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Horizon • A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE PROVIDED BY THE MEMBERS OF THE FLORIDA DENTAL ASSOCIATION

WE KNOW INSURANCE. WE KNOW DENTISTS. CALL YOUR FDAS RISK EXPERTS! DAN ZOTTOLI DAN

ATLANTIC COAST DISTRICT INSURANCE REPRESENTATIVE 561.791.7744 • Cell: 561.601.5363 dan.zottoli@fdaservices.com

DENNIS HEAD DENNIS

CENTRAL FLORIDA DISTRICT INSURANCE REPRESENTATIVE 877.843.0921 (toll free) Cell: 407.927.5472 dennis.head@fdaservices.com

JOE DUKES JOE

FDA Services is committed to being your trusted resource for insurance. We are here to help you and your staff.

NORTHEAST & NORTHWEST DISTRICT INSURANCE REPRESENTATIVE 850.350.7154 • Cell: 850.766.9303 joe.dukes@fdaservices.com

JOSEPH PERRETTI JOE

SOUTH FLORIDA DISTRICT INSURANCE REPRESENTATIVE 305.665.0455 • Cell: 305.721.9196 joe.perretti@fdaservices.com

RICK D’ANGELO RICK

WEST COAST DISTRICT INSURANCE REPRESENTATIVE 813.475.6948 • Cell: 813.267.2572 rick.dangelo@fdaservices.com

A Member Benefit Since 1989

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he Florida Dental Association (FDA) Subcouncil on the New Dentist publishes Horizon: A New Dentist’s Guide to a Successful Practice. It is designed to help practitioners who graduated from dental school in the last 10 years or are new to Florida. The Subcouncil on the New Dentist is composed of FDA members who can help new dentists as they begin their careers in Florida. Council members represent each of the FDA’s six component dental associations. Consultants include representatives from the American Student Dental Association and the American Dental Association Committee on the New Dentist. Organized dentistry is founded on a tripartite membership structure. In Florida, this tripartite system consists of the ADA, the FDA and six regional dental societies. Organized dentistry at all levels encourages and perpetuates improved oral health for the public. It also promotes the art and science of dentistry. For more information, contact the FDA’s Member Relations Department at 800.877.9922; fax, 850.201.5013; or email, scnd@floridadental.org.

INSIDE …

An Invitation to Join Organized Dentistry  2 American Dental Association  3 Florida Dental Association  4 Component Dental Associations  6 Online Resources  7 Allied Dental Organizations  8 Informed Consent Form  11 Regulatory Agencies  12 Best Management Practices for Scrap Dental Amalgam  14 Your Dental Team  15 Your Office  16 Five Risk Management Tips for Dental Practices  18 Your Peer Review Program  20 Q & A  22 Legal FAQs  23 Staff Directory  24

© 2014 Florida Dental Association

FLORIDA DENTAL ASSOCIATION

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An Invitation to Join Organized Dentistry

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ear Colleague,

The Florida Dental Association (FDA) is the voice of dentistry in Florida. It officially represents almost 7,000 Florida-licensed dentists. If not for the FDA, your profession would be markedly different today. The word “profession” denotes a calling that is bound by different rules than the average vocation. A profession practices by the highest standards, sets policies that place the public first, is self-regulating and adheres to a high ethical code. Your membership in the FDA signifies to the public your commitment to excellence. It demonstrates your resolve in keeping up with current scientific advances. And, it provides you with a forum of communication with colleagues throughout Florida and the nation. The Florida Dental Association is blessed by a public persona that is unsurpassed in health care. We have maintained a standard of care that is without equal. Our legislative leaders respect our opinions and act on our efforts to maintain our autonomy and prestige. These leaders know when we speak to them, we speak with integrity and truth. The benefits of membership, without a doubt, pay for the costs of membership many times over. But this is only a small part of the true meaning of joining the Florida Dental Association. The Florida Dental Association is dentistry in Florida. For the sake of this wonderful profession, it must remain strong and active. Your commitment to the future of your profession cannot be complete without membership in your FDA. Join us and the many thousands of your colleagues who guide the course of our great profession. Sincerely, The FDA Subcouncil on the New Dentist

FDA Services Inc. is a sponsor of the Florida Dental Association Membership Recruitment and Retention Program.

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HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

American Dental Association

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he American Dental Association (ADA) has several products and services for new dentists. With the ADA’s toll-free number, new dentists have access to financial services, publications and seminars, insurance services and legal information. American Dental Association 211 E. Chicago Ave. Chicago, IL 60611-2678 800.621.8099 or 312.440.2500 Website: www.ada.org

GET TING STARTED

Through the ADA, the Committee on the New Dentist provides a variety of resources. • New Dentist Resource Kit • Career Options for New Dentists • Words of Wisdom booklet • A New Dentist’s Guide to ADA Membership

ADVOCACY

Organized dentistry is represented on a national political level through the ADA’s office in Washington, D.C. As your “voice” in Congress, the ADA focuses on these issues: • OSHA • Drug Enforcement Administration • Health-system reform • National Practitioner Data • Bank regulations

PUBLICATIONS

ADA publications offer the latest scientific developments, information about clinical procedures and news about important dental-community events. • Journal of the American Dental Association • ADA News • ADA New Dentist News (for new practitioners)

CONTINUING EDUCATION

The ADA’s website contains valuable content exclusively for members, including a section specifically for new practitioners.

The ADA offers online CE courses at a reduced rate to member dentists. The Journal of the American Dental Association (JADA) also awards up to two credit hours a month through the JADA Online Continuing Education program. Go to www.adaceonline.org.

NEW DENTIST NOW BLOG

ADA LIBR ARY

ADA ONLINE — W W W. ADA .ORG

New Dentist Now features resources for new dentists and dental students as well as news and insight on the dental profession and beyond. Visit newdentistblog.ada.org.

CENTER FOR PROFESSIONAL SUCCESS

This interactive web resource offers members with relevant and effective solutions that member dentists can use every day: managing your career, expanding your knowledge and balancing your life. Visit success.ada.org.

EVIDENCE-BASED DENTISTRY

The ADA Center for Evidence-based Dentistry provides systematically assessed evidence as tools and resources to support your clinical decisions. Visit ebd.ada.org.

FINANCIAL SERVICES

• Financial planning • Accepting charge payments from patients • Retirement • Qualifying for Prudential home mortgage • Loan consolidation

LEGAL INFOR M ATION

• OSHA regulations • Federal-law issues (antitrust, insurance-contract appraisal) • AIDS-related issues

FLORIDA DENTAL ASSOCIATION

Members enjoy full library privileges, including mail order and photocopy services, at the most complete facility of its kind.

NEW DENTIST RESOURCE KIT

Gathered from divisions throughout the ADA, the information in this comprehensive kit includes ADA resources that specifically meet the new dentist’s needs. For more information, contact newdentist@ada.org.

ETHICS HOTLINE

This member service is designed to assist new dentists and other members manage ethical challenges that may arise in day to day practice. The Ethics Hotline is not a legal resource but rather a service for helping to resolve ethical dilemmas, much like an ethics consult service.

The unity of a tripartite membership produces a more effective dental profession. The ADA, FDA, and local associations enable us to speak with a unified voice at the national, state, and local levels.

— Erin A. Shiveler, DMD

Dr. Erin A. Shiveler Tallahassee Northwest District Dental Association

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Florida Dental Association YOUR OTHER STAFF

he FDA is part of an interactive network of professionals that allows dentists to come together, pool their resources, receive membership benefits and accomplish goals they cannot realize separately. Florida Dental Association 1111 E. Tennessee St. Tallahassee, FL 32308 800.877.9922 or 850.681.3629 Website: www.floridadental.org Email: fda@floridadental.org

FDA SERVICES INC.

FDA Services Inc., the FDA’s wholly owned subsidiary, provides members with a variety of high-quality insurance programs at competitive rates. FDAS is licensed to perform the functions of a third-party administrator. It is dedicated to meeting member-dentists’ needs. Call an FDAS customer service representative for more information about these programs: • Group and individual health • Life insurance • Disability • Long-term care • Professional liability • Workers’ compensation • Office package • Office overhead expense • Pension/retirement plan • Automobile insurance • Annuities

PEER REVIEW PROGR A M

The FDA Peer Review Program helps member dentists resolve complaints from patients about clinical care. It is designed to preserve the doctor/patient relationship and avoid embarrassing malpractice lawsuits and Board of Dentistry complaints. Peer Review is free of charge and member dentists may use this process when they cannot otherwise resolve a complaint. Most matters are settled amicably and in a timely fashion.

