sfdda Volume 57, No. 3 www.sfdda.org Winter 2016
President’s Message, Pg.3
Ethical Considerations In the Practice of Dentistry Continuing the Conversation The third of a multipart series: Financial Considerations. Pg.4
Top 5 Legal Questions,Pg. 11 Affiliate C.E. Dinner Meetings, Pg. 12 2016 Legislative Issues, Pg. 13 Classifieds, Pg. 19
The First Ever Joint Affiliate Officer Installation and Annual Business Meeting, Pg.8
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President’s Message Elaine deRoode, D.D.S.
At the South Florida District Dental Association, we celebrated the arrival of 2016 and hit the ground running! February has not yet closed and so much has happened: The SFDDA Lecture Series, FDA House Of Delegates (HOD), and Dentist Day on the Hill, to name a few. Our staff and many of our members are working hard to make this year a memorable one that brings with it unification and strength to our society. Led by Dr. Irene Marron-Tarrazzi, ADA Second Vice President, and Chairwoman of the SFDDA delegation to the FDA HOD, we proved to be a strong and influential team at the FDA House this past January. Among several noteworthy issues was a resolution requesting legislative support for a law similar to a Texas statute which requires secondary dental insurance carriers to pay for “all,” rather than only a portion, of a balance not paid by the primary insurance carrier. I look forward to seeing this resolution come to fruition in the June HOD.
Our affiliate societies have benefitted from the assistance of our SFDDA staff, helping to check-in members and record CE at affiliate meetings, maintaining current and accurate lists of members, consolidating and streamlining social media and website links and membership applications. This assistance has helped keep the focus of the affiliate boards on providing their own member services, including fascinating lectures – one of many reasons to join and to not miss your local affiliate society meetings! In addition, our staff has been integral in assisting new members with their application process from start to finish. We have seen membership at the SFDDA steadily increase during this last fiscal year. Finally, we are looking forward to hosting our first-ever combined installations of the boards of all three affiliate dental societies, and also conduct the SFDDA Annual Business Meeting. This event will take place on May 3 at the Kovens Conference Center on the campus of FIU in North Miami Beach. This will be an amazing opportunity for all affiliate societies to come together and celebrate. We look forward to continuing this tradition, while moving the location of the event each year to reflect each of our society’s geographic locations.
Diversity, leadership, financial and personal well being was the theme of the SFDDA Enrichment Lecture Series which took place in three parts starting in December. Many students, as well as members in various stages of their careers, attended the lectures which included, Dr. Sanjiv Chopra, Adrian Wilkins and concluded with Reese Harper, CFP earlier this month. Through an interactive presentation, Mr. I look forward to you joining us at this exciting upcoming Harper shared his simple formula for financial success and event, and the many other great future events planned for you by our local affiliate societies! retirement planning. I would encourage you to sign up for Mr. Harper’s weekly blog at: www.dentaladvisors.com.
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Ethical Considerations In the Practice of Dentistry Continuing the Conversation The third of a multipart series: Financial Considerations Richard A. Mufson, D.D.S., Editor
The beginning of this series took place in our Summer, 2015 issue, which sought to shed light on changes occurring within our profession over the past decade or more - and some of which have led many of us to question the nature of what is taking place within dentistry. As previously mentioned, the prevailing trends of most concern have had some relation, whether directly or indirectly, to issues involving ethics, or ethical decision-making. As if looking at ourselves in a metaphorical mirror, questions we could envision asking could include those such as, “May the procedures we choose to perform on a given patient be conceivably influenced by economic factors such as student debt, insurance plans and/or varying dental practice models?” Or, “Is the everescalating trend of itinerant dental surgical specialists (or those who claim to be specialists) traveling to ever increasing numbers of office locations throughout the city and state – when also considering the adequacy of preoperative evaluation and/or availability for post-operative follow-up care – helpful or harmful to our patients?”
pects of Referrals Within Dentistry.” And, my stated goal was to share the chapter with you, in several sections, in the form of a “multi-part series.” In the first article, following introductory comments, I began the discussion by first sharing the “preface” of the chapter, which essentially set the stage with my own view of the meaning of, or how I personally define, “ethics.” Part 2, which appeared in our last newsletter, included general information on patient referrals among the nine specialties within dentistry, and among others within the medical profession and ancillary health care community. This was followed by a section on the indications for patient referrals - i.e., having an appreciation for our own respective limitations, and knowing “when to refer,” while also citing, as a reference, Section 2.B. of the ADA Principles of Ethics and Professional Conduct - “Dentists shall be obliged to seek consultation, if possible, whenever the welfare of patients will be safeguarded or advanced by utilizing those who have special skills, knowledge and experience.” 1,2
“… direct “kickbacks,” or “fee-splitting” … is not only regarded as unethical in the practice of medicine and dentistry, it is also a violation of the laws of most, if not all, states and jurisdictions, and a violation of federal anti- kickback legislation when federally funded programs such as Medicare and Medicaid are involved.” “Are we performing an ever-widening scope of procedures which may exceed our training and expertise?” “Is the ever-more-invogue procedure of placing bone graft material into all or most extraction sites truly necessary?” “Are the procedures or treatment plans we recommend for our patients influenced more by what we want to do and accomplish, as opposed to what a given patient truly needs or wants?” As previously said, there are many other similar questions one could ask, imagine and discuss with one another. Sharing A Chapter Written For an Ethics Textbook - Part 3 As I related in the opening article, I had been asked several years ago to contribute a chapter for a textbook on the subject of ethics in dentistry. The chapter assigned to me was entitled, “Ethical As4
Other issues followed, including “misrepresentation of specialty status or training,” as well as an appreciation for when “not to refer” - i.e., if based on a patient’s race, religion, sexual orientation, whether a patient may have an infectious disease, such as HIV/AIDS, or when a genuine or forthright rationale, in the name of the best interest of the patient, is lacking.1-4 The next section of the chapter I would like to share is based on a topic which perhaps may not be the most convenient or comfortable to talk about, and perhaps not the most interesting in the eyes of many. However – referrals, when based on financial considerations, are no less important than other issues facing us in our daily practice, and which may at times be subject to question from an ethical perspective, or lack thereof, depending on individual scenarios or circumstances.
