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Left to right: Drs. Mike and Dan Warner on a recent fishing trip
WSDA news TOC photo by Rob Bahnsen
letter to the editor
the source: portfolio longevity
31, 33 35
WSDA News Editor Dr. Mar y Jennings Editorial Advisor y Board Dr. Victor Barry Dr. Richard Mielke Dr. Jeffrey Parrish Dr. Rhonda Savage Dr. Robert Shaw Dr. Mary Krempasky Smith Dr. Timothy Wandell Washington State Dental Association Dr. Danny G. Warner, President Dr. David M. Minahan, President-elect Dr. Gregory Y. Ogata, Vice President Dr. Bryan C. Edgar, Secretary-Treasurer Dr. Rodney B. Wentworth, Immediate Past President Board of Directors Dr. Theodore M. Baer Dr. Dennis L. Bradshaw Dr. D. Michael Buehler Dr. Ronald D. Dahl Dr. Christopher Delecki Dr. Christopher W. Herzog
Dr. Dr. Dr. Dr. Dr. Dr.
issue 2 · december 2012
Cover story by Rob Bahnsen
Gary E. Heyamoto Mary S. Jennings Bernard J. Larson Christopher Pickel Lorin D. Peterson Laura Williams
parrish or perish
Director of Government Affairs Bracken Killpack Art Director/Managing Editor Robert Bahnsen
In the event of a natural disaster that takes down the WSDA web site a n d e m a i l a c c o u n t s, t h e WS DA has establishe d a sep arat e email address. Should an emergency occur, memb ers can contact wash stat e d firstname.lastname@example.org.
WSDA Staff: Executive Director Stephen Hardymon
Manager of Continuing Education and Speaker Ser vices Craig Mathews
Assistant Executive Director Amanda Tran
Government Affairs Coordinator Michael Walsh
Director of Finance Peter Aaron
Membership Ser vices Coordinator Laura Rohlman
General Counsel Alan Wicks
Bookkeeper Joline Hartman
Director of Operations Brenda Berlin
Office Coordinator Leon Sandall
The WSDA News is published 8 times yearly by the Washington State Dental Association. Copyright © 2012 by the Washington State Dental Association, all rights reserved. No part of this publication may be reproduced without permission of the editor. Statements of fact or opinion are the responsibilit y of the authors alone and do not express the opinions of the WSDA, unless the Association has adopted such statements or opinions. Subscription price is $65 plus sales tax per year for 8 issues of the News. Foreign rate is $97.92 per year. Advertising is published as a service to readers; the editor reserves the right to accept, reject, discontinue or edit any advertising offered for publication. Publication of advertising materials is not an endorsement, qualification, approval or guarantee of either the advertiser or product. Communications intended for publication, business matters and advertising should be sent to the WSDA Office, 126 NW Canal Street, Seattle, Wash. 98107. ISSN 1064-0835
Director of Membership and Comunications Kainoa Trotter
Association Of fice: (206) 448 -1914 Fax: (206) 443 -9266 Toll Free Number: (800) 448 - 3368 E- mail: info@ wsda.org/w w w.wsda.org
Member Publication American Association of Dental Editors. Winner: 2008: Best Newsletter, Division 1, 2007 Platinum Pen Award, 2006 Honorable Mention, 2005 Platinum Pencil Award, 2005 Publication Award; International College of Dentists
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table of contents issue 2, december 2012
a day in the life
editorial dr. mar y jennings
What would Horace do? In 1864, the ADA recognized dentist Horace Wells for introducing anesthesia to the United States. Anesthesia — in gas, liquid and solid form — has always played a vital role in the delivery of dental care. In October, ADA House of Delegates had a rousing debate over Resolution 16, which would have recognized dental anesthesia as a specialty. It lost. I rarely indulge in post mortems on resolutions but this one still bothers me. So what happened? The ADA has six requirements for specialty recognition. In brief, it must have a sponsoring agency that can sustain a certifying board, it must be a distinct field, it must have advanced knowledge and skills that are not being met by other dentists or specialists, it must meet some aspect of patient care, and it must have formal advanced education of at least two years beyond dental school. Both the ADA Committee on Recognition of Specialties and Interest areas in General Dentistry, and the ADA Board of Trustees supported the application made by the American Society of Dental Anesthesiologists. The American Association of Oral and Maxillofacial Surgeons opposed it. The supporters argue that becoming a specialty increases acceptability of dental anesthesiologists by the public and marketplace. Their billing capabilities will be enhanced. Dental schools will be able to expand training programs for anesthesia. Having in-house programs will lend support to training more undergraduate dental students in anesthesia. The opposition maintains that dentistry has survived using the current model for over 100 years. They maintain “anesthesia belongs to all,” and fear that specialist anesthesiologists will be able to set policy and make rules that would injure general dentists and specialists who currently provide anesthesia. They do not think anesthesia will improve access to care because there are too few dental anesthesiologists to matter. They are concerned that the itinerant model does not provide enough safety precautions, and there are not hospital admitting privileges. They believe patient costs would be greater with specialty recognition. Hmmm. I can see that one specialty cannot restrict the rights of others practicing in kind. The supporters assure us that they would not impinge, but we all know that as generations of leaders change so does the tone of a group. Increased patient cost? Dental anesthesiologists’ training is impeccable. They deserve their fees. Some things just cost. I can see that an itinerant practice might not have all the bells and whistles for safety, but this kind of practice has been going on for years with an excellent record. If a patient has to be transported to a hospital, does it really matter if the anesthesiologist has hospital privileges? It is not as if they are going to ride in the ambulance, and commandeer the ER. I worked with a dental anesthesiologist at a FQHC for eight years. I loved it! It solved so many of our problems. When we found teeth with nine-millimeter pockets and compressible mobility on a thirteen-year-old severely developmentally disabled girl, my dentist anesthesiologist was able to support me, and help me explain to her mother that we could not “just prescribe mouthwash” and let her go. I have schizophrenic patients that I fear will hurt me. I have kept one eye on the mouth and the other on their fists for too many years. For what I have accomplished, I am very lucky. There are all kinds of patients that I have been wrestling with who really need anesthesia. It is time for me to offer them better options. There is need. “Take them to the operating room,” people say. It is the safest, albeit most expensive, option. I was just credentialed by a local hospital. It took 93 pages of paperwork. I hear that in other states only specialists and dentists with advanced training are credentialed. I would not qualify. I also fear that my patients will have a hard time paying for parking and finding me in a large hospital. As I discuss how to hire an anesthesiologist with dentists, I am surprised at how many of them advise me to hire an MD anesthesiologist. The theory is that if there is an adverse reaction the courts will be kinder if I hired the top of the line instead of anyone lower. I don’t want an MD. I want one of us. I want our anesthesiologists to be the very best in the field we actually pioneered. I fear in the current marketplace a dental anesthesiologist will not be considered top tier until they gain specialty recognition. The ADA will be reviewing its policies on specialty recognition this year. The ASDA cannot submit another application for twenty-four months. We need to spend that time sorting out these issues. We have the skill, expertise, and knowledge to turn this problem around…Horace would have wanted it that way.
Dr. Mary Jennings Editor, WSDA News
“The opposition maintains that dentistry has survived using the current model for over 100 years. They maintain ‘anesthesia belongs to all’ and fear that specialist anesthesiologists will be able to set policy and make rules that would injure general dentists and specialists who currently provide anesthesia.” Dr. Mary Jennings, WSDA News editor, welcomes comments and letters from readers. Contact her at her email address:email@example.com.
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How it will affect dental insurance in Washington
WSDA has been closely tracking the implementation of health care reform in Washington state. Passage of the federal Affordable Care Act and the Washington state supplemental legislation will change the individual and small group insurance markets beginning in 2014. Earlier this year, the WDSA Board of Directors created the Task Force on Health Care Reform to monitor health care reform activities and make recommendations as appropriate. Below are several important points that every dentist should be aware of before 2014. Additionally, the article on page 24 from the American Dental Association contains important information about the Affordable Care Act. While several state and federal decisions have been made, many additional rules on the implementation of health care reform have yet to be determined. This report will be one of several updates to WSDA members on what to expect in 2014 and beyond.
What are health benefit exchanges?
You may have heard a lot of talk about insurance exchanges. The Affordable Care Act requires each state to have an insurance marketplace (or exchange) for individuals and small businesses to purchase medical insurance. Exchanges are meant to accommodate the health insurance mandate that takes effect in 2014. Individuals and families that earn less than 400 percent of the federal poverty level will be eligible for subsidies. Individuals and small businesses are not required to purchase insurance through the exchange but individuals eligible for subsidies can only utilize these subsidies when purchasing insurance in the exchange. In Washington, the exchange is a public/private entity that will be branded the “Washington Healthplanfinder.”
Dr. David Minahan WSDA President-elect
Pediatric dental will become linked with medical insurance.
Beginning in 2014, all medical insurance plans offered in the individual and small group markets will have to include coverage for pediatric dental. This is because pediatric dental is one of the ten “essential health benefits” (EHBs) that must be included in all medical insurance. In Washington, pediatric dental is expected to include all children up to age 18 or 20.
Bracken Killpack WSDA Government Affairs Director
Is adult dental included in health care reform?
No. Adult dental coverage is not an EHB and is therefore not mandatory. Additionally, individuals and small businesses will not be able to purchase adult dental coverage in the exchange in 2014.
Task Force on Health Care Reform
Selection of the pediatric dental EHB coverage.
Dr. David M. Minahan, Chair (Kenmore)
Federal rules gave each state the option to choose one of ten health insurance plans to serve as its Essential Health Benefit benchmark. Last year, the Washington State Legislature selected the Regence Innova plan (the small group plan with the most purchasers) as the EHB benchmark. The Regence Innova plan does not include coverage for pediatric dental. The Office of the Insurance Commissioner (OIC) was charged with defining all EHB coverage that is not contained in the Regence Innova plan. However, OIC was only given the option of selecting the state’s CHIP plan (dental Medicaid) or a Met Life plan available to federal employees. OIC has decided to select the state CHIP plan as the coverage that must be offered to satisfy the pediatric dental EHB requirement. Selecting the children’s Medicaid coverage does not mean insurance companies will use Medicaid reimbursement rates. It is only a selection of coverage. All pediatric dental insurance plans must cover what the CHIP program covers.
Pediatric dental benefits in medical insurance plans outside of the exchange.
Beginning in 2014, all medical insurance plans offered in the individual and small group markets will have to include coverage for pediatric dental. Outside of the exchange, pediatric dental will likely be embedded into medical insurance if the insurance carrier sells dental insurance and has an adequate network. Embedding means the cost of providing the pediatric dental benefit will be rolled into the overall cost of the medical continued on page 48
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Dr. Lisa A. Block (Gig Harbor) Dr. Ronald D. Dahl (Ferndale) Dr. Christopher Delecki (Seattle) Dr. John L. Gibbons (Poulsbo) Dr. Spencer S. Jilek (Pasco)
guest editorial dr. david minahan, bracken killpack
Health Care Reform:
cover stor y dr. dan warner, your wsda president
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cover stor y dr. dan warner, your wsda president
DR. DAN WARNER Whether serving as a dentist in the Alaskan Bush (where his career could easily have been ended in a prop mishap) or serving as the President of the Washington State Dental Association, Dr. Dan Warner’s approach is sharp, witty and congenial.