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LEGISL ATIVE ADVOCACY

The association is a major leader in the health care advocacy arena. The FDA Governmental Affairs Office tracks and analyzes legislation affecting dentistry and health care in Florida. Recent legislative efforts supported by the FDA include legislation that: • prohibits insurance companies from dictating to dentists how much they can charge for services not covered under the dental contract. • maintains Florida’s current educational standards for graduates of non-accredited dental schools. • continues to authorize the state to operate dental services in the Medicaid program separate for medical services as the state transitions the entire program into managed care. • changes the Florida licensure exam to the American Dental Licensing Examination (ADEX) based on psychometric review that deemed both exams identical. • requires non-Florida licensed expert witnesses who want to testify in Florida to acquire a certificate from the Florida Board of Dentistry prior to testifying. • secures a $56 million Medicaid fee increase for Medicaid dental providers of children’s services, the first substantial dental fee increase in almost 20 years. • allows dental hygienists to apply fluorides and sealants in specified health access settings without prior authorization or supervision of a dentist. There are many opportunities to get involved in the legislative process. Attending the annual Dentists’ Day on the Hill puts you in the middle of the process as it unfolds. The Legislative Contact Dentist (LCD) program connects local dentists with their legislators. LCDs keep legislators informed about the impact of legislation on patient care. The FDA supports successful pro-dental candidates, including dentists currently serving in the House and the Senate.

CONTR ACT ANALYSIS

This service provides written legal analyses of insurance contracts members are considering. Through analysis, members learn about the merits and drawbacks of particular plans. They are alerted to provisions that might be confusing or could cause unexpected future liabilities. Unsigned contracts should be sent to the FDA.

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

As a dental health care provider, I choose to retain my tripartite membership for numerous reasons. Of course, I enjoy the CE, subscriptions, meetings, conventions and camaraderie. But perhaps the most important reason I retain my membership is supporting and belonging to an organization that remains committed to our profession, nurtures our profession’s growth, and moving forward into the future, is constantly thinking ahead regarding our profession’s well being. — Dr. Marcus Higgins

MENTOR PROGR A M

This program provides experienced dentists as mentors to dental students and dentists who have been in practice less than five years. Mentors help ensure a smooth transition from an academic environment to active practice.

HIPA A COMPLIANCE IN FLORIDA

Being fully HIPAA-compliant does not guarantee compliance with Florida law. If Florida law conflicts with HIPAA (1996 Health Insurance Portability and Accountability Act), federal privacy standards must be used. However, Florida law remains in effect if it is more stringent than the HIPAA standards. Members can find a comprehensive collection of FREE forms that comply with federal and Florida law as editable Microsoft Word documents on the FDA website.

CONTINUING EDUCATION

Florida National Dental Convention The Florida National Dental Convention (FNDC) is the FDA’s official annual meeting. FNDC provides: • Top-quality scientific sessions, many with little or no cost to members • Clinical lectures • Workshops • State-required courses (dental ethics and jurisprudence, HIV/AIDS, domestic violence) • Discounted or free registration for FDA members Online Continuing Education – receive free CE credit by successfully completing a test about “Diagnostic Discussion,” from Today’s FDA. Previously recorded FNDC courses with streaming video and complete course materials also are available.

PUBLIC OUTREACH

The FDA takes a proactive approach to public relations by developing campaigns promoting a positive image of dentistry. The association’s award-winning campaign, “Dentistry: Gateway to Good Health,” spreads the message that dental health is an important part of overall health. This ongoing campaign encompasses events, dental-health brochures, the Reception Room issue of Today’s FDA, online resources, media relations, oral hygiene materials, and building coalitions with state agencies and organizations.

FLORIDA DENTAL ASSOCIATION

Dr. Marcus Higgins Jacksonville Northeast District Dental Association

One of the FDA’s largest events is Give Kids a Smile (GKAS), a Project: Dentists Care program supported by the Florida Dental Health Foundation. GKAS provides free dental care to needy children, highlighting the importance of access to care in the media. GKAS has a history of providing $1 million of care to the underserved every year. The FDA joined the Mission of Mercy (MOM) network in 2013. MOM provides free dental care to anyone who shows up for treatment at the event. Volunteers from the whole dental community participate. Mouth Wise, dental-health education materials for elementary and middle school students developed by the FDA, are available free-of-charge to all Florida teachers though a grant from the Florida Dental Health Foundation.

PUBLICATIONS

Today’s FDA – As the FDA’s award-winning journal offers news, commentary, scientific studies and practice management articles. The journal keeps members apprised of association news and the latest advances in the dental profession. News Bites – This monthly email publication keeps members informed about current dental industry news and FDA programs. info@fda – These single-subject priority email bulletins are sent by the FDA to inform members about changes in law and regulations relating to dental practice and patient care, new member benefits and other important information. PacPower – This biannual newsletter keeps members up to date on legislative issues, the impact of new state laws and state-level political campaigns. Capital Report – During the annual session of the Florida Legislature, the FDA sends weekly reports about the dentalrelated legislation. Bimonthly updates are sent during the rest of the year.

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Component Dental Associations F

lorida has six component/regional dental associations that represent the interests and activities of dentists in those areas. Each component elects its own officers and conducts local meetings on a schedule its members decide. Components are comprised of local (affiliate) societies that have separate membership policies and programs, but often work in conjunction with their component societies.

ATL ANTIC COAST COMPONENT

Executive office: 561.968.7714 Email: acdda@aol.com Website: www.acdda.org Affiliates: South Palm Beach, Central Palm Beach, North Palm Beach, Treasure Coast and Broward County dental associations

CENTR AL FLORIDA COMPONENT

Executive office: 407.898.3481 Email: centraldistrictdental@yahoo.com Website: www.cfdda.org Affiliates: Alachua County, Brevard County, Greater Orlando, Lake County, Marion County and Volusia-Flagler County dental associations

NORTHEAST COMPONENT

Executive office: 904.737.7545 Email: ddeville@nedda.org Website: www.nedda.org Affiliates: Clay County and Jacksonville dental associations

NORTHWEST COMPONENT

Executive office: 850.391.9310 Email: nwdda@nwdda.org Website: www.nwdda.org Affiliates: Bay County, Escambia/Santa Rosa, Leon County and Okaloosa/Walton dental associations

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SOUTH FLORIDA COMPONENT

Executive office: 305.667.3647/800.344.5860 Email: sfdda@sfdda.org Website: www.sfdda.org Affiliates: North Dade/Miami Beach, South Broward and Miami Dade dental associations

WEST COAST COMPONENT

Executive office: 813.654.2500 Email: wc.dental@gte.net Website: www.wcdental.org Affiliates: Charlotte County, Collier County, Greater Highlands County, Hernando County, Hillsborough County, Lee County, Manatee County, Pinellas County, Polk County, Sarasota County, Upper Pinellas County and West Pasco dental associations

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

Online Resources

THE FDA’S WEBSITES GIVE MEMBER DENTISTS INSTANT ACCESS TO RESOURCES AND SERVICES.

W W W.FLORIDADENTAL.ORG

As the FDA’s main website, this portal provides information for members and dental professionals. Members can join discussion groups and contact colleagues on the redesigned website. Online Member Profiles – Colleague-to-colleague member information searchable by name, specialty, school and city or county. Go to Member Lookup under Benefits and Resources. State Laws and Rules Affecting Dentistry – comprehensive coverage of the statutes and administrative regulations that apply to the practice of dentistry. FNDC – Online registration and information about the Florida Dental Association’s official meeting: schedule of events, speaker profiles, registration forms, hotel information and maps of the area and the hotel. Download the FNDC app for convenient access. (www.floridadentalconvention.com) FDA Policies – Articles of Incorporation, FDA Bylaws, FDA Code of Ethics, and Administrative Manuals Mentor Program – Information about the FDA’s mentor program and contacts to get started: www.floridadental.org/ mentoring-opportunities-for-students

Governmental Affairs – Access issues of Capital Report, PacPower and the LCD Exchange (news about the Legislative Contact Program), track issues and look up legislators and their districts. Legal – Legal FAQs, state laws and rules affecting dentistry, peer review manual; free forms that comply with both HIPAA and Florida privacy law; Florida Department of Health Dental Directors; Government Listings Online Classified Advertising – ads for practices for sale, dental equipment and services, and employment opportunities. Publications – access to current and archival issues of Today’s FDA, News Bites, info@fda, PacPower, Capital Report and LCD Exchange Facebook and Twitter – Current news and interesting facts, all related to dentistry. Follow the FDA on Twitter at Florida Dental Assoc. Online Continuing Education – Receive free CE credit by completing previously recorded FNDC courses or by successfully completing a test about “Diagnostic Discussion,” fromToday’s FDA. Go to Benefits & Reosurces/Online Education.

W W W.FDASERVICES.COM Insurance Programs – information about a full range of insurance coverage tailored to the specific needs of dentists and their dental teams through FDA Services Inc. (the Florida Dental Association’s wholly owned subsidiary). News about new programs and insurance issues arrives in FDAS Alert. The website is enhanced with online forms, service and support. Corporate Affiliation Program – Through FDA Services Inc., the FDA Corporate Affiliation Program offers access to corporate resources and benefits that help you with your practice. The FDA corporate sponsors include a bank card, merchant credit card, patient-care financing, collections, practice acquisition, electronic claims processing, office supplies, payroll processing, website deveopment and marketing and professional apparel.