I would also like to repeat a previous disclaimer that (1) I do not consider myself an expert on the topic of ethics, but feel I have worthy information and opinions to share, and (2) if the information may appear too “basic” or elementary at times, or you may perceive a tone of being “lectured to,” please keep in mind that the chapter was written as part of a text for the expressed target audience of undergraduate and graduate dental students. Past 3 – Ethical Considerations in the Practice of Dentistry Referral Decisions Based on Financial Considerations Another group of referrals, which readily opens the door to potentially serious ethical questions - are those in which financial considerations may supersede the best interests of the patient. Three general categories of such referrals come to mind, and include those based on: (1) direct monetary advantage, such as kickbacks, also known as “fee-splitting,” or (2) when a lack of monetary advantage exists, or (3) when a monetary disadvantage plays a role. Let us further explore examples falling within these three categories. Category 1. Direct Monetary Advantage: Referrals falling within this category involve a financial incentive known as direct “kickbacks,” or “fee-splitting.” This practice is not only regarded as unethical in the practice of medicine and dentistry, it is also a violation of the laws of most, if not all, states and jurisdictions, and a violation of federal anti-kickback legislation when federally funded programs such as Medicare and Medicaid are involved.1,8 As mentioned earlier, the professions of medicine and dentistry are different from other businesses or professions, in which a “buyer beware” theme has no legitimate place, and patient wel-
Such practices are also inconsistent with ethical principles mentioned earlier of justice (“fairness”) and veracity (“truthfulness”), which are further addressed in Sections 4 and 5 of the ADA Principles, and which hold that dentists have a duty to “treat people fairly” and to be “honest and trustworthy in their dealings with people.” A separate question often raised when discussing the issue of feesplitting relates to whether this may, or may not, apply to the very common scenario of a dentist choosing to give an occasional gift at some point during the year (such as around the holidays) as a token of thanks for the sharing of a good professional relationship. The most common answer is that this generally does not fall below accepted ethical standards. However, if gifts, rebates or other remunerations are linked to specific or individual patient referrals, it is viewed as a violation of ethics, and in many cases, the prevailing laws as well. Other examples of referrals based on monetary incentives, which are not regarded as illegal, but in some instances, may be subject to ethical questions, may occur in situations involving “group dental practices.” A group practice is typically composed of one or more general dentists combined with one or more dental specialists. When patient referrals are required, an incentive may at times exist to keep the patient - along with their monetary funds they may otherwise spend elsewhere - “in house,” by referral to one of the dental specialists within the group practice. It should also be stated that the referring dentist may well regard the “in-house” specialist as highly qualified, and a very worthy choice of practitioner to whom he or she would entrust the care of a best friend or relative. However, a percentage of referrals take place on a daily basis in which the referring dentist may not feel the specialist within the group is as qualified as others outside the group, but may be discouraged from making outside referrals by those who own or administer the practice.
As a result, dentists within such group practices may face an ethical dilemma on a daily basis, in which they are required to make decisions as to whether to refer a patient to (a) a specialist who, in their opinion, may be more highly qualified and a more optimal choice for their patient, or (b) to a specialist who may be less qualified, but may better serve the financial interests of the owners or corporate administrators of the group dental practice. fare is to be placed well above that of our own self-serving economic interests. When a patient is referred to a specialist for evaluation or treatment, patients are entitled to, and should expect nothing less than, a professional chosen by the referring dentist for their level of knowledge, expertise and judgment, rather than for a reasons based on some hidden economic arrangement between the two dentists.
As a result, dentists within such group practices may face an ethical dilemma on a daily basis, in which they are required to make decisions as to whether to refer a patient to (a) a specialist who, in their opinion, may be more highly qualified and a more optimal choice for their patient, or (b) to a specialist who may be less qualified, but may better serve the financial interests of the owners or corporate administrators of the group dental practice.
The ADA Principles of Ethics and Professional Conduct, under Section 4.E., specifically deems the practice of a dentist accepting “rebates” or “split fees” as unethical.1 The same practice is also addressed and deemed unethical within the Codes of dental specialty organizations, including those of the American Association of Oral and Maxillofacial Surgeons (AAOMS) and American Association of Orthodontists (AAO).3,4
The difference between these two extremes of referral choices may not always be obvious and may, at times, instead be somewhat vague or unclear. However referrals made with the ladder goal in mind – i.e., financial considerations taking precedence over the best clinical interests of the patient - are regarded as a violation of ethical principles on multiple levels. continued on page 7
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Among these could include one or more principles discussed at the beginning of this chapter, including patient autonomy and veracity. From a patient’s perspective, they would like to assume, and by all rights should assume, that the choice of doctor they are being referred to for care would be made with their own best interest in mind, and moreover, that the process be transparent and honest, rather than contain hidden underlying motives, such as a financial one. Category 2. Lack of Monetary Advantage: An example falling within this category may include the referral of a patient out of the office to another consulting doctor or specialist, if done so under the guise of requiring more advanced care, but when the actual underlying reason may simply be a lack of finances and a resultant lack of motivation to keep the patient in the office. In many such cases, referrals take place without effective communication of the rationale for the referral or other extenuating circumstances (i.e., financial), and may result in frustration or a waste of time for a patient when going back and forth from office to office for inappropriate reasons and without proper communication. The specialist, in such cases, may then choose to take the ethical “high road,” and treat such patients with little or no finances at a reduced cost, or pro bono (especially in more emergent situations, such as when pain and/or swelling may be involved), or devote time toward searching out other potential legitimate venues for the patient and their needed care.