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“It wasn’t fair,” says Johnson, only half-joking, “Everyone got tired of him winning.” Warner developed his nearly encyclopedic knowledge of music trivia listening to stations like KORD Radio in Richland, Wash. in the 60s, when “Name It and Claim It” contests ruled the airwaves. On the popular shows, DJs played snippets of songs, and listeners called in if they knew what it was — winners claimed their prize at the station. Today, Warner has a collection of 1,100 45s from the 50s and 60s, and plays them in rotation on his near-mint 1954 Seeburg Selectomatic 100. For you younger dentists, 45s were the precursors to CDs and music downloads. Musical zeal aside, Warner is a warm and social person with a quick laugh, and that penchant for storytelling that makes him easy to be around. Because of it, he’s had solid friendships with people from all walks of life — be they Alaskan villagers, star college quarterbacks (his brotherin-law is famed UW quarterback Sonny Sixkiller), or fellow dentists. Singleton
— threatened to withhold his dad’s pay if he didn’t ask her out. The ploy worked, the two married, and they set off on travels that took them to Chicago, New Jersey, and, after his dad changed jobs, Hanford, Wash. The family was tight — still is — and they grew up with a love of the outdoors, and outdoor recreation. Warner and his family — Jeri and their two grown children, Mike and Angie — have an enviable closeness. He and Mike practice together, Jeri often finishes his sentences, and Angie, an esthetician, recently moved back to Camas to be closer to the family. Warner was drawn to dentistry early on, saying, “I thought it was a neat profession with sciences, and yet it was artsy-craftsy. I was always making model cars and airplanes, and drawing and painting — and they sort of went together with the science. It also seemed social, and I liked meeting people, and figured that everyone liked the dentist as much as I did — which of course, turned out not to be the case.” And so it was that in 8th grade, when asked to stand
Warner was popular in the villages, and not just because he was providing great dental care. As he says, “I took the attitude of ‘when in Rome,’ and didn’t complain. There were contractors building runways who bemoaned the lack of running water, or that the village was ‘dry’, but I never did. Because of that, the villagers liked me – they took me duck and goose hunting, and to their steam baths — and that was a primo deal in a village with no running water.” New WSDA President Dr. Dan Warner (or Danny, either is just fine, according to him) is many things: a dentist, of course — but he’s also a storyteller, a dedicated family man, an avid bird hunter and fisher, a fine golfer, an artist (favoring watercolors) and, according to friend and fellow dentist Dr. Mark Johnson — a “music phenom.” Warner’s love of music and music trivia is the thing of lore. Good friend (and one-time short stop for the Chicago White Sox) Stu Singleton explains, saying, “Dan has a memory like a steel trap, especially when it comes to music from the 50s and 60s. He knows the artist, the song, when it was released, and on what label.” Warner is so knowledgeable that a New Year’s Eve music trivia contest popular with friends and family had to be discontinued when he amassed too many victories over the years.
says, “Dan has a wide network of friends – business associates, people from church, and others he and his wife Jeri have met socially over the years. It says a lot about his character. Friendships are important to him. He values our relationship — we can talk about just about anything. We don’t always agree on things, but we can disagree without being disagreeable. I think he’s a person of strong character, and he’s a good friend.” It’s that social side to him that has contributed to his success in dentistry — whether in Vancouver, Wash., where he practices today— or the Alaskan Bush, where he got his start back the early 70s. He was born in Fargo, North Dakota, to parents who both worked for Armour & Co. Warner’s dad was a chemist, his mother was the person in charge of distributing paychecks. She — if you believe the legend
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in front of class and state what he hoped to do for a living, Warner told classmates that he was going to be a dentist — specifically an orthodontist. At the UW he majored in food sciences, but stayed on track to become a dentist. His resolve was only strengthened after shakeup at Hanford left his father temporarily out of work. He recalls, “You know how you sometimes have trepidation, and wonder if you are going to be able to do something? When I was in college, my dad got laid off from Hanford. He was 49 years old, and I remember thinking I never wanted to have to come home and tell my family that we had to move. I decided then that I would be self-employed — You either make it or you don’t.” While at UW, Warner met Jeri (he calls her “the prettiest thing in physics class”),
cover stor y dr. dan warner, your wsda president
“Did I tell you the one about the Fly Man?” Danny Warner stands in the office, eyes alight. He’s got a story to tell — it’s written all over his face. No, he hadn’t told that one yet. Like all of Warner’s stories, they meander a bit, snagging on tangents, steadying, then resuming course. The Fly Man yarn pauses for an aside about compressors failing in the Alaska cold, and another about instruments left to freeze in a sterilization tray. This was the Alaskan Bush, after all. “Sometimes when we’d fly in,” he says, “It was like they didn’t know we were coming. Nothing was ready, the heat hadn’t been turned on, and it was, like, 20 degrees below in the space where we were supposed to set up our clinic.” Continuing, Warner said, “In Alaska, the flies go to sleep at that temperature, and wake up at about 51 degrees.” As he tells it, when the villagers kicked on the heat to get the room ready, a swarm awakened. As if on cue, an Eskimo villager arrived, vacuum in hand, sucking the swarm into oblivion. Warner related, “He looked at me and said, ‘I’m the Fly Man,’” voicing him like an Yupik Clint Eastwood.
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he was offered a position at Kanakanak Hospital in SW Alaska, Bristol Bay, in the Alaskan Bush. There, he was one of two dentists stationed in the hospital, with 8-10,000 people in their service unit. He and the other dentist spent 80 days a year going to villages and setting up portable clinics – primarily treating children, but also working late at night on adults. Flying out of Dillingham, Alaska, with his dental assistant to 15 different villages, Warner recalls that most had no running water. They would land, set up their equipment in a school or village health clinic, prioritize the work, and treat the children. Warner says, “We were directing our care towards the children, but my partner and I thought it would be a good idea if we promoted health and getting better, as opposed to just doing repair work. They were used to dentists showing up and doing whatever they needed to their teeth, and then letting them rot, and getting them fixed again. We thought if we encouraged the parents to get more care, they would make sure that the
guys could, they’d say, ‘Dentist tough.’ They would never speak to me in English, other than to say that, otherwise they spoke Yupik.” Even then, with language and cultural barriers, Warner’s boundless social skills served him well. The Warners loved the Alaskan Bush and all it had to offer — Warner says, “We loved cross country skiing, especially out in the bush, because all you had to do there was go out your back door, put your skis on and set out across the tundra.” And, Jeri added, when they were really bored, “We would hook up a rope to a snow machine like we were water skiing.” Mike recalls summers full of outdoor activities, like fishing and camping, and adds “We did a lot of things as a family there, most of which we still do. And, I remember playing hockey and T-ball late into the night.” Warner recalls kids playing miyachi until 10 p.m. the first summer they were there, and wondering why they weren’t in bed. After their first winter, the Warners understood — during the winter months, they
Warner developed his nearly-encyclopedic knowledge of music trivia listening to stations like KORD Radio in Richland, Wash. in the 60s, when “Name It and Claim It” contests ruled the airwaves. On the popular shows, DJs played snippets of songs, and listeners called in if they knew what it was. Today, Warner has a collection of 1,100 45s from the 50s and 60s, and plays them in rotation on his near-mint 1954 Seeburg Selectomatic 100. showed your patients that you really cared and were doing your best – they would remember it more than ads in the paper.” Hagan also stressed the importance of balance — often taking the hard-working Warner out for beer, food, and guidance. “I remember telling him that when I got into practice I was going to have a lab at my house,” recalls Warner, “And he said ‘No, you never have a lab at your house, because you’re going to need to tell Jeri that you have to go to the office and do work – if you have a lab at the house, you’ll never be able to get out.’”
The Alaskan Bush
Warner wanted to take it easy after dental school and decided to do a residency or go into public health service. After applying to Indian Health Services in his last year,
children took care of their teeth.” They did good, vital work in the villages, where they helped the Alaskan people they treated go from twice the decay, missing and fill rate of the lower 48, to rates equal to that of the lower 48. Warner was popular in the villages, and not just because he was providing great dental care. As he says, “I took the attitude of ‘when in Rome,’ and didn’t complain. There were contractors building runways who bemoaned the lack of running water, or that the village was ‘dry’, but I never did. Because of that, the villagers liked me — they took me duck and goose hunting, and to their steam baths — and that was a primo deal in a village with no running water.” Warner remembers that the men liked the steam baths extraordinarily hot, “But because I could take it as hot as the Eskimo
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had just hours of light a day. “We got a lot of mileage out of a day there in the summer,” he says, “And we encouraged the kids to take full advantage of any sunlight we had – that’s when you get to be outdoors.” In 1973, Warner says, hardly anyone was a true native Alaskan, and people tended to make instant friendships. “I remember one time at Port Hayden, we worked until 3 p.m., and then went out hunting with Johnnie Carlson, the health aid’s husband. We ended up getting eight ptarmigan and six geese. I went to work, and got done at 10 p.m., and I thought about all the birds I had to clean.” When Warner went to get started on the task at hand, he found that Johnnie had done everything for him. “That’s just how they were,” he says, “They really liked visiting and the camaraderie, and they would go out of their way for you,
cover stor y dr. dan warner, your wsda president
and the two married before he started dental school. The two compliment each other wonderfully. About them, Johnson says, “Dan and Jeri are funny. They have their differences – they jest with each other with humor, they are solid mates. They get along, they enjoy music together, and when they are together they’re usually laughing. It’s one of those things that you look for in long-term relationships. They still laugh at themselves, at each other, and have a good time. It’s very genuine, one of those things you can’t fake.” Warner loved the UW and credits the school with providing him a top-notch education. “They taught us to do things perfectly, that speed would come later.” While at the UW, he met and worked for Dr. Richard Hagan, the man he calls his mentor. Warner describes him, saying, “He had the best chair side manner, ever. He showed me that it was possible to have fun while you’re doing dentistry – that you could joke with your patients in a good way, make them feel a part of what you’re doing. And, he taught me that if you
even if it meant stopping a project they were working on.” Though they loved the area and the people, they were ready for a change. “It was great there for three years – we were young, we had the kids, it was fun. But three years was enough. We were ready for a bigger town.” Warner gave his notice at PHS and readied the family for a move back to the lower 48. An accident would change all of that.
January 3, 1976 — a day like any other in the Alaskan Bush. Warner and a friend had been flying around the area in a 2-seater Piper Cub, looking, as he says “for critters.” When they landed back at Kanakanak, Warner was helping out, putting boards under the plane’s skis so they wouldn’t freeze to the snow, oblivious to the still-turning propeller. He recalls inadvertently sticking his arm out into the prop, the force of it flinging him across a pond. “It was pretty impressive,” he says, “I knocked two knuckles out of my hand, and had to be airlifted to Anchorage. I wouldn’t sign the piece of paper that said it was okay if they cut my hand off, so they fixed it in the hospital.” Warner didn’t practice from January to March, but got bored and frustrated with inactivity, and forced himself to go back to work. Jeri (who is a physical therapist) made him do things like pick up macaroni from the table and drop it in a jar to facilitate his rehabilitation. In light of the injury, he couldn’t leave PHS and move to back to Washington, because he needed the medical coverage. Instead, he took the boards and moved his family to Anchorage for an associateship. And though dramatic, the accident hasn’t altered his life or his practice to any great measure. “There are a few things I have to kind of twist around to do,” he explains, “But it rarely affects my daily stuff. It made it a little tough to play piano – I retook lessons four or five years ago, and my piano teacher would try and pick pieces that had an easy left hand.” She stopped when she realized it wasn’t a handicap to Warner, who says he rarely thinks about it any more. Singleton, who, along with Warner, coached their sons in Babe Ruth Little League, says “We have this running joke about baseball because Dan, bless his heart, he never let that wrist get in his way – whether fishing, golfing or shooting. He’s a very fine golfer, and of course, that’s the wrist that leads the shot. Although hisw right hand is fine, he had a hard time throwing batting practice – he’d go out there and instead of just throwing it, he kind of aimed it a little bit, and the boys would say ‘Let’s have Stu throw, let’s have Stu throw,’ so I tease him a little bit.”
