2010 Spring Bulletin

SPRING ISSUE 2010 VOL. 42, NO. 4

Bulletin

Editor

James Papp

Associate Editors

Seth Vruggink Jeff Smith Aric Smith Larrisa Bishop Sheryl Jenicke

Advertising Editor

Elaine Fleming Executive Secretary WMDDS 511-F Waters Building Grand Rapids, MI 49503 (616) 234-5605 efwmdds@aol.com

West Michigan District Dental Society Executive Board 2009-2010 President Douglas Klein President-Elect Seth Vruggink Vice President Larissa Bishop Secretary-Treasurer Ryan Lebster Editor James Papp Immediate Past Doug Killian President Directors Tyler Wolf

Christopher Morgan

Samuel Bander Area Representatives Kent County David Armbrecht Ionia-Montcalm Kathleen Ellsworth County Mecosta County Margaret Gingrich Ottawa County Thomas Phares MDA IV District Trustees

Norman Palm Brian Cilla

Big Rapids Dental Study Club Officers, 2009-2010 President Erick Perroud Vice President Christa Stern Secretary Christa Stern Treasurer Erick Perroud Holland-Zeeland Dental Society Officers, 2009-2010 President Meredith Smedley Treasurer Robert Ankerman Secretary Immediate Past President Ionia-Montcalm Dental Study Club Officers, 2008-2009 President Chris Morgan Treasurer Kirkwood Faber Kent County Dental Society Officers, 2009-2010 President Brant Erbentraut Vice President David Armbrecht Secretary Lathe Miller Treasurer West Michigan Dental Foundation Officers President Donald Vander Linde Vice President Matthew Gietzen Secretary Devin Norman Treasurer Carl Kruyswyk The Bulletin of the West Michigan Dental Society is published six times a year (the directory issue, fall issue, holiday issue, winter issue, spring issue, and summer issue). The opinions expressed in The Bulletin are not necessarily the opinions of the West Michigan District Dental Society.

Contributions to The Bulletin are welcome and should be addressed to The Bulletin Editor, 4880 Cascade Road SE, Ste. B, Grand Rapids, MI 49546.

Requests for purchase of advertising space should be directed to the Advertising Editor, Elaine Fleming, (616) 234-5605. The deadline is the 1st of the month prior to publication. © 2009-2010 West Michigan District Dental Society Bulletin

Contents President’s Message...................................................................................................... 2 Editor’s Thoughts......................................................................................................... 3 The Role of the Valuation Analyst in the Dental Profession..................................... 4 Annual Session At-A-Glance........................................................................................ 8 New Members............................................................................................................... 9 Legislative Breakfast......................................................................................................10 2010 Tuition Grant Recipients.....................................................................................14 Trustee Report by Dr. Brian Cilla................................................................................16 Trustee Report by Dr. Norm Palm..............................................................................18 Classified Ads................................................................................................................22 Advertiser Index............................................................................................................23

About the cover Photos courtesy of Elaine Fleming, Executive Secretary, WMDDS.

Mission Statement The Bulletin is the newsletter of the WMDDS and its mission is to inform the membership of upcoming and recent events, state & local issues related to dentistry, and as a forum for its officers, representatives, and members to discuss appropriate topics of interest to the membership.

Communication & Advertising Policy The Bulletin will publish submitted articles from members and others that relate to the practice of dentistry, small business, social, or political issues affecting dentists, or other subjects of interest to the membership. All published items are subject to space restrictions and the community standards of the WMDDS. The editors reserve the right to reject any article or advertisement deemed ­inappropriate and to edit submissions as they see fit.

Submission & Publication Policy: Articles and advertisements must be submitted no later than the 1st of the month preceding ­publication date. The Bulletin has six publications: the directory issue, fall issue, holiday issue, winter issue, spring issue, and summer issue. Direct submissions or ­correspondences to: Dr. James C. Papp • 4880 Cascade Road SE, Suite B • Grand Rapids, MI 49546 Phone: 616.940.9872 FAX 616.940.2854 • Email: DRJPAPP@aol.com Include “Newsletter” in the subject line

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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PRESIDENT’S MESSAGE

WMDDS Has Productive Year

By Dr. Douglas R. Klein, WMDDS President

H

appy Spring! I just love this time of year… spring break, March Madness, and the beginning of baseball, golf, and boating season. However, this spring brings some melancholy with it; it’s hard to believe my term as your WMDDS president is coming to a close. Time flies when you’re having fun! All sarcasm aside, I have truly enjoyed and will cherish this experience. I must confess, however, there is one part of this position I will not miss – writing the President’s Message! As I stated in my very first message, it was shaping up to be an interesting year with several hot-button issues looming around dentistry. In that respect it certainly didn’t disappoint.

On the federal level, the repeal of the McCarran-Ferguson Act’s exemption of health insurance companies from federal antitrust laws (H.R. 3596) got off to a good start. The U.S. House of Representatives voted overwhelmingly in favor of the repeal. From here the bill moves on to the Senate… stay tuned. For more information, visit the ADA website, www.ada.org/2388.aspx.

Here in Michigan, there are currently four bills before the House (H.B. 5839-5842) seeking to make it illegal for insurance companies to set fees for services they do not cover. Grass roots member involvement is crucial to the success of our legislative campaign. Please visit www.stopinsurancebullying.com to request a “Stop Insurance Bullying Communications Kit” for MDA members. This kit will provide you with talking points, valuable background information, and through the website you can directly contact local legislators to ask for their support in our legislative campaign.

Improving access to dental services for the underprivileged remains a very complex philosophical, financial, and political 2

problem. The current political sentiment is that all Americans are entitled to dental care, but the current economy has left state and federal government unable to pay for it. In several states, potential solutions to this problem are being investigated and in some cases implemented: a cheaper delivery model (mid-level provider) and increased revenue (dental service tax). Rest assured that the MDA, through its Special Committee on Access to Care (chaired by our own Dr. Norm Palm) is working diligently to stay in front of this complex issue. This will certainly not be the last you hear about access to dental care.

I am very proud of the work that was done this year by the Executive Committee of the WMDDS Board and the WMDDS Board itself. Many of the housekeeping projects that were started last year have come to fruition and we have an energetic and motivated group of volunteer leaders. Having an “organized organization” and motivated leaders are obviously very important, but I’d be remiss not to acknowledge all the hard work done by our Executive Secretary, Elaine Fleming. Thank you, Elaine, for keeping all the moving parts moving together.

As I said previously, I am thankful for and humbled by the opportunity to serve as your President. I am proud to be a member of the West Michigan District Dental Society and will cherish the time I’ve spent serving it. Thank you for the opportunity. Have a great summer!

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

EDITOR’S THOUGHTS

Lifelong Experiences

By Dr. James C. Papp, WMDDS Editor ences. These organizations also provide us with a sense of community, a voice, a stand, and information on vital issues that may affect our dental community as a whole. With the current issues at hand such as insurance bullying and alternative providers to name a couple, now it is more important than ever to interact, listen to their experiences, and arm ourselves for the good of our dental community. Embrace life experiences to better yourself and our profession, ignore them and risk compromising yourself and how someone else shapes our dental community.

F

rom a professional perspective, there are probably one or several people in your life experiences that have influenced your decision/drive to be a dentist. For me, Drs. Fred Duiven, Ted Williams, Leo Kupp, Jeff Johnston, and Fred Smith helped shape my vision to pursue dentistry and consequently periodontics. From each person, I retained valuable pearls of information and experiences that facilitated my thoughts that, “this was the direction for me to follow.”

Some influences were simply a pleasant experience at the dental office as a child. Others a bit more challenging – involving writing a thesis, a research grant, or defending treatment cases.