W W W.FDHF.INFO Volunteer opportunities – Find out about Give Kids a Smile, Project: Dentists Care, and Florida Mission of Mercy. Disaster Relief – Find information about ADA and FDA disaster relief for dentists and information about preparing your office to weather natural disasters. Dentists may use the portal site – www.MyFlorida.com – to find information about state government and agencies.

FLORIDA DENTAL ASSOCIATION

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All ied Dental Organizations

FLORIDA DENTAL HEALTH FOUNDATION

PROJECT: DENTISTS CARE

he Florida Dental Health Foundation (FDHF) is a charitable and educational organization that supports dentalhealth education and care programs. The Foundation: • Funds access-to-care programs for underserved adults and children. • Coordinates disaster relief for dentists and their practices. • Publishes the comprehensive reference, Five Step Guide for Disaster Preparedness and Recovery. • Supports humanitarian programs. • Sponsors Give Kids a Smile, Children’s Dental Health Month, and Mouth Wise (an educational program for elementary and middle school students).

roject: Dentists Care (PDC) is the FDA-supported accessto-care program for underserved Floridians. It is operated and funded by the Florida Dental Health Foundation. Through this program, Florida dentists and hygienists volunteer their services to provide preventive and restorative dental care to Floridians in the greatest need. FDHF also coordinates the Give Kids a Smile program in Florida year round.

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This information is available at www.fdhf.info.

FLORIDA MISSION OF MERCY

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ission of Mercy (MOM) was started in Virginia in 2000 and has since been replicated in many states in the US. These events target underserved populations and provide free dental care to anyone who shows up. FLA-MOM is a program of the Florida Dental Association to further our charitable mission. For more information and volunteer opportunities, go to flamom.floridadental.org.

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The mission of PDC is to establish dental-access programs statewide. Patients who receive services under PDC are typically low-income individuals who do not qualify for public assistance but have the greatest unmet needs. Many PDC associates have opted to have their volunteers join the Florida Department of Health’s Volunteer Health Care Provider Program. This program provides sovereign immunity to PDC volunteer dentists and the opportunity to earn up to seven hours of CE credit toward their biennial dental-license requirements. PDC coordinators are located throughout the state and work within their local dental association. They recruit volunteer dentists and allied personnel to provide pro bono or reduced fee dental care to patients meeting state and federal requirements. Information about PDC and access to care is available at www.fdhf.info.

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

I choose to keep my tripartite membership due to the professional contacts, networking and enormous social opportunities that membership brings with it. I take pride in knowing the dentists in our area on a professional and personal level, as I believe that makes me a more well-rounded leader in the community. — Dr. Brett Zak

Dr. Brett Zak Altamonte Springs Central Florida District Dental Association

Opportunities to Get Involved

FLORIDA DENTAL POLITICAL ACTION COMMITTEE

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ll FDA members provide political campaign support through the association’s political action committee. FLADPAC is organized dentistry’s vehicle in Florida for assuring its voice is heard in the political process. FLADPAC Century Club members provide additional financial support for state campaigns. As a FLADPAC member, you strengthen organized dentistry’s political presence and ability to effectively advocate public policy. PAC dollars and a strong political-action committee: • Support pro-dental candidates for election to the Florida Legislature and statewide offices. • Provide education and information to candidates for political office, including elected decision-makers. • Mobilize Florida dentists for grassroots political involvement. Find out more about FLADPAC at www.floridadental.org/ overview

ALLIANCE OF THE FDA

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he Alliance, made up of FDA members’ spouses, accomplishes its goals through legislative and community dental-health projects. The Alliance also works to promote a positive image for dentistry and improve dental-care practices in Florida. DENTAL EDUCATION • Senior Smiles – dental-health education project in partnership with the Alliance of the ADA, GlaxoSmithKline and Sullivan-Schein Dental • Baby-bottle tooth decay brochures • Stop the Pop – eliminating soda consumption in schools • Anti-smoking/spit tobacco programs for school-age children SUPPORT FOR ASSOCIATION PROGRAMS • Sponsor FDA Dentists’ Day on the Hill • Sponsor New Dentist Reception • Fundraising partner with the Florida Dental Health Foundation • Membership dues for ASDA spouses • ADA Leadership Conference • Camaraderie • Action team leaders and members • Alliance of the ADA Leadership Conference • Support for strong dental marriages and families

Your membership in allied dental organizations can broaden your commitment to your profession and professional growth. FLORIDA DENTAL ASSOCIATION

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MEMBER-ONLY SAVINGS Dental Supplies 800.448.7323

Health-care Financing 800.497.6076 Prestige Credit Cards 855.204.7199 Flexible Financing Program for Patients 800.839.9078 www.carecredit.com

Your Payroll. Our Passion.

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SAVE SOME DOUGH, SOME BUCKS, SOME MOOLAH, AND THEN SOME CABBAGE, TOO! JUST CLICK OR CALL YOUR FDA CAP MEMBERS TO CURTAIL YOUR EXPENSES AND ENLARGE YOUR PRACTICE COFFERS!

Payroll Processing Service 866.535.3592 SurePayroll.com/ADA Merchant Credit-card Service 800.725.1243 Accounts-receivable Management & Collection Services 800.279.3511 Www.Dentistcollect.Com Office Supplies 850.273.0695 Automated Marketing & Communications 800.210.0355 demandforce.com/fda Dental Websites & Internet Marketing 877.484.7187 www.officite.com/fda Professional & Uniform Apparel 800.490.6402 ada.landsend.com

& YOU COULD EVEN PAY YOUR DUES WITH SAVINGS FROM THE CAP PROGRAM! & THERE’S MORE SAVINGS … GO TO WWW.FDASERVICES.COM/AFFILIATE-PROGRAMS/

Insurance Provider Credentialing 561.422.9938 www.insurancecredentialing.com.

SCIENTIFIC METALS

Dental Scrap-metal Refining 888.949.0008 www.scientificmetals.com Electronic Claims Management 866.886.5113, Opt. 1 www. claimxedicom (Promo Code KCI3629)

Powered by Vantiv

Merchant Credit-card Service 800.731.3777 www.53.com

FDA Corporate Affiliation Programs offer special member pricing and valuable services to enhance your practice. Administered through FDA Services, the FDA Corporate Affiliation Program (CAP) reviews existing non-dues royalty producing programs and explores new opportunities that provide FDA members access to a variety of programs that may enhance their dental practice and offer good value through special member pricing.

Dr. Chad Lalsingh Boca Raton Atlantic Coast District Dental Association

I keep membership in the tripartite for a few reasons: ■ I am interested in trying to control the future of dentistry. ■ I enjoy the opportunity to meet with more experienced dentists and share discussions with them about cases or office management ideas. ■ I appreciate the ability to use things such as discounts on dental supplies and insurance, as well as the security blanket I receive from peer review. ■ Finally, I appreciate the opportunity to receive a great number of continuing education credits. — Dr. Chad Lalsingh

Informed Consent H

ealth-care providers are required to inform patients about proposed treatment. This sample consent form is included as an example of the language that may be used to authorize treatment. Before adopting a form for use, new practitioners should consult with personal legal counsel to ensure compliance with state law.

AUTHORIZ ATION FOR MEDICAL AND DENTAL TREATMENT

I hereby authorize and consent to any treatment or procedure or the administration of necessary anesthetics which my dentist deems advisable in the diagnosis and/or treatment of this patient. By signing this medical authorization and consent, I understand that as matter of law it shall be conclusively presumed: A. That the action of my dentist in obtaining this consent from me was in accordance with an accepted standard of medicaldental practice among members of the medical-dental profession with similar training and experience in this or similar medical communities; and from information provided me by my dentist, I, under these circumstances, have at least a general understanding of the procedures, the medically accepted alternate procedures or treatments and the substantial risks and hazards inherent in the proposed treatment or procedures which are recognized among dentists in this or a similar community who perform similar treatments or procedures; OR B. That I, considering all the surrounding circumstances, would have undergone such treatments or procedure had I been advised by my dentist as described in paragraph A above. Executed this day of , 20 . Patient or authorized person on behalf of patient___________________________________________________________________ signature

FLORIDA DENTAL ASSOCIATION

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Regulatory Agencies CIT Y HALL

Dentists should contact their local city halls and/or county clerks of the court for information about securing occupational and business licenses before starting their practices.

FLORIDA BOARD OF DENTISTRY

4052 Bald Cypress Way, BIN# C01 Tallahassee, FL 32399-3258 850.245.4474 • www.doh.state.fl.us/mqa/dentistry/ As part of the Department of Health’s Division of Medical Quality Assurance, the Board of Dentistry consists of seven dentists, two dental hygienists and two public members. It implements the laws and rules that affect the practice of dentistry and issues licenses and permits to practice dentistry. It also issues licenses to provide dental-hygiene services to the public.

