soon. Outside of Minnesota, most dental therapists seem to be working on Indian reservations.

In the future, I could see dental therapists providing much of what we call restorative dentistry. Dentists will need to become experts in advanced areas—taking on some of the work currently done by specialists and also new areas such as sleep apnea, occlusal therapy, laser dentistry, implant dentistry, wisdom teeth extractions and so on. This will require dental schools to become more demanding because graduating students who can’t do much more than a dental therapist would be of little value.

The two main organizations funding and promoting midlevel providers are the Kellogg and Pew Foundations.

Dr Drew Jones UDA Action Editor

Why is there a demand for midlevel providers? Simple, the American public believes they will provide less expensive care and care to otherwise neglected people. Cost and access to care. The University of Minnesota school of dental therapy prints in bold lettering, “Dental Therapists work primarily in settings that serve low income, uninsured and underserved populations or in a dental health professional shortage area”. That is a hard combination for dentists to take on. We sound greedy and heartless. Personally, I do not think that they will be inclined to go to unattractive places or to provide services for less than they can charge. Where will the dental therapists come from and how will they get training? I suspect that hygiene schools and hygienists will provide facilities, faculties, and students for schools of dental therapy.

Over my time as editor, I predicted the coming of two dental schools, the coming of a pandemic and now the future of dental therapy. Utah will be slow to join the dental therapy bandwagon because we already have plenty of dentists and a low reimbursement rates. But remember, sometimes it only takes one goof ball politician to mess things up!!

UDA Action

ASSOCIATION UTAH LEGISLATIVE EFFORTS INVOLVING DENTISTRY – PAST AND PRESENT (including the 2021 Legislative session)

From polling 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. Recognizing this 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 NonCovered 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. Many dental plans are federally regulated. 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 the Dental Insurance Reform messages to assist states in 6

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 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 Denial allows insurance companies 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 thirdparty payer a certain amount determined by the insurance company. It’s my understanding that often, the third-party payer strips out the “over-paid” 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 Retro 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. 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

March / April 2021

pre-treatment estimate is not technically a Prior Authorization. A Prior Authorization means the third-party 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 31A-22-650 . Virtual Credit Cards: This is a term given to the process where an insurance company requires dentists to accept payment 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 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.

Network Leasing: Many may not recognize the term Network Leasing. Network Leasing is when third-party payers sell dentists to a different insurance network 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. Now the dental office is contracted with more plans than they are often aware. The dentist may not have even been aware of dental plans of which they are 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 Continued on next page.

What’s your practice worth?

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 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 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. 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.

UDA Action

Since 1968

Receive a free market value analysis today. www.AFTCO.net | 800.232.3826

Utah Legislative Efforts: Continued from previous page. session (HB 359 sponsored by Representative Jim Dunnigan and Senator Karen Mayne). See UCA 31A-22-646.1

insurance reform topics made possible by the efforts of the UDA and My Practice, My Business (Thorups).

In the Fall of 2020, Dr Rob Thorup of “My Practice, My Business”, contacted the UDA with ideas of insurance reform that they wanted help in creating legislation. The ideas presented included two topics that were finally included with the plans already underway for a Network Leasing bill. Many hours of work with Representative Jim Dunnigan, the UDA and Dr Rob & Tracey Thorup were put in to finally create 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 thirdparty payers in regards to Bundling and Downcoding.

Other Dental related legislation during the 2021 Legislative session: Senator Todd Weiler sponsored a bill for the Utah Dental Hygiene Association for 2021. SB 103 requests Medicaid to reimburse a dental hygienist directly for certain services provided through the Medicaid program. After observing the progress Physician’s Assistants were making in the legislation session to open up their practices to be more independent from physicians, it became apparent this year’s legislative body would probably pass any bill that claimed to give “Access to Care” to the underserved population. A Collaborative Agreement with a dentist is still required for a hygienist to work in public health setting. SB 103 redirects payment directly to a hygienist, if requested, for services a hygienist performs in a Public Health Setting as long as it remains within the hygienist’s Scope of Practice.

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

Text to: 1. 2.

801 -261 -5315

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

The ADA recently announced new CDT coding that facilitates Teledentistry and could be applied to the codes a hygienist could bill when requesting direct payment from Medicaid. CDT codes for radiographs have previously and traditionally included diagnosis. Since legal diagnosis is outside the scope of practice for a hygienist, new codes have been introduced that would allow a hygienist to take a radiograph without diagnosis (see CDT codes 0701 to 0709). There is also a CDT code for a dentist to read and diagnose from a radiograph taken by another provider (see CDT code 0391). For dentists willing to engage with a dental hygienist in a Collaborative Agreement to provide hygiene dental care in a public health setting, they should become familiar with the process and documentation necessary in order to eliminate frustration and miscommunication and abide within Utah law. This would include the following: Utah law allows a Utah licensed dental hygienist to practice dental hygiene on a patient in a public health setting prior to that patient receiving a dental examination by a dentist when the following conditions are met: 1. The dental hygienist has a written agreement with a Utah licensed, resident dentist stating that: • The dental hygienist will practice in a public health setting.

• The dentist will be available for consultation as necessary in person, by phone, or by electronic communication. • The dental hygienist will refer each patient with a dental need beyond the dental hygienist’s scope of practice to a licensed dentist, and • The dental hygienist will obtain from each patient an informed consent form stating that the patient is receiving treatment by the dental hygienist within the scope of hygiene practice, but not a dental examination by a dentist.

2. The dental hygienist practices in a public health setting: • An individual’s residence if that individual is unable to leave the residence 8

March / April 2021

• A school as part of a school-based program

dentist, has been the primary and leading congressional advocate for the bill’s passage since being elected in 2010.

• An assisted living or long-term care facility

“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.

• A community health center

• A federally qualified health center, or

• A mobile dental health program that employees a Utah licensed dentist Two sample forms are available from the UDA that relate to these guidelines: • Agreement for dental hygiene practice in a public health setting (for signatures of the dentist and dental hygienist) • Informed Consent for dental hygiene treatment in a public health setting (for signature of the patient or other responsible party) [see UCA 58-69-102(6), 58-69-102(8), 58-69-501(2), and 58-69-801(4)] If you would like to be a collaborative dentist, please contact the UDA Office. McCarren-Ferguson Repeal: The US Senate on Dec. 22, 2020 voted to repeal the McCarran-Ferguson antitrust exemption for health insurance companies by passing HR 1418, the Competitive Health Insurance Reform Act.