during a given month. And when patients do appoint, the dentist is often not permitted to charge an additional fee (or if so, a small, or greatly reduced, fee may be allowed) for services provided, with the possible exception of certain “non-covered” procedures. Aside from obvious ethical issues raised by the questionable incentives inherent within the very structure and design of such plan contacts, and the resulting influence on patient care, or lack of care, delivered, a separate set of ethical considerations may arise as related to patient referrals. As a result of hidden financial incentives, unsuspecting patients may be referred to specialists – but not for the typical reasons of requiring the higher level of expertise and care, and not taking into account the fact that their primary dentists may well be capable and competent to provide the treatment required - but rather for reasons involving a lack of monetary gain or reimbursement to be made should the patient remain within the office of their dentist. Patients end up on the losing end when referred to a specialist for apparent routine care, as they are destined to incur a significantly higher cost (although in some cases, they may receive, or be entitled to, a discount), as compared to the same treatment the contracted primary dentist could have provided, and rightfully should have provided, under the plan contract in their own office.
Some dental plan contracts do not take this into account, but rather assume that “all teeth are created equal.” … Under such agreements, the primary/general dentist may be required to treat [more complex]cases rather than refer to a specialist, or if not, face the threat of a potential monetary deduction from the monthly capitation check. It must be pointed out, on the other hand, that dentists are not obligated to accept every patient who walks in their door, and may legally and ethically decline to accept a patient for any number of reasons, including a lack of finances. However, the previous example given speaks more to one’s intent in referring a patient under the premise of requiring a specialist, but when a different hidden reason (finances) is the underlying primary motivating factor. In the absence of any other clinical considerations or rationale, many would consider this type of referral as questionable from an ethical point of view. Other examples of referrals based on “lack of monetary advantage” may be found among some dentists who are contracted providers with certain dental insurance plans, in which separate and conflicting ethical and legal interests may be involved in the process of patient referrals. 2 Under some plan contracts, dentists are paid and receive a set monthly “capitation” check in exchange for basic dental procedures they have agreed to provide - and are presumed as capable of providing - to a certain number of patients or families assigned to that office. The monthly fee received remains the same whether the patients choose to appoint, or choose not to appoint, for care
Category 3. Monetary Disadvantage: Under some of the same plan contracts, there are also situations in which a referring dentist may stand to lose money, in the form of deductions from the monthly capitation check, if a given paid consultant of the insurance carrier determines that a patient was referred to a specialist for a so-called “routine” procedure inappropriately, and that the primary dentist could have performed that particular procedure in their own office. Examples of this could include patients requiring certain endodontic procedures or dental extractions, which the primary dentist may view as more complex than he or she is trained or capable of performing. However, rather than refer the patient to a specialist – as they would ordinarily do for any similar patient not on the insurance plan in question – the dentist may elect not to refer and instead perform treatment on his or her own, under the pressure of not wanting funds deducted from the monthly “cap check,” and even if it were to mean the results of treatment may be substandard. As many experienced and prudent dentists are aware, certain teeth requiring endodontic therapy or extraction may appear “simple” or “routine” on a two-dimensional dental radiograph, especially in eyes and minds of some insurance plan consultants - but yet turn out to require a far more complex level of treatment than continued on page 9
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SFDDA 2015-2016 Officers and Executive Council President ELAINE DEROODE, D.D.S. (305) 373-7799 Vice President Mark A. Limosani, D.M.D., Msc (954) 800-3453 Secretary Joseph Pechter, D.M.D. (954) 981-0012
ftäxMayà{x Wtàx 3, 2016
Treasurer RODRIGO ROMANO, D.D.S., M.S. (305) 667-8766 Immediate Past President MARCOS DIAZ, D.D.S. (954) 659-9990
First Annual South Florida District Dental Association & Affiliate Society Installations & Business Meeting
Young Member ENRIQUE MULLER, D.M.D. (305) 931 0607 Trustees & FDA Line Officer Michael D. Eggnatz, D.D.S., FDA 2nd Vice President (954) 217-8888 Jorge Centurion, D.M.D., Trustee 305-662-22167 Beatriz Terry, D.D.S., Trustee (305) 279-2828
We are excited to bring together for the first time, South Florida District Dental Association’s affiliate Societies Miami Dade Dental Society North Dade-Miami Beach Dental Society South Broward Dental Society for the First Annual Officer Installation and Annual Business Meeting.
Alternate Trustees Jeannette Peña Hall, D.M.D. Rodrigo Romano, D.D.S., M.S. Delegates to the Executive Council from the Affiliates Societies Carlos Sanchez D.M.D. (MDDS) Esteban Leon, D.M.D. (MDDS) Richard Mufson D.D.S (ND/MBDS) Isaac Garazi, D.M.D. (ND/MBDS) Ross Schwartz, D.M.D. (SBDS) Affiliate Society Presidents
At this special event the officers for each affiliate society as well as the SFDDA will be voted on and installed that very night. The SFDDA will also conduct their business meeting which will include a state of the association address by President, Dr. Elaine deRoode and the voting of any resolutions that may be presented.
