convention issue VOLUME 1
a business and lifestyle magazine for north texas dentists
Experiencing Expansion and Growth in North Texas
Beaird Harris & Co. Dental Logic
Reflections on Radiology Dr. Pete Benson
Southwest Dental Conference Recharge for a New Year
Know the Rules
Current Government Initiatives Could Affect You
Building Your Dream Office Today Your Partner For The Future
(972) 250-1170 (972) 250-0905 fax
Jorge Fernandez cellular (214) 532-5253
Bruce C. Goodhartz cellular (214) 212-8033
www.esa-construction.com 17806 Davenport, Suite 107 路 Dallas, Texas 75252
ON THE COVER
Experiencing Expansion and Growth in North Texas
COVER Photo: Ray Bryant, Bryant Studios
COVER FEATURE: Monarch Dental is growing and expanding in North Texas. As part of this expansion, Monarch Dental is modernizing their centers in North Texas and upgrading the technology, including the installation of digital radiography. Monarch Lead Dentist Dr. Laura Bratcher (pictured) uses digital images to help patients visualize their diagnosis and treatment plan.
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PRACTICE MARKETING 7 Reasons Your Website Needs a Blog A blog can improve your search engine rankings, drive patients to your website, and educate them about your services
PROFILE Paula W. Allgood, CPA Tap into the expertise of a seasoned advisor who specializes in healthcare
BAYLOR COLLEGE OF DENTISTRY Dr. Pete Benson is reflecting on the opportunities in radiology that have led him to fill new roles in leadership
SMILES IN THE SPOTLIGHT A Case Presentation In a multidisciplinary collaboration, Dr. Deji V. Fashemo puts a dazzling new smile on a young face
MISSION DENTISTRY EthiopiaSmile Dental Mission Trip Dr. Moody Alexander describes an inspiring journey that puts the stresses and cares of this world in perspective
PROFILE Joseph C. Danna, CDT Building partnerships between dentists and the laboratory
DENTISTRY IN THE FUTURE Why DMSOs Will Dominate Dentistry in 2020 Gearing up to survive in a changing industry
COMMUNITY NEWS Recharge for a New Year The 2012 Southwest Dental Conference will re-energize your new year
KNOW THE RULES How Current Government Initiatives Could Affect You What you and your staff should be doing to protect your practice
30 WINE CELLAR
Sparklers for Special Times Topping off the old year and the new year with a special sparkle
32 MONEY MATTERS
Disability Income Insurance What you need to know to prepare for your financial future
35 CONSTRUCTION & DESIGN
Building or Remodeling on Your Horizon? What to expect, what to look for, and what to ask
37 PRACTICE MANAGEMENT
You Can Do a “TON” for the New Year to Grow Your Practice Don’t just wait to see what the future brings – be proactive!
NORTH TEXAS DENTISTRY
from the publisher
Dentistry Publisher | LuLu Stavinoha Photographer | Ray Bryant, Bryant Studios Contributing Writers | Dr. J. Moody Alexander, Tina Cauller, Kim Clarke, Dr. Deji V. Fashemo, Jorge Fernandez, Marc Fowler, Jenny Fuentes, R. Kirk Huntsman, Dr. Richard V. Lyschik, Bob Michaels, Dr. Danette McNew, Sarah Q. Wirskye
I believe 2012 will be a fascinating one for readers of North Texas Dentistry. In addition to our great cover features and compelling editorial, The Special Issue for 2012 will be The Ultimate Dental Practice. This Special Issue will showcase all facets to developing the “ideal practice”… including design and building, dental equipment, computer technology and software, practice and personnel management, specialty equipment and more. If your business sells to or services the dental practice, you NEED to be part of this issue. For this issue’s cover story North Texas Dentistry features the group dental practices of Monarch Dental. We examine Monarch Dental and their expansion into new locations and updating technology in their centers.
This issue is packed with lots of great editorials and information. The North Texas Dentistry Custom Profile presents Joseph Danna, CDT of Dental Logic and Paula W. Allgood, CPA of Beaird Harris & Co., Beaird Harris Wealth Management, Inc. Dr. Moody Alexander shares his experiences with Ethiopia Smile Dental Mission and this issue’s Smiles in the Spotlight features an interesting orthodontic case by Dr. Deji V. Fashemo. Enjoy these articles and much more! Don’t miss the Southwest Dental Conference information inside this issue! Dr. Danette McNew, the 2012 Chair, welcomes you to the convention and offers some conference highlights. Check out the Special Booth Listing for the North Texas Dentistry advertisers who are exhibiting at the conference. Plan to stop by their booths to see what products and services they are offering. Let them know you appreciate their support of this publication.
Advertise in North Texas Dentistry For more information on advertising in North Texas Dentistry, call LuLu Stavinoha at (214) 629-7110 or email firstname.lastname@example.org. Send written correspondence to: North Texas Dentistry P.O. Box 12623 Dallas, TX 75225.
LuLu Stavinoha, RDH Publisher email@example.com (214) 629-7110
Use your Smartphone to find us at www. northtexasdentistry.com
Keep smiling and I will see you at the 2012 Southwest Dental Conference!
North Texas LuLu Stavinoha, RDH
4 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
North Texas Dentistry is excited to present the Convention Issue for the Southwest Dental Conference. We will strive to continue to bring the latest news and information to the North Texas dental community. I hope to see many of you at the Southwest Dental Conference, January 12-14 at the Dallas Convention Center. North Texas Dentistry will be in booth #1308 so stop by to say hello and tell us about your practice or business.
Although every effort is made to ensure the accuracy of editorial material published in North Texas Dentistry, articles may contain statements, opinions, and other information subject to interpretation. Accordingly, the publisher, editors and authors and their respective employees are not responsible or liable for inaccurate or misleading data, opinion or other information in material supplied by contributing authors. Copyright 2011. All rights reserved. Reproduction in part or in whole without written permission is prohibited.
North Texas Dentistry, a business and lifestyle magazine for dentists, is the leader in providing news and information to the North Texas dental community.
TRANSITION CONSULTANTS AFTCO
North Texas Dentistry Advertisers 2012 Southwest Dental Conference Booth Listing
Destiny Dental Laboratory is a full service laboratory specializing in dental implant cases, owned and operated by Bob Moyer, CDT and Darrell Jackson, CDT.
SockIt! is a hydrogel wound dressing approved by FDA for management of oral wounds. When directly applied to the wound, SockIt! provides drug-free pain relief, protects oral wounds from contamination, and promotes optimal healing.
RT Edwards & Associates, P.C. is primarily an advisory firm that also provides tax and accounting services to those in the dental industry. In addition, the firm offers comprehensive, individually tailored, fee-only financial planning, retirement guidance and investment services to its clients.
AFTCO is the oldest and largest national dental transition network with over 150 programs customized to meet your needs.
Med+Tech Construction is a dental-specific general contractor specializing in design, new construction and/or renovation of dental, medical and veterinary offices across the states of Texas & Oklahoma. Med+Tech also serves clients in the Southeast including Alabama, Georgia and Tennessee, and will soon be serving Florida. ia
Beaird Harris & Co. is a Certified Public Accounting firm providing tax, accounting and business consulting services.
Beaird Harris Wealth Management, Inc. is an independent fee-only wealth management firm providing sophisticated financial planning and investment advisory services.
830 ESA Construction is a design-build dental general contractor in the Dallas/ Fort Worth Metroplex specializing in turn-key dental office solutions since 1994.
Structures and Interiors is a commercial general contractor specializing in dental office construction offering design-build services including new building construction, interior finish out, office improvements and renovations.
Monarch Dental offers dentists an alternative to private practice while providing the latest in comprehensive quality dental care to its patients.
TDA Financial Services Insurance Program works with TDA members and their staff in providing life, health, disability income, employee benefits, long term care and malpractice insurance. Bob Michaels, CLU has been an Associate with them for over eight years.
NORTH TEXAS DENTISTRY
Photographer: Ray Bryant, Bryant Studios
There are currently 128 general dentists and 28 specialists with Monarch Dental in North Texas, and the group is growing to meet increasing demand for their services.