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 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 Radmall UDA Executive Director

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 Association 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. I look forward to this 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. The ADA also thanked Sen. Patrick Leahy, D-VT, Reps. Peter DeFazio, D-Ore., and Paul Gosar, R-Ariz., for getting the bill passed in the House. Rep. Gosar, who is also an ADA member

UDA Action

Utah’s leader in in-office Dental Anesthesia HOSPITAL QUALITY ANESTHESIA IN THE COMFORT OF YOUR OFFICE

Image licensed by IngramImage

• A nursing home

Able to induce anesthesia for complex treatment plans or procedures. To schedule an appointment, or for additional information call

801-631-1312

ASSOCIATION

A BOULDER TO THE ANKLE YEAR I rode in a dirt bike motorcycle rally last weekend. It was a fun rally that was hosted by the popular YouTuber, EveRide. He took us on a multi-day journey on incredible off-road trails around St. George, Utah. The second day of the ride, we rode towards the beautiful Toquerville Falls. The route was a single track “motorcycle only” trail that started from Valley Gun Club near Hurricane, Utah. It was a technical trail with cliff exposure, rocky sections and hill climbs. At a steep uphill section, I attempted to make a tight turn. With a six-foot drop on the one side, I didn’t make it and fell. My bike remained on the trail, but I fell down the six-foot drop and landed below. The fall was not bad, but I brought down a 200-pound rock that landed on my left ankle and foot. It is an inevitable possibility to get injured riding dirt bikes, so I always ride with gear that protects me. And while I may not always be able to prevent injury, I know my gear can go a long way to protect me. On that second day on the trail, that rock could have altered my life in a bad way. But my Sidi Crossfire 3 boots saved my foot from serious damage. I pushed the boulder off my foot and I scrambled up the hill to my bike. I could feel my ankle swelling and it started to get painful. We rode the rest of the way to the waterfalls and began the trail back to the trucks. Our return trail consisted of more that 25 water crossing that were technical and difficult, and required all of my concentration. Back at the truck, I was barely able to get my foot out of my boot. But, like all dirt bike enthusiasts, I’ll tell you that the ride was worth the pain. I can’t help but think how my motorcycle experience is similar to this past year. Last year was one of the most surreal years of my life. When I sent my staff home that day in March, I truly was afraid of the possibility we would never open again. The closing of our practices and the uncertainty that the COVID-19 scare has brought to many of our patients, have brought discouragement to many of us over the last year. But they have also shown me many good things I have taken for granted. So, among the “boulders to the ankle” of last year’s COVID-19 events, I would like to share some positives and gratitude from my experiences. Looking back, I am grateful that we were only closed to 6 weeks. My thanks go to the UDA Board for helping with that. When dentists opened our practices again for treatment in May, patients were waiting and happy to return for dental care!

I took for granted going out to dinner, and I enjoy it again with greater appreciation. I enjoyed getting my haircut in a salon. I am grateful for the PPP loan. It has helped me navigate financial difficulties that the Covid response had invented. I am grateful to experience “at home” church. I was grateful that we were allowed to go back to church. I am grateful that I was able to buy and learn to ride a dirt bike. I was grateful to be able to see family members again who had sheltered because of the risk. I enjoyed Zoom meetings (almost). I enjoyed getting better at home-cooked meals, but also going out to dinner again. I enjoyed seeing patients and friends show the Covid virus who was boss. I enjoyed eating Keto, and intermittent fasting and getting in better shape to help strengthen my immune system. I am grateful that I received the Covid vaccine and didn’t turn into a zombie because of it. I am grateful for the second PPP loan. I am grateful to learn that the McCarron Ferguson law was overturned, finally removing the anti-trust exemption for insurance companies. I am grateful that what I once thought could have been the end, is now the beginning of so many good possibilities. I hope that each of you has been able to negotiate this past year with similar results. While the negative effects of this last year will be felt for a long time, I am positive that we will come out better in the long run. Here is to looking forward with positive expectations for what is to come and to looking back at experiences that have hopefully made us better people than we would have been without them. I wish you all much success and happiness. You are an inspiration to me and many others. Thank you for all that you do. Dr Rodney Thornell ADA Delegate

I admit, I enjoyed the “staycation” vacation. My family got to know our wonderful state of Utah in greater way and spent a lot of enjoyable time together. I was grateful to go backpacking with my kids. I was grateful that we were able to go boating more often.

March / April 2021

PRACTICE

ALL THAT GLITTERS IS NOT GOLD Is it true all that glitters is not gold? In 1907, a Chicago dentist named W. H. Taggart introduced a casting method for small gold inlays. Then, in 1936, a Danish engineer, Thoger Gronborg Jungersen, filed a patent for a method of manufacturing precision gold objects utilizing the lost wax technique combined with a centrifugal casting machine. This ushered in the modern era of indirect cast gold restorations, including inlays, onlays, ¾, ⅞, and full-coverage crowns. Over the years, many refinements to this process have been introduced that have enhanced control over the size of the casting and have greatly improved the precision nature of the process. Consider how many of these restorations have been utilized since they were first introduced. The number is likely in the tens, or even hundreds of millions. Wow! The ability to reinforce tooth structure in a very conservative way with these restorations was a significant breakthrough. To say that many teeth have been saved by indirect cast gold restorations is, indeed, an understatement. As a witness to the remarkable nature of these restorations, it is likely that many dentists reading this article are sporting at least one, if not more, indirect cast gold restorations in their own mouths. As you well know though, partial coverage is really where gold shines. There is not a less-invasive, longer-lasting restoration in our toolbox. It is not uncommon for many of these restorations to be in service for more than 60 years. With that as a backdrop, according to a 2018 survey of 844 dentists across the United States, less than 3% of all crowns placed were cast metal, let alone cast gold. Currently, worldwide the number of cast gold restorations placed is likely less than 1%. The University of Utah School of Dentistry is one of only a handful of dental schools in the country that still teaches indirect gold restorations, including partial coverage. While visiting recently with a colleague, he indicated that his 2008 graduating class was the last class at his dental school that was taught indirect gold. Is the indirect gold restoration becoming a lost art?