The big city
Once in Anchorage, he got his first real taste of organized dentistry. One of the practice’s partners was the local component president, the other eventually became president of the state Association. Warner was expected to be involved as well, and he enjoyed it. It was there that he heard Dr. Geraldine Morrow, the only female dentist in the state of Alaska, urging dentists to take a stand. Warner recalls, “Everyone who practices in Alaska is there because of the recreation – hunting, fishing, skiing. Dr. Morrow would get up at our component society meetings and say, ‘If you guys don’t stand up for your profession, someone else is going to make the decisions, and they won’t be a dentist, and you’ll have to live with their decisions.’” He recalls the men grumbling, but she was unfazed. “She had a lot of nerve to stand up in front of all of these guys and tell them they had to pay attention to the political situation – this was in 1976!” Morrow, who would go on to become the first female ADA President, didn’t want new laws impinging on their practices. Warner admired her grit, and her foresight. “She didn’t have to say anything, but she did – because she cared about the whole profession, she didn’t want people to be complacent. We have a great profession, we have all kinds of options about how we work.” Her tenacity and commitment really stuck with Warner, and he made involvement in organized dentistry part of his life for those four years in Anchorage. Then, in 1980, he and Jeri made the decision to move the family back to the lower 48, and for a while, Warner took a hiatus — “The kids were growing up and I wanted to be really involved in their lives – I was coaching ball, and wanted to be watching games and participating with them.” Organized dentistry would have to wait. The family ended up in Camas — Jeri’s hometown — where college friend and UW basketball standout Dr. Gary Ostensen needed an associate. But the economy was terrible, interest rates were high, and a buy-in just wasn’t in the cards. To make ends meet, Warner did double duty – flying back to Alaska once a month for a week of stacked appointments at his former practice, and doing bush dentistry one month a year as a contract dentist with the native health corporation. He recalls that locally, business was lousy, and he and Jeri contemplated a move back to Alaska. About that time, a practice came available, and Warner took a chance — he bought it and made a go of it. It was a good decision — it allowed him to focus on his family – to do things like attend Angie’s soccer games and track meets, coach Mike’s Little League, and hunt and fish with friends he
would make in Camas — like Johnson, Singleton, as well as Jeri’s family in Camas. This was the life, and lifestyle, that helped cement his decision to become a dentist in the first place. For Mike, who first considered going into architecture and medicine before deciding on dentistry, having the time together meant everything. “The biggest reason I chose dentistry over medicine was that I knew I liked the lifestyle – the flexibility of it. Growing up I knew my dad would be at all of my games, be there for me whenever I needed him to be, within reason. It wasn’t the standard of living, it was really that he was always around. That, to me, was more appealing than anything. I don’t think you can get that in all of medicine.”
Getting back into politics
Once the kids were grown, Warner got back in the political game, taking a position as the Secretary of his local component. He remembered what he’d learned in Alaska from Dr. Morrow, recalling, “I like being involved in politics because I don’t want to be sitting around one day and say what other people say – How could you let that happen to us? Why didn’t you do something?” He continues, “I just don’t want to sit back and have things happen around me if I can take action and become more aware, and help to control the outcome, make an effect on dentistry.” Still, Warner was reticent about assuming a role with the Association, until some classic prodding from Executive Director Steve Hardymon. Warner recalls Hardymon coming up behind him, squeezing his shoulder and saying “You’ve got a guy down here who really needs to run for the Board – he’s just got too much to offer.” And so it was, that at the next House of Delegates Warner was nominated from the floor and won a contested election for a Board seat. “I remember when I first started on the Board,” Warner said, “I’d sit at the very end of the table, like I was in college, hoping I wouldn’t get called on. But Mark Walker was president, and he made everybody get involved.” Warner, once reluctant, became a vocal contributor to the Board, served on the Nominating and Government Affairs committees, and gradually assumed more leadership roles, and became an officer. Today, he stands as an enthusiastic advocate for Board service (and political involvement in general) saying, “I think dentists should really consider running for the board. It’s a time commitment, but it keeps you in the loop and makes you a conduit of information for your component. It makes you become knowledgeable and involved. You can read about it in the WSDA News and online, but when you have to be there, and be re-
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Morrraine River, Alaska Penninsula
sponsible for decisions, there’s a degree of commitment and responsibility that makes you become more aware, and forces you to develop a better connection with legislators.” Because of his long-term commitment to grassroots politics, Warner is well known in Olympia, which is exactly what our lobbyists and Government Affairs Directors have been espousing for years — forging long-lasting relationships with legislators. Warner says, “Now, they know who I am – they have come to expect my call. We have three districts in Clark County – 17, 18 and 49, and the Clark County dentists go as a group to all. We have coffees and meetings with them when the legislation is not in session, too.” But he’s been around long enough to know that sometimes, even with great relationships on the hill, it doesn’t go your way. “We’ve had legislators flip their votes and hurt us, even when we’ve thought we had consensus,” he says, “And, part of what you learn is that’s part of the deal in politics — compromise and trading on issues. It may not be right or logical, but it’s how the system works.”
Warner is excited about the year ahead as President, even with challenges like the midlevel provider. He’s a seasoned veteran now, and has forged alliances with dentists from all over the state. Once again, his gift for socializing and making fast friends has served him well. And while the midlevel issue has proven thorny, Warner understands the purpose of providing our own model, saying “Whether some of the dentists in the state realize it or not, there are influential legislators who think the independent midlevel is a good idea. Having HD-13 as an offering to our legislators shows them what our values are – that we think the dentist should be the sole diagnostician and should supervise any irreversible procedures. At least they can say we offered something.” Warner’s practice with his son continues to grow, and he credits the relationship with making him a better dentist, saying “Talk about peer review – when you’re bringing your son into the practice., you certainly don’t want to show him any
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slipshod work.” Both say they’ve never had an argument in their 16 years of practice together, and Warner quickly concedes that Mike’s contributions have been substantial. “Look, if you ever want to give your practice a boost, hire a young dentist,” he says, “They have new ideas. You’re there, in your practice, working along and seeing patients, and then somebody new comes in with fresh ideas. Because of Mike, we’re chartless, we use digital radiographs — we’ve embraced new technology. That’s because with him, I have to look at the future – I’m not just going to sell the practice to someone else and let them deal with it.” Mike adds, “He’s always been on board with me in terms of technology advances. He’s never said no. We’re partners, but I’m still not the guy who started the practice — it says a lot for him to encourage me to do that. It works really well when your partner is someone you trust — he knows when he is away that patients and staff will be in good hands. The future is important to both my Dad and me.”
membership news component society presidents Dr. Eric Kvinsland and his family
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from small towns to big cities, and everything inbetween — our members are as diverse as the state’s ecosystem. And while you likely know the president of your own component society (and if you don’t, you should - they represent you at functions throughout the year), you may not know who represents the adjoining component, or one clear across the state. We asked each to write a 250 statement and supply a picture of themselves doing something they enjoy — so it’s not surprising that we got a lot of pictures of them relaxing with their families (and fishing!).
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membership news component society presidents
We hail from all corners of the state —
Dr. Donald Arima
membership news component society presidents
Dentistry is under enormous pressure today. The economy stinks, everyone is watching how they spend their money, and dental care becomes a lower priority. There is outside pressure to solve the access to care problem with midlevel providers; the public believes that it’s not rocket science to drill a hole into a tooth and shove something into it to fill the hole. Washington Dental Service slashed reimbursements and told us to be more efficient, work an extra day to make up for the lost revenue, and be glad that we’re in their network. Unfortunately, there’s no easy answer. The one thing that we do have in our favor is organized dentistry. The leadership and staff of the WSDA have been working on these things and many more that have and will affect our ability to deliver the best dental care in the world. Talk to them; make your concerns known. By being a member of the tripartite organization, we have a way to multiply our efforts. To quote Lucy van Pelt from Peanuts: “These five fingers individually are nothing. But put them together, they become a fighting force terrible to behold.” Let’s be that fighting force.
Dr. Marissa N. Bender Snohomish County Dental Society
I was a reluctant dentist. I did not choose dentristry as a career. My parents decided my future early on in my childhood. Being a good daughter, I obliged and finished dental school in the Philippines with great emotional misgiving. After migrating to the United States, I worked in health care management. I thought this was an area where I could be more fulfilled and help people the most. Having worked in public health after my first dental school graduation, I have never forgotten the feeling of fulfillment that came with the job. Working alongside clinicians as an administrator, I realized that I actually missed delivering direct patient care. Luckily, I was fortunate enough to get accepted into the school and program I admired, when I finally decided to go back to clinical dentistry. This time around, school was unexpectedly enjoyable and fun, albeit difficult and challenging as ever. It may have taken some time for me to figure out that I actually liked my profession, but I haven’t looked back. I found out that I can help fearful patients overcome their anxiety. Having been one myself, when I was a child, I can directly relate and empathize. Whenever I can, I try to encourage young people to look into dentistry as a career. Although it can be stressful at times, it is the most rewarding job there is. I guess my parents were right after all, and I am reluctant no more.
Dr. Dawn Divano with staff and friends at a recent event
Dr. Francis J. V. Collins North Central District Dental Society
Greetings from the North Central District Dental Society area. This is my second term as President of the NCDDS, which essentially encompasses three counties: Chelan, Douglas and Okanogan. I’ve taken on the role because as I get older, I realize the importance of our regional dentists getting together, not necessarily for academic reasons, as there are now plenty of excellent continuing educational courses available. Recently I realized how important our local society is, when one of our members said just getting together for social reasons and allowing the time for open discussion about common problems is sufficient reason in itself. It also gives us an
Dr. Marissa Bender and her husband, John
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opportunity to welcome and interact with the younger dentists coming into the community. I would be remiss if I did not mention the many people in the past who have served at the local, state and national levels — people like Terry Grubb, Denny Homer, Bob Nau and Laura Williams. I also feel with our society we are able to discuss local needs in the community and address these. I commend many in our group for allowing access for needy patients. Hopefully this way we can also encourage and influence the younger generation of dentists to step forward and advance the cause of dentistry in the best interest of society as a whole, and not be perceived as a selfserving profession. Also I believe that our relation with the medical group should be
membership news component society presidents
Dr. Donald Arima Grays Harbor District Dental Society
membership news component society presidents
Dr. Francis Collins
Dr. Clifton Hodges with his son, Brayden
Dr. Brent Gill and family
strengthened, and during my tenure, I would like to strengthen that bond.
Dr. Dawn M. Divano Kitsap County Dental Society
I would like to continue Kitsap County’s contributions to our underserved population. Especially in these economic times, it is nice to know that so many of our Kitsap County dentists provide quality care, and participate in a number of programs to help the dental needs of those who need it. We have a number of programs available
and the compassionate relationship between our general dentists and specialists is enlightening. We have a close knit dental community here, and I am privileged to be a part of it. Since I am a military spouse and mom, my hobbies seem to be on hold these days, as my husband is on travel for the Navy about six months out of the year. But, I do participate in some running, sprint triathlons, bike rides, etc with my staff quite often. My two children, Michael (age seven) and Ali (age six) keep me busy with a full
soccer season. I am also the Treasurer of my children’s school PTA.