Monarch Dental Experiencing Expansion and Growth in North Texas by Tina Cauller
“When you’re following your energy and doing what you want all the time, the distinction between work and play dissolves.” – Shakti Gawain, author and teacher
or most dental professionals, a passion for dentistry fueled the efforts that got them through the rigorous training that underlies a dental career. However, some graduates find that in a traditional private practice setting, the number of “hats” a dentist is required to wear in order to maintain a vital, active practice can be daunting. The typical dentist
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must continually manage and have some proficiency with business, billing, insurance, bookkeeping, IT, interior design, personnel management, conflict resolution, payroll, equipment maintenance, marketing, advertising, continuing education (CE), and real estate – all while practicing dentistry and balancing family and personal life. Fortunately, most dentists are great jugglers, but some find the everyday tasks that take them away from actually practicing dentistry to be increasingly unsatisfying. After all, their passion is dentistry. Not surprisingly, some dentists are embracing a different model. Dr. Melissa Dean is a periodontist with Monarch Dental,
Photographer: Ray Bryant, Bryant Studios
which she joined after completing her training at Baylor College of Dentistry in 2005. “I went into dentistry because I enjoy talking with people and sharing experiences. I was drawn to Monarch because I liked the idea of a large practice with lots of opportunity for professional interaction. And at Monarch, I knew I would have the advantage of an established model where the systems had already been proven to work. When I joined Monarch, there were four other periodontists on staff and I have benefitted tremendously from their experience and mentorship. I have learned so much from their successes, and now I’m in a position to help support other new dentists coming in.” Dr. Dean finds her professional environment rewarding and stimulating, noting, “No man is an island here – there is always someone close at hand to weigh treatment options or discuss a challenging case. The frequent discourse with my colleagues is so helpful and keeps me energized about every patient, every day.” Dr. Dean also appreciates the opportunity to focus her attention on great patient care. “At the end of the day, I follow up with a call to every single patient I saw that day. I take pride in the personal care I give.”
While some might wonder if being part of a large group practice requires a dentist to conform to the group model, Dr. Dean is pleased by the active role she is able to take in decisions that impact her practice. “This feels very much like my own practice. I can tailor my schedule to meet my own personal needs, I am able to take part in hiring and other staffing decisions, and my
“I have the very real luxury of being able to focus on what I love doing, without distractions or compromises.” decisions direct patient flow within my practice. I welcome support when it comes to ancillary operational duties and things like equipment selection. The research is done and the kinks are worked out before any new technology is integrated into the practice, and I receive thorough training so I’m never left to figure things out on the fly. I have the very real luxury of being able to focus on what I love doing, without distractions or compromises.” Dr. Ryan Gordon came to Monarch via a different path, but
Periodontist, Dr. Melissa Dean, finds her professional environment at Monarch Dental rewarding and stimulating and appreciates the opportunity to focus her attention on great patient care. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
for a venue to become the best endodontist I can be, supported by outstanding staff and general dentists, all working towards a common goal of excellence in endodontics. I wanted to work in a setting with an established referral base, where I could exercise a unique practice philosophy, drawing from my own experience working for a large group practice. Monarch allows all of its dentists to diagnose and recommend treatment they feel is best and most appropriate for the patient. My mentors here gave me the faith, trust and space to bring what had worked for me in the past to my practice.” “Taking time to do things the right way the first time pays off in reproducible results.” Dr. Gordon’s practice philosophy is a good fit with the Monarch model. “My patients are never treated like a number,” he notes. “Rather than focusing on production, each patient is treated the way I would want to be treated. There are no shortcuts. I learned early on in my career that the slowest way is often the fastest way. Taking the time to do things right the first time pays off in great outcomes and reproducible results.”
Dr. Ryan Gordon keeps his knowledge of new technologies and procedures current and takes pride in what he has accomplished as an endodontist at Monarch.
shares Dr. Dean’s enthusiasm for the personal and professional lifestyle his position with the Monarch team affords. After graduating and completing a residency at the University of Minnesota, he jumped aboard a large dental practice in Minneapolis and married the love of his life, Ann-Marie. His new wife, however, was not in love with the Minnesota winters. The couple decided to make the move to Texas, where Dr. Gordon joined a private endodontic practice as an associate for a time before finding Monarch. “I came to Monarch looking
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A digital pan/ceph imaging system is used to assist dentists in diagnosing and treating patients.
Photos by Ray Bryant, Bryant Studios
Dentists have state-of-the-art technology at their fingertips.
Dr. Gordon is constantly “immersed in the literature” and travels frequently for CE, which he finds “fuels the fire” and supports his commitment to provide the best possible care. He keeps his knowledge of new technologies and procedures current and takes pride in what he has accomplished at Monarch. “We recently completed a two-year follow-up for a challenging trauma case in which we are helping a young patient to hopefully regenerate her nerve. This case represents some of the most advanced regenerative techniques available.” Now the proud father of a young baby, Dr. Gordon finds that the Monarch model gives him the freedom to adjust his schedule and enjoy a fulfilling family life as well as sustaining a busy endodontic practice. There are currently 128 general dentists and 28 specialists (representing oral surgery, orthodontics, pediatric dentistry, periodontics, endodontics, and prosthodontics) with Monarch Dental in the North Texas area, and the group is growing to
meet increasing demand for dental services. “Patient demand is strong, even in this economy,” states Dr. Roy Smith, Chief Dental Officer with Smile Brands Inc., which provides business support services to Monarch and its other affiliated dental groups. “They are responding to the quality care, affordable financing, and convenience Monarch provides.” Fred Ward, Area Vice President with Smile Brands, describes the expansion currently underway in North Texas. “We always welcome input from our affiliated dentists. What we heard consistently last year was that it was time to grow to meet the increasing demand for dental services. Dentists enjoy being busy, but never want to be so busy that it hinders their capacity to provide great care. This meshes perfectly with what we hear from patients – that they place a high value on Monarch’s convenient locations and their confidence in the providers’ commitment to quality care. In response, we have invested $3 million to open three new conveniently located offices and mod-
NORTH TEXAS DENTISTRY
The use of the intraoral camera enhances patient understanding of the necessary treatment plan.
ernize five existing ones. We have added operatories and equipment. We’re spending another $5 million to roll out digital radiography and other technology across the area, and expect that process to be completed by February 2012. Today, 25 of the 55 locations in the North Texas area have been modernized or are less than three years old.” According to Mr. Ward, agile response to feedback from the professionals is just one of several factors that make the Monarch model so attractive to general dentists and specialists “We have a very low rate of turnover among our affiliated lead dentists in the North Texas area – less than 10% last year.” at all stages of their career. “We have a very low rate of turnover among our affiliated lead dentists in the North Texas area – less than 10 percent last year. They believe in the Monarch brand, trust our leadership and enjoy their work. The new associate dentists appreciate having access to this committed powerhouse of peer mentors made up of lead doctors who “grew up” in the
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“Twenty percent of the Monarch dentists in the North Texas area are Baylor graduates.”
Monarch system. We continue to provide the resources needed to arm them with mentoring tools. As a direct result of our commitments, we are able to attract and retain an incredible base of talent for our affiliated dental groups, including local talent. Twenty percent of the Monarch dentists in the North Texas area are Baylor graduates.” Dr. Smith adds, “Just like the original vision behind the Monarch model, this expansion has tangible benefits for patients. It allows us to maintain our dedication to high value, high quality, comprehensive care and supports all the ingredients necessary to that success. We look forward to 2012 with tremendous excitement.” n
For more information about Monarch Dental, visit www.monarchdental.com or call Mike Duda at (972) 212-8222.
Your Dental Website Needs a
3) Increases your website’s page count. if integrated properly, each article added to your blog will be treated as a separate page by the search engines (additional indexed pages), which improves your site ranking and increases your credibility and authority with the search engines. 4) Provides original, unique content. Many dental website design companies utilize the verbatim copy for describing services across multiple dental websites. This leads to an issue called duplicate content which negatively affects your website’s ranking in the search engines. A blog provides content on your website that doesn’t exist elsewhere on the web. 5) Increases traffic to your website. Good blog content will bring your website more visitors. When we review website analytics for our clients, in many cases, their blog articles are the most visited pages on their websites. 6) Creates content that can be repurposed. Not only can the article be posted to your blog, but it can also be used as an update to your Facebook, Twitter and Google+ accounts. We have developed a process for automating this function so no extra steps are required.
by Marc Fowler
In prior articles we discussed the importance of a strong web presence and mentioned the three key components of optimizing your website for high rankings in the search engines: u Title tags u Inbound links u Blogging Today, we’ll look at how a properly utilized blog can improve your search engine rankings, drive more prospective patients to your website, and educate them about the benefits of your services, which then helps build trust and credibility. Why you need a blog 1) Content is King. You may have heard the phrase “content is king”. Google and the other search engines are continually changing the formula they use to rank websites, however the one thing that has remained constant since they said it over a decade ago is the fact that they love fresh, relevant, original content. They do not like stagnant websites where nothing changes. A blog will prevent your website from getting stale. 2) Gain the trust of prospective patients. A blog can provide valuable content to both current and prospective patients. In addition to educating them, it also gives them a feel for how you run your practice, the benefits of the services you provide and what they can expect when entrusting you with their dental care. 12 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
7) Attracts links to your website. Inbound links (other websites pointing to yours) are an important factor in search engine rankings. Often, other website owners will find your blog content and link to it, providing you with a valuable one-way link. A properly executed blogging strategy has always been a key component to a successful online marketing strategy, but with the recent round of updates by Google known as the Panda Update and the Freshness Update, having an active blog is more important than ever. How to get started Now that you know why blogs are a must-have, you’re probably wondering how to make all this happen. The first decision is whether you want to run a stand-alone blog or integrate it into your existing website architecture. Without a doubt, you want it integrated into your website. Avoid the free, instant setup blogs such as Blogger.com. Next is establishing a system for keeping your blog fresh. Ideally you’ll create an editorial calendar and regularly add good quality content. This can be done by you, assigned to someone in your office or outsourced to an experienced dental writer. If you would like information on how to properly integrate a blog into your website or to learn how our team of professional dental writers can manage your blog for you, please contact us today. n Marc Fowler is President of Bullseye Media, LLC, a McKinney, TX based digital marketing agency that specializes in helping dentists leverage the internet to grow their practices. He can be reached at 214-592-9393, firstname.lastname@example.org or by visiting OnlineDentalMarketing.com.