FLORIDA DEPARTMENT OF HEALTH 4052 Bald Cypress Way, BIN# A00 Tallahassee, FL 32399-1701 850.245.4444 • www.doh.state.fl.us This department administers several state programs: • Dental treatment or dental-care delivery • Radiological health services/inspection • Biomedical-waste disposal regulation • Children’s medical services • Infectious-disease control and education • Health-staff planning and distribution

Public Health Dental Program 4052 Bald Cypress Way, BIN# A14 Tallahassee, FL 32399-1701 850.245.4333 • www.doh.state.fl.us This DOH program is responsible for directing statewide policy on oral health issues; promoting/administering oral health education and preventive dental programs; collecting and analyzing data on oral health; and, supporting the provision of direct dental care services through the County Health Departments and other public and private organizations.

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A MERICANS WITH DISABILITIES

U.S. Department of Justice 800.514.0301 • www.ada.gov Dentists must comply with the Americans with Disabilities Act when dealing with patients and employees. The American Dental Association also has information about how to design dental offices so they are accessible to patients and/or employees who have disabilities.

MEDICAL WASTE DISPOSAL

Biomedical Waste Program Florida Department of Health 4052 Bald Cypress Way, BIN #A08 Tallahassee, FL 32399-1710 850.245.4250 www.floridahealth.gov/healthy-environments/biomedicalwaste Florida Department of Environmental Protection Permitting and Compliance Assistance Program Division of Waste Management 2600 Blairstone Road Tallahassee, FL 32399 850.245.8707 www.dep.state.fl.us/waste/categories/mercury/pages/ medical_facilities The Florida Department of Health and the Florida Department of Environmental Protection can provide information about state requirements for disposing of dental-office waste.

FLORIDA NEW HIRE REPORTING CENTER

P.O. Box 6500 Tallahassee, FL 32314-6500 https://newhire.state.fl.us/fl-newhire/ Phone: 888.854.4791/850.656.3343 Fax: 888.854.4762/850.656.0528 Federal and state law requires employers to report newly

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

hired employees in Florida to the Florida New Hire Reporting Center. Using this site, you can get information about reporting new hires, report new hires online, and learn about other reporting options.

transactions. Obtaining an NPI doesn’t change the way you prescribe medication. Neither federal nor Florida law requires NPIs on pharmacy transactions, so this regulation doesn’t affect your ability to write prescriptions in Florida.

X-R AY REGISTR ATION

INTERNAL REVENUE SERVICE

Bureau of Radiation Control Florida Department of Health 4052 Bald Cypress Way, BIN# C21 Tallahassee, FL 32399 Phone: 850.245.4266 • 407.297.2095 (24-hour emergency #) Fax: 850.487.0435 www.doh.state.fl.us/environment/radiation/ The Florida Department of Health provides a form to register X-ray machines. Dentists are required to register each X-ray machine in their offices. The department also provides information about state requirements for use of related equipment, such as lab aprons and film badges.

DRUG ENFORCEMENT ADMINISTR ATION

DEA Registration Sevice Center at 800.882.9539 Email: DEA.Registration.Help@usdoj.gov www.deadiversion.usdoj.gov/drugreg The Drug Enforcement Administration provides the form licensees need to prescribe drugs. It also has information about DEA rules and regulations. The Florida Department of Health can offer more information.

FLORIDA PRESCRIPTION DRUG MONITORING PROGR A M

4052 Bald Cypress Way, Bin C-16 850.245.4797 Tallahassee, FL 32399 www.floridahealth.gov/reports-and-data/e-forcse The Florida Prescription Drug Monitoring Program (PDMP), known as E-FORCSE® (Electronic-Florida Online Reporting of Controlled Substance Evaluation Program), requires health care practitioners to report to the PDMP each time a controlled substance is dispensed to an individual.

INFECTION CONTROL AND OSHA

North Florida Inquiries: 904.232.2895 Central Florida Inquiries: 813.626.1177 South Florida Inquiries: 954.424.0242 www.osha.gov The American Dental Association can supply some Occupational Safety and Health Administration information. OSHA has requirements for: • Infection control • Employee safety and training • Waste management and hazardous chemicals

NATIONAL PROVIDER IDENTIFIER

https://nppes.cms.hhs.gov 800.465.3203 to request a paper application. An NPI is accepted by all dental plans as a valid provider identifier on electronic dental claims and other standard electronic

FLORIDA DENTAL ASSOCIATION

Telephone inquiries only: 800.829.4933 • www.irs.gov The Internal Revenue Service can provide an application for your federal tax identification number. All businesses that have employees must have a federal tax ID number. Other available forms include: • Circular E Employers Tax Guide • W-2 and W-4 • 941 quarterly federal tax return • 8109 tax deposit coupons • Business start-up kit

MEDICAID

Agency for Health Care Administration 2727 Mahan Drive Tallahassee, FL 32308 888.419.3456 • www.fdhc.state.fl.us Medicaid Provider Enrollment 800.289.7799 (Option 4) • www.mymedicaid-florida.com Dentists who want to enroll in the Florida Medicaid Provider Program should call for applications, agreements, manuals and provider numbers.

REQUIRED POSTERS

There are many federal and state laws that require dental offices, like other employers, to conspicuously post up to a dozen notices in locations accessible to employees. Depending on the number of employees in your practice, you may need all or some of the following: If your practice has one employee or more, post the following notices: • U.S. Fair Labor Standards Act (Federal Minimum Wage) • U.S. Employee Polygraph Protection Act of 1988 (Lie Detectors): • U.S. Job Safety and Health Protection (OSHA) • U.S. Equal Employment Opportunity (EEOC) • U.S. Uniformed Services Employment and Reemployment Rights Act (Military Service) • Florida Minimum Wage • Florida Law Prohibits Discrimination (Florida Civil Rights Act) • Florida “EEO is the Law” Poster Supplement • Florida Workers’ Compensation Works for You • Florida Reemployment Tax (formerly Unemployment Tax) • Family and Medical Leave Act (if your practice has fifty employees or more) • Florida Child Labor Law (if your practice employs children) To download free posters, go to www.floridadental.org/posters for links to the government websites listed above.

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Best Management Practices for Scrap Dental Amalgam THE DOS AND DON’TS OF SCR AP A M ALGA M M ANAGEMENT

SCR AP DENTAL A M ALGA M M ANAGEMENT PROCEDURES

Do use the smallest amount of amalgam necessary.

Do use precapsulated dental amalgam only.

Do use disposable amalgam traps, if practical.

Do sterilize reusable amalgam traps if disposable ones are not appropriate for your practice facility.

Do install at least two filters on the vacuum pumps.

Do change the vacuum pump filters at least once a month.

Do keep written records of your generation and disposal of scrap amalgam.

Do recycle all elemental mercury and amalgam.

Do store amalgam in a container with an air-tight lid.

Do label scrap amalgam containers with your name, address and phone number and the date.

Do disassemble and clean the amalgamator on a regular basis.

Do properly seal all amalgam capsules before amalgamation.

Do reassemble capsules immediately after dispensing the amalgam.

Do determine if your dental office is a conditionally exempt small-quantity generator.

Do select a recycler that meets all federal and state regulations for amalgam waste reclamation.

Do place mercury spill kits in convenient locations for easy access in your dental office.

Do hold training sessions and develop written procedures to ensure all dental-office personnel know the proper techniques for handling and using mercury; how to immediately clean up a mercury spill; and how to manage scrap amalgam.

Don’t rinse amalgam traps over drains or sinks.

Don’t discard amalgam, extracted teeth containing amalgam or amalgam traps in the garbage, red bags or sharps containers.

Don’t handle mercury or mix amalgam in a carpeted area.

Don’t use a regular vacuum cleaner to clean up a mercury spill.

Source: “Best Management Practices for Scrap Dental Amalgam,” Florida Departments of Health and Environmental Protection, 2001.