Dr. Brent Gill Benton-Franklin Dental Society
The Benton-Franklin Dental Society has great doctors who provide exceptional care and are concerned about the future of our profession. I am grateful for the opportunity to represent them this year. My goal is to promote further community involvement and life-long learning among society members.
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I graduated from Brigham Young University in 1995 with my bachelor’s degree, and in 1997 with my Master’s degree in Audiology. I worked as an audiologist for seven years in the Tri-Cities and then decided I wanted to be a pediatric dentist when I grew up! This decision took me and my family to the University of Washington School of Dentistry where I graduated in 2008. I completed a pediatric dental residency in New York at the University of Rochester’s Eastman Institute for Oral Health, and Strong Memorial Hospital in 2010. My research was recently published in the Pediatric Dentistry journal for the American Academy of Pediatric Dentistry. My wife and I are very pleased to be back in the Tri-Cities to raise our six children. We enjoy all kinds of outdoor activities, sports, community service projects, music, reading and travel.
Dr. Tim Gutmann Yakima Valley Dental Society
What a great time to be involved in organized dentistry. I feel privileged to be a part of such a great group who care so much for what happens to our profession. Our society has taken great initiative to make dentistry accessible to all in our community, through projects like assisting in the construction and operation of the Union Gospel Mission dental clinic. We will continue to develop ideas to better our community through continued growth and involvement in our Society.
Dr. Princy Rekhi (left) and his family
I have been involved with the Yakima Valley Dental Society since graduation from the University of Washington in 2004. Organized dentistry was first introduced to me at the University of Washington through participation in Legislative Day in Olympia, so it was a natural transition to join organized dentistry once I began my career. I look forward to the future of our profession and will continue to do so with the efforts of organized dentistry.
Dr. Clifton Hodges Lewis County Dental Society
The Lewis County Dental Society has a long history of excellence. Our treasurer, Dr. William Ehret, has kept this history alive for us with a trove of photos, notes,
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County is a wonderful place to practice and has provided so much for myself and my growing family.
Dr. Brian J. Jacobsen Grant County Dental Society
I was educated at BYU and Oregon Health and Science University and have been practicing dentistry for 10 years. I grew up in Astoria, Ore., and moved to Ephrata, Wash., 2 1/2 years ago to escape the rain, and purchase the practice of Dr. Douglas Beaudry. I am President of the Autism Society of Grant County, help lead my church congregation, and serve in Rotary. I enjoy riding my bicycles (I have many), exploring the coulees with my oldest son, playing the piano, and studying leadership.
membership news component society presidents
Dr. Tim Gutmann and family
memorabilia, and first-hand knowledge from decades of participation in the society. Although the area has grown, we still remain a small tight-knit component society, which allows us to maintain close relationships with fellow dentists and specialists, and easier access for those wishing to participate in organized dentistry. I joined Lewis County Dental Society in 2008 and found the society to be warm and welcoming. The meetings provide an easy and convenient framework to pursue continuing education and talk about the issues of governance at a regional and national level. With members such as Dr. John Henricksen and Dr. Lou Ann Mercier keeping us updated with insight into the WSDA, WDS, House of Delegates, legislative days, and DQAC, I felt informed and encouraged to participate. I am thankful for the opportunity to serve my component as an alternate delegate this year in Walla Walla. I believe that our local societies serve as a foundation for governance as a whole, and represent an ideal environment for dentists to develop professional relationships and be a part of organized dentistry. Lewis
membership news component society presidents
The things I’d like to do most include hiking the Pacific Crest Trail, learning to fly, and achieving a respectable golf game. My wife, Laura, and I have three children. I believe that now, more than ever, it’s vital to be involved in organized dentistry. We need a unified voice to represent what’s best for our patients, and best for the profession. The WSDA makes that happen. I also appreciate the camaraderie I’ve felt in our local society. It’s great to have that support, and my fellow dentists have been a great resource in helping me make good decisions for my practice.
Dr. Eric Kvinsland Pierce County Dental Society
It is absolutely my pleasure to serve as President of the Pierce County Dental Society this year. The challenge for all of us is to stick together as an organization and be united in our pursuit of excellent dentistry. One of the bigger issues that is threatening us is the role insurance is playing in the doctor/patient relationship. We have to make sure that, as an association, we are able to stay ahead of these threats, and come up with innovative ways to maintain control. I am a second generation dentist that grew up in Gig Harbor, Wash., and now practice in my home town. I graduated from Washington State University, and also attended Pacific Lutheran University for the prerequisites to dental school. After graduating from the University of Washington School of Dentistry, I joined my father in general private practice. I love to take advantage of the Northwest outdoors by boating, snow skiing, fishing, hunting, and flying. It is especially a treat to be able to do these things with my 3 ½ (one on the way) kids and my wife.
vital to maintain a strong dental community. Therefore, my goal for this coming year is to see more of our membership become active in the society. I am especially excited to see younger members get involved, and stay involved. This year holds a lot of change for the future of dentistry in our state. Now more than ever, we all need to be working together to help shape our profession.
Dr. Brady McDonald Thurston-Mason Counties Dental Society
First, I want to thank our members for their hours of volunteer work. From the Union Gospel Mission, to Children’s dental health month, to organized dentistry, our component societies give back to our communities in a huge way. All dentists should be thanked for the free and reduced fee work they donate, so thank you! The general population, and more importantly, politicians, don’t realize how much uncompensated dentistry we all do. With the push for midlevel providers by outside groups (can you believe the hospitals are against us?), we, as organized dentists need to show everyone how much we give back to our communities. It is my
hope that our dental society will start a program to track the free and reduced fee work done in our dental offices. It’s time for us to stop being so humble about our uncompensated work and use this information to protect our profession! Do you think midlevel providers will be doing free and uncompensated care? It is a pleasure to serve the members of the Thurston-Mason Counties Dental Society, thanks for all your support.
Dr. R. Graham McEntire Walla Walla Valley Dental Society
I am happy to serve the Walla Walla Valley Dental Society. As president, I am trying to follow in the footsteps of the past officers of our society in bringing quality continuing education to the Walla Walla valley. I am originally from western Montana, went to dental school at UW, and did a stint with the Indian Health Service in New Mexico. My wife and I enjoy flying our small plane, boating in the summer and hiking when we can get away. We have four kids, three of whom are grown, and one little guy who will be four in January.
Dr. Aaron Lamperes Mt. Baker District
After graduating from UWSoD in 2005, I returned to my hometown, Bellingham. My wife, Lisa, and I have two beautiful girls, Addy and Sophia. We stay active with our church, Calvary Chapel Northwest, along with camping, biking, hiking, and traveling. Since graduating dental school, I have become an avid photographer, almost exclusively doing landscape and nature photography. This hobby dovetails well with my love for hiking. Over the summer I spent three days at Mt. Rainier hiking, and taking photographs with some longtime friends. I have worked in the same general practice since graduating, and purchased the practice in 2007. Mt. Baker District has a large number of active members, and the local dental community is rich with study clubs and high quality practitioners. I know personally the challenges to stay involved in organized dentistry. However, I feel strongly that if dentists do not stay connected on a regular basis, we lose the cohesiveness that is so
Dr. Brady McDonald
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membership news component society presidents
Dr. Aaron Lamperes and family
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membership news component society presidents
Charlotte, NC. I have since been in private practice in Kelso ,Wash. for the last 14 years. I love dentistry, and have a passion for helping the underserved get access to dental care. I am privileged to serve as the President of the Lower Columbia District Dental Society which has active and engaged members who work for the benefit of organized dentistry in our community. Personally, my wife, Tracy and I have been married for over 20 years and have five children who keep us busy with all of their activities. We particularly enjoy sports of all kinds.
Dr. Princy Rekhi Seattle-King County Dental Society
Dr. Alan Peet
As President of SKCDS, I am enthralled by the opportunity to serve dentistry in such a vital role with the support of an incredible organization. The past few years in organized dentistry have been jam-packed with new developments for the profession, while being an exciting time for change and progress towards my greater vision in dentistry. Born in India, I was raised here in Seattle, and attended Inglemoor High School, graduating as valedictorian in 1997. I then found myself suddenly in drastically different, but similarly comfortable, surroundings at the University of Missouri Kansas City, completing an accelerated six-year program, earning both my BA in biology, and DDS upon graduation in 2003. Since then, I moved back home to Washington, immersed myself in my practices, and became intrigued in the concept of organized dentistry. After being the only dentist in the family for eight years, I was joined in practice by my sister, Tisha Rekhi, who graduated from UOP’s Dugoni School of Dentistry in 2011. Along with my professional focus, I’ve made it a point to find time for other passions: boating out on Lake Washington, enjoying the waterfront in my backyard, traveling and spending time with family and friends. Through my involvement with SKCDS,
Dr. Alan L. Peet Olympic Peninsula Dental Society
Organized dentistry keeps you informed of the challenges facing dentistry and makes you less isolated in your individual practice. In addition, it provides a means to have a voice in the regulatory process that impacts all of us. Finally, it enables you to meet and work with very good people, and develop friendships on a personal and professional basis.
Dr. Steven H. Pond II Lower Columbia District Dental Society
Dr. Tyler Shoemaker and his daughter, Brooke
Having grown up in southwest Washington, I was excited to come home after finishing my dental education. After graduating from Castle Rock High School, I pursued my undergraduate education at BYU in Utah. I graduated from Oregon Health Sciences School of Dentistry in 1996, and then completed a two-year general practice residency in Carolinas Medical Center in
Dr. Graham McIntire
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Dr. S. Tyler Shoemaker Spokane District Dental Society
I recently returned from the WSDA House of Delegates in Walla Walla. I feel lucky to have survived the trip. Delegates were dropping like flies due to food poisoning, a bike accident, a stroke, and my personal experience choking on some stringy lasagna. As with all such experiences, it gave me pause for reflection. What happens if all of those dentists, like our WSDA past President Dr. Rod Wentworth, who have committed themselves to greater levels of compassionate service, disappear? Why should I care if WSDA fails to accomplish its mission because committed people like Executive Director Steve Hardymon decide to do nothing? Where will the future of our profession end up if visionary leaders like Dr. Joel Berg, the new dean of UWSoD, fail to show up? Compassion, commitment, and vision are the legacy that we have an opportunity
Dr. Kathryn C. Wright and sons David (left) and Cameron
to leave for those who follow. I thank and applaud those who have already contributed to that legacy, and challenge each of us to consider what the sacrifices of these leaders means to us personally and to the dental profession.