Q. Does Beaird Harris have experience working with dentists?
Q. What asset protection strategies do you recommend?
Paula: Yes; for over twenty years Beaird Harris has worked with dental practices of all sizes and specialties. This includes recent graduates working as associates, sole practitioners as they launch a new practice or buy an existing one and large dental groups with multiple owners.
Paula: Just as you would encourage a patient to take preventative measures to ward off gum disease, it’s prudent to organize your financial affairs and assets to guard against risks in advance. This process is very individualized and the complexity of an asset protection strategy will depend on the dentist’s unique circumstances.
Realizing that our dental clients have specific tax and financial needs, we’ve assembled a team of CPAs, CFP® Practitioners and Quickbooks ProAdvisors® to serve this niche. We provide a complete range of services designed to address both personal and business issues, including:
Paula W. Allgood, CPA Beaird Harris & Co., P.C. Beaird Harris Wealth Management, Inc. 12221 Merit Drive, Suite 750 Dallas, TX 75251 (972) 503-1040 PaulaA@bh-co.com www.bh-co.com www.bhcocapital.com
Our team provides practical, innovative solutions that can help your company whether you are a new entrepreneur or an established professional.
Beaird Harris & Co., P.C. is a Certified Public Accounting firm providing tax, accounting and business consulting services to dental practices of all sizes and specialties across North Texas. Beaird Harris Wealth Management, Inc. is an independent fee-only wealth management firm providing sophisticated financial planning and investment advisory services.
• Tax Planning & Compliance • Entity Selection & Practice Transitions • Bookkeeping & Payroll • Financial Statement Compilation • Retirement Plan Services • Financial Planning • Investment Management • Estate Planning
Q. What makes the Beaird Harris business model so attractive to dental clients? Paula: Dentists are extremely busy and appreciate having all of their tax and financial needs met under one umbrella. Proactive tax and financial planning is a coordinated effort between your tax and financial advisors. The synergy created by working with Beaird Harris provides increased convenience, a deeper understanding of your overall financial situation and peace of mind. With a full staff of CPAs and CFP® Practitioners, we’re in the enviable position of being able to consider the tax ramifications of every investment and financial planning decision.
While making a recommendation is beyond the scope of this article, the key point is to employ a strategy early and work with an experienced advisor to walk through the pros and cons of the various alternatives.
Q. What message do you most wish to communicate to dentists? Paula: After more than twenty years in the business, I can say with confidence that the people who get good advice early in their careers have a huge jump on those who wait. There is simply no way to overstate the importance of avoiding mistakes that have negative repercussions for many years to follow. With regards to financial planning and retirement plan services, it is important to work with a “fee-only” investment advisor who doesn’t sell any products and has a legal, fiduciary duty to put your needs first. Most dentists find that they make better financial and tax decisions when they tap into the expertise of a seasoned advisor who specializes in healthcare.
To ensure compliance with Treasury Regulations (31 CFR Part 10, §10.35), we inform you that any tax advice contained in this correspondence was not intended or written by us to be used, and cannot be used by you or anyone else, for the purpose of avoiding penalties imposed by the Internal Revenue Code. If you desire a formal opinion on a particular tax matter for the purpose of avoiding the imposition of any penalties, we will discuss the further Treasury requirements that must be met and whether it is possible to meet those requirements under the circumstances, as well as the anticipated time and additional fees involved. Beaird Harris’s marketing material should not be construed by any existing or prospective client as a guarantee that they will experience a certain level of results if they engage the adviser’s services. This announcement is only intended for interested investors residing in states in which the adviser is qualified to provide investment advisory services. Please contact the adviser to find out if the they are qualified to provide investment advisory services in the state where you reside. Past performance is no guarantee of future results.
Paula W. Allgood, CPA Beaird Harris & Co., P.C. / Beaird Harris Wealth Management, Inc. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Leadership Beckons With an Air Force Surgeon General consultant appointment and a four-year CODA term on the horizon, Benson reflects on radiology’s unique career opportunities By Jennifer Fuentes
Dr. Pete Benson still gets a chuckle from a conversation he had years ago with his daughter Brittany’s elementary school teacher. It was an interesting exchange, to say the least. “I told her I was a dentist, and she looked at me very strangely. She said, ‘I asked your daughter what you did, and she said you played video games,’” says Benson, professor and vice chair of Texas A&M Health Science Center Baylor College of Dentistry’s Department of Diagnostic Sciences. It may have been easy for his daughter to make that correlation at the time, considering Benson spends his days scrutinizing MRIs, CT scans, digital photographs and radiographs in his work as director of the dental school’s Oral and Maxillofacial Imaging Center. “I also did explain to her what I did for a living,” Benson adds, pointing out just what drew him to oral and maxillofacial radiology, the newest of the nine recognized dental specialties. “The best thing about radiology is it’s the most intriguing game I’ve ever played,” says Benson. “It’s a mystery game.” 14 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
There’s no doubt Benson is passionate about what he does. He’s been in the dental diagnostics and imaging field for more than 27 years, and 24 of those have been spent at TAMHSC-BCD as a faculty member.
Drawing from past experiences, filling new leadership roles Over the years, Benson’s leadership roles in his field have taken a decidedly upward turn. In May, he was appointed to a threeyear term as the Civilian National Consultant in Oral and Maxillofacial Radiology to the U.S. Air Force Office of the Surgeon General. This month, he also was installed as one of the 30 Commission on Dental Accreditation commissioners during the American Dental Association’s Annual Session. It’s been a big year for Benson, and he links the opportunities back to 1999 when he became president of the American Academy of Oral and Maxillofacial Radiology and the “stars lined up,” as he puts it. “It was the 50th anniversary of the academy and it was the year
the American Dental Association recognized radiology as a specialty,” Benson recalls. “We were excited because we were the first newly recognized specialty in almost 40 years; it was a monumental achievement.” Benson, also a diplomate of the American Board of Oral and Maxillofacial Radiology and a past president of that organization, acknowledges that the size and newness of his specialty have played a role in his leadership opportunities. “It expands my opportunities for leadership,” Benson says. “To me, that is one of the advantages of a smaller specialty.”
Gaining a broader perspective Benson’s four-year term with CODA means he’ll participate in site visits, review policies, and serve as the chairman of the commission’s oral and maxillofacial radiology review committee. While Benson won’t have any external part in TAMHSC-BCD’s upcoming CODA visit, he predicts serving on the commis-
sion will help him see how other institutions have addressed problems and created solutions. “Gaining that broader perspective will help me identify policies and procedures that would increase our effectiveness,” Benson says. Benson’s appointment as an Air Force Surgeon General’s consultant is a natural extension of his leadership experience but of a different sort. Benson, who has two years of active duty experience as a dental officer in the U.S. Navy and is a retired Navy Reserve captain, comes from a long family lineage of military service. “I had experience in military health care so I was excited to do it, from that point of view,” says Benson. It didn’t hurt that he had Dr. Diane Flint, an assistant professor in diagnostic sciences, oral and maxillofacial radiologist, and retired career Air Force dental officer, urging him to accept the position.