There are several obvious reasons why gold is falling out of favor; but, poor performance is not one of them. Do we give our patients ample opportunity to choose gold? Are we taking the time necessary to educate them regarding the benefits of gold? Are we, as dentists, maintaining our skills with regards to gold, or are we simply taking the path of least resistance and doing what is most expedient? Whatever the reasons for the decline, we still have a responsibility to pursue the best for our patients. I am not advocating that we abandon the myriad of ceramics at our disposal. They are amazing products also. I love using them. They have expanded our ability to provide highly esthetic and durable restorative options for our patients. However, there are still situations wherein indirect gold, especially partial coverage, is the most appropriate restorative option for a patient. That being the case, then I would contend we have a responsibility to make that option available for them. Give our patients the same opportunity to choose gold, like you would for yourself. All that glitters may not be gold, but no one can argue with the fact that for some restorative situations, nothing outshines gold. Mark R. Taylor, D.D.S., UDA Secretary

UDA Action

PRACTICE DISABILITY INSURANCE: DO I REALLY NEED IT? A Disability Insurance Attorney’s Perspective

More than 1 in 4 of today’s 20-year-olds will become disabled before reaching retirement age, according to the Social Security Administration.1 A recent study ranked dentistry as one of the most hazardous careers, outranking firefighters, nuclear equipment operation technicians, and oil and gas derrick operators.2 And dentists are also near the top of the list for risk of COVID-19 infections, the long-term consequences of which remain largely unknown. 3

Understand Your Policy Most dentists know that they should purchase “own occupation” policies. However, many dentists are not aware that there are several variations of “own occupation” policies that are not true “own occupation” policies.

In our practice, which focuses on professionals’ “own occupation” disability claims, the majority of our clients are dentists. Many are in their late 30’s or 40’s and never expected to be facing a disabling condition at the height of their careers.

When dentists come to us needing to file a claim, virtually all of them believe that they have a true “own occupation” policy because they asked for an “own occupation” policy and, when they received it, they checked for the phrase “own occupation” in the policy schedule or summary. However, many policies use the phrase “own occupation,” but add additional qualifications or limitations that you may not be expecting.

Bottom line—if you are a dentist, you should have a plan for protecting yourself financially if you can no longer practice. What are the Most Common Reasons Dentists File for Disability? Many dentists view disability insurance as something they only will need if there is a catastrophic event and they are severely injured. However, the most common dentist disabilities we see are slowly progressive musculoskeletal disorders, mental health conditions (such as panic and anxiety disorders), and progressive vision loss. These conditions may seem less dramatic than the loss of a limb or a serious accident but are just as devastating for dentists who rely heavily on their sight and need to be able to sit for extended periods of time, keep their hands steady, and operate with precision within very small confines and margins. Notably, the Council for Disability awareness has also found that musculoskeletal disorders, such as arthritis, back pain, and spine/joint disorders, are among the leading causes of disability.4 For dentists, the risk of these disorders ending their careers is heightened, as a dentist can spend up to 60,000 hours in a lifetime working in tense and distorted positions.5 Many of these conditions are chronic and exacerbated by the practice of dentistry. Over time they can progress to a point where continuing to practice not only jeopardizes patient safety, but also the health of the dentists themselves. What Do I Need to Be Aware of if I Think I May Need to File A Disability Claim? Hopefully, you will be able to practice safely, without interruption, and retire on your own terms. But if you do end up facing a disabling condition, it is important that you go into the claim informed and prepared.

A true “own occupation” policy allows you to earn income in a new occupation and collect your full total disability benefit.

Here are just a few examples of some common variations that use “own occupation” language but are not true “own occupation” policies: • Own-Occupation with “Offset/Work” Provisions: These provisions reduce your benefit amount if you work post-disability, even if it is in a different occupation. Sometimes these provisions go so far as to require you to work in another capacity, if you are able, and give the insurer the ability to offset benefits as if you were working full-time if they think you can go back to work. • Own-Occupation with “No Work” Provisions: These provisions cut off your benefits if you go back to work post-disability—even in a job that is completely different than your prior occupation. • Shifting “Own Occupation” Provision: These provisions allow you to receive benefits based on your inability to work in your prior occupation, but only for a limited period of time (usually somewhere between 2 to 5 years). After this window has passed, you can only continue to receive total disability benefits if you are unable to work in any occupation. If your policy has one of these “own occupation” variants, it does not necessarily mean that you cannot collect or that you should give up on your claim. However, it does mean that you need to read your policy carefully and understand how it works before you file, so that you are prepared to make a claim that is consistent with what is permitted under your policy.

1 See Social Security Administration, Facts, https://www.ssa.gov/disabilityfacts/facts.html, last viewed Dec. 7, 2020.

4 Council for Disability Awareness, What Are the Most Common Causes of Disability?, https:// disabilitycanhappen.org/common-causes/, last viewed Dec. 7, 2020.

2 Andy Kiersz, The 32 most dangerous jobs for your health, Business Insider, Mar. 8, 2019.

5 A. Grupta, et al., Ergonomics in Dentistry, Int J Clin Pediatr Dent 2014; 7(1):30-34).

3 See Franziska Beier, DTI, SARS-COV-2: Dentistry tops list of most dangerous jobs, Dental Tribune, June 23, 2020.

March / April 2021

Additionally, if you have a policy that allows you to transition to new employment, insurers will closely scrutinize whether the new job has any overlap with your prior occupation’s duties. Accordingly, if you are a specialist, it can also be helpful if your policy contains a specialty-specific definition that defines your occupation narrowly as the specialty you were practicing prior to the onset of your disability. Understand the Process Many dentists assume that all they need to do to collect disability benefits is notify the company that they cannot work and provide a signed statement from their doctor confirming that they are disabled. However, the process is much more involved than that.

Be Prepared for the Claim Investigation, Which Often Begins at First Contact Many disability insurers are now interviewing dentists in the very first call that the dentist makes to request a claim packet. The length of these calls and the questions asked vary depending on the insurer. However, at a minimum, you should not call in to request a claim packet until you understand how your policy works and the nature of the claim you are making. Disability policies are complex and often provide for multiple types of benefits designed to apply to different situations. Before filing a claim, dentists should read through their policies and consider the following:

Unlike other insurance claims, most disability policies require you to continuously establish your ongoing eligibility for benefits each month. Each month, the company takes into account any new developments and makes a new determination as to whether you remain disabled under your policy. Even if your disability claim is initially approved, further evaluations and investigations can (and do) occur throughout the lifetime of the claim.