Alexandra Castillo, D.M.D. (MDDS) Chandy Samuel, D.D.S.(ND/MBDS) Mark Limosani, D.M.D. (SBDS) Richard A. Mufson, D.D.S., Editor Yolanda Marrero, Managing Editor Jackie Quintero, Advertising Manager SFDDA NEWSLETTER Copyright: © SFDDA 1996 Published by the South Florida District Dental Association 420 S. Dixie Highway, Suite 2E Coral Gables, FL 33146 Send announcements and correspondence to the Editor: 420 S. Dixie Hwy, 2-E Coral Gables, FL, 33146-2271 Phone: (305) 667-3647 FAX: (305) 665-7059 or email to: sfdda@sfdda.org
But most importantly, it will be a nice opportunity to share and celebrate the year’s accomplishments. The evening will include dinner and entertainment. Save the Date! May 3, 2016, 7:30pm Koven’s Conference Center North Miami, Florida.
Disclaimer: Opinions stated in the SFDDA Newsletter are not necessarily endorsed by the South Florida District Dental Association, its Executive Council or Committees. Advertisements printed should not be construed as an endorsement by the Association of the company, product or service.
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We look forward to seeing you there.
continued from pg 7
expected. Some dental plan contracts do not take this into account, but rather assume that “all teeth are created equal.” As an example, all single-rooted teeth (i.e., incisors, canines, certain premolars) requiring endodontic therapy, or those with two roots (i.e., upper first premolars, certain lower premolars or incisors) may be categorized as “routine” and less complex. Under such agreements, the primary/general dentist may be required to treat such cases rather than refer to a specialist, or if not, face the threat of a potential monetary deduction from the monthly capitation check. However, this makes little sense from a clinical point of view when considering the fact that some of the more challenging endodontic procedures, relative to performing adequate treatment and obtaining a successful result for the patient, may often involve teeth with only one or two roots. Upper lateral incisors, for example, are known to have an often forgotten and under-appreciated distal curvature associated with the apical third of the root, thereby resulting in a greater number of treatment failures and/or the requirement of endodontic retreatment or apical surgery as compared to many other teeth. Many single-rooted lower incisors or premolars may similarly appear “simple” to the unsuspecting or untrained eye, but may instead be quite complex, as they are known to have a relatively high incidence of two canals, hidden second canals, and varying patterns of branching and/or coalescing of canals, as compared to other teeth. Similar hidden challenges may exist relative to teeth requiring extraction. The intent of this discussion is not to incorporate clinical lecture material on oral surgery or endodontics, but rather to illustrate the point that the clinical realities of dental treatment and the factors influencing our judgment on issues, such as when a referral to a specialist would be appropriate and indicated for optimum patient care and safety, may often not coincide with the views of an insurance carrier, their plan contract, or paid consultant. Again, as mentioned earlier, allowing financial considerations to take precedent over that which may be in the best clinical interests of the patient, or as in the above example, allow insurance carriers, their contracts, or paid consultants dictate decisions which may supersede competent or optimum patient care – is regarded as a violation of multiple ethical principles discussed earlier and alluded to throughout this chapter.
Announcement: The SFDDA is currently taking nominations for the following leadership positions:
To summarize, this brings us back to the important principles which take into account the rightful expectations of our patients that, (a) our intent and actions take place with their best interest in mind (beneficence, “do good”), (b) we refrain from decisions or actions which would not be in their best interest (nonmaleficence, “do no harm”), and that (c) we treat them with fairness (justice) and honesty (veracity), and as we ourselves would expect to be treated. Also going hand in hand with the expectation of truthfulness and lack of any hidden motives or agendas when making referral and treatment decisions, is the right of all patients to take part and play a role in determining their own treatment decisions, their own self-determination, and what is in their own best interest (patient autonomy, “self-governance”). Future Chapter Sections Include: - Decisions Affecting Our Choice of Specialist or Consulting Doctor - Proper Communication in the Referral Process - Ethical Considerations From the Specialist/Consulting Dentist’s Perspective - Respect for the Referring Dentist-Patient Relationship - Justifiable Criticism - Choosing Words Carefully When Speaking About Others References: 1. Principles of Ethics and Code of Professional Conduct, with official advisory opinions, American Dental Association, revised to 2011. 2. General Guidelines for Referring Dental Patients, American Dental Association Council on Dental Practice, revised 2007. 3. American Association of Oral and Maxillofacial Surgeons Code of Professional Conduct, September, 2011. 4. Principles of Ethics and Code of Professional Conduct, American Association of Orthodontists, adopted May, 1994, amended through May, 2009. 5. Ethics Handbook for Dentists: An Introduction to Ethics, Professionalism, and Ethical Decision Making, American College of Dentists, Gaithersburg, MD, 2008. 6. Mufson, RA, Dentists Talking Negatively About Dentists, East Coast District Dental Society Newsletter, Volume 40: No 1, pg 4-5, September/October, 1998. This article is the third in a series on the topic of ethical considerations in the practice of dentistry. Dr. Mufson is the editor of the SFDDA Newsletter, and may be contacted at (305) 935-7501 or MufsonOralSurg@aol.com
SFDDA Secretary - Open Seat SFDDA Treasurer - Incumbent, Dr. Rodrigo Romano FDA Trustee - Incumbent, Dr. Jorge Centurion FDA Alt Trustee- Incumbent, Dr. Rodrigo Romano To request a candidate application or to nominate someone please call (305) 667-3647. You may also download and application at www.sfdda.org
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WHA WHAT ATT SHOUL SHOULD I KNOW KNOW ABOUT “PATIENT “PPATIENT T ABANDONMENT” ABANDONMENT” AND TERMINA TERMINATING ATING T THE DOCTOR/PATIENT DOCTOR/PPATIENT T RELATIONSHIP? RELA LA ATTIONSHIP? Impr Improperly operly terminating terminating the doct doctor/patient or/patient rrelationship elationship is commonly commonly known known as “patient abandonment.” If the patient suffers suffers harm because because of of how how you you or yyour our employees employees tterminated erminated the rrelationship, elationship, yyou ou ma mayy be hel heldd liabl liable. e. Mak Makee it yyour our writ writ-tten en ooffice ffice policy tto o send patients lleaving eaving yyour our pr practice actice a writt written en notic noticee or cconfirmation onfirmation that your your office office is no llonger onger tr treating eating them as a patient ooff rrecord. ecord. Don’t make make the letter letter eff effective ective “immediat “immediately. ely.” Immediat Immediatee ttermination ermination doesn’t giv givee the patient enough time to to locate locate another doct doctor. or. Pl Please ease rremember emember that yyou ou rremain emain llegally egally and ethically ethically rresponsible esponsible ffor or pr providing oviding emer emergency gency ccare. are. Don’t den denyy it ttoo them bbyy a poorl poorly-worded y-worded notification notification lletter etter that might be admissibl admissiblee as eevidence vidence against yyou. ou.