Through it all, Benson has maintained his teaching role at TAMHSC-BCD for more than two decades. Among his favorite memories is hooding his son, Dr. Andrew Benson, during commencement five years ago. Having his son in the dental class presented some unique, if not humorous, situations. Benson had started giving a lecture with PowerPoint slides and dimmed the lights. He asked if the class had any questions and was met with a pause. “From the darkness I heard a voice say, ‘Hey Dad, I’ve got a question,’” Benson says, recalling the laughter that resonated through the room. “For the next three years, virtually his whole class called me Dad,” Benson says with a laugh. n
Jennifer Eure Fuentes is a communications specialist at Texas A&M Health Science Center Baylor College of Dentistry. A 2006 graduate of Texas Christian University, she has worked in the communications and editorial field for five years.
Founded in 1905, Baylor College of Dentistry in Dallas is a college of the Texas A&M Health Science Center. TAMHSC-BCD is a nationally recognized center for oral health sciences education, research, specialized patient care and continuing dental education. The TAMHSC serves the state as a distributed, statewide health science center that is present in communities throughout Texas. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
SMILES SPOTLIGHT in the
LEADERS IN NORTH TEXAS DENTISTRY CREATING UNFORGETTABLE SMILES
Immediate post-op with surgical splint
After splint removal
After treatment CASE PRESENTATION Teenage female patient referred by her dentist for orthodontic evaluation of chief complaints of ‘underbite’ and ‘poor teeth alignment’. Oral examination revealed maxillary arch constriction, missing upper right lateral incisor, microdontic left lateral incisor, delayed exfoliation of mandibular molars, crowded & retroclined lower anterior teeth, and Angle Class III molars. Esthetically and functionally, this patient was dissatisfied with her occlusion.
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Deji V. Fashemo, DDS, MPH
TREATMENT PLAN Detailed orthodontic cephalometric analyses showed that the observed skeletal malocclusion was due to a combination of mild maxillary hypoplasia and moderate mandibular prognathism. Adequate, stable correction required combined orthodontic and surgical procedures. Surgical intervention was timed to coincide with cessation of facial growth. The peg-shaped lateral incisor required restorative enhancement, and ideally, the missing upper right lateral incisor required space creation and an implant replacement. However, the patient/parents opted to accept substitution of the missing incisor with the canine, the canine with a first bicuspid and accept a molar Class II finish on the right side. PROCEDURES The over-retained lower deciduous molars were extracted, fixed upper and lower orthodontic appliances were placed after a short course of rapid palatal expansion. Dental compensations were removed and progressively, space was created for the resolution of the crowded dentition. The teeth were aligned, maxillary and mandibular arches coordinated; orthodontic biomechanics also ensured creating space mesial and distal to the upper left lateral incisor for esthetic bonding. Progress/pre-surgical records and re-evaluation revealed that the best results would be attained by a 2-jaw procedure of Le Fort I maxillary advancement and bilateral sagittal split ramus osteotomy for mandibular set-back. A hand-wrist x-ray film was also taken to confirm that the patient’s skeletal growth has neared completion. Surgical hooks were placed pre-operatively. An acrylic splint was inserted intra-operatively to aid maxillomandibular positioning based on pre-determined movements as planned on plaster models. Post-operative observation was done, and vertical inter-arch elastics utilized for further teeth positioning after removal of the acrylic splint. After debonding, the patient was seen by the restorative dentist to build up the left lateral incisor and re-shape and modify the right canine into a lateral incisor. Retainers were delivered. RESULTS A very pleasing facial balance was achieved with excellent orthodontic and occlusal results; the patient and her family were highly satisfied with the attained results from a combined multi-disciplinary collaboration of a restorative dentist, an oral & maxillofacial surgeon, and orthodontist Dr. Deji Fashemo who coordinated the treatment.
Dr. Fashemo graduated from University of Ibadan School of Dentistry in Ibadan, Nigeria in 1992. After a year at the orthodontic residency in Lagos University Teaching Hospital, he moved to the United States. At the University of Rochester Eastman Dental Center, Rochester, N.Y. he underwent two years of Advanced Education in General Dentistry (AEGD), and eventually received the degree of Master of Public Health (MPH) in clinical research. In Rochester, Dr. Fashemo continued his clinical training with a residency in orthodontics; this was followed by a year of clinical fellowship in craniofacial & surgical orthodontics at the Indiana University School of Dentistry. Dr. Fashemo came to Texas in 2004 to pioneer a hospital-based orthodontic program at Driscoll Children’s Hospital in Corpus Christi and ran that program for five years. His professional career continues in the Dallas area where he established Fourth Dimension Orthodontics & Craniofacial Orthopedics – a unique private orthodontic practice to cater to general orthodontic patients while supporting the craniofacial anomalies program within Medical City Dallas Hospital where he also serves as the medical director of craniofacial orthodontics. He is actively involved in clinical outcomes and health care access research initiatives, gives lectures at national and international meetings, and serves on several professional association committees and is a reviewer for the Cleft PalateCraniofacial Journal. Dr. Fashemo’s professional memberships include: • American Cleft Palate-Craniofacial Association • American Association of Orthodontists & Southwest Society of Orthodontists • American Dental Association, Texas Dental Association, and Dallas County Dental Society While not fixing teeth, jaws and faces with braces, Dr. Fashemo enjoys playing soccer and spending time traveling with his wife and three daughters.
For more information concerning this case, contact: Fourth Dimension Orthodontics & Craniofacial Orthopedics 7777 Forest Ln, Suite C-770, Dallas, TX 75230 Tel: (972) 566-3100 e-fax: (214) 237-6522 www.4dorthodontics.com
NORTH TEXAS DENTISTRY
EthiopiaSmile DENTAL MISSION TRIP
by J. Moody Alexander, DDS, MS
e thought adopting our new son from the country of Ethiopia in 2008 was going to be the thing that changed our family. Little did we realize, that was only the beginning. Three years and two dental mission trips later, my family’s life as well as hundreds of others will forever be changed.
to extractions. The patients were taken to an “anesthesia station” then to the next open “chair” for their extraction or extractions. Once the dental work was performed and had time to recover, the patient was given analgesics, oral hygiene instructions and antibiotics if indicated.
The first EthiopiaSmile dental mission trip began as a group of friends came around the idea using dentistry to love the people of Ethiopia. In a country of 80 million people with under 100 trained dentists in the entire country, dental needs are rampant to say the least. Dental prevention and basic oral hygiene are not a part of the national culture. Morbidity and even mortality, directly related to dental infection, is a common occurrence, especially among the millions living in extreme poverty.
Keeping with the mission to love the people of Ethiopia as we felt Jesus would, we had a “buddy system” in place. Non-dental friends partner with a patient and walk them through the various stations as they receive treatment. Holding hands, rubbing their backs and stroking their hair broke down the language barrier and calmed their fears as most of them had ever seen a dentist before.
This past September, eight dentists from various places across the U.S. were joined by 40 other non-dental volunteers and traveled to Addis Ababa, Ethiopia. Just under 1,000 patients were treated in spite of the fact that the majority of our supplies ended up being held up in customs the entire trip. Partnering with local ministries and churches, we were able to care for those most vulnerable. In light of the Biblical passage of James 1:27, we focused on caring for orphans, widows, the elderly and those children with obvious dental infection. The majority of our treatment occurred in an incredibly impoverished part of Addis Ababa called Korah. Korah is a former leper colony. Today it is the home to over 100,000 living in severe poverty, many surviving by scavenging in the city dump. A large open building with tin roof and walls was converted into a MASH-style dental clinic. After waiting sometimes for hours, the patients were screened and assessed for dental needs. Due to lack of predictable electricity and instruments, our services were limited 18 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Another unique aspect of our trip is the sterilization process that has been developed. A dear and talented friend reconstructed a large pressure cooker into a fully functional autoclave. We used three, continually running, butane-heated autoclaves to keep sterile instruments available. This was especially important this year due to the significant amount of supplies held up in customs, not to mention the area we were serving in is rampant with HIV and other communicable diseases. Multiple things impact my life on the EthiopiaSmile trips. God has
a way of showing up there. He is seen in the faces of the patients we treat. The joy that radiates, in spite of their dire circumstances, is infectious. He is evident in the team working together, with a common purpose and goal. Seeing the many moving parts that need to all come together to pull off the operation is inspiring. It’s a beautiful thing for a dentist to step in, graciously care for patients in a less than ideal setting with limited resources to do what he or she knows how to do. It’s just as beautiful seeing an engineer, stay-at-home mom, salesman, grandmother or teenager work outside of their comfort zone as an assistant or patient buddy. All in the spirit of love, being the hands and feet of God to these dear people.