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CONTACT INFOR M ATION

For more information about best management practices for disposal of scrap dental amalgam, contact: • Biomedical Waste Program, Florida Department of Health 4052 Bald Cypress Way, Bin #A08 • Tallahassee, FL 32399-1710 850.245.4250 www.floridahealth.gov/healthy-environments/biomedical-waste • Florida Department of Environmental Protection Permitting and Compliance Assistance Program Division of Waste Management 2600 Blairstone Road • Tallahassee, FL 32399 850.245.8707 www.dep.state.fl.us/waste/categories/mercury/pages/ medical_facilities • Florida Dental Association 800.877.9922 / 850.681.3629 • www.floridadental.org • Occupational Safety and Health Administration Region 4 Office – Atlanta 404.562.2300 • www.osha.gov • U. S. Department of Transportation Office of Hazardous Materials Safety 800.467.4922 • www.phmsa.dot.gov/hazmat/regs

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

Your Dental Team DENTAL HYGIENISTS

All dental hygienists must have a Florida license to practice. They can apply for a license with the Florida Board of Dentistry after they graduate from dental-hygiene school and pass the state board examination. They are required to complete continuing-education requirements for relicensure. There are 21 ADA-accredited dental-hygiene programs in Florida. Florida Dental Hygiene Association P.O. Box 13675 Tallahassee, FL 32317 860.896.0603 • www.fdha.org

DENTAL ASSISTANTS

The Florida Board of Dentistry regulates all dental-assisting duties. The board can provide a list of duties dentists may delegate to dental assistants. Florida has many accredited dental assisting programs at community colleges, technical centers or private independent colleges. American Dental Assistants Association 35 E. Wacker Drive, Ste. 1730 Chicago, IL 60601 877.874.3785 • www.dentalassistant.org

DENTAL L ABOR ATORY TECHNICIANS

Certified Dental Technicians (CDT) have graduated from an accredited dental laboratory technology program or have completed a five-year apprenticeship, and have passed the national board examination for dental laboratory technology certification. There are two accredited dental laboratory technology programs and more than 1,000 private registered dental laboratories in Florida. Florida Dental Laboratory Association 325 John Knox Road, #L103 Tallahassee, FL 32303 850.224.0711 • www.fdla.net

Dr. Robin Nguyen Wesley Chapel West Coast District Dental Association

FLORIDA DENTAL ASSOCIATION

I maintain my tripartite membership because of the priceless benefits that it brings. Sure there are tangible benefits such as quality CEs, discounts on products, but it is the camaraderie, unrivaled in any organization, that draws me in every year. The people that I meet have become not only great mentors but close friends. I wouldn’t be where I am today without the opportunities that organized dentistry brings. — Dr. Robin Nguyen

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Your Ofce TA XES

DISASTER PL ANNING

Personal Property County tax assessors can provide personal property tax worksheets to list tangible assets, such as equipment and furnishings, used in dental practices. Find contact information at http://dor.myflorida.com/dor/property/.

The Florida Dental Health Foundation provides comprehensive disaster-planning information for the dental office in Five Step Guide for Disaster Preparedness & Recovery. You can access this guide online at www.fdhf.info. Topics covered include:

Employee Dentists are required to withhold certain taxes from each employee’s paycheck. Dentists in business for themselves may want to consult an accountant. Required taxes are: federal, Medicare, Social Security and federal unemployment. Use Tax on Out-of-state Purchases Florida law imposes a 6 percent use tax on out-of-state purchases if sales tax was not paid at the time of purchase. The use tax normally applies to items purchased outside Florida, including another country, which are brought or delivered into this state, and would have been taxed if purchased in Florida. Examples include: • Purchases made through the Internet • Mail-order catalog purchases • Purchases made in another country • Furniture purchased from dealers in another state • Computer equipment ordered from out-of-state vendors advertising in magazines If an out-of-state seller fails to collect sales tax, the burden to voluntarily comply with Florida law is yours. You can submit payment directly to the Florida Department of Revenue. For information and forms go to www.myflorida.com/dor or call 800.352.3671.

FLORIDA REEMPLOYMENT TA X For reemployment (formerly unemployment) guidelines, call Employer Taxpayer Information Services at 800.352.3671 or http://dor.myflorida.com/dor/taxes/reemployment.html#how

WORKERS’ COMPENSATION The Department of Insurance administers Florida’s workers’ compensation program. Call the Division of Workers’ Compensation at 850.413.1609; 877.693.5236; or www.myfloridacfo. com/wc/

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• Work sheets and checklists for earnings loss, generator costs, inspection guide, inventory, preparation, and telephone contacts • Application forms – ADA and FDHF grants/loans • Reviewing insurance coverage • Chemical, biological and radiological threats • Creating a written plan • Protecting equipment and data • Securing the office and property • Hurricane disaster grants and loans for dentists • Recovery process • Resources for recovery and mental health assistance, restoration services, and weather information • Other sources of disaster recovery funds After a disaster or storm impacts your area, be sure to contact your district dental association. Experience suggests dentists who contacted their component executive directors early, and maintained contact, fared better than those who did not. The information they shared allowed the executive directors to focus their resources on helping those in need recover more quickly.

PATIENT RECORDS Electronic Files: Backup your electronic patient files daily. This first backup should be maintained in a waterproof/fireproof/ crushproof lock box in the office. As a second layer of protection, maintain a weekly backup off site. There are many commercial “off site” back up centers on the Internet. Paper Files: Even if you have converted to all electronic patient files, you may have older paper files. There are no published rules governing the disposition of soiled or damaged paper patient files. In the absence of rules, treat the damaged files as a potential biohazard risk.

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

Dr. Estaban Leon Miami Beach South Florida District Dental Association

Following graduation from dental school, I regretfully did not renew my membership and failed to understand the rewards and value of being a tripartite member. After a few years, I started to admire and learn a great deal from many of the elite dentists in my area who were actively involved and quickly realized the many benefits of being a member. I forgave myself and made up for lost time by joining the board of my local affiliate society, the Miami-Dade Dental Society. I continue to embrace involvement at the district level and new leadership roles as they come. It has proved to be a valuable opportunity for mentorship and sharing information with top dentists in the area from practice management advice to the latest technologies and techniques; and, in my experience it is the best way for an associate or new dentist to be connected with job or practice opportunities. In addition, I remain current with relevant issues in dentistry through valuable CE courses while enjoying a nice dinner with my colleagues. It is an exciting night of the month that I look forward to. — Dr. Esteban Leon

INSUR ANCE CHECKLIST FOR DENTAL PR ACTICES ❒ PROFESSIONAL LIABILITY INSURANCE

Malpractice coverage for individuals, corporations, or employees. The policy covers damages for a variety of dental incidents. A policy also can cover hygienists and assistants employed in your office.

❒ WORKERS COMPENSATION INSURANCE

Mandatory for all offices with four or more employees, but strongly recommended as protection for all dental offices.

❒ DENTAL OFFICE POLICY

Covers general liability, office furnishings, equipment, building, improvements to leased space and build-outs. Can include business income, accounts receivable and wind/hail coverage.

❒ FLOOD

Property insurance does not include damage from flood waters, regardless of the source. The National Flood Insurance Program operated by the federal government provides most policies for damage from flooding.

❒ COMMERCIAL UMBRELLA/EXCESS LIABILITY

Provides coverage in the event of a catastrophic liability loss in excess of underlying policy limits. Can cover general liability, employer’s liability, and commercial auto insurance liability.

❒ EMPLOYMENT PRACTICES LIABILITY

Responds to allegations of wrongful termination, failure to promote, harassment, or discrimination.

❒ DATA BREACH/PRIVACY INSURANCE

Responds to risk involving personal health information.

❒ CYBER LIABILITY

Protection for exposures arising out of Internet communications, including privacy issues, the infringement of intellectual property and virus transmission.

❒ DIRECTORS & OFFICERS

Liability coverage for allegations against the dental practice’s officers or board members.

❒ GROUP OR INDIVIDUAL HEALTH INSURANCE

PPO, POS, HMO and HSA plans for your practice. Expert help navigating the new health exchange environment.

❒ DISABILITY INSURANCE

Coverage to protect your loss of income due to a disability.

❒ OFFICE OVERHEAD

Protection to continue business operations should you become disabled.

❒ LIFE INSURANCE

To facilitate buy-sell agreements should a partner die, protect the practice, protect the family, or replace the income derived from a key employee.

❒ LONG-TERM CARE INSURANCE

This voluntary benefit for you and your employees covers costs of home care, assisted living, nursing home.

❒ BONDS

ERISA compliance for pension and profit-sharing plans

❒ PERSONAL AUTO INSURANCE & UMBRELLA

Personal auto protection and excess liability protection.

To get quotes on insurance programs designed for dentists, contact FDA Services Inc. at 800.877.7597 or visit their website – www.fdaservices.com.

FLORIDA DENTAL ASSOCIATION

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FIVE RISK MANAGEMENT TIPS FOR DENTAL PRACTICES By Don Dennis Former FDA Associate General Counsel

H

ere are the Top 5 general principles to guide you and your practice to “manage the risk” of litigation. I say “manage the risk” because there is no way to entirely avoid litigation. Just as the Florida Dental Health Foundation urges members to conduct a disaster-preparedness checkup for their practices and homes as hurricane season approaches, we urge you to evaluate your practice for litigation risks. Planning ahead might not keep you from being sued, but it surely can help mitigate the situation if it ever arises.