• Does my policy allow for total or partial disability benefits, or both? Am I filing a total disability or partial disability claim? • Do I have a true own occupation policy? Can I work and collect benefits? Will working in a new job offset or otherwise impact my benefits under my policy? • Am I keeping or selling my practice? Am I hiring an associate? How will this impact my claim? Continued on next page.

MCNA Insurance Company is pleased to administer benefits for the Utah Medicaid Dental Program. MCNA is a provider-centered organization committed to helping dentists serve Medicaid and CHIP enrollees. We provide dentists with leading-edge technology and superb customer service support to reduce missed appointments and encourage patients to seek timely dental care. For more information, visit us online at: www.mcnaUT.net

UDA Action

Disability Insurance: Continued from previous page. • Do I have a sufficient treatment history to prove up my disability? What is the long-term treatment plan? Does it fit with the care requirements for my policy? Is surgery an option? How will I respond if the insurer pressures me to undergo surgery? • How is occupation defined under my policy? Do I have a specialty-specific policy? Have I been practicing in my specialty? Have I modified my occupation by changing my duties, reducing my hours, or beginning a new job? This last point trips up a lot of dentists because many disability policies now define your occupation as the “occupation or occupations” that you were engaged in prior to the date of disability. When facing slowly progressive conditions, many dentists cut back their hours and look for other, non-clinical ways to generate income. Depending on the policy, this can limit a dentist’s ability to qualify for certain disability benefits later on. Consequently, if you have a slowly progressive condition, you should not make these types of changes without evaluating how they could affect a future disability claim. What Should I Expect Once the Claim Has Been Filed? If a dentist is facing a permanent disability and has several years left on his or her policy, the company can end up paying out millions of dollars over the lifetime of the claim. Because of the significant amount of money at stake, insurance companies often devote significant time and resources into investigating dentist claims. While each claim is different, over the course of a claim investigation, insurance companies will typically: • Seek to speak with others about your condition. This may include treating providers, pharmacies, insurance agents, financial institutions, the Social Security Administration, family, friends, co-workers and employees, among others. • Seek to gather a wide range of documentation for their file, beyond what they request from you directly. This may include medical records, tests, or consultations, prescription history, mental health records, records for substance abuse treatment, court records, occupational data, employment history, driving history, financial statements, and/or your earning history. • Schedule face-to-face interviews with you. Many insurers seek to interview you in your home, so that they can view your surroundings to see if they can find discrepancies in the claim, or learn more about you so that it is easier for them to conduct surveillance. • Order an In-Person Exam. The insurance company may claim that an in-person exam is needed to verify a disability. In some instances, this may be the case. However, some insurers use these exams to criticize your provider’s course of treatment, dispute your own provider’s conclusions and diagnoses, or challenge your

reported limitations (particularly symptoms that are subjective in nature, such as pain and numbness). Most disability policies also provide that refusal to participate in an exam allows the insurance company to deny a claim or terminate benefits. • Use a private investigator to conduct surveillance. The insurance company may employ a private investigator to conduct photo, video and/or online surveillance, in an attempt to find discrepancies in your claim or evidence of “malingering.” This can pose a particular challenge for dentist claims, as oftentimes a dentist’s symptoms and limitations may be nuanced and/or significantly alleviated once he or she steps away from the demands of practicing. This process can feel very invasive and, if you have never experienced it before, it can be hard to tell whether your insurer is taking things too far. If you feel your insurance company is being too aggressive, an experienced disability insurance attorney can help you to assess the scope of the investigation and advise whether the insurer has engaged in any improper conduct. Do I Need an Attorney/How Do I Know If I Have Complex Claim? While there are certainly claims that may not require attorney involvement—for example, a disability claim due to the loss of a limb or something very serious, such as paralysis from the waist down—in our experience dentist claims are typically not that straightforward. As noted above, many of our clients have more nuanced conditions, such as slowly progressive radiculopathy due to degenerative disc disease. Others have conditions like a tremor, that may not prevent them from working in other jobs, but have a significant impact on their ability to work as a dentist. Others have mental health conditions (anxiety disorder, panic attacks, PTSD) that cannot be verified by a single, definitive objective test. Obviously, if your claim is denied or you have a dispute over policy interpretation, you may need an attorney to become involved to resolve the matter. That being said, lawsuits with insurance companies are often costly, stressful, and, in some instances, can drag out over several years. Even if you prevail it can be an exhausting process. Consequently, in our view, it is more prudent to approach your claim carefully from the outset and address any concerns that the insurer may have over the course of the investigation itself, so that you are not placed in a position where benefits have been cut off and your only option is a lawsuit. In our experience, the most common areas where complexities can arise in dentist claims include: • The timing of the claim (particularly in situations where a disabling condition is slowly progressive); • Claims made by dentists who own their practice and need to decide whether to sell, bring on new associates,

March / April 2021

or keep working in a limited capacity; • Claims where the underlying condition is a diagnosis by exclusion; • Claims involving multiple co-morbid conditions; • Claims involving recommendations for or against surgery; and • Claims involving mental health conditions.

have it if you need it. Before selling your practice or making changes to your occupation, you should carefully consider how those decisions could impact your ability to collect under your particular policy. And if you believe that there may be any issues with your claim, you should speak with an experienced disability attorney as early as possible so that you can ensure that those issues are properly addressed and resolved.

This is not an exhaustive list, but if your claim encompasses one or more of these areas, it is a good idea to at least consult with a disability attorney to determine what issues may arise over the course of your claim.

* Derek R. Funk, Esq. is an attorney licensed in Utah and Arizona. His practice is solely dedicated to handling professionals’ “own occupation” claims and he works with dentists at all stages of the disability claims process.