Photo: Major Images Photography
Traveling to Ethiopia has a way of changing you, putting the stresses and cares of this world in perspective, helping break out of the small world we live in to see a larger world full of needs, needs we have been blessed to be able to meet – at least in some small way. Our next trip to Ethiopia will be in June 2012. n
Dr. Alexander and his wife Emily are the proud parents of seven children, three of whom were adopted from Ethiopia. They are pictured here with Hill, Wick, Avery, Isabelle, Eyasu, and Abe. Gigi is still in Ethiopia until her adoption is finalized in the next month or so. Dr. Moody Alexander is a graduate of the Baylor College of Dentistry orthodontic program and an orthodontist in private practice in Arlington since 1995. If anyone would like more information, feel free to contact Dr. Alexander at email@example.com or visit www.drsalexander.com. www.northtexasdentistry.com
NORTH TEXAS DENTISTRY
Q. How do you support the restoration goals of your clients?
Joseph C. Danna, CDT Dental Logic, Inc. 112 Hampshire Lane Suite 105 Richardson, Texas 75080 (972) 234-2219 firstname.lastname@example.org www.dentallogic-lab.com
Q. The partnership between dentist and laboratory is so crucial to good teamwork. How do you build a relationship with your dentistclients and ensure clear communication? A. Getting to know a dentist personally is central to developing a good working relationship. I spend one-on-one time with new clients and visit their office to key in on how they work and their style of practice. I also try to meet with the staff, especially the front desk personnel and lead dental assistant to discuss how I can best support their practice and interface with the office.
A. I try to develop a thorough familiarity with the team, the patient, the materials, the procedure, and the overall goals of the restoration. I am available to visit the office for a consult if needed on a specific case, and offer recommendations based on my experience. I sometimes even meet with the patient to address any aesthetic considerations. Itâ€™s important to be familiar with the materials the dentist is using and maintain thorough, current knowledge of the product. I spend time to research the procedure and understand the factors that form a foundation for excellent results.
Q. How do you ensure quality and safety? A. While the materials we use are hightech, we still work the old-fashioned way. There is no assembly line here. All of our technicians are trained to focus on one case at a time and stay with the basics. This means that our restorations take time, but we keep our commitment to both quality and timeliness and keep our clients informed of the status of their product along the way if needed. From start to finish, I monitor all critical stages of the process â€“ from the case design and impression, to die trim and delivery. I personally look at each impression and accompanying instructions within hours of receiving it. Within the first 24 hours, I analyze the prep design and spend a lot of time on the wax-up. I oversee each casting as the model is poured so there is adequate time to identify any concerns or needs. This allows us to order anything we might need immediately and avoid delays or lastminute issues. Because our quality is so carefully controlled, we are able to offer a 5-year warranty on our craftsmanship.
Dental Logic, Inc. Joseph C. Danna, CDT
20 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
We offer a wide range of dental laboratory products, and all are manufactured only with FDA-approved and ADA-accepted materials purchased from a major, well-known supplier to ensure the utmost safety, quality and purity of our final products.
Q. Do you send laboratory work offshore? A. No. I prefer to have control over the entire process rather than trying to compensate for discrepancies in the product. In order for the final product to be optimally strong and of the highest quality, the substructure must be perfect, not patched to correct imperfections. Creating every stage of every restoration in house directly impacts our ability to deliver consistent quality. I invite our clients to x-ray our products so they can see for themselves that the quality of the foundation is just as high as the quality visible to the eye.
Q. Do you allow tours of your laboratory? A. We not only allow them, we encourage doctors and their assistants to visit our facility. This almost always leads to a better understanding of how we can work together more effectively to achieve the best possible results. In fact, we even encourage patients to come to our facility for precise shading. While they are here, we show them how a crown is created, and often take time to explain why their dentist has chosen a particular material for their restoration and discuss the advantages of that material in language they can easily understand. Patients are universally appreciative of this opportunity and impressed that their dentist has taken such great care to select the best possible material for their smile.
They are corporate-owned and operated DMSO (Dental Management Service Organization) practices, with highly successful and proven business models, very deep pockets and intent on targeting local patients just like yours! In the greater DFW area alone, there are an estimated 218 corporate owned dental practices – up from less than half of that just four years ago. Many more are coming in 2012! Over the last two years, New Patient Flow has held steady in these practices, while independent practices experienced a decline of 50%! What happened in your practice?
Attend this highly educational seminar! Even the most successful solo practices face increasing competitive pressure that can threaten their future survival. You need to know what is going on – that’s why we put together this informative seminar. January 17 Embassy Suites DFW South 4650 West Airport Freeway Irving, TX 75062 January 31 The Westin Stonebriar 1549 Legacy Drive Frisco, TX 75034 February 21 The Westin Park Central 12720 Merit Drive Dallas, TX 7525 All seminars are 7:00 to 9:00 p.m. Cost $95.00 • Registration begins at 6:30
R. Kirk Huntsman n n n n n
23 years dental industry experience Co-founder of Dental One Partners Founding member of Dental Group Practice Association CEO ReachOut Healthcare America Founder and CEO Nexus Dental Alliance
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What do you need to compete? An Action Plan We’ll show you exactly what steps you must take in order to preserve your practice and secure your future.
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The Future of Dentistry
Why DMSOs Will Dominate Dentistry in 2020 by R. Kirk Huntsman
ike all professions, the practice of dentistry is evolutionary. And based on what has happened in other professional market sectors, the track of that evolutionary path is highly predictable. What began in antiquity as a crude trade or craft that could be plied by just about anyone, eventually morphed into a profession, with clinical standards, regulations, licensing requirements, and oversight. Along the way, the charlatans were purged, the public gained confidence, and the privileged few who met the high standards for practice began to prosper. Eventually, as the profession honed its services to the public and as the public came to value those services as a truly indispensable part of life, the professional pursuit evolved further into something far more complex and commercialized. In today’s modern dental practice, the commercial aspects and economic considerations come to the forefront, and as already happened to pharmacists, optometrists, veterinarians, and other professions, large and efficiently run corporate models come to dominate the market as big money seeking high returns pours in. Dentistry in the 21st century has clearly moved from the back alleys of antiquity, through the independent professional model of the last century, and now finds its future in a corporate model. Some may take issue with this assessment, but they do so at their own peril, because the facts are not on their side. Corporate Dental Management Services Organizations (DMSOs), flush with huge amounts of capital from Wall Street and large private equity funds, are expanding rapidly. According to the Dental Group Practice Association (DGPA), the top tier 20-25 DMSOs alone will account for over $4 billion in revenues in 2011—and that just scratches the surface, as smaller DMSOs (under $40 million in 22 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
annual revenues) outnumber their large corporate brethren by an estimated 20 to 1. Overall, an estimated 25-30% of all dental services rendered in the US will soon come by way of corporate DMSO practices. Why Corporate Dentistry Is Growing As to why the corporate sponsored DMSO model is winning the battle for market share, one need look no further than what they offer the consumer. First, they typically accept all insurance plans and offer patients convenient appointment times before and after work in highly visible, modern, well designed facilities with easy access. Simply put—they are easy to do business with. Second, many DMSOs offer one-stop, single point of service dental care, where all specialty services can be obtained. Third, because of their size and purchasing power, they have lower operating costs—often a full 20-25% lower than their solo practice competitors. Thus, they can compete on price far more effectively—without compromising quality of care or service. Ironically however, DMSOs typically receive higher PPO fees than local solo doctors, again due to their size and negotiating leverage. Fourth, these companies run like finely tuned business machines, led by professional businessmen and women who are smart, focused, and bring many years of success to their jobs. Fifth, these companies have huge marketing budgets and have now moved well beyond their traditional managed care, low end type focus. Modern DMSOs target the same cross section of Middle America that traditional solo practices have monopolized for the past 100 years. Their marketing programs are targeted, sophisticated, and well executed. Finally, DMSOs have been infused with hundreds of millions of dollars, and they need to deploy that capital either in
purchasing existing practices or growing them from scratch. Not many solo practices offer anything close to the total value proposition these corporate competitors offer patients. No wonder more and more patients are leaving their solo doctors behind in favor of the corporate practice model.