1. Treat Patients with Courtesy a nd Respect The first impression a patient has of your practice most likely does not even involve you. By the time a patient actually meets the dentist who will treat them, they already have called your office to schedule an appointment, been checked in at the front desk, and waited in the reception area. And as the saying goes, you never get a second chance at a first impression. Make sure the first impression is warm, welcoming and courteous. Your office policy should address front-desk etiquette and customer service. One of the biggest complaints patients have with health care professionals is not related to the actual work done, but the way they were treated by staff, and the amount of time they had to wait. Being able to efficiently schedule patients is a skill that should not be overlooked. And staff’s bad attitudes and poor communications skills cause far more lawsuits than do negative results in the procedure.

2. Maintain Open and Realistic Lines of Communication Most times, whether we view an experience as negative or positive is shaped by our expectations. When you have an open and realistic dialogue with your patient, it helps shape their experience in a positive way. Don’t say a procedure will be painless if you know there will be discomfort. Don’t promise a procedure will come out a certain way, but discuss the possible outcomes and the likelihood of each. French surgeon Ambrose Paré cautioned all doctors that, “We are sometimes to cure, often to treat, but always to console.” Dentists need to not only communicate with their patients in the doctor/patient relationship but person-to-person. Patients who feel they have a connection and can relate to their dentists are less likely to sue. Patients don’t expect to go out golfing with their dentist, but when you take the time to ask how the kids are doing or if the fish are biting, it shows you don’t just see them as another body being rushed in and out of the office. A simple way to develop this rapport could be by asking about hobbies or interests on the initial patient intake form, and attaching a note card or sticky with the information to the patient’s file.

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HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

3. Keep Accurate Records Having poor records is the fastest way to find yourself in trouble with the Board of Dentistry, or before a jury. Failing to properly maintain records in and of itself can constitute a violation of board rules. Here are some short tips: • Consistency. Use the same color pen and be consistent with abbreviations and notations. • Legible. Seems simple, but if a judge or jury has to resort to guesswork about the meaning of your notes, the result may not go in your favor. • Professionalism. Patient records are not the place to use offensive language or make derogatory comments. It can taint how you are viewed and damage your credibility in other matters of a case.

Creating a pleasant work environment not only is a nice thing to do, it makes good business sense. Constant turnover in staff is costly, and patients will pick up on tension among staff members. If staff members do not enjoy coming to work, you can bet they are not making it enjoyable for your patients either. Moreover, dental offices are not immune to the problems that face all other types of businesses.

5. Have a Business Game Plan In a perfect world, when you become a dentist, you only have to worry about dentistry, and all the bills would get paid and your employees would greet you every morning with a smile and maybe a cup of coffee.

Another tip important enough to be addressed separately relates to proper correction of records. Never erase, white-out, scribble through or “fix” an entry. No matter the true intent of your actions, you can rest assured a plaintiff’s attorney or prosecutor will characterize such actions as an attempt to cover up.

But, in the real world, you not only are a dentist, you are an entrepreneur who has to deal with all the issues that accompany running a small business. You wouldn’t begin a complicated dental procedure without having a treatment plan and preparing for unexpected contingencies, so why would you run your business without a plan?

The proper method to correct an error is to use a single strike through and write the correction to the side that is dated and initialed.

All dental offices are unique so there is no one way to run the “perfect” office, but the one constant is to make sure you and your dental team members have a plan for how to handle issues that invariably come up during the life of your business.

4. Be Aware of Your Responsibilities as an Owner One of the greatest things about being a dentist is that, for the overwhelming majority of practitioners, you are your own boss. This also can cause you the most headaches. “Vicarious liability” is the doctrine that can hold you, as a dentist, responsible for the actions of those you supervise. This is true in terms of your role as dentist supervising the dental team, and as business owner responsible for the workers you employ. Understanding the precise nature or extent of how vicarious liability works is not as important as understanding and appreciating the fact you can be held liable for the acts or omissions of those who work for you. This is why it is crucial that each dental office have a policy covering what each employee may or may not do, as well as a procedure for addressing problems that may arise. The form of these policies will vary depending on the nature of your practice, but the important part is you have addressed potential problems and your staff knows what to do when something comes up. Remember, the buck ultimately stops with you, so you should know what is going on. A well set-out policy not only will help smooth out office procedures, it can make your office a better place to work. As with any group effort, your dental team members will work more efficiently when they know their roles and can work together.

FLORIDA DENTAL ASSOCIATION

Have a personnel/office manual that addresses common problems that arise routinely, as well as establishes proper procedures and protocols for dealing with unforeseen and unique issues. It’s also a good idea to have a lawyer who is familiar with your business. We all know that preventive medical or dental care is more effective and cheaper than having to treat an illness after it has manifested. We also know that a doctor who has been treating a patient for years will be in a much better position to diagnose and treat that patient than a practitioner who is seeing a patient for the first time. The same is true in the legal world. Should your business incorporate or be a partnership? Does your personnel manual have adequate policies to protect you from employment discrimination claims? A lawyer can help answer these questions, along with others, to protect you and your business. This article (reprinted from Today’s FDA, May 2006) is for informational purposes only and is not intended to be a substitute for professional legal advice. If you have a specific concern or need legal advice regarding your dental practice, you should contact a qualified attorney. The FDA Legal Department is not available to address individual member’s legal questions and concerns.

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Your Peer Review Program: HOW IT WORKS

by Luis E. Martinez, DMD, PA

Patient calls the component office with a concern.

I have been involved in the Peer Review process for more than ten years. You can often avoid costly legal fees and malpractice suits by using this free service available only to members. This is usually where the description of the program ends, without much insight into what actually happens. Here is how Peer Review at the Pinellas County Dental Association (PCDA) works:

1. Usually, a patient calls the PCDA office with a complaint about a dental care outcome. Many times our secretaries can resolve the issue over the phone. As Peer Review chairman, I don’t see a lot of complaints until they are beyond minor mediation. 2. Once I get involved, I generally review the patient’s complaint and the dentist’s records; then, I begin using my mediation skills to try to resolve the issue. Generally, it involves money — as in, the refunding of money. 3. If the complaint is not resolved by refunding all or part of the money, the next step is arbitration. This involves bringing in the patient. A team of three dentists interviews the patient and evaluates the treatment. After the patient leaves, the dentist under review comes in and explains his or her side of the dispute and treatment. 4. The Peer Review team then recommends a solution, which could involve not only returning the money, but also what it would cost to correct the issue. A recommendation is made that neither the dentist nor the patient has to abide by. I have learned a lot from my involvement in the Peer Review program, including improving my own record keeping. I offer a few recommendations gleaned from my decade of experience. 1. Peer Review doesn’t always have to be started by a disgruntled patient. A frustrated dentist who feels that everything has been done to satisfy the patient, with no success, also can recommend Peer Review. 2. Although it’s a natural reaction, a phone call from me (or your district’s Peer Review chair) shouldn’t be looked on as a bad thing. This is a service we provide to our members to help mediate problems, and most of the time avoid costly and emotionally draining litigation or Board of Dentistry complaints. 3. Don’t let your ego get in the way when trying to resolve the issue. It is not a direct reflection of your abilities as a dentist — and returning fees paid for service is much less troublesome than possibly having to pay someone else to re-treat along with refunding the original fee on top of that. 4. Be assured that when the evaluators review a case, it is in strict confidence. We all treat the situation as if we were the ones who had the complaint against them. 5. Always keep in mind when someone comes into your office complaining about another dentist’s treatment — next week, a disgruntled patient could be in a colleague’s chair complaining about you. Do your best to not pass judgment and give the dentist a courtesy call. It could make a real difference. Peer Review is only possible when members work together to support each other. Dr. Martinez is the Peer Review chairman for the Pinellas County Dental Association. He can be reached at GATOR2TH@aol.com. This column first appeared in an info@fda email bulletin on Aug. 22, 2013.

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Component staff decide if the situation falls under the duties of peer review and can start paperwork.* The case is sent to the peer review chair (volunteer dentist) in the area near the patient. The peer review chair calls the patient to discuss the issue. The peer review chair then calls the dentist to discuss the issue and see if he or she is willing to settle by refunding all or some of the fee. If not, the chair convenes a peer review panel and collects information from the dentist who treated the patient.

The peer review chair negotiates a settlement to which the patient and dentist both agree.

Three dentists other than the peer review chair evaluate the patient anonymously, dismiss the patient and then evaluate the treating dentist’s records. They may also interview the treating dentist. The peer review panel comes to a decision regarding the acceptability of the treatment and any recourse necessary. The peer review chair writes up the evaluation and submits the report to the component.

The component notifies the patient of the proceeding’s outcome. If there is agreement, and the patient is due a refund, the treating dentist will write a check to the component. The component will secure a release of liability from the patient and then distribute the refund to the patient. The FDA dentist retains the original release form as a crucial part of the patient’s record. If there is no agreement, no records generated by the peer review process can be used against the dentist in a subsequent malpractice lawsuit, even if the mediation/ arbitration failed.

* Only cases involving problems with actual treatment and procedures are eligible for mediation. Cases not eligible for the program include: malpractice litigation; formal regulatory investigations; disputes over dental fees; treatment that occurred more than 12 months before the patient’s last appointment with the dentist; and cases involving dentists who are not FDA members.