Looking back, some of these were tall tasks (and it kind of makes me exhausted just thinking about it) but priceless none the less. Priceless experiences that help shape us as professionals and how we conduct ourselves in a professional environment.

Experiences that continue each and every day – listening, learning, interacting with your peers in a respectful sort of way. I hold in high regard the interaction I have with my fellow dentists and co-workers. Continuing to learn each day how to be a better professional in both the clinical and social setting.

I am always taken back by the thought that dental school and specialty training were, although very important, only a fraction of what I am as a professional today. I hold in high regard the people I am surrounded by in the dental community at all levels and continue to learn from them each day. The West Michigan District Dental Society, as well as our state and national associations, provide ample opportunity to better ourselves as professionals. Not only from just a technical standpoint to better ourselves as clinicians, but also to provide opportunity to interact and learn from each other’s experi-

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PRACTICE MANAGEMENT

The Role of the Valuation Analyst in the Dental Profession Submitted by Reggie Vander Veen, DDS General Valuation Approaches The subject of dental transitions has exploded in recent years. Literally hundreds of articles have been written on this topic.1,2,3 One of the most significant aspects of any transition is determining the fair market value of a practice. Numerous approaches can and have been employed to establish a reasonable valuation for a practice. In fact, it may be safe to assume that until recently most transactions involving the sale of a dental practice occur without the benefit of a valuation conducted professionally by an independent third party.

“What the market will bear” was and may be the standard attitude concerning sale prices for practices.

Currently the profession is experiencing an upsurge in the number of businesses that offer valuations as part of a transition service.4,5,6,7,8 Some companies are combining resources to offer this service cooperatively.9,10,11 Suffice it to say, there is more than one way to transfer ownership of a dental practice and central to all of this is to place a price tag on a dental practice.

One of the most dependable methods in determining the value of a practice prior to its sale, transfer, or transition of ownership to a new dentist is to have a professional conduct a valuation. Many companies (referenced above) do just that.

Others do not. Determining the most appropriate valuation method for all parties should be the overriding goal of any due diligence process. Arriving at the most appropriate value of a dental practice is safest way to assure a smooth sale, transfer, or practice transition. The confidence that both selling and purchasing dentists gain from a professionally determined practice value cannot be understated. A Certified Public Accountant with demonstrable experience using general valuation approaches is a start. Finding one that has a suitable understanding of the ins and outs of a dental practice is a different challenge. In general, all CPAs are expected to understand the three basic approaches used in the valuation exercise. Those approaches are: • Income-based 4

• Asset-based • Market-based Reputable CPAs with valuation experience will incorporate all three when rendering an opinion on a valuation. Each approach involves a complex set of methods that must be employed when determining the value for a business. The income-based approach, for example, requires the valuation analyst to include the capitalization of benefits method and the discounted future benefits method which include but are not limited to the intangible assets, terminal values, capitalization rates, capital structure, forecast and projection assumptions, goodwill, and much, much more. Valuation analysts with specialized knowledge in dentistry will perform these calculations and many more for their dental clients.

Dentistry comes with its own set of modifiers that should be taken into consideration if an accurate valuation is desired.

Making it fair for both the buyer and seller is in everyone’s best interest. A “win-win” situation should serve as a mutual and commendable goal which will provide the cornerstone for any transition.

Valuation Components Related to a Dental Practice Numerous factors specific to dentistry affect the value of a dental practice. The purpose of this article is to draw attention to those aspects that may help the selling dentist, the purchasing dentist, and the valuation analyst understand those factors that are unique to buying and selling a dental practice. It is not meant to serve as an all-inclusive, exhaustive treatise on the considerable amount of time and effort that take place in a transition nor is it intended to explain any of the legal ramifications of entering into and completing a purchase agreement and practice transition; however, the reader should be able to begin the process of understanding how a proper valuation of a dental practice is conducted.

Valuation components specific to dental practices may have substantial influences upon a valuation analyst’s appraisal of a dental practice. The description and explanation of components exclusive to the dental profession are provided by the author for informational purposes only. Valuation analysts cannot and will not deviate from the American Institute of Certified Public Accountants (AICPA) valuation standards.

Moreover, the author presupposes that valuation analysts WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

PRACTICE MANAGEMENT

utilizing this information are familiar with the Statement on Standards for Valuation Services (SSVS)12 issued by the AICPA Consulting Services Executive Committee or its most recent version of that statement. Dentists can expect any respectable valuation analyst to adhere to these standards when determining the value of a dental practice. Moreover, a valuation analyst can also be expected to apply valuation approaches and methods to information obtained from transition components specific to dentistry. The specific dental transition components beyond those found in typical business valuations used for transactions for total acquisitions and/or partner and shareholder buy-ins/buyouts include but are not limited to: • Determination of active patient population • Management of recare (or recall) patient base • Fee schedule analysis • Facility assessment This list does not attempt to consider the complianceoriented engagements that occur in a practice transition such as income tax compliance, corporation conversions, purchase price allocation, and other matters, nor does the list reflect the comprehensive aspects of applying valuation theory and principles in the valuation analyst’s performance of due diligence in determining a practice’s valuation. Those elements specific to an individual purchase agreement and practice transition are left up to the valuation analyst for their proper execution and detailed explanation and the attorneys responsible for executing the related documents.

The scope of this article is not intended to address when a valuation should be determined; however, relationships have been tarnished and even broken if careful consideration isn’t given to the timing of when a valuation is to be determined for a practice. Common sense leads reasonable minds to the conclusion that any a practice valuation that is determined long after the arrival of an associate would be skewed in favor of the selling or owner dentist. An associate that works many months or even years in a practice in such a scenario would, in fact, be increasing the value of a practice by the increase in the gross production and net revenues simply by his or her presence in the practice. Suffice it to say, practice owners may wish to include a clause to remedy such undesirable consequence in an employee agreement prior to bringing an WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

associate into the practice if a delay in the valuation of the practice goes beyond six months to a year. Many new dentists understand the need for such language in an employee agreement and may even demand it. The old “timing is everything” axiom makes sense in this instance.

Determination of Active Patient Population Plenty of articles have been written on how an active patient population should be determined.13,14,15,16 Consultants have varying views on what the number of active patients may mean to a practice’s bottom line. The valuation analyst must take into consideration these differences of opinion in the profession. Buyers and sellers would be advised to explore all the methods that are used to determine an active patient figure. Many software applications have a proprietary feature built into their programs to come up with a number and, as expected, definitions vary. For the purposes of the valuation analyst, a raw yet demonstrable number may be all that is necessary in arriving at a valuation for any given practice.

In any event, the easier it is for a practice to identify, control, and retain its active patient base, the less difficult it is for the valuation analyst to determine the health of a practice – a valuable piece of information that may need to be used in appraising a dental practice. Dentists fundamentally depend upon this number for deciding whether or not an office can sustain an associate during a transition and support the owner dentist as a “senior associate” after the sale of the practice is executed; however, valuation analysts use this number to objectively appraise the health of a practice as an intangible asset which may ultimately affect the value. A practice’s patient base, in contrast, is a tangible asset – invariably the largest asset listed in a valuation – and in most cases will make up the lion’s share of a practice’s goodwill, if not all of it. After all, the whole point in purchasing a practice is to obtain the selling dentist’s patient base, therefore the importance placed upon it cannot be understated. The obvious conclusion from this is to make sure that care and concern is exercised when ascertaining the number of active patients in a practice.

Management of Recare (or Recall) Patient Base The significance being placed on a practice’s recare program is debatable as it relates to valuations of practices. The impor-

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PRACTICE MANAGEMENT

tance to the health of a dental practice, however, does not appear to be debatable.17,18,19 Practices that understand the need to cultivate the process of keeping their patients active have strong recare programs in place. Figures vary amongst the members of the consulting crowd, but a case can be made to conclude that good practices reappoint 80 to 85% of an active patient base, better ones 85 to 90%, and the best ones even more.20,21,22 The number of patients active in a recare program directly correlates with a dental practice’s ability to bring on an associate.