Options for Solo Doctors Solo practitioners facing this corporate tsunami basically have two options: sell out or remain independent and try to compete. Some few will make that trade by exchanging their independence for a W-2 from a DMSO. Others will hold out and hope these guys go away. They won’t. My bet is that the vast majority will actively seek out ways and means to retain their independence and compete. Independent solo dentists who wish to compete against the big boys are not without their options. Nothing prevents them from partnering up with the right people to form their own multi-location, multi-specialty practices. That’s one way they can begin to operate their practices more like a business, with the same kind of systems, processes, and disciplines that will allow them to generate more production at lower cost. With the right team, they’ll gain access to the same kinds of leveraged discounts that the large DMSOs enjoy on everyday purchases. One piece of advice—don’t try to do this without first having a good plan and getting the very best professional advice available. When put together properly with the right partners, group practice can be both professionally and financially rewarding—and in this case it may just be the only way to survive what’s coming! n
R. Kirk Huntsman has been active in the dental industry for over 23 years. In 1988, he became the Dallas/Ft. Worth licensee for AFTCO Associates, a dental practice brokerage company with over 65 offices nationwide. Within two years, his was the top performing office in the nation. In 1991, he acquired the Houston license and continued to rapidly expand. By 1995, he was ready to begin owning and operating practices, so he launched Dental One as a dental management services organization, or DMSO. Under Mr. Huntsman’s leadership and direction, Dental One (now Dental One Partners) grew from scratch to over 150 offices in 14 states. After leaving Dental One Partners in the spring of 2010, Kirk began working closely with Morgan Stanley Private Equity in their acquisition of ReachOut Healthcare America, the nation’s largest mobile dentistry provider. Mr. Huntsman recently left ReachOut in order to form Nexus Dental Group, a virtual DMSO providing a wide range of DMSO-type resources and services to independent dentists. Mr. Huntsman is a 1981 graduate of Brigham Young University’s Marriott School of Management.
Protection is our Business Disability Life Health Long Term Care Malpractice
Our only business is working with TDA Members and their staffs. We are committed exclusively to servicing TDA membership’s needs. Let us review, compare and provide options for your coverage. Bob B b Michaels, Mi h l CLU Local Associate 214-696-5103
NORTH TEXAS DENTISTRY
85 REASONS to attend the
2012 SOUTHWEST DENTAL CONFERENCE
The Southwest Dental Conference began in 1927 by a visionary group of dentists. I can only imagine that they were innovative, daring, and had high hopes for this dental conference. And their dreams have come true! Of course it has changed names through the years but what we now know as the Southwest Dental Conference has become the preeminent dental meeting of the southwest. Eighty-five years since its inception, we are celebrating the vision of our dental forefathers who prepared the way for its success today. REGISTER NOW! Mark your calendars for January 12-14, 2012. Registration online at www.swdentalconf.org or you may mail in the registration form in the 2012 SWDC brochure. Make sure you check out all the speaker choices and topics. I invite you to start 2012 with an educational meeting that will set the tone for your dental practice in this coming year. Come and join me and your fellow dentists in celebrating the 85th Anniversary of the Southwest Dental Conference. Danette McNew DDS Chairman SWDC 2012
Have you noticed that as the years march on, trying to keep perspective, energy and passion alive for our wonderful profession gets a little harder? The economy also continues to take a hit and may assist in driving this downward spiral. Then why not take advantage of this time to broaden your dental knowledge and return to your practice with the excitement of bringing new information, products and services to offer your patients? Here are 85 reasons to recharge your New Year by “practicing in the present while focused on the future”:
6 course updates on sedation and anesthesia which prepares you for the recent changes in sedation regulation in Texas 4 sessions teaching dentists how effectively to manage “more mature” patients
courses designed to improve our esthetic planning and adhesive resin applications by 10 unique speakers.
5 sessions to help you battle the economy and be more profitable, productive and prepared to exit your practice at the appropriate time
7 current concept courses in implant dentistry 11 speakers focusing on the health of the practitioner, the patient, and team member
24 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
specialized forums addressing traumatology, missions, women health concerns, and new dentist challenges
3 live-patient demonstrations showcasing the latest in dental advancements 1 mobile phone app to try your hand at 3 sessions to learn how sleep apnea treatments can be a part of your dental practice
3 courses to incorporate pediatric dentistry in 2012
topics to boost hygiene productivity utilizing ultrasonics, new products, implant maintenance, and oral fluid diagnostics
7 sessions to improve our endodontic performance 13 courses for the dental assistant to manage radiographs, photography, materials, bleaching, provisionals, and stress, and 1 celebration of the
85th Anniversary of the Southwest Dental Conference with over sixty speakers providing both lectures and hands-on workshops to benefit the entire team.
How Current Government Initiatives May Affect Your Practice by Sarah Q. Wirskye
ealthcare fraud has been a priority since the Health Insurance Portability and Accountability Act established a National Healthcare Fraud and Abuse Control Program to coordinate Federal, State, and Local law enforcement regarding healthcare fraud and abuse in 1996. Since that time, the federal government has recovered over $18 billion for healthcare fraud and abuse, $2.5 billion of which was won or negotiated in fiscal year 2010. The states have also ramped up their enforcement efforts in this area in recent years. In 2010, Texas Medicaid recovered $418 million and avoided costs of approximately $333,000 due to healthcare fraud enforcement. It is no surprise that Medicaid orthodontics have come under attack in Texas based upon the amount of money paid to orthodontists. In 2010, providers in Texas were paid $184 million for Medicaid orthodontics, and 34 clinics received more than $1 million during that period. The conduct being examined in these investigations is no different than what the government examines in all healthcare fraud cases. However, there are some twists based upon how these issues are applied in the orthodontic and dental contexts. In light of that, there are some things that you can do in order to minimize your liability if you find yourself under audit or investigation. (It is impor-
tant to note that if you are currently under audit or investigation, you need to retain an attorney experienced in this area of the law to guide you through this process and any changes you may be implementing). POTENTIALLY PROBLEMATIC CONDUCT Services Not Rendered The government often examines whether or not services that were billed were actually rendered. One of the governmentâ€™s favorite techniques for doing so is examining the amount of time the doctor spends with each patient. In other words, they divide the number of hours the doctor is in the office by the number of patients seen during that day. If the time per patient is unreasonable in the governmentâ€™s opinion, they frequently take the position that the doctor did not see all of the patients and/or did not see the patients long enough to adequately provide the service. The government has an even stronger case in situations where the billing codes are time based. The government also often examines a doctorâ€™s travel records to determine which days he or she was in the office. Services not rendered are perhaps one of the most critical issues that the government will examine. If the government feels that unqualified personnel, such as dental assistants, instead of doctors must be treating patients because of the num-
28 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
ber of patients seen and/or the doctor is not spending adequate time with each patient, the government views this as a quality of care issue. When there is a quality of care issue, the government is much more likely to suspend payments or shut a clinic down, as opposed to a situation where there is merely a billing issue. In the orthodontic and dental context, the doctor needs to ensure that he or she is spending adequate time with each patient. It is helpful to have the doctor sign the charts contemporaneously upon treatment. You also need to ensure that each doctor has a Medicaid provider number for each clinic in which they are working. Necessity Necessity is another critical issue in government investigations. In certain areas, such as orthodontics, home health, and hospice care, if the government can successfully challenge the determination of necessity, they can take the position that all charges paid for a patient were improper. In the orthodontic field, patients who are under age 12 receiving full braces have been an area of focus. It is imperative that with all patients, but particularly these, necessity be adequately documented. Upcoding The government often examines whether a provider is consistently coding a more
complex procedure, for which the reimbursement is higher, rather than a less complex version of that same procedure. This is called upcoding. This has been applied in dental cases when the government is examining the types and/or materials of sealants or fillings being used. The government has focused on upcoding in orthodontic cases with appliances. Unbundling Unbundling is a situation when there is one procedure that is split up to maximize reimbursement. For example, two procedures can be performed separately and are reimbursed at $100 each. However, when those two procedures are performed together, there is one billing code which pays $150. When those procedures are performed together, the third code must be used instead of â€œunbundlingâ€? those procedures and billing the two other codes separately in order to obtain higher reimbursement. Appliances are an area that has been an issue in recent dental and orthodontic investigations. Kickbacks Kickbacks can be gifts or benefits to referral sources, beneficiaries, or employees. These are easier cases for the government than cases that turn largely on expert testimony regarding complex medical procedures. It is good practice not to make any substantial gifts to referral sources or any gifts at all to beneficiaries, such as rebates or gift cards. The government could also take the position that employee compensation based upon revenue is a kickback. While this may not seem as obvious as the conduct discussed in the previous paragraph, this is not a good practice and should be discontinued. PROACTIVE MEASURES Because of what is at stake, it is imperative that providers are very careful when working with the government. In addition to severe monetary sanctions, the government has the ability to require a provider to have a corporate monitor, place a monetary hold or suspend payments to a
provider, exclude a provider from government programs, and even put a provider in jail. The collateral consequences from a government investigation may also implicate licensure issues with the State Board. One of the most basic things a provider can do to minimize liability is to accurately chart. Often, because a provider is busy, the level of detail in patient records does not support what was billed. This is an issue in all healthcare cases. The clinical staff needs to understand that patient treatment is only half of their job and the other half is accurately and adequately documenting the chart. Providers and their staff must take the time to learn and follow the often complex Medicaid rules. If an office is big enough, hire an in-house compliance officer. If not, find a competent consultant to advise you. You need to make sure you are following every procedure in order to minimize your liability if you find yourself in the governmentâ€™s sights. n
Ms. Sarah Wirskye has represented numerous individuals and entities in civil and criminal disputes with federal and state governments and private insurers. She is currently representing several healthcare providers, including dentists and orthodontists, in inquiries by both the state and federal authorities. For more information contact Ms. Wirskye at email@example.com or call (214) 749-2483.