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

Mediation Makes Sense

by Lynne Knight, FDA Marketing Coordinator

Recently, I spoke with Peer Review (PR) chairmen from around the state about their experiences as mediators in the program. While Dr. Edward Daniel thinks that PR is the best reason to join the FDA, Dr. Andrew Adelson says that one of his biggest obstacles is convincing the dentist that he is on their side and doing them a favor by helping to resolve a case, even it means they must apologize or refund money. Together, these dentists have almost 130 years of service in the Peer Review program: Dr. Philip Glatstein, South Florida District Dental Association Dr. Alan Price, Central Florida District Dental Association Dr. Andrew Brown, Northeast District Dental Association Dr. Andrew Adelson, Atlantic Coast District Dental Association Dr. Edward Daniel, EscaRosa Dental Society

CONFLICT RESOLUTION AND COMPROMISE ARE THE MEDIATOR’S TOOLS Dr. Daniel: Of the cases I see, 75 percent can be resolved without clinical review. When I ask the patient involved in these cases what they want, they tell me that they want their money back. I then go to the dentist involved and explain to them that prior to clinical review, they can resolve the case by refunding the fees for the treatment in question. Usually the dentist will opt to refund the fees instead of proceeding with clinical review. Dr. Adelson: I make sure both parties understand where the problem lies and what can be done to correct the situation. Someone usually admits to a breakdown in communication or a mistake in how something was explained. Compromise is the process and neither side may be totally happy with results. Dr. Glatstein: With effective communication, most are pretty reasonable. I have a good track record in mediating. My objective is to get the patient back to the dentist, and to solve the problem. Dr. Price: The patient or the dentist may be angry, but I don’t pass on that animosity when speaking with the parties. I try to convince the patient and the dentist that compromise is necessary to make PR work — the dentist has lab costs; the patient’s confidence in the dentist is evidenced by seeing him numerous times. The dentist sometimes gets defensive about the quality of his work. I encourage him to refocus on placating his unhappy patient, which usually involves a financial compromise. Dr. Brown: I listen to both sides. Most dentists appreciate the mediation, even if something was wrong. In about 60 percent of our cases, something went wrong. I explain the exposure and risk of fighting the patient and encourage the dentist to settle the bill, write it off, offer a refund, or refer to another dentist. Sometimes, a patient just needs to rant, and I am happy to listen. Sometimes, I may be able to unruffle some feathers. Sometimes, we have to let the patient know that their complaint doesn’t fall under peer review — like the letter we received complaining about a dentist having an affair with the letter-writer’s spouse.

THIS MEMBERS-ONLY SERVICE IS FREE. ONE HOUR WITH YOUR ATTORNEY COULD COST UP TO $300. WHAT WOULD YOU SAY TO A DENTIST RELUCTANT TO USE PEER REVIEW? Dr. Daniel: It’s the best reason to join the FDA! PR is a very friendly, low-key, nonadversarial process that looks out for the best interests of the dentist and the patient. Ninety-five percent of cases are easy to resolve and it’s obviously better than the legal system. Dr. Adelson: You are about to make the biggest mistake of your life! The other options are terrible! Board of Dentistry hearings are difficult; usually the least they will do is fine you for bad record keeping. And, if the patient calls a lawyer — even if you win, you will lose two years of sleep. When PR comes knocking, don’t slam the door. Dr. Glatstein: If a dentist decides against PR, he’d best inform his carrier of the situation and it would be wise to inform his personal attorney, too. Dr. Price: If PR is able to reach an acceptable compromise for you, the patient will sign a legally binding agreement before any money is refunded. Sometimes PR doesn’t work. If that happens, all the PR records are shredded. Dr. Brown: Sometimes a dentist doesn’t want to use PR because he or she doesn't want another dentist to know about a problem in their office. Since PR is confidential, fewer people will know about it than if it becomes a malpractice case.

WHAT’S THE BIGGEST PROBLEM? ALL AGREE, “IT’S MISCOMMUNICATION!” Dr. Daniel: There is breakdown in communication when the dentist doesn’t listen to the patient well enough or address their concerns adequately. I don’t see much treatment that doesn’t meet the expected standard of care. Dr. Adelson: Miscommunication happens when there are assumptions on both sides; the dentist assumes the patient knows or understands the procedure and the patient assumes the dentist understands their expectations. Dr. Glatstein: The practitioner doesn’t fully understand the patient’s needs or make sure the patient understands the procedure. Many cases involve a patient who has expectations not realized. Sometimes heavy advertising creates an expectation and a patient ends up with something else, something unexpected. Dr. Price: Some patients are dissatisfied with results; i.e., dentures are not like your own teeth and the dentist should explain possible problems at the beginning and not say that they will be as good as real teeth. Dr. Brown: The treatment plan and costs should be discussed up front so there are no surprises at checkout. Your staff and front desk employees should be trained to communicate clearly, too.

Dr. Andrew Adelson is a general dentist in West Palm Beach. He can be reached at jockdoc101@aol.com. Dr. Andrew Brown is an orthodontist in Orange Park. He can be reached at ddsbrown@bellsouth.net. R. Edward Daniel practices family dentistry in Pensacola. He can be reached at eda9049237@aol.com. Dr. Philip Glatstein is a general dentist in South Miami. He can be reached at mouthmavens@bellsouth.net. Dr. Alan Price practices family and cosmetic dentistry in Winter Park. He can be reached at 407.645.4645. Ms. Knight is the FDA’s marketing coordinator. She can be reached at lknight@floridadental.org.

FOR MORE INFORMATION

about the FDA Peer Review Program 800.877.9922 • fda@floridadental.org www.floridadental.org/peer-review

This article is reprinted from Today’s FDA, November/December 2013.

FLORIDA DENTAL ASSOCIATION

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Q&A What are the biggest differences between predoctoral dentistry and “real-world” private-practice dentistry? Dr. Zuknick: First, patient volume is drastically increased. In dental school, a student treats one to three patients a day. An average day in the “real world” may consist of two to 40 patients a day. Second, auxiliary staff is present. It is easy to forget how hard it is to practice four-handed dentistry with two hands. It may take a long time to develop a seamless working relationship with your chair side assistant and help your front desk run the practice with your values and goals. And lastly, you will need to become a profitable businessperson. Dr. Lemieux: The days of three-hour fillings are over once you enter the “real world.” Fortunately, you won’t have to wait around anymore to have an instructor check your matrix band placement, so your work pace will automatically speed up. What is the best way for dental students to pick up their hand-skill speed without losing the quality in their work? Dr. Zuknick: Time – it is not called the practice of dentistry arbitrarily. Repetition builds confidence and speed. Try to put yourself in a position of low stress where income is not directly affected by speed. Many associateships allow new dentists to earn a salary based on the number of days worked, versus pay for a percentage of dental production. Dr. Lemieux: First, remember that it’s not necessarily production you want to focus on, it’s profitability. Looking back at my first few months of practice, I produced more than I thought I could because I had a chair side assistant for once! After three or four months, I became more comfortable with my surroundings and my production started to pick up. How do you avoid liability issues in the real world? Dr. Zuknick: Understand your limitations. Refer procedures you have difficulty with to a talented specialist. Surround yourself with knowledgeable professionals such as accountants, insurance agents and financial planners.

Many dental students are faced with the decision to either join a large corporate dental practice or seek out two to three part-time associate positions in private practices, what would you do in our shoes? Dr. Zuknick: Many times it comes down to simple economics. What situation is going to allow me to pay my bills? Corporate dentistry often comes with an income guarantee, but with that guarantee comes an increase in patient volume. Associateships may not come with a guarantee, but may allow for a nurturing relationship with a potential financial upside. My suggestion would be to find the ideal associateship that allows you to be economically sound, while providing a situation of growth in the practice. Dr. Lemieux: When you first graduate from dental school, an associateship can be very beneficial as you are growing professionally and developing your clinical skills. When looking for an associateship or partnership, find someone committed to excellence with whom you will feel comfortable working – they will have a vested interest in helping you succeed. As an associate dentist, I had the flexibility and freedom to conduct any treatment plan I was comfortable doing. However, some of my friends found themselves only doing a lot of cleanings, exams and simple restorative procedures. Be sure to discuss the expectations of the senior dentist before accepting employment. Most of my friends who had trouble entered agreements on a handshake instead of signing a clear contract. How did you recruit new patients? Dr. Zuknick: Marketing, but it can sometimes be expensive and ineffective. Get involved in family activities and community events. It can be very beneficial to live where you practice. Dr. Lemieux: As a new dentist, your initial focus will be simply survival. You may be interested in attracting anyone with a pulse, but ultimately you will want people who appreciate your care, are friendly to your staff and are responsible enough to pay their bills. The best long-term way to recruit is to treat your existing patients well and they will sing your praises to their friends and family.