If an adequate patient base is available and the recare program is performing poorly, an underdeveloped asset exists. If the owner dentist is amenable to requests to activate measures reverse such a downward trend, this may positively affect the practice’s valuation. Obviously, the facility’s capacity to handle the anticipated increase in patient flow needs to be addressed and its overall effect on the practice’s value. This serves as another example of the need for the valuation analyst’s familiarity with the intricacies of a dental practice.

From strictly a facilities standpoint, offices with a small footprint usually consider expanding office hours to compensate for the addition of an associate. Needless to say, offices faced with this dilemma have to weigh the increased gross production and net revenue against the strain on staff and potential loss of goodwill and reduction of one-on-one mentoring that will undoubtedly ensue. Therefore, it may be wise for the valuation analyst to take this aspect of facilities capacity into consideration and for the owner dentist to acknowledge the effect that this may have on practice value.

Many offices considering transitions are painfully aware of this consequence and address it in distinctive ways. Others have unused or adaptable space that can readily adjust to the addition of an associate; however, those practices with underutilized space have to accept the negative implication that this unquestionably has on a valuation. Larger, underutilized facilities bring their own set of complexities to the equation.

The precise valuation analyst understands the difference and considers this appropriately in the calculation.

Fee Schedule Analysis A sometimes overlooked aspect of the value of a practice to the purchaser is the strength of its fee schedule. You would expect a corresponding drop in value for a practice that has a weak schedule of fees and dependence upon capitated fees or other forms of fixed reimbursement levels. The purchasing dentist should not overlook this important aspect in evaluating the worth of a dental practice nor should the competent valuation professional. Valuation analysts have at their disposal numerous sources for securing fee schedule analyses of dental practices.23,24,25 The impact of the existing fee schedule on the valuation of a practice should never be viewed as a trivial component of a practice’s value.

Conclusion It is incumbent upon the prudent dental practitioner to set up strategies well in advance of the sale of a dental practice: when to exit practice, what it is worth, what the retirement needs are, and how a sale will maximize one’s pension planning.

Although the dependence upon the sale price of a practice as a major part of a dentist’s retirement package varies widely from case to case, every dentist considering a transition from active practice must not ignore the importance of finding the right professionals to assist in this life-changing event.

Moreover, the role of the valuation analyst in determining fair market value for dental practices cannot be overemphasized.

Purchasing dentists should never take for granted the business repercussions associated with the valuation process. Securing a fair and sound figure is of paramount concern. Never assume that “60% of last year’s gross” should ever serve as being “close enough.” Seeking out the services of a true valuation specialist protects everyone’s investment. Practitioners and future practitioners should seek out this indispensable service as locally and logically as possible. No one loses when it’s done right.

Facility Assessment As stated above, a dental transition depends upon a large mix of factors available to the valuation analyst when determining the value of a dental practice, not the least of which is the physical plant in which dental services are delivered. The valuation analyst must understand that mere square footage does not address the complexity of arriving at an accurate valuation figure for a dental office. The proper balance of operatory space, business space, and support space should have a direct relationship upon the final figure.

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

PRACTICE MANAGEMENT

Bibliography

Bibliography

11

Dentaltown, http://www.towniecentral.com/Dentaltown/SearchResults. aspx?q=dental%20%20transitions

14

Professional Transition Strategies, http://www.professionaltransition. com/Dental-Practice-services.htm

12

American Dental Association publications, http://gsa.ada.org/searc h?q=dental+transitions&site=ADAorg_Collection&client=ADAorg_ FrontEnd&proxystylesheet=ADAorg_FrontEnd&output=xml_no_ dtd&proxyreload=1&btnG.x=0&btnG.y=0&btnG=Search

15

Dental Practice Report, Thomas L. Snyder, DMD, MBA “Patients Lists” – Best Practices Section, http://www.professionaltransition.com/DentalPractice-services.htm

16

13

PennWell Dental Group, http://www.dentaleconomics.com/search/results. html?keywords=practice+transitions&collection=de

“The Most Important Number – The Active Patient Count,” http:// www.henryschein.com/us-en/images/dental/ActivePatientCount.pdf

17

14

AFTCO Transition Consultants, http://www.aftco.net/

Dentistry.com, http://www.dentistry.com/articles/Increasing_Your_ Recall_Rate_Through_Your_Dental_Hygienist.aspx

15

Paragon Dental Practice Transitions, http://www.paragon.us.com/

18

16

Henry Schein, http://www.henryschein.com/us-en/dental/services/ PPTaboutus.aspx

Dental Success, http://dentalsuccess.biz/index2.php?option=com_ content&do_pdf=1&id=48

19

The Profitable Dentist: “Coaching,” http://www.newdentalforum.com/ index.php/coaching.html

17

Mercer Advisors, http://www.merceradvisors.com/services/transitions.php

18

Practice Transitions Partners, http://www.practicetransitions.com/

20

19

Professional Practices Consultants, Inc., http://www.practicesales.com/ dental/default.asp

AnnetteLinder.com & Capital Assoc., http://www.annettelinder.com/ articles.htm

21

“The Perfect Recall System” – presentation by Fran Martini, RDH of Lighthouse PMG, http://c1-preview.prosites.com/70102/wy/docs/The%20 Perfect%20Recall%20System.pdf

22

The Journal of Practical Hygiene, July/August 2001, http://www. mmcpub.com/pdf/2001jph/200104jph_pdf/01jphv10n4p53.pdf

23

Proveer, http://www.dentistfee.com/

24

Tracker Enterprises, http://www.trackerenterprises.com/index. php?option=com_content&task=view&id=74&Itemid=71

25

Renaissance Services & Systems, LLC, http://www.rss-llc.com/r_fees.php

10

Transdent, http://www.transdent.com/ (Patterson Dental and Mercer Advisors)

11

ADS Brokers, http://67.199.84.244/Public/adsbrokers.aspx

12

AICPA SSVS #1, June 2007, http://fvs.aicpa.org/NR/ rdonlyres/672E1DD4-2304-47CA-8F34-8C5AA64CB008/0/SSVS_Full_ Version.pdf issued by the AICPA Consulting Services Executive Committee

13

Dentalcompare, http://www.dentalcompare.com/featuredarticle. asp?articleid=78

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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MDA NEWS

Annual Session At-a-Glance

Dr. Chris Smiley at the Candidate’s Forum.

Dr. Colette Smiley gives nominations speech for Dr. Chris Smiley, candidate for MDA Journal Editor.

Dr. John Vander Kolk was presented with the MDA Public Service Award.

8

Dr. Norm Palm, MDA Secretary.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

NEW MEMBER PROFILE

Drs. Ryan & Jolanta Wilson Dr. Ryan Wilson obtained his undergraduate education from Alma College earning a Bachelor of Science degree with Biology major. Dr. Jolanta Wilson completed three years of undergraduate studies in Chemical Engineering at the University of Michigan College of Engineering. The two met in dental school and completed their dental education and training at University of Detroit Mercy School of Dentistry. Ryan graduated in 2003 and Jolanta in 2004. The couple married one week after Jolanta graduated. In 2006, Ryan and Jolanta purchased the Rockford practice of Dr. Lisa Sostecke.

Dr. Sostecke continues to practice with the Wilson team.

On any given day you may find Ryan road biking, keeping bees, brewing craft beer, or perfecting his shot at the local sportsman’s club. Jolanta is an avid painter and gardener,

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

even growing hops to supply their home brewery. Recently, Jolanta has made a commitment to add running to her schedule and will compete in her first road race this summer. The couple has two loving “children,” Bella, a toy poodle, and Ko-Ko, a standard poodle.