WHO DO I CALL ALLL IF I SEE UNLICENSED PRACTICE PRACTICE OF DENTISTRY OCCURRING? DENTISTRY OC O CURRING? Call the Unlicensed Unlicensed Activity Activity Unit (ULA) hotline of of the Department of of Health Health at 1-877-HALT-ULA (1.877 .425.8852) or visit their website website (floridahealth.gov/ (floridahealth.gov/ 1-877-HALLT-ULAA (1.877.425.8852) ( licensing-and-regulation/enforcement/report-unlicensed-activity). Unlicensed ensed pr practice actice licensing-and-regulation/enforcement/report-unlicensed-activity). Unlic is a felony Florida orida and shoul shouldd be rreported eported immediat immediately. ely. felony in Fl
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The Lighter Side of C.E. South Florida District Dental Association Joining an affiliate society simple as calling us Affiliate Society Dinner Meetings & More isatas305.667.3647or visit At the SFDDA, we offer many opportunities for you to receive continuing education, participate in personal enrichment and meet and mingle with your colleagues. There are three affiliate societies under our umbrella including North Dade /Miami Beach, South Broward and Miami Dade Dental Society. Each society meets in an area near your practice or your home, making it easy for you to attend continuing education dinner meetings throughout the year. Enjoy a very nice meal while receiving CE credit at the many interesting lectures being presented. Whether it may be information on the latest science, technology and practice management or programs designed to inspire, the SFDDA and its affiliate societies are always thinking of ways to help you succeed. Miami Dade Dental Society Dr. Alexandra Castillo
North Dade / Miami Beach Dental Society All Meetings Held at Bonefish Grill, Aventura March 1, 2016 Dr. Irwin Becker “How Emotional Intelligence Has Become Essential In Dental Practice Success”
South Broward Dental Society All Meetings Held at Tropical Acres, Davie March 9, 2016 Dr. Ozwaldo Mayoral “Microscope Based Dentistry”
North Dade / Miami Beach Dental Society Dr. Chandy Samuel
sfdda.org and click on “affiliates”
Miami Dade Dental Society All Meetings Held at Graziano’s, Coral Gables March 8, 2016 Dr. Irene Marron “Current Approaches to the Assessment, Diagnosis and Treatment of Halitosis”
April 5, 2016 Dr. Rodrigo Romano “Regeneration”
South Broward Dental Society Dr. Mark Limosani
2016 Legislative Issues The FDA’s Governmental Action Committee (GAC), in collaboration with the FDA Board of Trustees and the FDA House of Delegates, prepare for each legislative session by developing an “issues sheet” outlining dental related priorities to be addressed during the legislative session, on the issues as they happen (please visit www.floridadental.org for complete details and updates. And the following represents this session’s issue sheet (with the word “Support” or “Oppose” indicating FDA’s position on a given issue).
Donate Dental Services Program (Support) In 1997, the Florida Dental Lifeline Network and the South Florida District Dental Association established the Donated Dental Services (DDS) Program, which eventually evolved into a statewide program supported by the Florida Dental Association. The DDS Program allows dentists and dental laboratories to donate comprehensive treatment to people with disabilities, the elderly, the medically fragile, or to those who cannot afford dental care.
Dental Care Access Account (Support) - For Repayment of Student Loans and More During the 2016 Legislative Session, legislation will be considered that will help provide an opportunity for dentists to practice in underserved areas and have the ability to pay back their student loan debt. SB 234 and HB 139 will establish dental care access accounts for eligible dentists who are able to secure local funds that will then be matched with state funds, while practicing in a dental health professional shortage area, medically underserved area or treating medically underserved populations. The Department of Health (DOH) would be authorized to establish no more than 10 new dental care access accounts per year. Eligible dentists participating in this program could receive matching funds of up to $100,000 per dentist per year for up to 5 years, if all requirements are met. Dentists will then be able to use these funds for repayment of their student loans, or for investment in property, facilities or equipment needed to set-up a dental practice. In order to remain eligible to receive funds from the dental care access accounts, dentists must agree to practice in an underserved area for at least two years, or otherwise forfeit their eligibility and access to the funds in the dental care access account. Additionally, a dentist can access these funds if he/she shows a commitment to opening a private practice in one of the areas designated, maintain an active Medicaid provider agreement, enroll in one or more Medicaid managed care plans, and expend sufficient capital to make substantial progress in opening their own dental practice.