The Takeaway If you are a dentist, you should have disability coverage that protects you if you can no longer practice. If you need to file a disability claim, you should take it seriously and not go into the claim blindly. If you are not able to locate a copy of your policy, request a duplicate and keep it in a safe place so that you

The information in this article has been prepared for informational purposes only and does not constitute legal advice. Anyone reading this article should not act on any information contained herein without seeking professional counsel from an attorney. The author and publisher shall not be responsible for any damages resulting from any error, inaccuracy or omission contained in this publication.

We have practice in selling your practice. We have all of the experience, tools, and resources necessary to help you transition your practice into the right hands. With our help, you can avoid common pitfalls. We provide expertise on appraisals, practice sales, mergers, partnerships, and everything you might need for a fulfilling practice transition.

801.298.4242 | ctc-associates.com Randon Jensen | Larry Chatterley

UDA Action

PRACTICE

THE UDA OFFICE IF FIELDING MULTIPLE QUESTIONS REGARDING TEMPS. THIS IS A GREAT REMINDER. Temporary employees (Temp) are defined as individuals hired to assist an office to meet increased short term needs. There are many reasons why a dental office needs a Temp. For example, Mary calls in sick at the last minute, Joni’s having a baby and the office needs a Temp for a month, and unexpected patient “over-load” for cleanings. And the list goes on. However, it’s important to understand the legal and payroll implications of hiring Temporary employees. That is, when a Temp comes into your office, what are you truly responsible for? Below is a list I’ve put together to assist you navigate this minefield. These do’s and don’ts will hopefully help you steer clear of potential issues with Utah employment laws, Federal tax laws as well as several other laws that apply. Please be advised that this is not legal or tax advice and that you should consult an attorney or tax expert to understand how these laws specifically apply to your office. Payroll considerations: According to Utah Employment Law you must pay the Temp for hours worked in your office including any training, working interviews or other administrative assignments. Also, each Temp will need to complete a W-4 and you must withhold taxes according to their W-4 selections. Independent contractors/ 1099’s: When you give someone a 1099, it means that the government considers them to be self-employed. Independent contractors are responsible to pay their own taxes, including Medicare and Social Security payments, to the IRS. In some cases, independent contractors are required to estimate their annual income and make quarterly income tax payments to the IRS. As you know, office staff need to be directly supervised by a licensed Dentist and therefore cannot be considered independent contractors. This means all office staff need to be employed by the Dentist. Issuing a 1099 to an employee under your supervision is a common mistake which may result in an audit from the IRS and/ or the state. According to the IRS website https://www.irs.gov, mis-classifying employees as independent contractors is one of the main reasons for an employee audit and failing to provide W-2 forms can subject an employer to back taxes of as much as 41.5% of the contractors’ wages. These penalties may be applied retrospectively for three years. Regardless of whether the Temp has made more or less than $600 in your office, they still cannot be self-employed and shouldn’t receive a 1099 Unemployment or Workforce Services: Once you’ve paid the Temp, you need to register them as a new hire on Workforce Services website (https://jobs.utah.gov/) according to the Employment Security Act.The unemployment insurance program is operated on general insurance principles wherein the employer pays the contributions into the Utah Unemployment Compensation Fund (trust fund) to sustain the program. If the Temp ever files for unemployment you

will be sent a letter about your potential costs based on your contribution rate. If you’re unsure about your coverage call Utah Workforce Services 801-526-4400 for additional detail. Worker’s Compensation: It is also important to know that the Temp employee also falls under your worker’s compensation plan. That is, if they poke, pull, fall, trip, knock or flip there’s administrative work to do in addition to sending them to instant-care or emergency room! Remember to call your carrier to ensure you have Temp coverage or fill out a form online with your company of choice. I found the Workers Compensation Fund easy to work with. Their phone number is (385) 351-8000. Best-Practices: While this shouldn’t be news to anyone, it needs constant repeating. There always needs to be a current licensed Dentist physically overseeing the office!! That goes for all the dental staff and patients. Another safeguard is to develop a list of what your expectations are for the Temp. Create a list of your office policies and what the Temp needs to do while Temping in your office (sterilize the room, where the barriers go, how to sterilize instruments, who take X-rays, etc.) have the Temp sign and date it so you know they understand what to do so there’s no questions or problems later. Outsourcing the Problem: Outsourcing these issues to a Professional Employer Organization (PEO) may be the way to go! POE’s like Doctors Staffing & Resources, Inc. will take care of the payroll, payroll taxes, Workforce Services and Workers Compensation for your Temporary employees. Some think of this as Doctors Staffing and the Dentist co-employing the Temp! That is, the Dentist oversees procedures, protocol, etc. and Doctors Staffing and Resources will handle the payroll, Workforce Services and Workers Compensation. Doctors Staffing will then ensure that the employee will be paid in compliance with all applicable state, federal and IRS regulations. Dr. James D Johnson of South Jordan said, ‘Doctors Staffing has saved me countless hours of record keeping and hassle in regards to Workforce Services and year end accounting records for Temporary employees”. As we all know, the “Gig Economy” is growing, and the IRS and state want to make sure that every person is correctly categorized and all taxes are correctly paid. Make sure you go over all this with your accountant and you’re ready for any audit that comes your way! This article was written by Stephanie Sawatzke, President of Doctors Staffing & Resources. She has over 25 years’ experience serving the needs of the Utah Dental Community. She can be reached at (801) 301-3440. Reprinted from Jan/Feb 2020 issue of the UDA Action.

March / April 2021

ASSOCIATION

NEW LAW REPEALS ANTITRUST EXEMPTION FOR HEALTH INSURERS Just prior to leaving office, President Donald J. Trump signed “The Competitive Health Insurance Reform Act of 2020” into law. The legislation, which repeals the antitrust exemption for health insurers, including dental insurers, passed the United States House of Representatives in September 2020 and the U.S. Senate in December 2020. For nearly 75 years, health insurers have enjoyed an exemption from federal antitrust laws under the McCarran-Ferguson Act of 1945. The new law now makes the conduct of health insurers subject to much of the nation’s antitrust laws like all other U.S. businesses. The purpose of the new law is to improve transparency and competition in the health, dental and vision insurance marketplaces. This is the culmination of several years of advocacy efforts by the American Dental Association and other organizations. Over the last several years, the ADA has provided congressional testimony on multiple occasions arguing in favor of repealing the health insurance industry’s antitrust exemption. According to the ADA, repealing the health insurers’ antitrust exemption would enhance competition and “compel insurance companies to deal more fairly, effectively, and creatively with both consumers of dental services and with providers.”