The Wilsons are members of local, state and national dental societies and continue to further their education with the goal of providing state-of-the-art care their patients deserve.

Drs. Ryan and Jolanta Wilson enjoy working together, with their exceptional staff, and enjoy the community in which they live.

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LEGISLATIVE BREAKFAST

WMDDS Hosts Legislators

O

n Friday, April 23rd, the West Michigan District Dental Society held a legislative breakfast at GVSU’s Eberhard Center. Thanks to all the legislators and dentists who attended. There was some very good discussion around the tables about the Michigan Dental Association’s legislative action to stop dental insurance plans from setting maximum fees for non-covered dental services. If you haven’t requested your Stop Insurance Bullying Communications Action Kit for MDA Members, go to www.stopinsurancebullying.com.

Lawmakers attending: Rep. Dave Agema, Rep. Justin Amash, Sen. Bill Hardiman, Rep. Dave Hildenbrand, Sen. Mark Jansen, Sen. Wayne Kuipers, Rep. Arlan Meekhof, Rep. Roy Schmidt and candidate for state representative, Rusty Richter. Also in attendance were staffers Lindsey Koorndyk, Janis DeVree, and Kerry Van Laan.

Attending from the Michigan Dental Association: Mr. Drew Eason, Mr. Bill Sullivan, and Mrs. Caroline Ruddell.

WMDDS members attending: Drs. Richard Baldridge, Eugene Bonofiglo, Aaron Boucher, Mark Brieden, James Brennan, Todd Brower, Brian Cilla, Steven Dater, Jason Dew, Bradley Dykstra, James Hur, Douglas Klein, Ryan Lebster, Erik Lee, Debra Peters, William Rocker, Michael Smith, Donald Vander Linde, Seth Vruggink, Tyler Wolf, and Peter Zwier.

Representative Dave Hildenbrand.

Dr. Douglas Klein, WMDDS president.

More new from the WMDDS Legislative Committee Dr. Steve Dater is the new committee chair. If you have any legislative questions or concerns, please contact him at 616.866.0869 or by email at smdater@comcast.net. He also recommends you sign up for ADA Legislative Alerts by going to http://capwiz.com/dental/mlm/signup/.

Representative Roy Schmidt and Representative Arlan Meekhof.

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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WMDF NEWS

Announcing 2010 Tuition Grant Recipients Submitted by Rosemary Jeruzal, Chairperson, WMDF Tuition Grant Committee

h 3 Requests for Grant applications received. h 3 Grant applications received and reviewed by Tuition Grant Committee. h 3 Personal interviews held with each applicant. h 3 WMDF Tuition Grant Committee makes final decision on Grant Recipients.

The following exceptional students are named the recipients of the 2010 West Michigan Dental Foundation Tuition Grants: Stephen Mancewicz, University of Michigan School of Dentistry Steve’s plan upon graduation in 2011 from dental school is to return to Grand Rapids and practice with his father, Gary Mancewicz, DDS. Since taking on certain leadership responsibilities while in dental school, he plans to pursue leadership roles once in organized dentistry and in his community. He says that “coming from the city that began the greatest advancement in Dental Public Health with the fluoridation of city water, I grew up learning about the importance of oral health and preventative care.” His goal is “to continue to educate the public about how to maintain good oral hygiene and work with fellow colleagues to provide care to underserved communities.” With a student of Steve’s caliber, the future of organized dentistry in West Michigan looks strong.

Ezequiel Rios, Grand Rapids Community College Dental Hygiene Program “Zeke” has worked in the dental setting since he was 18 years of age. He has loved the experiences he has gained through his work in a private practice in Muskegon and at Clinica Santa Maria in Grand Rapids. A letter of recommendation received from Dr. Carl Branyan stated that “I cannot possibly say enough good about this completely outstanding young man.” He always showed foresight, anticipation, and attention to detail, and 14

was the master at multi-tasking in Dr. Branyan’s practice. Dr. Branyan added that “he (Ezequiel) has the strongest work ethic I have ever seen in a young man of his age.” When Zeke does graduate in 2011 as an RDH, he will definitely be an asset to any lucky dental practice.

Kristine McCallion – Grand Rapids Community College Dental Hygiene Program Kristine has worked for Steve Dater, DDS, in Rockford for the last 4½ years as a dental treatment coordinator. She has a lot of knowledge from her years of private practice experience, both in front office and assisting areas. Her goal is to work for a general dentist in the Grand Rapids area upon graduation as an RDH in 2011. Her personality, attitude, and love of the dental profession won over the committee in her personal interview. Kristine will be a definite asset to a lucky dental practice.

Nicole Weemhoff, Grand Rapids Community College Dental Assisting Program Ni c o l e wa s vo te d cl a s s President in her dental assisting program because of her willingness to be involved. She relates well to everyone and feels this is an important asset in the worka-day world. She has thoroughly enjoyed her participation in the lab and clinical areas and has had perfect attendance throughout her dental assisting program. She will receive her Associates degree in Dental Assistance in June 2010. She says “a nice and healthy smile can go a long way in contributing to the success of everyone who obtains one.” Her major goal and desire is to put a smile on everyone’s face by cosmetically helping to make their smile the nicest it can be so they will feel good about themselves. To Nicole “making others happy and pleased with the results of her service is a goal in itself.”

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

WMDF NEWS

Leah Waterman, Grand Rapids Community College Dental Assisting Program Leah impressed the committee with her desire to give back to her local community by helping to serve their dental healthcare needs. She has worked every day she can to continue her schooling, a work ethic taught to her by her mom. Her ultimate goal would be to continue her education in a dental hygiene program. Leah’s attitude toward life and giving to others will serve as an inspiration to the West Michigan Dental Community.

Life Lesson #1: Handicapped-Impaired-Disabled

By JoAnne Hodder, RDH BS Whenever I saw someone with an obvious handicap, I would think, “There but for the grace of God, go I. Thank you, Lord, and bless that person.” That is, until February 20 this year, when I fractured my right wrist. I was a spectator at a basketball game at the Basketball Courthouse on 84th Street, sitting in the only three-riser bleacher seating behind the backboard. Just before halftime, one of the players threw a ball from midcourt, but missed the backboard totally. The ball headed straight for my head.

My reflex action was to put out my right hand to prevent a face plant. The ball hit my hand so hard it bent my hand back and fractured the radius wrist bone. Welcome to the world of the handicapped!

I never realized how cumbersome a cast can be, especially when it covers half of your hand and arm, or when the use of your dominant hand is limited to holding nothing heavier than a cup of coffee or water. Brushing and flossing my teeth, eating, dressing myself, doing my makeup and hair, cooking and cleaning, typing on the computer, starting the car (ignition and gear shift are on

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

the right side), grocery shopping, babysitting my grandchildren, and holding dental hygiene instruments have all become major challenges. The cast is off and I am in a brace now and doing physical therapy to relieve the “frozen wrist.” It’s a process. But it has also given me time to think about all those other “handicapped-impaireddisabled people” who have permanent injuries (e.g. war veterans, work-related injuries, and those with arthritis and other debilitating diseases and injuries, etc.) as well as those with birth defects and anything else that limits one’s agility and mobility.

As dental professionals, how do you view your patients who are handicapped? What is your “Office Plan of Action” to assist your impaired patients with their oral health needs? What would you do if you were disabled?

This has been a tough “life lesson” for me, and it’s not over yet. But it has given me a whole new appreciation for those people with impairments who have to deal with theirs every day in every way. Bless us all, Lord.

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TRUSTEE REPORT

Spring 2010

By Dr. Brian Cilla, MDA Trustee

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his year, the MDA annual session was held at a new venue, the Rock Financial Showplace, in Novi. The attendance was excellent, with over 5,000 dentists and staff turning out for this event. Given the state of the Michigan economy, everyone was pleasantly surprised to see that these numbers surpassed the previous Detroit session.