Dr. Kathryn C. Wright Clark County Dental Society
Dr. Steven Pond II and family
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One of the reasons I wanted to be president of the Clark County Dental Society was to play a more active role in the decision making of our local organization. It’s easy for us to get so focused on our individual practices, that we disregard the lawmaking process that affects us as a whole. As a group, Clark County has an outstanding reputation within the state for volunteerism, charitable giving, and support of organized dentistry in Olympia. I’m proud to represent Clark County Dentists and look forward to serving them for the rest of my term. On a personal note, I have been an avid golfer since the age of ten. Back when the PAC-12 was the PAC-10, I played on the women’s golf team at Oregon State University. In 1987, the Navy was in my future, and who knew that the Armed Forces had a golf team? 1988 brought the Women’s Armed Forces Interservice Championship while stationed at the Marine Corps Recruit Depot in San Diego, California. My favorite activity is playing golf with my two sons whenever I can. We have a tradition that they take me golfing every Mother’s Day! David is a senior at Camas High School and Cameron is a sophomore at Gonzaga University in Spokane. Darryl is my husband of 20 years and the master chef of the family.
membership news component society presidents
I’ve been delighted by the passion of member dentists, fueling my hope to uniquely serve a common cause. As things change in our professional world, one thing remains constant: my desire to serve patients and the dental community, remaining cognizant that service is the true essence of dentistry.
legislative news affordable care act
AFFORDABLE CARE ACT
Special to the WSDA News from Thomas J. Spangler, Esq.,Senior Director, Legislative and Regulatory Policy, American Dental Association
A federal perspective Potential Effects of the Affordable Care Act on Dentistry
The Affordable Care Act has the potential to reshape health care in America. The expansion of medical insurance coverage, a move toward more integrated care delivery, and significant changes to how health care is financed are some of the main changes expected. Several aspects of the ACA have important implications for dentists as oral health care professionals and small business employers, as well as consumers of medical care. While much of the effect of the ACA on health care in general and on dentistry in particular remains uncertain at this stage, it is important to highlight some of the potential changes that are likely to occur.
The ACA provides for the expansion of Medicaid to cover people with incomes below 138 percent of the federal poverty level (FPL). The federal government will pickup 100 percent of the cost of covering this additional population initially and 90 percent of the cost long term. The actual expansion of Medicaid coverage will vary significantly depending on how states respond to the Supreme Court ruling last June, which held that the federal government could not withhold all federal Medicaid funds from states that refuse to expand their programs. According to various policy experts, the number of children and non-elderly adults added to the Medicaid roles could be as high as 24 million or as low as 11
million, depending how many states accept the ACA money and expand their Medicaid program. Actual increases in monthly enrollment will likely be lower than these numbers because of the frequency with which beneficiaries enter and leave Medicaid as their financial circumstances change.
Health Care Delivery and Financing
A major goal of the ACA is to better integrate and coordinate health care delivery and financing by expanding the level of health care provided under an Accountable Care Organizations (ACO) umbrella. ACOs are designed to align provider incentives with provision of quality and coordinated care and to shift reimbursement away from volume of services toward health outcomes and quality. ACOs are also meant to improve the infrastructure underlying care delivery. To date, the ACO models that have emerged have largely focused on health care services for the Medicare population. Expert analysis recently completed indicates that there are very few ACO type models of care that include any dental services. Looking forward, it is uncertain when and to what degree ACOs will integrate dental care delivery and reimbursement as part of the core health care services they provide. The ADA has taken the lead in developing the Dental Quality Alliance to ensure that specific concerns of dentistry are adequately addressed. The Association is likewise engaged with federal health
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Health Insurance Exchanges
Exchanges must be in place in time to begin enrolling beneficiaries by October, 2013. Initially, the exchange will be available to individuals and small businesses only allowing the purchasers to select from various private health care plans. Under the ACA, people with incomes between 100-400 percent of the FPL are eligible to receive federally subsidized coverage through the exchange. A key aspect of the ACA is the individual mandate to obtain health insurance covering ‘essential’ health benefits. The law includes pediatric dental care in a list of essential health benefits to be provided by small and individual group health plans but dental care for adults is not included in that essential benefit package. To ensure a consistent level of consumer protections, standalone dental plans must offer the pediatric oral essential health benefit without annual and lifetime limits. Stand-alone dental plans will also likely have to meet certain marketing requirements, ensure a sufficient choice of providers, and perhaps meet performance quality measures. Further, they may be required to use a single enrollment form and a standard format for presenting health benefits plan options. It is estimated that 3 million children will gain dental benefits through the health insurance exchanges by 2018, or roughly a 5 percent increase over the current number of children with private dental benefits. It is important to note that a significant portion of children will also gain dental benefits outside of the health insurance exchanges through, for example, employer-sponsored dental benefits with dependent coverage, although the number is uncertain at this time. The effects for dentistry could be significant if, for example, the ACA-required essential pediatric dental benefit is inadequate or too expensive or if plans with inadequate dental networks dominate the exchange marketplace. The ADA offers advocacy materials and shares best practices with constituent dental societies to encourage maximum competition in the exchanges that gives consumers a real choice of benefit plans with robust dental networks. Case studies are shared with constituents on how a state society can ensure an adequate essential dental benefit for children (California), advocate for maximum competition within the exchange that includes stand-alone plans and plans with embedded dental benefits (Washington state and Colorado), and determine whether to include adults as an add-on to the essential benefit package (Vermont).
The ACA does not require small businesses with 50 or fewer employees to provide health insurance. More than 99 percent of dental practices have 50 or fewer employees. Small business employers who pay at least 50 percent of the premium for employee coverage may qualify for a small business tax credit. To qualify, the employer must have fewer than 25 full-time equivalent employees whose average annual wage does not exceed $50,000 per employee. The tax credits, which disappear after 2016, will be available on a sliding scale to assist the purchase of health insurance.
Taxes and Limits on Tax Preferred Accounts
Flexible spending accounts allow employees to set aside tax-free money to pay medical and dental bills. Starting in 2013, the FSA
set-aside will be limited to $2,500 a year and increased annually by a cost-of-living adjustment. The ADA continues to support repeal of ACA provisions that are inconsistent with Association policy. This includes the 2.3 percent medical device excise tax scheduled to take effect Jan. 1, 2013. The ADA and members of the Organized Dentistry Coalition have opposed implementation of the tax, and the U.S. House of Representatives has passed legislation, which is stalled in the Senate, to eliminate the tax. The coalition estimates that the tax will increase the cost of dental care by more than $160 million annually. The IRS has yet to issue final regulations. In 2013, there is 0.9 percent payroll surtax on wage and salary income over $200,000 for single filers or $250,000 for joint filers. The 2012 Medicare Hospital Insurance (Part A) tax for the Medicare Hospital Insurance (HI) Trust Fund is 1.45 percent of all salary income, with an equal 1.45 percent paid by employers. Starting January, 2013, the tax will be 2.35 percent on all earnings above $200,000 and $250,000 respectively. For the self-employed, the rate increases from 2.9 to 3.8 percent. There is also a 3.8 percent tax in 2013 on some investment income of taxpayers whose modified adjusted gross income exceeds $200,000 for single and $250,000 for joint filers. Investment income includes rents, dividends, interest, royalties and capital gains on property sales (with a partial exclusion for primary residence sales).
Dentists as Health Care Coverage Consumers
Plans in the individual and small group market could include prohibitions on refusal to cover pre-existing conditions, excessive waiting periods, copayments or deductibles for certain preventive services and on coverage rescissions, and comprehensive coverage, guaranteed issue and renewability, premium rating limits on rate increases based on age, gender or health condition and required coverage for dependents up to age 26.
Public Health Infrastructure
ACA provisions consistent with Association policy include: • increased funding for public health infrastructure, including Centers for Disease Control and Prevention oral health programs and national oral health surveillance programs; • additional funding for school-based health center facilities; • increased grant opportunities for general, pediatric or public health dentists; • funding for National Health Service Corps loan repayment programs; • CDC initiation, in consultation with professional oral health organizations, of a five-year national public education campaign focused on oral health prevention and education. Many of these new programs have not been funded. The ACA also authorizes federal spending to support a state alternative provider demonstration project, which is inconsistent with Association policy. Money has not been appropriated by Congress to support the demonstration.
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legislative news affordable care act
information technology officials to represent dentistry’s interests.
legislative news save the date for dental action day
‘13 dental action day one profession, january 25 · 7:15 a.m. one voice Schedule of Events Decisions made dur7 AM
DAD Tent opens Capital Grounds
Legislative Briefing Breakfast DAD Tent, Capital Grounds
Continuing education course (1 hour CDE)
• Health care reform
Appointments with Legislators
ing the 2013 legislative session could result in fundamental changes to dental care delivery Issues facing the 2013
• Dental workforce • Funding for higher education and dental residency programs • Dental licensure fees and renewals • Further cuts to dental care funding for children,working poor, and medically-complex patients
Register ONLINE Today!
Call Michael Walsh at 800-448-3368 or email at firstname.lastname@example.org
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legislative news election results
2012 Election results Democrats retain control of the Governor’s Office, Senate, and House The 2012 election resulted in both change and continuity in state government in Washington state. While Democrats maintained control of the Governor’s Office and the Legislature, retirement and turnover will result in new individuals taking positions of power. Jay Inslee will become Washington’s 23rd Governor, and his administration will propose a 2013-15 biennium budget to the Legislature. Additionally, the Inslee Administration is expected to lift the rule-making moratorium that has been in effect for the last two years. In the Legislature, 27 legislators retired this year including Senate Majority Leader Lisa Brown (D-3), longtime House Health Committee member Bill Hinkle (R-13), and the Senate Republican’s primary budget writer, Joe Zarelli (R-18). Four incumbent legislatures were also defeated in November: Sen. Mary Margaret Haugen (D-10), Sen. Dan Swecker (R-20), Rep. Katrina Asay (R-30), and Rep. Mike Armstrong (R-12). Both Sen. Swecker and Rep. Armstrong lost to fellow Republicans. There are currently three vacancies on the House Health Committee, and two vacancies on the Senate Health Committee. The legislative caucuses will determine committee assignments and leadership positions this month. At the time of writing, only two legislative races remain too close to call, and both races are located in the 17th legislative district (Clark County). In the Senate, Rep. Tim Probst (D-17) is challenging incumbent Sen. Don Benton (R-17); the margin between both candidates is 16 votes. In the House, Monica Stonier (D) is facing Julie Olson (R) to fill Rep. Tim Probst’s seat; the margin between both candidates is 81 votes. Depending on the outcome of 17th District Senate race, Republicans will either pick up one seat in the Senate, or the composition will stay the same. In the House, Republicans will either pick up one or two seats. The results of the legislative races in your area can be found online at: http://vote. wa.gov/results/current/.
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Contact us for all your practice banking needs! • • • • •
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Kitsap Bank has been named a Preferred Lender by the U.S. Small Business Administration.
Kerry Keely Vice President Commercial Loan Officer 360-876-2297
Bob Banks Senior Vice President Commercial Market Manager 360-876-7800
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 27
www.kitsapbank.com • 800-283-5537
Financial clarity changes lives. An hour of your time may change yours. For 27 years, Mercer Advisors has been helping individuals retire and develop strategies for multi-generational wealth. We offer a complimentary Wealth Management Consultation structured to provide a glimpse into how a team of experts can help you establish financial clarity on topics such as portfolio longevity, asset protection, tax sheltering, risk and leverage. Call 888.642.4636 today – our Seattle Wealth Management Team will be happy to schedule your complimentary Wealth Management Consultation. Endorsed by the WSDA since 1998
I Investment Management I Financial Planning I Retirement Plan Services
2 8 · th e wsda ne w s · issue 2, december · 2012 · www.wsda.org Mercer Global Advisors Inc. is registered with the Securities and Exchange Commission and delivers all investment-related services. Mercer Advisors Inc. is the parent company of Mercer Global Advisors Inc. and is not involved with investment services.
As you build your financial portfolio both for your financial security now and in anticipation of enjoying a long retirement, you need to factor in the cost of care for if, and when, you need assistance in performing the activities of daily living. This care can take place in your home, or as a resident in an assisted living facility or a nursing home. The average length of stay at a nursing home is 2.4 years, which in the greater Seattle area would cost you over $200,000. You can designate money in your portfolio to cover the costs or you can purchase Long Term Care Insurance.