Currently, 400 Florida dentists and 200 Florida dental labs participate in the DDS Program. They have helped over 1,511 patients in Florida with seriously neglected dental problems and have donated almost $5.8 million in dental services. These individuals would end up seeking dental care in the emergency room if it were not for the volunteers who provide their services for free through this program. Seeking dental care through an emergency room setting is cost prohibitive and would not resolve the patient’s underlying issue. Nationwide, with over 15,000 dentists and 3,600 dental labs, the program has provided $250 million in donated dental services. The FDA supports state funding for two full-time coordinators and operating expenses for the DDS Program through the Dental Lifeline Network at approximately $170,000, recurring annually.
Recent reports have indicated that dental students are graduating with an average student loan debt of $250,000 from public dental schools and $400,000 from private dental schools. This substantial amount of debt typically dictates what areas of the state dentists move to after graduation in order to meet their debt obligations. It has been noted that some participants from previous student loan repayment programs have set-up their dental practice in the area where they served out their dental student loan repayment commitment. By providing financial support to dentists, more people will be given the opportunity to access quality dental services. This program has the potential to create a winwin situation for the state of Florida, for dental graduates and for patients who will have access to much needed dental care.
Community Water Fluoridation (Support) Proclaimed as one of the 10 greatest public health achievements of the 20th century by the Centers for Disease Control and Prevention (CDC), community water fluoridation has proven to be one of the most efficient and safest ways to prevent dental decay, which is one of the most common childhood diseases. Studies show that for more than 65 years, community water fluoridation has resulted in a significant reduction of tooth decay among individuals of all ages, and especially those without access to regular dental care. Fluoride is naturally occurring and is present in all water sources. In Florida, about 77 percent of the population receive optimally fluoridated water. Community water fluoridation is simply the precise adjustment of the natural occurring fluoride to the level recommended for optimal dental health. The level of concentration, established by the U.S. Public Health Service, is currently set at 0.7 milligrams per liter. Apart from recommendations by the CDC, the public health benefits of water fluoridation is recognized by the American Dental Association (ADA), the American Medical Association (AMA), the World Health Organization (WHO) and 125 other national and international organizations. One argument against adding fluoride to the water supply is budgetary restraints. The average annual cost for a community to fluorcontinued on page 15
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idate its water system is estimated to range from approximately $0.50 a year per person in large communities to approximately $3.00 per person in small communities. Compared to the cost of dental treatment, community water fluoridation actually provides cost savings. For most cities, every $1 invested in water fluoridation saves $43 in dental treatment costs. In fact, the average lifetime cost per person to fluoridate a water system is less than the cost of one dental filling.
tiveness of the MMA plans to: • Increase patient access to dental care • Improve dental health • Achieve satisfactory outcomes for Medicaid recipients and the dental provider community • Provide outreach to Medicaid recipients • Deliver value and transparency regarding the dollars intended for – and actually spent on – dental services
While representatives from both sides of the fluoridation issue have expressed passionate views, the facts at hand are unequivocal. In 2012, 74.6 percent of the U.S. population on public water systems received optimally fluoridated water. Fluoridation has been thoroughly reviewed in the United States’ court system, and found to be a proper means of furthering public health and welfare. No court of last resort has ever determined fluoridation to be unlawful. The overwhelming weight of credible scientific evidence consistently indicates that fluoridation of community water supplies is the single most effective, safe and economical way to prevent dental decay among citizens, regardless of their age or socioeconomic status.
The Legislature will use this report to determine whether to separate dental from medical in the MMA program. If the Legislature fails to take action on this issue during the 2017 Session – or before July 1, 2017 – AHCA must move ahead with implementing a statewide Medicaid prepaid dental health plan for children and adults that is separate from medical, and use at least two dental managed-care plans, which was the system used for pediatric dental care before the state transitioned all Medicaid to the MMA.