The vendors were very impressed by the facility and staff. This group expressed sentiments which overwhelmingly supported return to the same location in three years. Dental attendees expressed similar opinions and as a consequence, the MDA will be looking to return to Novi in 2013. The MDA annual session rotation will return the meeting to Grand Rapids next year and it will be our turn to host this event.

Once again, West Michigan and Muskegon District Dental Societies were well represented by our delegates and alternates.

This group needs to be congratulated. Everyone on the delegation has volunteered their time and effort to insure that we are well represented for the issues that have potential impact on our profession. It is important to note that our representatives are not shy and have a knack for asking the right questions at the right time. We, as a district dental society, encourage participation and are always looking for individuals to sign on to the delegation. No experience required, just be ready, willing, and able to serve.

I would like to report on the most pertinent resolutions and actions taken at the 2010 HOD: • The HOD passed an extension of the building dues assessment (up to $160/year) for three more years. It is anticipated that this will provide for a five-year payoff of the mortgage on the new MDA Headquarters.

• Approval was given for ongoing MDA lobbying activity in order to achieve support for passage of “I’m Sorry” legisla 16

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tion. This is a common sense approach to resolving potential patient-related issues that will be strongly opposed by the legal profession.

The most discussed topic at this HOD pertained to whether or not the MDA should be involved with funding issues related to public oral health programs. Ultimately, the HOD passed a resolution that allows our MDA speaker, Dr. Deb Peters, to appoint a committee for the purpose of investigating the feasibility of new revenue sources dedicated to funding Michigan Public Oral Health programs.

This committee will report back to the 2011 HOD or in a special session called for this purpose.

The HOD adopted a resolution, which advocates that the State of Michigan needs to have an Oral Health Program that is supervised by a state dental officer. This position would be held by a licensed dentist and allow for positive interaction with the Michigan Department of Community Health (MDCH) in determining public dental needs, provide pertinent oral health care advice, supervise regulated dental procedures, and act as a guardian of a state comprehensive oral health plan.

It has become apparent over time that there are significant deficiencies with the legislative act that allows for the operation of mobile dental clinics. As a consequence, the HOD has resolved that the MDA should seek specific changes to statutory public health code regulations. This process would be done in collaboration with the MDCH and the State Board of Dentistry. The most pertinent issues requiring change revolve around the concepts of comprehensive dentistry, establishment of a dental home, informed consent, and post-treatment information. These are serious issues, which hopefully can be resolved with active MDA input and participation.

Certain medical technologies, such as a dental CAT scan, require a Certificate of Need prior to their use in a clinical setting. The HOD has requested that the MDA Board of Trustees investigate the feasibility of appointing a dentist to the Certificate of Need Commission in order to advance the interest of dentistry for these FDA-approved devices.

The HOD has resolved that the MDA should endorse the candidacy of Dr. Jane Grover for State Representative. Jane is seeking election in the Jackson area. She has experience WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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in private practice and with public health dentistry.

Interestingly, there has never been a dentist elected to any state office. The general consensus is that Dr. Grover will provide a reasoned voice for issues that might have impact on the dental profession.

• Dr. Chris Smiley was in a contested election for MDA editor. The campaigns were conducted in a collegial and professional manner. Both candidates had impressive credentials and the necessary attributes for continuation of the fine traditions of our past Journal editors. In the end, the HOD elected Dr. Virginia Merchant as the new MDA Journal editor. I believe that Virginia (as Chris would have been) is certainly up to the task of keeping our Journal relevant and informative.

• Dr. Norm Palm announced his candidacy for MDA vicepresident. Talk about a glutton for punishment. The amount of time and effort required for his work on the Special Committee on Access to Care would have killed a mere mortal. Norm has demonstrated that he is as tenacious as a pit bull and is unafraid of addressing difficult or challenging issues. We can be thankful for his willingness to continue on with service to the MDA. • Dr. Deb Peters announced her candidacy for MDA speaker.

Deb possesses an exemplary knowledge of parliamentary procedures and has a proven ability to run an efficient meeting. Those of us that attended the HOD are certainly appreciative of her ability to keep us on task.

Bill Sullivan will be our new MDA director of Legislative and Insurance Affairs. He is taking the reigns from Caroline Ruddell, who has retired in order to be a stay-at-home mother.

You will find that Bill is eminently well qualified for this position and that his strong legislative experience will be a necessary asset to the MDA. He will be taking a lead role in our opposition to Delta Dental and the policy of setting fees for non-covered services (NCS).

The MDA has been very active with the “Stop Insurance bullying” campaign. In March, a legislative reception was held in Lansing. Dentists from across the state were in attendance to meet and greet legislators. There have been fundraisers for representatives friendly to our cause. Locally, WMDDS had a well-attended legislative breakfast. These events are important mechanisms for demonstrating our concern over this issue. It WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

is apparent, from the sentiments that I am hearing from our colleagues, that Delta Dental executives might as well have poked a hornet’s nest with a sharp stick. If they wanted to see where the line is drawn in the sand, then I believe that they have accomplished that objective.

Nationally, there are twenty-seven states that have introduced bills to overturn Delta NCS policies. New York already had existing laws that prevent insurers from offering inducements, such as fee reductions for NCS, to purchasers of insurance policies. At the end of April, twelve states had passed, or were finalizing, laws that prohibit this absurd policy. It is of interest to note that support is bipartisan and overwhelmingly in support of our position (1816 yes vs. 93 no).

Our efforts at the local level are absolutely required in order to counteract the influence of Delta Dental in Michigan.

This dental insurance company is not without influence. They have begun to paint a picture that Delta is a white knight riding in to do battle with greedy and uncaring dentists. As a consequence, conversation with your local state representative and/or senator is strongly encouraged. The bill sponsors have indicated that a personal letter will have more impact than e-mail. Please take the time to send some of your stationery to Lansing.

As always, I will try to keep everyone informed about MDA activities. Do not hesitate to call or write (blcilla@aol.com) if you have any questions, concerns or commentary. I hope that everyone has a good summer!

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What You Should Know About Alternative Providers

By Dr. Norm Palm, MDA Trustee

M

ember dentists have been hearing more about alternative providers recently.

What is behind this move for a new dental provider?

New providers are being proposed as a solution to the access to care problem, particularly to improve access to underserved children. Proponents of an alternative provider cite a lack of capacity of the existing dental delivery system to treat the large number of people in the U.S. that do not have ready access to dental care. In addition, a declining ratio of dentist to population, an increasing age of the dentist workforce, and the lack of participation by most dentists in the Medicaid system are stated reasons to create another provider in dentistry.

Are there any alternative dental providers currently in the United States?

The first alternative provider was the Dental Health Aide Therapist in Alaska. The Alaska DHAT is sponsored by the Alaska Native Tribal Health Consortium and has had sovereign control of the project. They will train and deploy this dental provider in remote areas of Alaska to provide basic oral health care with collaborative supervision by a dentist. The design is to train from the community and to return to the community to serve. Although the Alaska Dental Association and the ADA provided a dentist workforce and support to serve these rural native Alaskans, the ANTHC required a culturally-sensitive dental provider, not an outsider. The ANTHC saw the Community Health Worker as a model to which dental services could be added, spawning the DHAT. The W. K. Kellogg Foundation has provided a four-year

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grant for the training of the Alaska DHAT in a two-year curriculum with didactic instruction through the University of Washington MEDEX in the first year and clinical training under supervision in Alaska in the second year of training. A comprehensive two-year evaluation of the DHAT’s effectiveness in Alaska will begin soon, with the ADA having a seat on the evaluation panel. The Indian Health Service sought approval to expand DHAT deployment to the lower fortyeight states in late 2009 with mixed results. Only Minnesota will have DHATs available for serving native Americans as that state sanctioned the development of this provider model in legislation passed earlier in 2009.