NORTH TEXAS DENTISTRY
Sparklers for Special Times by Kim Clarke
here’s something special about sparkling wine. The word itself, “sparkling” is a cool word. So is Champagne, an extra-special sparkling wine from a certain special part of France. The Holidays always seem to bring out that seasonal desire to do something special with a bottle of sparkling wine – give one to a special friend or drink some with special friends. Behind that special sparkle, however, lie some interesting and somewhat complicated details about wine-making and labeling. There’s also the question of which one to buy as there are some that are more special than others.
History and Process Wine that sparkled was not always considered a good thing – cause unknown, it was attributed to faulty winemaking and often caused the bottles to burst. As it turns out, cold winter temperatures sometimes halted the wine’s original fermentation, leaving residual sugar and dormant yeast in the wine. Once bottled, warmer temperatures reactivated the yeast and a secondary fermentation of the wine created the bubbles. This discovery, coupled with the production of stronger glass bottles, gave late-17th century winemakers better control of the process and allowed them to deliberately make sparkling wine. The traditional method (methode traditionnelle or methode champenoise) of making sparkling wine involves adding yeast and sugar to bottled wine, capping the bottle and allowing the fermentation to produce carbon dioxide that dissolves in the wine. The bottles are then placed in racks with the necks slanted downward and given a slight shake and turn several times a day, allowing the dead yeast cells (lees) to gravitate toward the bottle opening. When all the lees have settled out, the neck of the bottle is frozen, the cap is removed and the pressure pushes the frozen lees plug out of the bottle, at which time the bottle is topped off with a wine/sugar mixture and corked to preserve the carbonation. 30 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
The amount of sugar used in the “topping off” mixture determines the sweetness of the sparking wine: “Brut” will have a small amount of sugar, “Extra Dry” will be sweeter and “Dry” even sweeter.
Champagne While many people refer to sparkling wine as Champagne, European Union laws only allow sparkling wines from the Champagne province of France to be labeled Champagne. There are five legally defined wine-producing districts covering 76,000 acres of vineyards around 319 villages that are home to more than 19,000 grape growers and 5,000 wine producers. The main business centers are the towns of Reims and Epernay. The Champagne house of Gosset was founded in 1584 and is the oldest Champagne house still in operation today. Other well known houses include Ruinart (1729) Taittinger (1734), Moet et Chandon (1743) ,Veuve Clicquot (1772), Roederer (1776), Piper Heidsick (1785), Krug (1843) and Mumm (1847). Sparkling wines from these historical houses are not inexpensive, with entry-level prices in the range of $40. The Yellow Label from Clicquot is a great example of Brut Champagne. The White Star from Moet et Chandon is an Extra Dry, a bit sweeter than a Brut with floral and peachy notes that would go great with a fruit dessert. The Moet Nectar Imperial and the Clicquot Demi-Sec are dessert-style champagnes with pear, vanilla and almond notes and a long finish – perfect on its own or with chocolates after dinner. Expect premium Champagnes to cost $150 or more. Some of the more famous ones include Dom Perignon from Moet et Chandon, Cristal from Louis Roederer, Belle Epoque from Perrier-Jouet, Grand Cuvee from Krug and La Grande Dame from Veuve Cliquot.
Rest of the World Sparkling Wines Spanish Cava, French Cremant, Australian Sparkling Shiraz, Bubbly from New Mexico – these and thousands more make up the Sparkling Wine “not Champagne” category. The wines are great – in fact, many of the Champagne houses have outposts in the new world. Roederer purchased 580 acres in the Anderson Valley of California in 1982 and today produces 80,000 cases of Roederer Estate Brut, a perennial 90pointer with a price tag of around $20. Mumm also owns acreage in Napa Valley and makes 150,000 cases of non-vintage Brut Prestige selling for around $15 that always seems to land on the Wine Spectator Top 100 List. Domain Chandon, owned by Moet et Chandon, was founded in 1973 and now farms over 1,000 acres of California Pinot Noir, Chardonnay and Pinot Meunier used to craft a wide range of sparkling wines. Other outstanding California sparkling wine producers include Iron Horse, J Vineyards (part of the Jordan family) and Schramsberg. Gruet, a New Mexico winery, makes a variety of sparkling wines that represent some of the best values of the genre. The non-vintage Blanc de Noir (around $13) was recently named #43 on the 2011 Wine Spectator Top 100 List. Spanish sparklers, called Cava, are inexpensive and good choices to drink on their own or use for making mimosas or champagne punch. One of the best I’ve had was a 2007 Naveran Dama (around $20). Cordoniu and Segura Viudas are reliable producers as well. Great sparkling wines at reasonable prices are widely available and worth trying. Champagne or not, they make any occasion more festive, unique and, well, special!
NORTH TEXAS DENTISTRY
Disability Income Insurance What Every Dentist Needs to Know by Bob Michaels, CLU
hen you educate your patients about the basics of preventative dentistry, you’re not only showing them how to keep their smiles beautiful for life. You’re also helping them avoid learning the hard way about the most common dental disasters—up to and including the loss of their teeth. But have you prepared as well for your own future—in particular, your financial future? What if, for example, you suddenly become disabled—through an accident, an injury, or an illness—and are unable to work? Are you fully prepared for such a scenario? Statistics show that disability is much more commonplace than most people think: In a recent survey more than half of employees surveyed felt they had less than a 2% chance of becoming disabled during their working years, but in reality more than 25% of Americans entering the work force today (1 in 4) will become disabled before they retire.2 Perhaps you believe that you’re fully covered by a group policy or the association coverage you may have purchased. While group DI is often relatively inexpensive and easy to administer, it can also fall short just when you need it most—leaving you in for some unpleasant surprises when it’s too late to correct the situation. 32 NORTH TEXAS DENTISTRY | www.northtexasdentistry.com
Want to be better prepared? Consider the following:
Learn to speak the lingo The right disability income policy can help you keep your household going if you suffer a long-term disability. But before you go shopping for a DI policy, you need to know what features to look for—and the language the insurance industry uses to describe them. The following terms are part of the language describing high-quality policies, and are what you should look for to get coverage you can count on: Non-cancellable and Guaranteed Renewable. To avoid the possibility of losing your coverage just when you need it most, choose a policy that’s non-cancellable and guaranteed renewable to age 65. This will also guarantee premiums until age 65. With a group policy, you run the risk of being dropped and left unprotected at a time in your life when, due to your age or to a change in your medical condition, it could be very difficult to qualify for coverage with another provider. The premiums for your classification can also be increased at any time. Conditionally renewable for life. Although premiums may
increase after age 65, your policy should be guaranteed renewable for life, as long as you are at work full time. Own-Occupation definition of disability. Own-occupation coverage defines “totally disabled”—and therefore eligible for benefits—as not able to work in your own occupation even if you are at work in some other capacity. As a highly skilled professional who has invested much into your education and training, you want to make sure you have genuine own-occupation coverage so that even if you can teach, for example, in your field—but cannot practice dentistry—you are still eligible for benefits. A few companies even consider your ADA-recognized specialty your own occupation. Residual Disability coverage. Through a rider, a good individual DI plan can provide you with a benefit when you suffer a loss of income as a result of partial disability—even if you have never suffered a period of total disability. The best policies continue to pay a benefit even after you have returned to work fulltime so long as you have suffered a 20% loss of income. A choice of Riders. Riders offer optional additional coverage such as annual Future Increase Option, Automatic Increase and Cost of Living Adjustments, or “COLA”.
Protecting your practice, as well as yourself As a dental professional, you must also protect the source of your income: the practice you’ve worked hard to establish and grow. Special business DI policies, available from the same DI providers who offer high-quality individual coverage, offer your practice protection while you recover from a disability. For example, to help meet the expenses of running the office while you are disabled, consider a separate type of disability coverage known as Overhead Expense (OE). OE benefits reimburse your practice for expenses such as rent for your office, electricity, heat, telephone and utilities, as well as interest on debts and lease payments on furniture and equipment.
abled partner’s share of the practice. With the proper agreement in place before disability occurs, hard feelings and the conflicts of interest that can result from a partner’s disability can be avoided. The fact is, as part of your overall planning, you owe it to yourself to look into protection for the one thing that makes all the other planning possible: your ability to earn an income. n 1
CDA 2010 Consumer Disability Awareness Survey.