The FDA supports the optimization of fluoride levels in community water systems in Florida and encourages the state to dedicate $1 million in recurring general revenue to continue these efforts locally. Sunset Review of Medicaid Dental Services (Support) During the 2011 Session, legislation passed to transition all Medicaid services to managed care by October 2014. This means that health care providers who participated in the Medicaid program no longer contract directly with the Agency for Health Care Administration (AHCA) to provide services. Instead, providers are required to contract with a managed care company directly for services and reimbursements to participate in the Medicaid program. Prior to the transition, pediatric dental care was provided through the prepaid dental health plan (PDHP), under which AHCA contracted with MCNA and DentaQuest dental managed care plans, to provide services. As the state transitioned all Medicaid recipients into managed care plans, the FDA supported keeping dental funds separate from medical funds. Funding for dental services in the state budget is extremely limited. Of the $24 billion Medicaid budget, less than one percent is spent on dental care. The FDA supports the separate payment methodology for Medicaid dental services. This would result in a less complicated system and ensure that more tax dollars go toward patient care and less towards program administration. SB 994 by Joe Negron (R-Palm City) and HB 819 by Rep. Jose Felix Diaz (R-Miami) are supported by the FDA. Encounter data is crucial in determining whether dental services are actually being utilized in a managed care model. To that end, this legislation requires AHCA to prepare a comprehensive report on dental services provided under the Medicaid Managed Medical Assistance (MMA) program, which combined medical and dental care under the same program. The report is due by Dec. 1, 2016 and must examine the effec-
Increase Medicaid Dental Funding (Support) Florida’s $24 billion Medicaid program does not provide adequate resources for dental care. Funds appropriated to dental care in the Medicaid program make up only about 1% of the overall Medicaid budget. The FDA supports an increase in the overall funding of the Medicaid dental program and a thorough assessment of the policies and administration of the program. Extremely low reimbursement rates for Medicaid dental providers have been a significant barrier for increasing the number of dentists willing to participate in the Medicaid program. During the 2011 Legislative Session, the Legislature approved a $56 million reimbursement fee increase for children dental services only. The FDA applauds the Legislature’s effort to address an area of the Medicaid program that has not seen any significant changes in over 20 years. However, even with this fee increase, Florida still ranks in the bottom of all states for Medicaid reimbursement rates. Current Florida Medicaid reimbursement rates are 36 percent of private dental insurance rates. Under the statewide managed care program, the medical plans contract directly with the dentists or through a dental managed care plan and the majority of the plans continue to set the reimbursement rates at the Florida Medicaid rate. There needs to be a larger portion of money designated specifically for dental care in the Medicaid program so the plans have the ability to increase the reimbursement rates for dental care. Maintain Educational Standards for Internationally Trained Dentists (SUPPORT) Current law requires that graduates of non-acccredited dental schools complete a 2-year supplemental general dentistry education program before taking the Florida licensure exam. The purpose of the supplemental education program is to: 1) ensure that internationally-trained dentists attain the same knowledge and skills as graduates of accredited programs and 2) familiarize internationally-trained dentists with the oral health care delivery system in the U.S., including the techniques, procedures and standards of oral health care. In the past, there have been legislative efforts that tried to create a “back-door” pathway to licensure in Florida for internationallytrained dentists. There have been proposed changes to the current continued on page 17
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Finally…a place to send those difficult patients!
Dr. Harold Menchel limits his private practice to treatment of TMD and orofacial pain in Coral Springs.
TMD Headache Neuropathic pain Sleep disordered breathing (OSA) Dr. Menchel coordinates treatment with restorative dentists, orthodontists, endodontists, and oral surgeons for these complex patients.
Dr. Menchel has been in practice in S. Florida since 1981. He received the majority of his training at the University of Florida Parker Mahan Facial Pain Center under the tutelage of Drs. Mahan and Gremillion from 1992Ǧ 1999. He achieved the prestigious Diplomate of the American Board of Orofacial Pain in 2000. Treatment includes: (partial list) Splint therapy, medical management, physical therapy, joint mobilization, diagnostic and therapeutic injections. All referrals will be respected and appreciated. 1720 University Drive, Suite 301, Coral Springs, FL 33071 (954) 345Ǧ2264 website; tmjtherapy.com
continued from pg 15
law that would provide exemptions for internationally-trained dentists who agree to treat Medicaid recipients in exchange for bypassing the supplemental education requirement. The FDA believes that all Floridians should have access to the same standard of care regardless of economic status. These supplemental education programs are offered to ensure that a minimum standard of care for Floridians is consistently achieved for all licensees in the state. The FDA supports maintaining the current supplemental education requirement for internationally-trained dentists. Florida’s Action for Dental Health (SUPPORT) In February 2015, the FDA rolled-out Florida’s Action for Dental Health, a comprehensive plan developed to implement initiatives that will focus on improving the oral health, and resulting overall health, of all Floridians. Since then, the FDA has been involved in supporting initiatives like the Community Dental Health Coordinator (CDHC), who serves as a patient navigator helping individuals access available dental care in their communities. By incorporating the CDHC into the dental workforce, patients will benefit from coordination of care, educational and social interventions in the community, and prevention. CDHC’s work under the dentist’s supervision in clinics, schools, and other public health settings with people of similar ethnic and cultural backgrounds. They will also be able to provide limited clinical services such as radiographs, fluoride treatments, sealants and coronal polishing. During a radio interview with WFSU/NPR affiliate on Florida’s Action for Dental Health, a concerned parent called the radio station to inform listeners that as a foster parent, he was unable to find a dentist who could treat his foster child because the state had not contracted with a managed care company in his local community. Based on this information, the FDA contacted the DOH to look into this situation. As a result, the DOH eventually finalized an agreement with a dental managed care plan to provide dental care to foster children in eight counties: Jefferson, Leon, Madison, Marion, Suwannee, Taylor, Volusia and Wakulla. The FDA applauds the work of the DOH and their continued support in improving access to dental care.
These are a few examples of the many accomplishments achieved by the efforts of Florida’s Action for Dental Health. The FDA will continue to work on this plan and look forward to many more success stories. Medicaid Reimbursement for Dental Hygienists (Oppose) The FDA opposes issuing a separate Medicaid provider number to dental hygienists for the limited services that may be provided in public health access settings. Current law is adequate and flexible enough to allow hygienists to collaborate as needed in order to utilize existing provider numbers that are already assigned to dentists and physicians. This information was reprinted with the permission of the Florida Dental Association and the Governmental Affairs Office.