How are DHATs in Alaska and Minnesota similar?

How do they differ?

The Alaska DHAT really works in a collaborative manner with a supervising dentist. After completing training, the Alaska DHAT initial worksite is supervised. The supervising dentist makes an assessment of the skill set of the DHAT and issues standing orders of allowable duties. Thereafter, the supervision is remote. The scope of treatment includes diagnosis, restorations, prophylaxis, extractions, pulpotomies, and crowns for primary teeth. The Alaska DHAT has tribal certification and is not state sanctioned.

The Minnesota DHAT has two levels of training and, right now, two differing curriculum tracks. This has caused some confusion, but what you need to know is that Minnesota will have two types of DHATs – a basic and an advanced. The scope of the Minnesota DHATs will include irreversible procedures and surgical treatment and is similar to the Alaska model.

The duties list includes interim therapeutic restorations, local anesthesia, restorative care, pulpotomies, pulp capping, primary extractions, and prescription writing. Supposedly, the Minnesota DHAT will provide care in FQHC’s, assisted living centers, military or VA facilities, and other sites where at least 50% of the population is enrolled in a public program or has an income less than 200% of the federal poverty level.

However, at this time the regulatory oversight and supervision of the Minnesota DHATs has not been settled and is in transition. The crucial decisions of whether the DHAT will have a CODA approved curriculum, oversight by the Board of Dentistry, and direct or general supervision have yet to be WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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made. While the design was created to direct treatment to those most in need, enough latitude exists in deployment to question whether the intended increase in the capacity of the delivery system will actually be seen where the greatest disparity in access to care exists.

What has happened with the ADA-sponsored provider, the Community Dental Health Coordinator?

The rural and native American pilot programs are underway in Oklahoma and are supervised by UCLA School of Dentistry. The inner city program, however, was delayed and will be starting soon in Philadelphia under the auspices of the School of Dentistry at Temple University. Like the DHAT, the CDHC will be an individual who is drawn from the community to be served. The curriculum is 18 months long and will have a clinical scope of preventive care such as fluoride application, sealants, prophylaxis and very limited scaling, placement of interim therapeutic restorations, plus screening and diagnostic data collection. The scope excludes irreversible treatment. The CDHC will be a community health worker who will play a primary role as a demand aggregator and patient navigator, demonstrating skills in cultural competency, community networking, and barriers to care resolution. I think it is fair to say that the lack of vigorous support from well intentioned but misinformed dentists for the CDHC has affected the momentum behind this model. There is existing ADA policy in effect since 2004 which declares that the ADA is opposed to non-dentists making diagnoses, developing treatment plans, or performing irreversible procedures. The 2009 ADA House directed the Council on Dental Practice to review this policy statement and report its findings to the 2010 House.

Am I correct in thinking that the DHAT is the model with the most proponents?

Right now the DHAT movement has the most velocity.

Recently, the American Association of Public Health Dentists announced their intent to develop a DHAT curriculum in cooperation with the Kellogg Foundation. There are other models as well such as the Advanced Dental Hygiene Practioner, supported by the American Dental Hygienist Association and the Pediatric Therapist in Maine. The ADHP WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

was proposed in 2004 and has the broadest scope of practice with only a collaborative supervisory role for the dentist. The educational requirement is six years, nearly that of a dentist.

No pilots for the ADHP are in progress. In Colorado, where independent hygiene practice has been in place for ten years, there has been no measurable improvement in access for the underserved. The Maine Pediatric Therapist is sponsored by the Maine Dental Association as an alternative to an ADHP proposal in that state.

This seems confusing. Why the differing models?

Each state is seeing varying components to their access workforce issue, and models for alternative providers are being developed to address local needs while accommodating the political culture in these states. Additionally, non-dentist stakeholders are vying for influence in the outcome of this proposed reordering of the dental workforce. What we can be sure of is the legislative and regulatory process in each state will guarantee inevitable variation from state to state in any alternative provider that is produced and sanctioned.

What is the political environment on the alternative provider issue right now?

Again, variation from state to state is the norm. States such as Maine, Connecticut, Washington, and New Mexico have been coping with alternative provider proposals for some time.

In these states, dentists are making decisions that we in Michigan have not had to face. Legislatures across the country are responsible for a chronic underfunding of dental Medicaid programs. The result has been an increasing disparity in dental care for poor children on Medicaid compared to children covered by private insurance in this country. This underfunding is attributable to an actual increase in the caries rate in poor children aged 2 to 5 in the last decade and a concentration of 80% of dental caries in 25% of children in the United States. However, the fact that state Medicaid programs for dental care are typically inadequately and inconsistently funded is being masked by the development of the alternative provider movement as a solution to the access problem. These alternative provider models have political appeal as they appear to be flashy solutions with low costs and are modeled after community health workers, physician assistants, and

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nurse practioners in medicine. However, these newer workforce members in medicine do not provide surgical treatment with remote supervision as is proposed with some of the new dental alternative providers.

In the states facing alternative providers, did their legislatures force the issue upon dentistry?

In a number of states, dentists found it important to enter into an intensive process of engagement with legislators and proponents of alternative provider solutions. This action was necessary in order to achieve the best outcome with legislation, and prevent actions that they did not necessarily want to happen. Minnesota had a protracted two-year fight on alternative provider proposals. It was an exhaustive process for the Minnesota Dental Association. The Minnesota experience could be repeated. Legislators state that poor access to dental care is one of their most frequently heard health care complaints. While Democrats have been more traditionally attuned to access issues, many Republicans embrace these issues with an eye toward cost containment in one of each state’s biggest line items, health care costs. Many legislators are legitimately concerned and view the foundations as an independent voice on the issue. The entrance of the Kellogg Foundation and the Pew Charitable Trust into the access to care issue has accelerated these new alternative provider proposals. Workforce creation is voiced by them as a more measurable metric in which to gauge success on access improvement. Also to be expected will be the entrance of the dental education establishment into the foray with opinion and a desire to protect turf.

How did these foundations get into this issue?

What can we expect from them?

They became involved by identifying the need for better oral health care for poor children, proposing solutions, and funding pilot programs. The two most vocal foundations have been the Pew Charitable Trust with its Children’s Dental Campaign and the Kellogg Foundation, which has been involved with the DHAT movement since its inception in Alaska. Both of these foundations are seeking to call attention to poor children’s inadequate access to dental care and mean to affect social change to correct the access problem. They describe the 20

problem as ripe for reform, and these foundations are giving poor children a voice when they historically have had none.

Kellogg has become very aggressive in its position and has marked five states that it wishes to start DHAT pilot programs in the next year: Vermont, New Mexico, Kansas, Washington, and Ohio. They intend to be community based and partnered with an in-state, non-profit agency that will help Kellogg move public opinion on access issues for dental care. Pew initiated its campaign in October of 2009. Pew states that, unlike so many other of America’s health care problems, the challenge of assuring children’s dental health and access to care is one that can be overcome. There are a variety of solutions, Pew states, that can be achieved at relatively little cost; and the return on investment for children and taxpayers would be significant. Pew supports state efforts to expand the existing dental health care team with new providers. Proposals for new workforce models, Pew reasons, should be based on research and evidence from both domestic and international sources. Pew also agrees that Medicaid dental programs are chronically underfunded with most states way below the cost of providing the service.

What is the public’s perception on access to dental care?

National surveys show that the public is comfortable with medical mid-level providers, as such providers have been in the medical workforce for many years. The public states they want lower costs for dental care and greater access. They have less well formed opinions on what constitutes quality and safety in care. They are distrustful of institutions and prefer to form their own opinions. The public also indicates that they are overwhelmed by information on topics in health care.