Students from Nova Southeastern University College of Dental Medicine and the University of Florida College of Dentistry submitted questions and Drs. Steve Zuknick and Pete Lemieux, consultants for the FDA Subcouncil on the New Dentist provided the answers. Excerpted from Today’s FDA, May 2008.

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HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

Legal FAQs

What are the most frequent / most serious disciplinary violations? Practicing below the standard of care is number one. Failing to maintain adequate patient records is the second most frequent violation. It is mandatory that the board suspend or revoke your license for improper delegation and felonies under Chapter 409 (Medicaid fraud), Chapter 817 (fraudulent practices) or Chapter 893, F.S., (drug abuse prevention and control). What does the FDA do to help members comply with the standard of care? Patient relations peer review is available at no charge for patients of FDA members. Peer review will quickly and confidentially help you resolve patient care complaints. If necessary, a panel of local dentists can assist with determining minimum acceptable standard of care. We also routinely publish informational articles on how to comply with federal and state health law requirements, which daily grow ever more complicated. If you need a referral to a health law attorney or risk manager, we can help you find one in your area.

What does the FDA want members to know about patient records? A dentist must maintain written dental records for at least four years from the date the patient was last examined or treated. Usually these dates coincide but not always (e.g. missed appointment and emergencies). Dental records include your day-to-day patient appointment book so make sure your practice management software does too. Also, remember to have a Business Associate agreement with your software or EMR vendor. Seven years is typically the statute of repose on malpractice liability so keep them at least that long. Also, note that participating provider agreements and hospital privileges may contractually require longer retention periods.

What does the FDA want members to know about “patient abandonment” and terminating the doctor/ patient relationship? Improperly terminating the doctor/patient relationship is commonly known as “patient abandonment.” If the patient suffers harm because of how you or your employees terminated the relationship, you may be held liable. Florida courts recognize patient abandonment as a tort and some federal courts also recognize it as a breach of contract (or implied contract) claim. Make it your written office policy to send patients leaving your practice written notice or confirmation that your office is no longer treating them as a patient of record. Always do it for every patient who leaves or is terminated from your practice. Keep a copy of the letter with the patient’s chart. Treat the letter with equal dignity as you would any other medical or business record. Don’t make the letter effective “immediately.” Immediate termination doesn’t give the patient enough time to locate another doctor. Please remember that you remain legally and ethically responsible for providing emergency care. Don’t deny it to them by a poorlyworded notification letter that might be admissible as evidence against you. As to how much time you must give the patient to locate another dentist, thirty days is commonly used in termination letters. Also, please remember that it may be legally and ethically improper for you to refuse treatment. Most dental practices are “places of public accommodation” under federal and state law. Don’t terminate or refuse to treat a patient based on actual or perceived disability status such as HIV, deafness, obesity (contact the chair manufacturer or supply house if you think the patient is too heavy) or mental illness. Termination or refusal to treat based on age, race, sex, national origin, marital status, etc. is extremely high-risk.

These questions and answers have been prepared by FDA legal staff based on years of experience; Florida Bar certification as an expert in health law; and AHCA licensure as a healthcare risk manager. The Florida Dental Association has an extensive Legal FAQ section on its website for members (www.floridadental.org).

FLORIDA DENTAL ASSOCIATION

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HEADQUARTERS 800.877.9922 or 850.681.3629 1111 E. Tennessee St. • Tallahassee, FL 32308

EXECUTIVE OFFICE Drew Eason, Executive Director deason@floridadental.org 850.350.7109 Rusty Payton, Chief Operating Officer rpayton@floridadental.org 850.350.7117 Graham Nicol, Chief Legal Officer gnicol@floridadental.org 850.350.7118 Judy Stone, Agency Relations Manager jstone@floridadental.org 850.350.7123

ACCOUNTING Jack Moore, Chief Financial Officer jmoore@floridadental.org 850.350.7137 Leona Boutwell Bookkeeper – FDHF & A/R lboutwell@floridadental.org 850.350.7138 Deanne Foy Bookkeeper – PAC & Special Projects dfoy@floridadental.org 850.350.7165 Tammy McGhin Payroll & Property Coordinator tmcghin@floridadental.org 850.350.7139 Mable Patterson, Bookkeeper – A/P mpatterson@floridadental.org 850.350.7104

COMMUNICATIONS AND MARKETING Jill Runyan, Publications Manager jrunyan@floridadental.org 850.350.7113 Lynne Knight, Marketing Coordinator lknight@floridadental.org 850.350.7112 Jessica Lauria, Publications Coordinator jlauria@floridadental.org 850.350.7115

FLORIDA DENTAL HEALTH FOUNDATION

Staff Directory

GOVERNMENTAL AFFAIRS OFFICE 850.224.1089 or 800.326.0051 118 E. Jefferson St. • Tallahassee, FL 32301

FLORIDA NATIONAL DENTAL CONVENTION Crissy Tallman Director of Conventions and Continuing Education ctallman@floridadental.org 850.350.7105 Elizabeth Bassett FNDC Exhibits Planner ebassett@floridadental.org 850.350.7106 Mary Weldon FNDC Program Coordinator mweldon@floridadental.org 850.350.7103 Ashley Liveoak FNDC Meeting Assistant aliveoak@floridadental.org 850.350.7106

GOVERNMENTAL AFFAIRS Joe Anne Hart Director of Governmental Affairs jahart@floridadental.org 850.350.7205 Alexandra Abboud Governmental Affairs Coordinator aabboud@floridadental.org 850.350.7204 Casey Stoutamire, Lobbyist cstoutamire@floridadental.org 850.350.7202

INFORMATION SYSTEMS Larry Darnell Director of Information Systems ldarnell@floridadental.org 850.350.7102 Lisa Cox, Database Administrator lcox@floridadental.org 850.350.7163 Ron Idol, Network Systems Administrator ridol@floridadental.org 850.350.7153

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FDA SERVICES (CONT.)

Kerry Gómez-Ríos Director of Member Relations kgomez-rios@floridadental.org 850.350.7121

Marcia Dutton, Administrative Assistant marcia.dutton@fdaservices.com 850.350.7145

Josh Freeland Membership Assistant jfreeland@floridadental.org 850.350.7111 Christine Mortham Membership Concierge cmortham@floridadental.org 850.350.7136 Kaitlin Alford Member Relations Assistant kalford@floridadental.org 850.350.7100

FDA SERVICES Group & Individual Health Medicare Supplement • Life Insurance Disability Income • Long-term Care Annuities • Professional Liability Office Package • Auto Workers’ Compensation

Maria Brooks Membership Services Representative maria.brooks@fdaservices.com 850.350.7144 Nicole White Membership Services Representative nicole.white@fdaservices.com 850.350.7151 Pamela Monahan Commissions Coordinator pamela.monahan@fdaservices.com 850.350.7141 Porschie Biggins Membership Services Representative pbiggins@fdaservices.com 850.350.7149

FDAS RISK EXPERTS DAN ZOTTOLI

Atlantic Coast District Insurance Representative 561.791.7744 Cell: 561.601.5363

dan.zottoli@fdaservices.com

Scott Ruthstrom Chief Operating Officer scott.ruthstrom@fdaservices.com 850.350.7146 Carrie Millar Agency Manager carrie.millar@fdaservices.com 850.350.7155 Carol Gaskins Assistant Membership Services Manager carol.gaskins@fdaservices.com 850.350.7159 Debbie Lane, Assistant Membership Services Manager debbie.lane@fdaservices.com 850.350.7157 Allen Johnson Support Services Supervisor allen.johnson@fdaservices.com 850.350.7140

Jamie Chason, Commissions Coordinator jamie.peddie@fdaservices.com 850.350.7142

The last four digits of the telephone number are the extension for that staff member.

MEMBER RELATIONS

Angela Robinson Customer Service Representative angela.robinson@fdaservices.com 850.350.7156

Stefani Dedmon Coordinator of Foundation Affairs sdedmon@floridadental.org 850.350.7161

FDA SERVICES 800.877.7597 or 850.681.2996 1113 E. Tennessee St., Ste. 200 Tallahassee, FL 32308

Kristen Barrett Membership Services Representative kristen.barrett@fdaservices.com 850.350.7171

DENNIS HEAD

Central Florida District Insurance Representative 877.843.0921 (toll free) Cell: 407.927.5472

dennis.head@fdaservices.com

JOE DUKES

Northeast & Northwest Insurance Representative 850.350.7154 Cell: 850.766.9303

joe.dukes@fdaservices.com

JOSEPH PERRETTI

South Florida District Insurance Representative 305.665.0455 Cell: 305.721.9196

joe.perretti@fdaservices.com

RICK D’ANGELO

West Coast District Insurance Representative 813.475.6948 Cell: 813.267.2572

rick.dangelo@fdaservices.com

HORIZON: A NEW DENTIST’S GUIDE TO A SUCCESSFUL PRACTICE

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