Seventy percent of people over the age of 65 will require Long Term Care services at some point. Long Term Care Insurance is similar to Disability or Life Insurance, in that you are paying a monthly premium to have a pool of money available to you when you need it. Unfortunately, “Long Term Care” is not an accurate description of the benefits provided on a Long Term Care Insurance policy: “Family Freedom Coverage” may be a bit more accurate. This type of insurance frees you from the substantial financial burden of paying for care, while it frees your family from the burden of caring for you at the detriment of their time, finances and physical and emotional well being.
In 2010, the average annual cost of a nursing home in Washington was $90,000, assisted living facility was $48,000 and home care with a health aide was $58,000. Washington Dentists’ Insurance Agency strongly believes in the need for Long Term Care Insurance. Along with Disability and Life Insurance, Long Term Care Insurance will protect your family and you from the large financial burden that an accident or illness may cause. Purchasing coverage will relieve your family of having to center their lives around your personal care, while giving you the freedom to choose where you would like your care to take place.
Forty-one percent of people receiving long term care are between the ages of 18 and 64. Since the need for assistance, not age, is the trigger for receiving long term care benefits, this insurance will cover you should the unexpected happen at any age. For example, if at age 47 an illness or accident leaves you needing care, you would be eligible to receive benefits. This would allow your spouse to continue working or caring for your children, while a professional caregiver comes to your home to help you with your daily needs such as bathing, dressing or getting in and out of bed. Having Long Term Care Insurance will help you meet the cost of your spouse’s and your care should you need assistance with daily living at any age. It gives you the flexibility to choose when and where you receive care and to provide emotional and financial support for your family. WDIA encourages dentists to consider a Long Term Care Insurance policy as additional insurance protection for your financial security. To learn more about Long Term Care Insurance and to receive quotes, please contact WDIA at 206-441-6824 or 1-800-282-9342 or at email@example.com.
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 29
Matthew French Director of Insurance Services WDIA
“The average length of stay at a nursing home is 2.4 years, which in the greater Seattle area would cost you over $200,000.”
wdia news long term care insurance
The need for long term care insurance
DENTAL PRACTICE TRANSITIONS THE PARAGON DIFFERENCE C
After handling thousands of transactions over the past two decades, PARAGON consultants know that no two clients and no two transactions are the same. A practice transition is a very personal event that requires very special attention. Nothing is taken for granted. We customize every single transaction to satisfy the needs and goals of our clients. We handle each transaction as if we are the client. This is just one of the many reasons why PARAGON is so unique.
Judge for yourself! Call us for a complimentary consultation. No obligation… just a very worthwhile education! Sign up for our free newsletter at paragon.us.com Approved PACE Program Provider FAGD/MAGD Credit Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement 4/1/2012 to 3/31/2016 Provider ID# 302387
Your local PARAGON consultant is Mark Fleming, D.D.S. Contact him at 866.898.1867 or firstname.lastname@example.org
3 0 · th e wsda ne w s · issue 2, december · 2012 · www.wsda.org
Last November, we rolled out two programs aimed at making our member’s lives a little easier — online dues payment, and a 12-month payment option. Paying your annual dues online is fast, easy and secure, and saves you time — there’s nothing to mail. The 12-month payment option makes membership easier on the wallet by allowing you to pay for your WSDA membership over the course of the year.
Getting started is easy
We’re providing you with the same FAQs that accompanied an email you should have received in November — If you have not received your billing, please contact Laura Rohlman at email@example.com, or (206) 973-5218.
Q: How do I pay my dues online? A: Visit www.wsdasource.org. You should have received an email and a paper invoice alerting you to this membership benefit. If not, please contact Laura Rohlman at firstname.lastname@example.org, or (206) 973-5218.
Q: What do I need to access my account on www.wsdasource.org?
A: You will need your ADA# or your WSDA Customer ID#. Both of these were provided to you in the email you received announcing online dues payment.
Q: How do I sign up for the 12-month payment plan?
A: When you visit www.wsdasource.org to pay your dues online, you will have the option to pay your dues in full, or enroll in the 12-month payment plan. The installments will be automatically charged to your credit card every month. It is important to note that the 12-month payment plan option is only available online by credit or debit card. Q: Is there a deadline to sign up for the payment plan? A: Yes. Those wanting to participate in the 12-month payment plan must sign up by December 17, 2013.
Q: Is there a processing fee for the payment plan?
WSDA: Yo u ’ r e t h e r e f o r your patients. We ’ r e h e r e for you.
A: Yes. A $72 processing fee will be assessed for those participating in the payment plan. Note that there is no processing fee if you pay your dues online in full.
Q: What happens if I cancel my enrollment in the payment plan before the end of 12 months? Will I be refunded for my payments to date? A: No refunds will be issued. Q: Can I pay-off my remaining dues balance before the end of 12 months? A: Yes, please call the WSDA. This cannot be done online. Q: How do I update my credit card information on file with the WSDA? A: You will need to return to www.wsdasource.org to update your credit card
information on file, or call the WSDA.
Q: What happens if my credit card is declined sometime within the 12 months? A: You will be notified by email. If a valid credit card is not provided within 30 days
of the invoice due date your membership status may be revoked with no refund.
Q: Can I still make voluntary contributions to Washington Oral Health Foundation, ADPAC, DentPAC, and the WSDA Alliance online? A: Yes, you will have the opportunity to make voluntary contributions whether
you pay in full or select the 12-month payment plan option. Note that when the 12-month payment plan option is selected all voluntary contributions are collected with the first installment. Only the tripartite membership dues are spread over 12 months.
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 31
membership 12-month payment plan, onlie dues payment
Fast, secure, easy: online dues options return
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For the second time in three years, WSDA member dentist Dr. Michael Huey and the Kitsap County Dental Society have taken home the ADA’s top prize — the Golden Apple Award — for “Excellence in Science Fair Program Support and Promotion,” for their efforts in promoting the Washington State Science and Engineering Fair (WSSEF). The WSSEF began in 1957 as a local PTA fair, and today is the state science fair. It is open to all students in grades 1-12. This past year, more than 500 students from 19 counties in the State of Washington participated in the annual event in Bremerton, Wash. Huey, president of the WSSEF and head judge for the event, has been one of the driving forces in the promotion of the fair for years, and is credited with getting nine member dentists to join the team of judges this past year alone. In an event of its size, with so many entries, it is imperative that they have enough judges on hand. Huey explains, “We are always in need of volunteers for the event, whether it’s to be a judge, mentor, or for some other special talent, such as grant writing.” Volunteers can sign up online at www.wssef.org, and we’d like to invite all WSDA members to follow us on Facebook at facebook.com/
Dr. Mike Huey with his latest Golden Apple Award
wssef. The 2013 fair will take place April 5 and 6 at Bremerton High School. The WSSEF is committed to providing students the tools and the opportunity to conduct scientific and engineering research. Additionally, the Fair provides a venue to the students to present projects to peers and get feedback from experts. Over one million dollars in scholarships and awards are presented each year.
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The Washington Oral Health Foundation (WOHF) provides a cash award and an opportunity for the students to present their dental related project at the Pacific Northwest Dental Conference. This past year, students from Washington State have been featured in Popular Science, and have been recognized by Broadcom Masters, NASA, and at ISEF (International Science and Engineering Fair).
membership golden apple award
Huey, Kitsap get the gold…AGAIN!
Kids will spend 11 minutes dressing Spike up like a princess. How about two minutes to brush their teeth? Brushing for two minutes now can save your child from severe tooth pain later. Two minutes, twice a day. They have the time. For fun, 2-minute videos to watch while brushing, go to 2min2x.org. 3 4 路 th e wsda ne w s 路 issue 2, december 路 2012 路 www.wsda.org
FACILITATING MTI VANS The Washington Oral Health Foundation has partnered with Medical Teams International (MTI) for a number of years, helping to provide free dental services in their mobile operatories to those in need around the state. However, renting the vans fell mostly outside of WOHF’s operating budget, and they weren’t able to utilize the service as much as they hoped, or wanted. This past October, the Foundation sponsored three events that delivered more than $19,000 in donated services to 37 patients in the van, with an additional 163 seen for x-rays, screenings and cleanings. WOHF staff had been seeking ways to fortify the relationship with MTI, and realized their time was best spent identifying areas of need in the state, coordinating volunteer dentists to staff the vans, and serving as a liaison between MTI, community groups, and dentists. Ruth Abate, Director of Operations and Community Outreach, says “We have a direct line to dentists across the state who want to help, and we can utilize that connection to make sure that the underserved are getting proper dental care.” WOHF staff have been reaching out to area groups like Asian Counseling and Referral Services to determine the need of their constituents, and assist in triage of
care. Tom Tidyman, Director of Programming and Development explains, saying, “We have found that WOHF serves as the link between community organizations who wish to provide dental care, and our WSDA member dentists who want opportunities to give back in a meaningful way. There is obviously a need and a demand out in the community for dental care, and WOHF will continue to work with MTI to help as many as they can.”
If you would be willing to volunteer for a day on an MTI Van, or you are involved with a local organization in your community that has a need for a mobile dental van, please contact Ruth Abate at 800-4483368 or by email at email@example.com. Most vans are scheduled on Friday. Can’t volunteer? You can still help! WOHF would like to begin hosting more MTI Vans in communities of need, and have multiple requests for vans. For $1,000 you can sponsor the van and WOHF will find the volunteers. Charitable donations to WOHF are tax deductible and can be earmarked for specific projects. Contact Tom Tidyman at 800-448-3368 or tom@ wsda.org to lend a hand.
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 35
Tom Tidyman Director of Programming and Development, WOHF
“We have a direct line to dentists across the state who want to help, and we can utilize that connection to make sure that the underserved are getting proper dental care.”
Photo: WSDA member Dr. Jennifer Thornton volunteered on the MTI Van at the Day of Hope on October 20
wohf news working together: mti vans
Ruth Abate Director of Operations and Community Outreach, WOHF
Congratulations on the following successful transitions: - Dr. Bernhard Kopfer to Dr. Jon Dickson Wenatchee, WA - Dr. Theresa Cheng to Dr. Ken Akimoto Issaquah, WA
- Dr. Virginia Lee to Dr. Lee Rojas Issaquah, WA - Dr. Robert Hughes to Dr. Jonathan Smith Spokane, WA
$600K in collections with good net. 4 operatories with strong hygiene department. Excellent visibility. Possible real estate sale down the road. $415,000.
4 ops, $850K collections, high $200’s net on approximately 150 days. Dr. willing to stay for a while to transition. $625,000.
Western Washington Area—NEW
Prosthetic practice. 400K collections, $152K net. Three equipped ops, with a fourth for xrays. Two well-trained employees with 25 and 12 years with the practice. Doctor works three days a week and is open to stay to help transition. $257,000
Practice opportunity in quiet, smaller community. Practice on track to collect just over $1 million in 2012. Less than two hour commute from Seattle. Seller willing to stay on if desired.
Sandpoint, Idaho Well-established general practice in new building. 6 ops, private office, separate consult area and large staff room. Collections over $100K/monthly with net $500K. Seller will stay to assist transition. $895K.
Fantastic opportunity for practice in growthmode, digital, ready for quick transition.
Newly listed. Very visible location. 4 operatories. Paperless, digital. Collecting high $700K.