Social Security Administration Fact Sheet, January 2011.
Overhead expense insurance specifically designed for professionals reimburses some additional costs not included in regular business overhead expense policies—including the salaries of all regular employees who are not members of your profession. In a practice such as yours, for example, salaries for your receptionist and assistant would be covered, but not the salary of your dental professional partner(s) or employee(s). However, high-quality professional overhead policies will cover at least part of the salary of a professional temporary replacement for you, such as a dentist retained to fill in during your total disability. Dentists who are partners in a group practice will want to consider a policy known as a Disability Buy-Out (DBO). In much the same way that life insurance benefits can be set aside to fund a buy-out by the remaining partner if the other partner dies, this type of policy is designed to fund the healthy partner’s purchase of the dis-
Bob Michaels, CLU has been in the insurance business in Dallas, Texas for over forty years. He has been an Associate with the TDA Financial Services Insurance Program for the last eight years. Bob’s scope of operation in the TDA Insurance Program includes life, health, disability income, employee benefits, long term care, and malpractice insurance. For more information, visit www.TDAmemberinsure.com. You can contact Bob at bmichaels@TDAmemberinsure.com or call (214) 696-5103.
NORTH TEXAS DENTISTRY
Helping dentists buy & sell practices for over 40 years. AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.
Brandon S. Burgar, D.M.D. has acquired the practice of (Boston University 1999)
Walter J. Thomas, D.D.S. - Mineral Wells, Texas (University of Texas - Houston 1960)
AFTCO is pleased to have represented both parties in this transaction. â€œI have learned that an AFTCO analyst is the most important person in the world when it comes time to do a proper practice transition. I have been a buyer and a seller with AFTCO and I am exceptionally impressed by how dual representation works to the considerable benefit of BOTH the buyer and the seller at all times.â€? Alan S. Martin, D.D.S. (Duncanville, TX)
Call 1-800-232-3826 today for a free practice appraisal, a $2,500 value!
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construction & design
Is Building or Remodeling a Practice in Your Near Future? by Jorge Fernandez, Principal, ESA Construction
f you have considered completing a build out in a new space, or a remodel in your existing space or in a new location, read on for some helpful guidelines.
This article will help educate you on what to expect, what to look for in your space, and some questions to ask during your decision process.
It is advised you first choose a lender, realtor, and contractor with a proven track record in the dental community. All of those who will work with you should be familiar with the specifics and unique requirements of a dental office. Part of the process will include establishing a relationship with one of the many dental equipment companies in the DFW metroplex. You will also need to choose a lender. It is strongly suggested you evaluate those who participate in, and are familiar with your field. You will also need to choose a realtor who can provide updated information and location opportunities. This will be a critical element of your eventual success. Numerous items can affect your build out costs, as well as your monthly utility bills and construction expenses. Is there natural gas to the building for heating? Electric heat is generally more expensive, but you may offset some of the electric costs by using more efficient heat pump units. Does the building have post tension cables? If so, this can prolong the construction and add to the costs. Will your drains have sufficient drop based on your design and expectations? If you are looking at an existing space, do investigate if asbestos is present. Finding asbestos in an existing space can be costly to remove. Be sure and inquire about the age of an existing A/C unit or units. Will the landlord provide a warranty for the existing unit, or units?
There are several other significant areas you will want to consider, including the following: If the project is a remodel, the state comptroller’s office requires sales tax paid on the entire cost of the project, or “sales price”. If the project will be in a new space (and one never occupied), then only materials’ sales tax applies. This difference can equate to many thousands of dollars in costs. Will the project be subject to Road Impact fees levied by the city as it is being permitted? This has come as a surprise to clients in the past several years. Make sure you know the answer on the front end so you can plan for the fees if necessary. These guidelines and questions are considerations as you move forward with your objectives and goals of locating, building and financing your new practice. It is highly recommended you spend the quality preparation time today to evaluate the individual specialists who can assist you in making your dream office the reality of tomorrow. n
ESA Construction is one of the most experienced and leading design build dental general contractors in the DFW Metroplex. Specializing in turn-key dental office solutions since 1994, they truly strive to be “Your partner for the future”. Jorge Fernandez and Bruce Goodhartz, principals of ESA, are a step above your typical general contractors. Offering site selection evaluation, in-house design and engineering, Realtor, financing, architectural and dental equipment company referrals along with budget compilation, ESA will ensure that your project runs smoothly from start to finish. Please check out the many projects completed and services offered by ESA on the website www.esa-construction.com or call for a FREE no-obligation consultation or site visit at (972) 250-1170. We can also be contacted at firstname.lastname@example.org. Our offices are located at 17806 Davenport, Suite 107, Dallas, TX 75252.
NORTH TEXAS DENTISTRY
Provided by Leading Doctors in North Texas n High Resolution Photography n Step by Step Details of Treatment For more information on sharing your expertise in a future Smiles in the Spotlight contact
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bringing your practice to the next level You Can Do a “TON” for the New Year to Grow Your Practice by Richard V. Lyschik, DDS, FAGD The news is generally positive. Are you cautiously optimistic? Or are you just waiting to see what the future brings to your practice without doing something about it yourself? Why not take a different approach; be pro-active! There are a “TON” of things you can do to improve your practice:
Do you recognize some of these issues might apply to your practice? How do you get help to solve the problems, and how do you get answers to some of the tough questions? Is there anyone you can turn to and trust enough to point you and your “baby” in the right direction?
IT’S CONVENTION TIME!
Is the practice a “zoo” at times? Who “puts out the fires”? Who starts them? Do you have a “Million Dollar Team” or not? No, that is not the combined total of their salaries, but the production they can easily help your office generate if they are very well trained, professional, and goal-oriented! Recognize the leaders on your team. Who can you depend on the most? Everybody? Somebody? Anybody? Nobody?
Be sure you take advantage of your exclusive membership to attend. There are many great minds, creative concepts, and technological innovations to help your practice rise to the top! All you need to do is add discipline, structure, and direction. And if you think you are already doing everything the right way, then get that second opinion to see if you are on track!
O: OPERATIONS The average dental office is only operating at 40% of its potential because the dentist is “too busy” in the back. “Being busy” and “being productive” are not the same thing! Time management is the key. Put time on your side! Did you know there are doctor-hours, patient-hours, and staff-hours that need to be considered when running a dental office? How well do you keep those concepts separated to maximize your efficiency? Time management with creative scheduling can make for a further efficient and more productive business model. Is there an operations manual? Are there job descriptions? Is your office running at its peak efficiency? How would you know? N: NUMBERS What are the goals for the day, the week, for the month, for the year – for the future? Will you exceed last year’s numbers? You should! Do you read your practice reports at the end of the month? How many new patients are coming in the door? Is your average annual production per patient close to $700? Have you ever looked at your list of incomplete treatment plans? Last month, over one million dollars in incomplete treatment plans were found in a Duncanville practice that was for sale. When this was discovered, the Buyer, without hesitation, offered full price for the practice! The Seller left a lot of dentistry behind for the new Buyer. Doctor, don’t let your numbers get away from you!
How do you improve your practice’s TEAM, OPERATIONS, and NUMBERS to get a TON of rewards? Most importantly, how do you make the positive changes last permanently? Speak to the experts… the Convention is full of them! n
Richard V. Lyschik, D.D.S., FAGD is one of AFTCO’s leading innovative Senior Analysts who has helped over 2,900 dentists in associating, buying, expanding, or merging and guided older, disabled and/or “burned out” dentists to sell their practices. Dr. Lyschik’s clients have seen the considerable benefits of incentive programs, pension funding plans and increased productivity through his guidance. There is no substitute for experience in this business. Who better could you choose to talk to about your future transition plans than a seasoned fellow dentist, a recognized premier transition expert, and AFTCO Analyst of the Year Award winner? Check out the impressive AFTCO website at www.AFTCO.net, then call for a free appraisal and a no-obligation consultation with Dr. Lyschik at your office or the AFTCO office in Dallas, TX at (214) 893-0410 or 1-800-232-3826.
NORTH TEXAS DENTISTRY
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ESA Construction ............................inside front cover Med Dent Advisors..................................................29 Med+Tech Construction .............................back cover Nexus Dental Alliance .............................................21 Ray Bryant Photography .........................................11 Sockit! .............................................inside back cover Southwest Dental Conference ................................25 Structures and Interiors...........................................19 Thiel & Thiel .......................................................26/27 Tina Cauller.............................................................31 US Navy Recruiting.................................................33