What are the ethical issues for the profession on this issue?

In Michigan, we are very proud of the success of Healthy Kids Dental, which is the Delta Dental administered Medicaid program for children in 61 of Michigan’s 83 counties. The program is successful by most any metric used to assess a publicly-funded health care program. However, despite tireless efforts on the MDA’s part, we have not seen HKD expanded to all Michigan counties. Of concern is the fact that WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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only about 31% of children on Medicaid reside in a HKD county. Yet, these counties not served by HKD are the ones where the greatest disparities exist. These are the counties that have the highest minority populations and where it is known that 64% of Latino children and 65% of African American children under age six come from a poor family. These are also the poor minority children that we know have the greatest concentration of dental caries. This should cause all dentists in Michigan concern. Lastly, with respect to the development of an alternative provider, reserving a lower standard of care for children who are disadvantaged at no fault of their own creates a separate and unequal level of care for these children that is undeserved. Such a distinct two-tiered standard of care has not been sanctioned in the health care delivery system in the United States until now.

What is the MDA doing about access and the alternative provider issue?

The MDA Board formed a Task Force on Access to Care in late 2007. The Task Force reported to the Board of Trustees in June 2008. In that report, the Task Force defined several mission directives that the MDA must pursue on the access issue: • MDA must become an authority on access-to-care in Michigan via research and sound collection of data.

• MDA must demonstrate that it is the credible and authoritative leader on access-to-care in Michigan and remain a credible leader.

• MDA must develop educational opportunities that focus its members, the public, and policy makers on the nature of the access-to-care issue in Michigan.

• MDA must open more collaborative pathways with stakeholders and communities of interest to improve access-tocare and advocacy efforts.

in the Medicaid program, the creation of a dental home for all children, as well as calling attention to the increasing problem of early childhood caries and its later affects in school aged children. In addition, the MDA has embarked on a project to develop a public policy statement on oral healthcare in Michigan, including not only member dentists but other stakeholders and parties who have an interest in the oral health of Michigan residents. The report of the Michigan Access to Oral Health Care Work Group is anticipated in June of this year. Broadly based recommendations are anticipated from the Work Group, and new partners with common interests are being identified. It is hoped that the MDA can nurture these new relationships further. Some of the work of the SpCAC is reflected in four resolutions that will be before the MDA House this April. The SpCAC is alarmed that the access issue is suddenly being overcome by proposals that the development of an alternative provider will solve the access problem.

What can I do as a member dentist about the alternative provider issue?

Don’t be antagonized about the issue. Try not to react emotionally to what you see and hear. Try to think about the potential ramifications for dentistry if part of our scope of practice is given to another lesser trained provider. Realize, too, that we have no timeline and we don’t know the outcome on this issue. Don’t be ambivalent: another dental provider of the designs being considered will affect all dentists in Michigan no matter where you are at in your practice life and where in Michigan you practice. Rather, be assertive on the issue by staying informed on developments in access and workforce. Come to understand that we may be faced with difficult decisions in the next several years.

In response to these directives, the MDA Board formed a Special Committee on Access to Care (SpCAC) to formulate specific measures to improve assess. This MDA Board committee began meeting in October 2008. This SpCAC is working on the goals of expansion of Healthy Kids Dental statewide, support of the Michigan Department of Community Health’s oral health plan for Michigan, administrative reform WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

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CLASSIFIED ADS

The classified ad rate is $10.00 up to and including 30 words; additional words 15¢ each. Space permitting, WMDDS members may place ads free of charge as a membership service. Ads should be submitted in writing and sent with payment to Elaine Fleming, WMDDS, 511-F Waters Building, Grand Rapids, MI 49503. Telephone numbers and hyphenations count as two words, abbreviations count as one word. Ads received after the first of the month prior to publication may appear in the following issue.

Space for Lease – Holland (great north side neighborhood location).

Previous tenant was a family practice dentist. High visibility sign available.

Building interior is ready for equipment installation. Three ops and small lab. Owner is willing to adapt building to needs. Call 616.245.9098 or 800.669.0717.

SE Grand Rapids – Opportunity for a younger dentist to begin transition to their own practice. Recently remodeled office in an excellent location.

Gradually meet the patients and earn extra money as existing dentist takes additional time off over the next three to five years. If interested, email cascadedentistry@gmail.com.

Office Space for Lease – Great location! 2426 Burton St. SE, 915 sq. ft., ­ 3 operatories, lab, private office, reception, business office, basement. Contact Dr. Sam Bander at 616.949.5980 or email at drsam@sbcglobal.net Storage Space for Lease – Safe, secure, 24/7 access. Ideal for records, models, or just stuff you need to store. Located in the basement at 1151 East Paris Ave. Contact Dr. Sam Bander at 616.949.5980 or drsam@sbcglobal. net for more information.

Dental Practice For Sale – Jenison, Michigan. Established and growing dental practice on major Jenison traffic route. Great income potential.

Call for details 616.245.2767 or cell 616.485.1348.

Established Dentist with an Existing Office in Grand Rapids Wants to Buy – in or partner with another dentist.

Open to all options. Please contact P.O. Box 141661, Grand Rapids, MI, 49514-1661.

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Dental Practices Wanted to Buy – Two dentists separately looking for a practice to buy in the Grand Rapids area. Contact Greg McGlaun of Proveer at 616.425.5523 or gmcglaun@proveerpm.com.

Dental Office Suite/Three Opera­tories for Lease – Desirable SE Grand Rapids location. Some shared space (reception room, lab, etc.) with two other general dentists. Great opportunity for general, specialty, or start-up.

Excellent terms. Call 616.949.8990.

Grandville: 2000+ sq. ft. office space available for lease in exclusive professional office building. Other tenants include endodontist, family dentist, pediatric dentist, oral surgeon and orthodontist. Building partnership buy-in also possible as investment.

Call 616.531.6377 or 616.531.1260.

RDH/RDA – Dental professional with over 5 years experience seeking fulltime, part-time or subbing opportunities where I will be able to utilize my professional experience with patients.

Please contact me at 616.262.8719.

Opening a Satellite Office. Looking for a good used panoramic x-ray and some other used equipment (in good shape). Please email: hanyb@juno.com or call my office at 616.774.9402 or cell phone 616.307.2213 (leave message). $190,000 Medical/Dental Office Building for Sale – Just south of 28th St. off Eastern Ave. in Grand Rapids.

2,345 sq. ft. For more information call Tyler DeGraaf at NAI West Michigan 616.242.1118.

Dental Office for Lease – Sparta, MI. 2,000 sq ft., includes two x-ray machines, vacuum extraction, cabinetry, laboratory. $1,350 plus utilities.

Traffic flow/14,000 daily. 616.874.4192.

Spielmaker Accounting, Inc. – Specializing in medical practice accounting. Providing all aspects of accounting, payroll, and tax services.

Licensed. Over 20 years of practice experience. References available.

616.885.0432.

Kentwood, Muskegon, Fowlerville – We have three practices for sale. These opportunities are excellent starters and satellite offices. Kentwood and Fowlerville have buildings also for purchase. Starting gross of $470,000 to $600,000. Financing and working capital available. Contact Dr. Jim David, Henry Schein PPT Sales at 586.530.0800 or daviddental@comcast.net.

Half of Building (2,424 Square Feet) for Lease. Other half is a full-service dental laboratory. Two year old building, excellent for a dental practice.

Great location in Kentwood on the corner of Breton and 32nd Street. If interested please call 447.0190.

RediDental Emergency Dental Care is now accepting applications from dentists. This is a perfect opportunity to “moonlight” to bring in extra money.

Schedule not full? Consolidate your office hours and work a few with us for guaranteed pay. We have morning, evening, and weekend hours available.