ODA Executive Director David Owsiany, a lawyer who served on the staff of the U.S. Senate Judiciary Committee at the beginning of his professional career, stated that the actual effect of the new law will play out over time. “Because health insurers have had this exemption from antitrust laws for so long, it is unclear to what extent health or dental insurers have engaged in collusive anticompetitive behavior,” said Owsiany. “This new law will now empower the Federal Trade Commission and the Department of Justice to engage in investigations and enforcement activities if they find evidence of such collusive activity.” The U.S. Department of Justice issued a statement hailing passage of the new law stating that it will strengthen the Department’s ability to “investigate and prosecute anticompetitive behavior.” According to the Department of Justice spokesperson, “Americans deserve competition in health insurance markets just as they do in any other industry.” ODA Today February 2021

UDA Action

ASSOCIATION

COVID-19 FATIGUE: KEEPING MASKS ON AND OFFICE MORALE UP • Have you been attentive to your own sleep and health needs, or even made shift adjustments, so you are able to come to work rested and ready?

After nearly a year of compliance with complicated, and sometimes uncomfortable, COVID-19 protocols, many dental professionals are exhausted. And practice owners are conscientiously taking steps to show their teams compassion and empathy. However, fatigue with wearing mandatory personal protective equipment (PPE) doesn’t change the regulations or the potential for serious risks. Letting your guard down, even when the intention is to accommodate employees’ comfort, can create health risks for all patients and staff as well as liability risks for the practice.

• Have you recognized your own signs of fatigue and sought ways to be optimistic and engaged with your team?

 Be direct in your response. Despite ongoing education

and awareness about PPE requirements, some employees will still fail to comply. In this event: • Review practice expectations and regulatory requirements during staff huddles, but don’t wait for the next huddle to address noncompliance issues.

How can practices stay vigilant and combat COVID-19 fatigue?  Foster an atmosphere of trust. Being a compassionate employer means listening to employees and finding safe, practical ways to meet their needs. • Is the PPE fitted properly to the employee and are compliant mask options available that are more comfortable to wear?

• Address any issues immediately and in person with the employee. Whether the action necessitates a friendly reminder or a more serious discussion, don’t put it off until a repeated instance or “give them a break” before interceding.

• Are employees taking regularly scheduled breaks and having socially distanced opportunities to rest?

• Document your interaction and be clear about disciplinary consequences for noncompliance.

• Do they feel they can tell you if they observe another employee being noncompliant?

 Model the behavior you seek. As a practice leader,

you’re likely fatigues as well. However, your role is to demonstrate best practices, clinical protocols and healthy ways to manage stress. • Are you wearing your own mask consistently, even when no patients are present and you’re conversing with an employee?

Every team member should be committed to creating a safe practice environment, which means they make conscientious, consistent efforts to preserve the health of peers, patients and the community even when they feel exhausted. Keep your chin up. TDIC

March / April 2021

ASSOCIATION

GIVE KIDS A SMILE: “THE NEED HAS NEVER BEEN GREATER” Leaders, volunteers stress importance of GKAS during virtual national kickoff event It was 20 years ago when a group of dentists gathered in a downtown St. Louis building — one that had been condemned and was ready to be demolished within the following month. “Boy, don’t we remember that first venue?” said Jeffrey Dalin, D.D.S., Give Kids A Smile St. Louis co-founder. “But we delivered full-service dental care to 325 children.” It was a story of the first two-day GKAS clinic that ultimately expanded nationally, thanks to the American Dental Association. Dr. Dalin shared that story during the Feb. 4 virtual 2021 GKAS National Kickoff event — a small reminder of how far the program has come, helping more than 6 million underserved kids nationally receive free dental services since 2003. Due to the COVID-19 pandemic, the GKAS kickoff event, typically a large, in-person affair that includes volunteers providing free dental care to hundreds of children, looked a little different. Nonetheless, the 30-minute virtual event highlighted the program’s mission and importance. The remarks of leaders, sponsors and volunteers stressed one certain fact: in light of the pandemic, Give Kids A Smile is needed more than ever this year. In 2021, nearly 1,000 programs, comprised of over 8,100 dentists and approximately 17,000 volunteers, have signed up to provide oral health services to nearly 300,000 children. These programs will be held this year with enhanced safety and infections control protocols in place. “With the impact of the current pandemic, the need has never been greater,” said ADA President Daniel J. Klemmedson, D.D.S., M.D. To help ensure programs are safe and effective, the ADA has been able to provide program coordinators with planning resources, webinars, toolkits and donated personal protective equipment it acquired from the national stockpile after meeting with officials from the Federal Emergency Management Agency, the U.S. Department of Health and Human Services and the White House Task Force for COVID-19 response in 2020.

With the support of GKAS national sponsors, ColgatePalmolive and Henry Schein, Inc., along with the support of Henry Schein’s supplier partners, the ADA’s GKAS program will once again provide treatment and education product kits for local volunteers to use at their events. “This year’s program is also the first step in helping families find a dental home where they can receive ongoing care,” Dr. Klemmedson said. “Indeed, it’s something to smile about even in this challenging time.” Among those participating this year, the Indian Health Service will collaborate with the ADA for the second year to hold events at its clinics across the U.S. Last year, IHS held 113 events across 27 states, providing nearly $700,000 worth of dental services to over 14,000 American Indian and Alaska Native children. “We want to continue to show the public that our Indian Health Service and providers are committed to providing high quality dental care to American Indians and Alaska Natives,” said Rear Adm. Timothy Ricks, D.M.D., chief dental officer of the U.S. Public Health Service and assistant surgeon general. “We want to continue to raise awareness of the tremendous successes in reducing dental caries in American Indian and Alaska Native children and youth, but also continue to highlight the large disparities in dental disease in this population.” As an example of how some states’ GKAS programs are responding to the pandemic, in 2021, the New Jersey Dental Association is extending its program throughout the entire month of February, hosting events organized by 1,500 volunteers in over 100 locations comprised of private practices, hospital residency programs, the Rutgers School of Dental Medicine and dental hygiene schools. “We are very proud of our volunteer members as they include students from the dental school and from hygiene schools, as well as our pre-dental students as they share in the delivery of passionate care to our most vulnerable,” said Cavan M. Brunsden, D.M.D., statewide chair of New Jersey Dental Association GKAS. In Ohio, more than 400 dentists have participated annually in GKAS events throughout the state to date. “In 2021, due to the COVID-19 pandemic, many schools are still doing online education,” said David Kimberly, D.D.S., Ohio Dental Association president. “So Give Kids A Smile events may look different this year.” Continued on next page.