- Associate to Purchase option Wenatchee Western Washington (rural area)
- Coming Soon -
Everett area– 3 ops Downtown Seattle
- Space Only Renton—1,300 sq. ft. Bellevue—5 ops. Edmonds
Covington Lake Stevens Everett
Congratulations on the following successful transition: - Dr. Dean Irwin to Dr. Polly Ma, Lake City, WA - Dr. Ted Forman to Dr. Matthew Huang, Mukilteo, WA - Dr. Micheal Melkers and Dr. Jeanine McDonald to Dr Rob Wilder, Spokane, WA
Close to downtown, 3 ops, well established with long-term staff.
4 ops in heart of growing, desirable area of Seattle’s eastside—only one PPO.
Close to downtown, 4 ops, beautifully appointed/ 4 ops. Spacious. Currently a satellite on two days digital. Must see! per week. Poised for growth!
9 equipped ops, $2.4 millions in annual collections. 4 new chairs/delivery/computers.
Building also for sale.
4 ops, in the heart of downtown Poulsbo.
2 ops, 2 days per profitability. 3 week, 6 · thgreat e wsda ne w s · issue 2, december · 2012 · www.wsda.org
nordic news employment liability
Got a case of the nerves or peace of mind?
As many American businesses continued to downsize in 2011, a whopping 99,947 claims for discrimination were filed with the Equal Employment Opportunity Commission (EEOC). In the agency’s 46 year history, it was the largest number of cases ever filed. With the economy continuing to try to find its footing, and employment remaining uncertain for many, employers are facing the added pressures of increasing claims for wrongful termination, sexual harassment, discrimination and other employment-related exposures. It’s just one more thing to be concerned about. And you should be concerned. The potential for an employee claiming they were inappropriately touched, the wrong joke was told, they were passed over for a raise, or were discriminated against during a job interview, are very real examples of employment practices liability claims that we hear about all the time. So what do you need to know about employment liability? Well first, if you’ve ever interviewed someone, or hired or terminated an employee, you have exposures and should be carrying Employment Practices Liability Insurance. Before someone can file an EPL civil claim, they first have to file an action before the EEOC, and even if the case is found to be without merit, there is still the expense to defend it. According to the EEOC, in 2009, the average cost for a small to mid-sized business exceeded $235,000. Employment Practices Liability Insurance will provide coverage, within policy limits, to defend and indemnify against covered job-related lawsuits. (This pre-filing is not required prior to an action under Washington State law against discrimination.) But what can you do to try and mitigate employment liability? As with all risk management, good communication and documentation is the key. Having well defined policies in place that are clearly communicated to your staff is critical. An Employee Handbook can not only help protect you from litigation, but can also help your staff by conveying in positive terms, what the practice’s policies are. Your Employee Handbook should outline your policies against harassment, state EEOC designation details, have a statement that the practice follows EEOC policies, and any other federal and state laws that need to be posted. The handbook can express your policies on paid time off, salaries and promotions, benefits, and employee conduct (attendance, dress code, conflict resolution, breaks and rest periods, texting, cell phones, internet usage, etc.). Having the appropriate disclaimers should also be considered, e. g. the handbook is not a contract and does not guarantee employment, the handbook is the ultimate word on company policies, the policies in the handbook may be subject to change, etc. You should also have employees sign and return an acknowledgment page that they have read and understood the Employee Handbook. To avoid discrimination claims, have written anti-discrimination policies in place that conform to EEOC guidelines. Use interviewing procedures and job applications that comply with local and federal laws. Job descriptions should comply with the Americans with Disabilities Act. Have a leave of absence policy that complies with the Family and Medical Leave Act of 1993, and the Pregnancy Disability Act of 1978. Your policy on office holidays should conform to state and federal laws. Post employment-related notices as required by law. If layoffs are necessary, your policy should be based on nondiscriminatory staff reductions. continued on page 39
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 37
Melissa Moore-Sanchez Manager, NORDIC Sales and Marketing
“But what can you do to try and mitigate employment liability? As with all risk management, good communication and documentation is the key. Having well defined policies in place that are clearly communicated to your staff is critical.”
letter to the editor dr. ron snyder
Dear Editor Just to let you know how far removed from traditional Dental care things have become I thought I would share this story with you. Last night I received a call from a new patient who was in pain from an impacted, partially erupted upper right wisdom tooth. We had him come in to our office today for treatment which was probably going to be an extraction. When he presented his insurance card it was for a capitation plan through WDS, and we are no longer an in-network provider with WDS, much less with the capitation plan. Luckily, one of the corporate clinics in town is now a WDS capitation clinic. So we called WDS to see if he could be seen in the local clinic. The telephone tree was very responsive in answering the call and we were guided to a real person promptly when his ID code was keyed in. We let the patient talk to the representative directly since this is his insurance. As it turns out the local clinic could not see him either because he had just moved from Marysville. The capitation fee for October and November had been paid to the Marysville clinic and could not be transferred to our local clinic because that is not how the system works. He would have to wait until later to have benefits locally. Today is October 25th, this gentleman is driving to Marysville to chase down his pre-paid benefits, so he can get relief from his dental emergency. This sad scenario is the norm for this designed benefit, and the patient knows he has no other choice but to pay out of pocket, or receive charity from a caring dentist, which we offered. This is how far we have come from traditional dental care when the corporations act as agent between the patient and the dentist, oops-sorry, provider. What is really sad is that he could be out of pain, and back to work in the time it has taken me to write this letter. — Dr. Ron Snyder Richland, Washington
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To protect against sexual harassment claims, have a written policy against sexual harassment and make sure the policy is communicated to both employees and management. Be mindful that harassment can also come in the form of a third party, e.g. a delivery person or even a patient, and that you are responsible to respond to an employee’s complaint. Have a complaint procedure in place that protects the employee making a complaint. All complaints must be documented. Any complaint should be immediately, thoroughly and confidentially investigated. Following the investigation, appropriate action should be taken to resolve the complaint. To manage wrongful termination claims, have employees acknowledge in writing the at-will nature of the employer-employee relationship. Perform periodic performance evaluations, and keep them and employee warnings in personnel files. Use counseling, employee assistance and outplacement programs. When interviewing, perform thorough pre-employment interviews and
background checks, and avoid statements at the time of hire that could be construed as promises of permanent employment. Take your time when hiring! It can be tempting to just hire someone who presents well at an interview when you’re shortstaffed and you just want to fill the position. To avoid becoming the proud new employer of an embezzler or other employee-related issues, do your due diligence! Thoroughly check references, and even ask the reference for a reference. Again, always do background checks. Be clear on questions you can and cannot ask during an interview. Take advantage of character assessment tools and also test for the particular skill set you are hiring for. Use well known, established agencies when using temporary employees. NEWS DECEMBER 2012 WSDA To reduce wage claims, have a specific policy on paid or voluntary overtime and breaks. If an employee is voluntarily working off the clock, advise them to stop and document their personnel file. Nonexempt employees should be expected to
take their breaks and clock out and back in during their designated break period. By requiring employees to take their breaks, even if they continue to work during their break, your office demonstrates that it is following wage and hour laws and this can help reduce unpaid overtime claims. This is by no means an exhaustive list but it is meant to get you thinking about the steps you are taking to protect yourself and your staff. Implementing clear policies and guidelines, that are reviewed and updated regularly and shared with staff, are good ways to promote safe work environments for everyone. And having those policies in place also aids in defending you, should the need arise. There is no way to guarantee that you won’t be sued for employment practices liability, but taking the proper steps to mitigate those risks and carrying the proper coverage can sure give you more peace of mind. And I don’t know about you, but I like more peace of mind.
PROFESSIONAL RACTICE P SPECIALISTS,
Aaron Pershall - Randy Harrison HAPPY HOLIDAYS AND THE BEST IN 2013 TACOMA – G/P collecting around $400K in 2011. Neat and tidy 3 operatory office with recent upgrades! EVERETT, WA – Very high profit Denturist practice collecting around $290K. Includes dental equipment. CHEHALIS, WA – Great merger or start up alternative! G/P collected $200K in 2011. Flexible lease! KENT, WA – G/P collecting $350K. Nicely appointed office features 4-ops, pano, and newer cabinetry.
ANCHORAGE, AK – Wonderful Fee-for-Service G/P collecting $2M+. Well managed office with recent updates. Seller available for transition and work-back.
IDAHO PARTNERSHIP – Group practice seeking partner. Multiple rural locations available with updated equipment and great staff! Numerous transition/ownership options.
FAIRBANKS, AK – Exceptional G/P collecting $1.6M+. Excellent cash flow! 100% fee for service! Newer facilities, CT scanner, Cerec, and more! Flexible transition options.
CENTRAL, ID – Excellent satellite opportunity! Highly Profitable G/P on just 2 days/week. Incredible lease! Associate position available!
NEW–SW WASHINGTON PERIO! NEW - OREGON ENDODONTIC!
WESTERN OREGON OMS – Excellent, high profit practice with tremendous growth potential. Great location close to a major hospital.
Aaron@PracticeSales.com RandyH@PracticeSales.com th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 39
nordic news continued
nordic, continued from page 37
2959 Northup Way | P.O. Box 99590 | Bellevue, WA 98009 | Toll Free: 800.735.7231 | nakanishidentallab.com
Nakanishi’s industry-leading, full-contour zirconia restorative option is virtually designed for a precise fit and unparalleled marginal integrity. These high-quality restorations are digitally designed by our most experienced technicians, and machine milled in our Bellevue laboratory using high-precision WIELAND Dental milling technology. Nakanishi’s ZENOSTAR™ crowns are backed by our DAMAS accreditation, which certifies that only the highest-quality materials and processes are used in all our restorations. ZENOSTAR™ Pure Features • Next generation innovative zirconia material from WIELAND Dental creates lifelike esthetics • Natural appearance through individual shading to match the desired shade • 1200 MPa flexural strength means a long-lasting restoration and conservative preparation design • Zirconia ceramics offer excellent biocompatibility • No discoloration of the gums • High translucency and opal-like qualities compared to any other full-contour zirconia on the market • Very cost-effective • Not outsourced — fabricated from start to finish on-site at Nakanishi Dental Laboratory using zirconia and high-precision milling machines from WIELAND Dental • Crowns and bridges are made from a single block of ceramic, eliminating the risk of veneering porcelain chipping
Nakanishi Dental Laboratory has achieved DAMAS accreditation, a level of certified quality only 1% of laboratories in the world have reached. Quality certifications, such as DAMAS and CDL, are just another way for us to provide our clients with peace-of-mind that the restorations they receive from us not only look and fit great, but are made using the highest quality materials and production processes. • We have a system for tracking and controlling the manufacturer’s lot number for all the materials used in every patient’s restoration. • All the materials used in our products have been verified as FDA registered. • Our laboratory equipment has been maintained and inspected above and beyond industry standards, and used strictly within the manufacturer’s guidelines.
4 0 · th e wsda ne w s · issue 2, december · 2012 · www.wsda.org
WSDA/Webinar Tuesday, December 18 Speaker: Bracken Killpack, WSDA Director of Government Affairs
Topic: Discussion on Health Care Reform
cess with Posterior Composites Location: Salty’s on Alki, Seattle Time: 6-9 p.m. (CDE Credits: 2) For registration contact SKCDS at 206448-6620 or firstname.lastname@example.org
Friday, May 3 Speaker: Dr. Tim Hess Topic: Review of Facial Aesthetics: Clinical
•Overview of recent federal and state legislation on health care reform •Discussion of Health Benefit Exchanges •The role of dentistry in health care reform •How health care reform may impact dental insurance Webinar Link: https://www3.gotomeeting.com/register/504654718 Time: 12 noon (CDE Credit: 1)
Applications of Botox and Dermal Fillers in the Dental Practice with Live Demonstration Location: Airport Marriott Hotel, SeaTac Time: 8 – 4 p.m. (CDE Credits: 7 ) Co-sponsored with Washington AGD. For registration contact SKCDS at (206) 4486620 or email@example.com.