Email resumé to dr.lebster@tds.net.

CPR/AED Training – your site. Two year certification. Medical professional with 18 years of training experience.

Heartsine AED’s for sale. Penny Loosenort RRT www.healingheartscpr.com or call 616.485.4669.

Office Condo for Sale – Income producing! 3769SF new medical tenant on 5-year lease, 5351SF available to occupy.

High traffic corner. Norton Shores.

Call 616.776.0100.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

CLASSIFIED ADS

RDH – 19 years Hygiene experience, professional demeanor with excellent chair side manner seeking part-time or substitute opportunities, flexible, proven individual/team player, strong references. Kathy 616.682.1967.

Gorgeous Brand New 9120SF Class A Grand Rapids, Michigan area – General practice with average revenues of $600,000. Great family community convenient to Grand Rapids. Fully paperless office with complete digital, computerized system in four fully equipped operatories. Contact Phil Stark, Peak Transitions 888.477.7325 or visit www.peakdental.com.

Practice Wanted – Experienced general dentists wish to grow existing practice through buy-out or merger. Greater Grand Rapids. All options considered.

Contact smile01@sbcglobal.net.

Grand Rapids, Michigan area – General practice for sale, average revenues of $600,000. Great family community convenient to Grand Rapids.

Fully paperless office with complete digital, computerized system in four fully equipped operatories. Phil Stark, Peak Transitions 888.477.7325 or visit www.peakdental.com.

Dental Office for Lease – Rockford, MI. 1,000 sq ft, includes some dental equipment and furnishings. $675/mo., plus utilities. Traffic flow/10,000 daily.

616.874.5300.

Tired of your IRA losing money? Is your IRA insured? Invest in an insured, secured, diversified real estate note package paying income each and every month. 20% return on full purchase. Investment is $500,000.

Partials considered for a 15% return.

Current owner has other business opportunity. Call now. TPS Holdings, 616.299.5778.

Charlevoix County – Well established, solo general practice for sale in Northwest Lower Michigan between Charlevoix and Petoskey. Averaging $357,000 the last three years on a part time schedule. Great potential to grow practice or add satellite office. Possible associateship with option to buy.

Three equipped operatories, real estate with lake views available as well. Ken Smith Peak Transitions (888)477-7325 or peakdental.com Non-Profit Organization seeking gently used dental chair for program serving autistic children. Contact Deb Frost at 616.726.1914 or email Dfrost@hopenetwork.org.

Our very busy, well established family/ esthetic practice has an opening for a full-time associate dentist. Great buy-in opportunity. Facility located in a small town near the lakeshore. Has 6+ operatories and long term devoted staff members. This is an excellent opportunity to benefit from the advantages of a group practice, learn from us and have management input.

Contact Wendy at 616.218.8159 for more information.

Associate Position Wanted – General dentist looking for a position in a private practice as an associate in the Grand Rapids and surrounding areas.

Open to all options (buy-in, partnership). Please call 616.307.2472 or email kmvdds@gmail.com.

SE Grand Rapids/Cascade – Office suite available on 28th Street. Up to 3,000 sq. ft., remodel to suit, adjoining new office of established general ­dentist, perfect for a specialist. Lease or purchase option. Contact Randy Chambers, DDS at 616.974.9947, or Eric Trierweiler with Prime Development at 616.957.4733.

WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRING ISSUE 2010

Orthodontist Needed in Northern Kent County/Sparta – Two unequipped operatories ready in new, 2-dentist, 10-operatory, general dentistry building with room to expand to multi-chair practice. Ideal for satellite or start-up practice. Great referral base with six general dentists in Sparta and many more in just a 5-6 mile radius. See facility at www.spartadentistry.com.

Email mcfalldds@sbcglobal.net or call 616.887.7389. We are open to all scenerios of space sharing and partnerships.

ADVERTISER INDEX The Bulletin wishes to thank our valued advertisers who support organized dentistry by helping to defray the cost of printing and mailing.

Advertising in the Bulletin is seen by over 90% of the dentists in the West Michigan District. This includes five of the fastest growing counties in the state: Kent, Ottawa, Ionia, Montcalm and Mecosta.

For information on advertising rates, call Elaine Fleming, WMDDS Executive Secretary at 234-5605. Target your Market – advertise in the Bulletin!

Davis Dental Laboratory................ inside front cover Founders Bank & Trust.......................9 Henry Schein.............inside back cover Hungerford, Aldrin, Nichols & Carter, PC.............................................7 MDA IFG............................................13 Professional Solutions.............................................11 ProNational........................................24 TechTrust...........................................12 Weston Financial.................................3

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WEST MICHIGAN DISTRICT DENTAL SOCIETY | SPRIING ISSUE 2010

Developing your own own Developing your Professional ProfessionalBuilding Building

JUNE 18TH · 8:30AM–5:30PM JUNE 18TH · 9AM–5PM

Course attendees will gain a thorough Course attendees will gain a thorough understanding of the process of developing understanding of the process of their own professional building as well as developing their own professional understand the economic benefits derived from it. building as well as understand the Learning Objectives Include economic benefits derived from it.

• Determining the Size of the Building

• Financing the Project

• Various Relationships with the Professionals the • Determininginth e SProcess ize of the& Creating Your Team Building

• Accumulation of Wealth

Learning Objectives Include

• Contractors • Various Relationships with the • Architect Professionals in the Process & • Engineer Creating Your Team • Dental Suite Designer • Contractors • Developer • Architect • Realtors • Engineer • Lenders • Dental Suite Designer • Property Manager • Developer • Site • Selection Realtors • Lenders • Demographics • Property Manager • Site Plan Approval Process • Site Selection • Developing the Project Cost • Demographics • Determining Rent • Site Plan Approval Process • Project Feasibility

DeveloConsiderations ping the •• Design Project Cost • LEED & Green Considerations • Determining Rent • Value Engineering • Project Feasibility • Retro Fitting Existing Space • Financing the Project The Course begins with fielding • Accumulation of Wealth regarding topics from the attendees • Design their goalsConsiderations and objectives for attending Course and creating • LEED &the Green Considerations a working list of topics, in addition • Value Engineering to the above, that the Instructors • Retro Fitting Existing Space will make sure are covered.

The Course begins with fielding The Course concludes with a review topics from the attendees regarding of the goals and objectives and a their goals and objectives for Question & Answer session. After attending the Course and creating a the Course there will be networking working list of topics, in addition to over cocktails.

“If you don’t have time to “If you have time to do do itdon’t right, when will you have time do you it over?” it right, whentowill have –John Wooden time to do it over?”

Presented by

–John Wooden

The Prosperity Partners

✷

Hilton Garden Inn

the above, that the Instructors will 27355 Cabaret Drive

make covered.

Novi,sure MI are 48377

6CE

Credits

Cost is $195 The Course concludes with a review of the goals and objectives and a Supported by

Question & Answer session. After

the Course there will be networking over cocktails.

For register, To more information, please call please The contact Prosperity RobPartners Hulick atat 616-454-1223.

616-285-4991 Registration or emailbegins KBriggs@theprosperitypartners.net. at 8:15am the day of the course.

WEST MICHIGAN DENTAL SOCIETY 511-F Waters Building Grand Rapids, MI 49503

PRSRT STD US POSTAGE PAID GRAND RAPIDS, MI PERMIT # 657

MARK YOUR CALENDAR West Michigan Dental Foundation Annual Golf Outing Friday June 4, 2010 Returning to beautiful Egypt Valley Country Club Watch for more information about this event!

Mission Statement: An organization dedicated to the improvement of oral health through the financial support of education and service programs to address the needs identified by the dental profession and the communities it serves in Kent, Ottawa, Ionia, Mecosta and Montcalm counties.