FDA Staff Contacts: - Joe Anne Hart, Director of Governmental Affairs: jahart@florida - Alexandra Abboud, Governmental Affairs Coordinator: aabboud@floridadental.org - Casey Stoutamire, Lobbyist: cstoutamire@floridadental.org (800) 326-0051 or (850) 224-1089 Get the latest legislative updates at www.floridadental.org/members/governmental-affairs/legislative-action-center/capital-report
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Classifieds
OPPORTUNITIES AVAILABLE FAMILY DENTIST: Hallandale Beach family-owned, private practice seeks team-oriented doctor to treat adults and children. You must have at least 3 years of experience in these areas, and willing to become a Medicad provider for children, if you are not one already. Adult patients will be seen on a fee for service or private insurance basis. You must be available to work in our office 2-4 days each week. We prefer that you are bilingual in English and Spanish. Please email your CV, including current contact information, and the days and times that you are available to meet with us, to southeastfloridadental@live.com PEDIATRIC DENTIST: This is a tremendous earning opportunity for a Pediatric Dentist to join a high quality single owned multi-specialty practice. These highly successful dental practices are located in Country Walk and West Kendall. FT or PT, could lead to partnership. Start working immediately. Please contact Dr. Nick Lekkas 954-383-4973 or email drnicklekkas@altimadentalgroup.com DENTAL ASSISTANT: Pediatric/General Dental Practice is seeking a experienced dental assistant for operative assisting, and prophylaxis treatment. You must be bi-lingual in English and Spanish, or English and Russian. Expanded Duties Certification, and experience assisting in orthodontic treatment are both valued highly. Benefits will be offered to qualified employees. Please email your resume, including current contact information, and the days and times that you are available to meet with us, to southeastfloridadental@live.com ORTHO/PEDONTIST/ENDODONTIST: Excellent opportunity for associate dentist position available PT. Start working immediately 2 Locations Miami/Aventura area. State-ofArt facilities. Please fax resume to (305) 5539688 or email to onestopsmileshop@hotmail.com PART TIME: High quality prosthodontist and periodontist needed for selective cases at my office. Please call or e-mail. David Vine, D.D.S. 305.538.1115 ( dvine@davidvinedentist.com ).
SEEKING: an “on call” substitute General Dentist in Dade Co. Salary Negotiable. Ideal opportunity for retired or persons needing extra income. Please call for details. Judy Jones 615202-8864
ORTHODONTIST WANTED: We are a growing dental group looking for an Orthodontist to join our dental team. Excellent compensation. English/Spanish required. Call Manuel 305.915.2953
ORTHODONTIST: Hallandale Beach family-owned, private practice seeks team-oriented Orthodontist with at least 3 years of expierence in your specialty to work in our office one day each week. Please email your CV, including current contact information, and the days and times that you are available to meet with us, to southeastfloridadental@live.com
GENERAL / SPECIALIST: Ft/Pt Great opportunity for General Dentist / Specialist. Excellent compensation, bonus and partnership positions. Multiple locations in South Florida. Please fax resume to (305) 770-1232 or call Kathy (954) 430-2188 or email to haroldhui@aol.com
PEDIATRIC DENTIST WANTED: Excellent opportunity for Pediatric Dentist to share office space in a well established Orthodontic practice in Plantation Fl. Office is available 13 days per week. Ideal location in a spacious & modern facility located directly next to a large Pediatrician group practice. Perfect situation for an initial start up or satellite office location. Contact: pltnortho@gmail.com A BLOCKBUSTER OPPORTUNITY: Full or part time for General Dentists, Pedodontists, Periodontists, Oral Surgeons, Orthodontists and Endodontists. Generous compensation with unlimited potential. Guaranteed referrals. Join our group specialty care practice with a significant general dental component. Established in 1975 in Aventura, Coral Springs, Delray Beach, Boynton Beach, Stuart, Ft. Pierce and Melbourne. Call: Kelly Oliver at (954) 461-0172. Fax resume to: (954) 678-9539. Email: careers@dentaland.net. FLORIDA (SOUTHEAST AND ORLANDO): Seeking experienced General Dentists and Specialists to come grow with us! We offer excellent earning potential and the opportunity to focus on patient care in our state-ofthe-art facilities. We take care of the administration (insurance claims, payroll/staffing, marketing, etc.) for you so that you can enjoy a work-life balance again! Take the next step in your career and apply online at www.gentledentalgroup.com/career or email your CV to careers@gentledentalgroup.com today!
GENERAL DENTIST WANTED: Hialeah, Pembroke Pines or Kendall area, excellent compensation and bonus with guarantee income. Eng/Spanish required. Call Manuel 305.915.2953 BUSY DENTAL PRACTICE: Looking for PT associate dentist in Fort Lauderdale and Delrey Beach. Competitive % compensation based upon experience. Ask Dr. Martin 786525-9946
OFFICE SPACE-SALE OR RENT HALLANDALE BEACH: Practice for sale, 3ops, FFS/PPO. Located in a professional building. Nice equipment, good lease terms. Dr. relocating out of state. For details call (954) 471-7569 or email claus22h@yahoo.com SPACE AVAILABLE TO SHARE: 1300 Ft. facility in NMB near I-95 and Aventura. Only utilized 2+days Dr. Steven Rifkin srifkindds@gmail.com DOWNTOWN BOCA RATON: 2450 SF office. Move in ready. 4 private treatment rooms, 2 hygienist stations, lab, private office w/ shower. Immediate occupancy. $28 PSF. Call Lee at (561) 392-8894 or e-mail at Lburke@bbbins.com Buy, sell, hire, or announce? Place advertising in the SFDDA Newsletter Call Ms. Jackie Quintero at (305) 667-3647 ext. 13. Or visit us on-line at www.sfdda.org
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