UDA Action

Give Kids A Smile: Continued from previous page. Dr. Kimberly said that some Ohio events will feature dentists and their teams providing oral health instruction by video conferencing, reminding kids how to brush and floss properly and to eat healthy foods. “Other direct health care events may be postponed until later in the year as we hopefully get back to more normal school routines this spring and fall,” he added. The care provided at the Give Kids A Smile events throughout the country would not be possible without its national sponsors, Henry Schein, Inc. and Colgate-Palmolive. “Our partnership with Give Kids A Smile provides great synergy with our own Bright Smiles Bright Futures program, which has reached over 1.3 billion children globally,” said Barbara Shearer, Ph.D., director of scientific affairs at Colgate-Palmolive Company and chair of the GKAS National Advisory Committee. “We have recently developed a new goal to reach 2 billion children by 2025, and our partnership with Give Kids A Smile will help us achieve this goal. This relationship between the ADA and Colgate is a great example of the power of partnership; however, none of this could be achieved without the volunteer dentists and dental teams. We are so inspired by their willingness to continue to volunteer

and help their communities in these unprecedented times.” AJ Caffentzis, Henry Schein, Inc. president, U.S. dental distribution, echoed Dr. Shearer’s sentiments on volunteers who make Give Kids A Smile possible. “We are proud to support the thousands of dental professionals who volunteer their time and provide much needed care to underserved children,” Mr. Caffentzis said during the virtual kickoff event. “Good oral health is a key component to overall health. All children, regardless of their circumstances, deserve access to quality dental care and oral health education, and it’s needed now more than ever in light of the pandemic.” Although GKAS will be celebrated nationally in February during National Children’s Dental Health Month, events take place throughout the year, such as GKAS back-to-school events held in August. To view a recording of the kick-off event and for more information about GKAS go to ADA.org/gkas. Kimber Solana ADA News

PRACTICE

ORAL PATHOLOGY PUZZLER: DO YOU SEE WHAT I SEE? With COVID-19 being a big part of all of our lives (patients and practicioners) for more than a year now, I thought it would well worth it to present and discuss the top oral manifestations that are considered to be a possible result of being infected with the virus. I will focus on those that a dentist may be able to directly assist in remedying. This information comes from news reports, online searches and studies. Without getting into the specifics of the research, nor the debates, my purpose to just to present the top oral manifestations linked to SARS-CoV-2 and oral disease. I do this in hopes of helping you treat a patient (or patients) that may present to your office with symptoms and a correlation with a past or recent infection with COVID-19: 1. Gingival Inflammation: Current research (nationwide and here at the University of Utah School of Dentistry) is examining, and providing supporting evidence for, a link between periodontal disease and COVID-19 severity. Currently, it is estimated that patients with periodontitis are at least three times more likely to experience COVID-19 complications (death, ICU admission, ventilation, etc). I would encourage you to read the recent press release by the American Academy of Periodontology (https://www.perio.org/periodontitis_

COVID-19_complications). Periodontal disease can increase levels of circulating cytokines (i.e. IL-6, interleukin 6), which can lead to a cytokine storm(1). It is being reported in many studies that patients with periodontitis have an increased risk of exhibiting COVID related adverse outcomes. Taking this into consideration, you may consider strongly recommending routine periodontal and oral hygiene care during the current COVID pandemic.

2. Xerostomia: The most common reason for this being a symptom is due to wearing a mask (open mouth breathing). Studies also suggest that the virus can enter and reside in the salivary glands, leading to

March / April 2021

decreased function (2). We all know that polypharmacy is a major reason our patients present with dry mouth. Just remember that when a patient has xerostomia, they have an increased risk for dental caries and yeast (candidal) infections. Anything we can do as providers to encourage the use of OTC dry mouth products, prescriptions when appropriate, supplement with fluoride, etc., can only be a benefit to our patients.

240 mL, instruct the patient to hold 1-2 teaspoons in the affected area for 5 minutes after meals (TID) and expectorate. It can greatly reduce symptoms and speed up the healing process.

Dr Bryan Trump, University of Utah 3. Aphthous-like ulcerations (moveable and attached mucosa): Case reports are out there which demonstrate COVID-19 positive patients getting oral ulcerations as result of the SARS-CoV-2 virus. It is presumed that the virus causes damage to blood vessels, leading to tissue necrosis/breakdown. Stress and anxiety over the pandemic or other changes in life can lead to this as well. These same factors leading to recurrent herpes simplex also have to be considered. As I consult with Oral & Maxillofacial Pathology colleagues across the country, this particular oral manifestation seems prominent. In my clinical practice, I use dexamethasone elixir 0.5mg/5mL, dispense

Works Cited Vaibhav Sahni, Shipra Gupta, COVID-19 & Periodontitis: The cytokine connection, Medical Hypotheses, Volume 144, 2020, 109908, ISSN 0306-9877, https://doi.org/10.1016/j. mehy.2020.109908. Xu J, Li Y, Gan F, Du Y, Yao Y. Salivary Glands: Potential Reservoirs for COVID-19 Asymptomatic Infection. Journal of Dental Research. 2020;99(8):989-989. doi:10.1177/0022034520918518 Petrescu N, Lucaciu O, Roman, A. Oral mucosa lesions in COVID-19. Oral Diseases. 2020. https://doi.org/10.1111/odi.13499

Your patients rely on your expertise to evaluate and make recommendations to keep them healthy. Your local independent insurance agent can do the same for you when it comes to suggesting the right combination of coverage to protect the practice you’ve worked hard to build.

SPEND YOUR TIME EXAMINING YOUR CLIENT’S TEETH, NOT YOUR COVERAGE.

Find an independent agent representing The Cincinnati Insurance Company by visiting cinfin.com or by calling Mike Terrell, 800-769-0548.

UDA Action

ASSOCIATION

HPI POLL: DENTISTS SEE INCREASED PREVALENCE OF STRESS-RELATED ORAL HEALTH CONDITIONS Monthly survey finds patient volume estimated at 81% of pre-pandemic levels

The vast majority of dentists indicate that the prevalence of stress-related oral health conditions among their respective patients have increased since the onset of the COVID-19 pandemic, according to the ADA Health Policy Institute’s latest data from its COVID-19 economic impact tracking poll conducted the week of Feb. 15. More than 70% of dentists surveyed saw an increase of patients experiencing teeth grinding and clenching, conditions often associated with stress — up from just under 60% in the fall. More specifically, 71% of dentists surveyed reported an increase in prevalence of teeth grinding and clenching; 63% for chipped teeth; 63% for cracked teeth; and 62% for temporomandibular joint disorder symptoms, which includes headaches and jaw pain. “Our polling has served as a barometer for pandemic stress affecting patients and communities seen through the eyes of dentists,” said Marko Vujicic, Ph.D., chief economist and vice president of the ADA Health Policy Institute. “The increase over time suggests stress-related conditions have become substantially more prevalent since the onset of COVID-19.” Other findings from the Feb. 15 poll covered issues related to recovery and renewal, financial sustainability and consumer sentiment. It found that: 22

• Patient volume was estimated at 81% of preCOVID-19 levels on average. Staffing in dental offices was at 99% of pre-COVID-19 levels. HPI expects a slight increase in patient flow in the coming months. • Over the past month, the most common measure taken by dentists to maintain financial sustainability was raising fees. Others responded to the financial challenges of practice ownership by taking out loans, reducing their dental team hours and changing suppliers. Dentists in large group practices have had to take fewer measures to maintain financial sustainability compared to those practicing solo. • More than a third of dentists are practicing some form of teledentistry, most commonly to triage emergencies, do post-ops and follow-up care and for consults. • Approximately 10% of dentists who were enrolled as Medicaid providers prior to the COVID-19 pandemic have since disenrolled.

• Consumer confidence in returning to the dental office hit a new high, with 90% reporting to have already been back or are ready to go. In addition, despite speculation from recent news reports that frequent mask-wearing may impact dental health and cause

March / April 2021

“mask mouth,” the survey found no meaningful change in the prevalence reported for conditions such as bad breath and dry mouth compared to pre-pandemic. HPI launched its COVID-19 economic impact tracking poll on March 23, 2020. Dentists were asked to join to a panel in which they complete the now-monthly poll. In this latest wave, a nationally representative sample of approximately 2,500 dentists responded.

Webinars on previous data are available on the ADA YouTube channel. Links to reports and the interactive data dashboard are available at ADA.org/HPI. Kimber Solana ADA News

PRACTICE

RESOURCES AT THE READY: YOU’VE GOT MORE HELP THAN YOU KNOW We never find success exclusively on our own, especially in dentistry. We have the fortune of many different support systems that guide us through the professional ebbs and flows of our careers. Early on in practice, it is important to be mindful of the learning opportunities and resources right at our fingertips on a daily basis. The sweat and the stress, the successes and the failures, and the ups and downs. They are all requisites and rights of passage to professional growth. The most obvious knowledge pools may be our owner dentists or CE course instructors or clinical publications. However, there are other simple, effective ways to grow as a clinician beyond solely continuing education and to cultivate or seek out the right practice environment for you. Embrace your resources; you’ve got more help than you know. Tap into the Knowledge of Your Current Team Arrive at your practice with open ears, open eyes, and an open mind. I have worked with assistants who have decades of experience in the field, compared to my three years of practice. They are incredible resources for clinical tips and tricks, patient management skills, and treatment plan communication strategies. They have assisted on countless procedure with a variety of doctors, and you can guarantee that they have identified the pearls with all of them. I find assistants to be a wealth of knowledge. When I am struggling with a procedure, my assistant may hand me an unprompted instrument or write me a note on the cassette wrapping for a reason. And guess what? It works. I have never been shy about asking my experienced assistants for feedback after a patient encounter. What did they think worked well? What did they think I could do differently? What did they notice about the patient that I did not? I have also learned an incredible amount from my patient care coordinators regarding scheduling, behavior management, and understanding patient patterns and tendencies. Form a Study Group with Your Local Peers Your local general dentists and specialists are exceptional resources, and I would encourage new dentists to form “study groups” with a diverse group of professionals in your area. With those

practitioners, you can share case challenges in a judgment-free, supportive, casual environment. Arrange meetings at a frequency that works for your schedules. In a Zoom-oriented world currently, your study groups do not even need to be facilitated in person. The goal of reaching out to other practitioners is to generate a discussion regarding each of your clinical questions and needs. Dentistry is not an individual sport; we need other perspectives and voices in order to become a well-rounded provider as we gain experience. Additionally, you may even strengthen your referral network through assembling a study group. Investigate the ADA Practice Transitions (ADAPT) Program Everyone’s career trajectories move at different rates and in different directions. At a certain point, you may decide that you want to eventually buy your own practice or seek out a work environment that aligns with your practice philosophies and values. This is where the ADAPT Program can help you. ADAPT successfully passed its pilot stages and has recently launched in all fifty states. It “makes the process of buying, selling, or joining a dental practice more predictable and successful. However, ADAPT isn’t just another listing service. Instead, it connects dentists who share a similar practice approach – which leads to more successful transitions and careers.” According to the ADA ADAPT program website. You can create a profile and be connected by an ADA Advisor that keeps your philosophies and values at the heart of matches with other practice opportunities. This is a modern, up and coming benefit to new dentists that are members of the ADA. The volume of participants and its network will begin to thrive with its official launch, and it is a great resource to explore where your next steps may lead you in associateships or transitional practice ownership. To learn more about ADAPT visit http:// ada.org/en/member-center/member-benefits/practice-resources/ ada-practice-transitions. Or you can reach out to the program directly with inquiries at ADAPT@ada.org. Dr Tyler Fix

UDA Action

PROBLEM SOLVED Pacific Office Automation makes office printing and IT easy Document management, IT services, printers & multifunction products, and more for your digital success.

Pacific Office Automation 1325 West 2200 South, Ste B Salt Lake City, UT 84119 801-990-4001 pacificoffice.com