Snohomish County · 2012
Tuesday, January 29 Speakers: Drs. Bobby Butler and Mark
December & January -- No Meetings
Topic: Is the Tooth Fractured? Diagnosis
and Decision Making in Today’s Clinical Practice Location: The Harborside Restaurant, Seattle Time: 6-9 p.m. (CDE Credits: 2) For registration contact SKCDS at 206448-6620 or firstname.lastname@example.org.
Tuesday, February 26 Speaker: Dr. Ankur Gupta Topic: The 10 Most Profitable Changes I made to My Dental Practice
Location: The Sheraton Hotel, Bellevue Time: 6-9 p.m.
(CDE Credits: 2) For registration contact SKCDS at 206448-6620 or email@example.com.
Friday, March 1 Annual Seminar Speaker: Terry Donovan, DDS Topic: Restoration of the Worn Dentition Location: Lynnwood Convention Center Time: 8:30AM - 4:30PM
(CDE Credits: 7) Co-sponsored with University of Washington School of Dentistry and the Snohomish Co. Dental Society. To register call SKCDS (206)443-9308.
Tuesday, April 30 Speaker: Dr. Grant Chyz Topic: Fundamental Techniques for Suc-
Wednesday, February 20 SCDS General Meeting Speaker: Dr. Mark Drangsholt Topic: TBA Location: Mill Creek Country Club (CDE Credits: 1)
Friday, March 1 Annual Seminar Speaker: Terry Donovan, DDS Topic: Restoration of the Worn Dentition Location: Lynnwood Convention Center Time: 8:30AM - 4:30PM
(CDE Credits: 7) *Co-sponsored with University of Washington School of Dentistry and the Seattle-King Co. Dental Society. To register call SKCDS (206)443-9308.
Professional Management Associates, Inc
FRAUD INVESTIGATIONS Feeling your numbers aren’t adding up? We can help review your records in a discrete manner. Call for a free list of items to help thwart embezzlement in your office. Feeling overwhelmed at the end of the day and can’t find the time to review your reports? Don’t have the time you want at home? We’re able to dial into your office, review your reports, and issue a written report of our findings.* *Certain requirements apply
Five op practice for sale. Specialized type of GP practice. Great location and room to expand! Collecting 600K/year.
Wednesday, March 2 SCDS General Meeting Speaker: Dolphine Oda, DDS Topic Oral Pathology Location: Mill Creek Country Club (CDE Credits: 1)
Wednesday, April 17 SCDS General Meeting Joint meeting with Snohomish Co. Dental Hygiene Society Speaker: Kimberly Hanson Huggins, RDH Topic: TBA Location: Mill Creek Country Club (CDE Credits: 1)
Want to be listed here? Send your CDE offerings to Rob Bahnsen at firstname.lastname@example.org
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 41
Linnell Isoshima Steven Kanzaki 1206 Olympic Avenue Edmonds, WA 98020 Pager: (206) 399-0242 Fax: (425) 712-1859
cde webinar, king and snohomish counties
CDE across the state
Member Company: American Dental Sales Practice Valuation Study Group Institute of Business Appraisers
Call Toll Free Phone (866) 348-3800 Fax (866) 348-3809
email@example.com 16300 Christensen Rd. Suite 213 Seattle, WA 98188 4 2 路 th e wsda ne w s 路 issue 2, december 路 2012 路 www.wsda.org
Dr. Charles A. Borgman
Dr. Charles Borgman of Kirkland, Wash. died on September 16, 2012. He was 83. Born April 11, 1929, in Jackson Hole, Wyo., Borgman was married to Sandy, and was the father to Barbara, Erica, Marit, Inger and Greta. He graduated from the University of Washington School of Dentistry in 1962, completed his internship in Boston in 1963. He practiced dentistry for 45 years in Juanita, Wash. Borgman loved sailing, fishing, skiing, building and being surrounded by his family.
Dr. J. Harvey Losh
Former WSDA President Dr. J. Harvey Losh died on October 9, 2012. He was 95. The son of Mary McFarland and John L. Losh, was born in the silver mining town of Wardner, Id. on June 24, 1917. Losh graduated from Oregon City High School in 1936, and with honors from North Pacific School of Dentistry (University of Oregon) in 1942. He moved to Seattle in 1942, and in December of that year married Marion Jean Slizeski. Losh practiced dentistry in Seattle for more than 45 years, and was one of the area’s first periodontists. Well-respected by his peers, he was the President of the Washington State Dental Association in 1972. Harvey served his country as a Major in the U. S. Air Force from 1953-1954 in Montgomery, Ala. In 1949, they moved to Blue Ridge. Losh was the unofficial mayor and oft-times president of the Blue Ridge Club. Following Marion’s passing, he married Yvonne Webb of Atlanta, Ga. in 2002. Losh loved all things Irish; he had a twinkle in his eye and an Irish sense of humor to complement his Irish temper. He marched in every St. Patrick’s Day parade since his friend John Doyle Bishop painted the green stripe down Fourth Avenue, many years ago. He pleased the crowds dressed in full leprechaun regalia including pointed ears and brogues with curled toes. Losh also originated the Blue Ridge 4th of July Parade, leading each year with his Model ‘A’. Losh’s last parades were this year at age 95.
He was preceded in death by his wife of 58 years Marion, his parents, his siblings Grace and Stanley, his lifelong friend Charles Mulvey, and his honorary son Larry Breene, USMC. He is survived by his wife Yvonne, his four children, Andrea Papageorgiou (Nick), John Brian (Betsy), David (Lupe;), nine grandchildren, 10 great grandchildren, his loving caregiver Patricia Vaisberg, and countless friends, including his kind friend, George Marble.
Dr. William (Bill) E. Mathers
Dr. William (Bill) E. Mathers passed away on Friday June 2012 in Kirkland, Wash. He was 93. Mathers was born in 1918 in Chelan, Wash, but lived most of his life in Ephrata, Wash., where he practiced dentistry for 32 years. After graduating from Chelan High School, he attended the University of Washington from 1937-1941. In 1942, Mathers enlisted in the US Navy, serving during WWII. Additionally, while in the Navy, he attended dental school at the University of Maryland in Baltimore. While there, he met and married Glendola “Glennie” Smith. Mathers finished dental school at the University of Oregon in 1945, and then moved to Chelan where he opened his practice and worked from 1947-1950, when he was called up to serve as a dentist in the Korean War. Following his service, Mathers and his family moved to Ephrata, Wash., where he opened his dental practice and served the community for 32 years, until 1983. After the death of his first wife in 1988, Mathers married Dorothy Corrigan. The two moved to Soap Lake, Wash., where they lived for 15 years, on the Lakeview Golf Course. They enjoyed entertaining, golfing, fishing, and time in their RV. The Mathers spent winters in southern California, Arizona or Baja. Following Dorothy’s death in 2006, Mathers returned to Ephrata, and in 2007, met Joan Warner, with whom he shared a relationship until his death. Joan’s love, encouragement and steadfast visits during the last four months of his life were a precious blessing to Mathers. His life was full of adventure, laughter and love. His passion for life was punctu-
ated by generosity, humility and integrity, and was an inspiration to those lucky enough to know him. Mathers is survived by his loving family; Sharon, Brooke and Billie Mathers, John Tobey, John Bierlein, Binx, Sandy and Kelly Hoyem and their extended families.
Dr. Harry O. Nyhus
Dr. Harry O. Nyhus passed away on Saturday, October 6, 2012. He was 92. Nyhuswas born on March 2, 1920 in Hurum, Norway, and immigrated to the United States in 1931. He lived in Port Angeles, Wash., and later moved to Seattle. Nyhus served as a medic for the US Army during WWII, and belonged to a unique unit, the 99th Infantry Battalion (Separate). All of the men were selected for this elite position because they were US citizens born in Norway, and could speak Norwegian and English — and most importantly, could ski. Their original mission was to liberate Norway while on skis. They arrived in Normandy, in June of 1944 and from there, the 99th continued north. As winter approached, conditions grew treacherous. Had it not been for the bravery, stamina, and sacrifices of the 99th, the lifestyles and wonderful way of living in Europe and the US might be very different. After coming home from the war, Nyhus went to the University of Oregon Dental School, and began practicing general dentistry, and opened a second practice for prosthetics. He raised a large family with six children. He owned a farm in Port Angeles stocked with cows, horses, and chickens, and enjoyed weekends there with his family. Summers were spent on Lake Goodwin, and during the school year, he lived in Magnolia. He set the example for hard work and good values, while showing everyone a good time. He is survived by his daughters: Jacque Lantz; Caroline Ellison; Tamera Nyhus; Stacey Nyhus; son Chris Nyhus, and numerous grandchildren and great- grandchildren. He was preceded in death by his son, Timothy Nyhus and wife Mary Lou Nyhus.
If you know of a member who has passed away, please send information to Laura Rohlman at laura@ wsda.org.
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in memoriam drs. borgman, losh, mathers, nyhus
the source mercer advisors
PORTFOLIO LONGEVITY: What Constitutes an Optimally Designed Investment Portfolio?
Portfolio Longevity: The successful conversion of retirement savings into a secure, sustainable stream of income requires three things:
A comprehensive financial plan—outlining how much, when and how to withdraw from your portfolio—is the foundation for a well-designed retirement income strategy;
Sophisticated portfolio design—including extreme diversification across multiple asset classes, companies and countries, customized for your unique vision and risk tolerance profile—positions the investment and retirement income strategy for success;
maximize return potential at an acceptable level of risk. So, what exactly are asset classes? Asset classes are categories of investments that share similar risk and return characteristics, regulatory constraints, financial accounting measures and occasionally, geography. Scientific and sophisticated asset class definitions extend far beyond the traditional asset classes of stocks and bonds. Examples include U.S. large company value stocks, investment-grade government bonds, high-yield bonds, managed futures, commodities, emerging markets small company stocks, international real estate and many more. With regard to asset class incorporation into your portfolio, the adage “more is better” resoundingly applies.
Beyond-the-market portfolio management—the big-picture implementation and oversight of your portfolio design—can generate incremental return beyond that derived from the portfolio design itself. Collectively, these three elements can extend your portfolio’s longevity, maximizing the security of your retirement income.
Many factors influence the performance and sustainability of an investment portfolio. Inflation, taxes, emotion-driven investment decisions, poor diversification, misinformation — to name just a few — each impact a portfolio’s longevity. Given these potential risks, how should you go about optimizing your portfolio’s life expectancy while maximizing your retirement income? The first step involves developing a comprehensive financial plan that includes your values, spending aspirations, charitable intentions, estate plans, taxes, health status, risk tolerance and lifestyle expectations both now and in retirement. The amount of income you choose to withdraw from your portfolio is not a decision to rush or arrive at lightly. The amount, timing and method of portfolio withdrawals are each and collectively critical to portfolio longevity and retirement income security. Furthermore, the how involves logistical planning and understanding, including: Which asset classes should be sold to raise the cash needed? From which accounts — pre-tax, taxable, or taxexempt — should these withdrawals be taken in order to minimize taxes? Which accounting method should be used to process withdrawals from taxable accounts? Should withdrawals be taken monthly, quarterly or annually? Regarding taxes, how might imminent/future tax law changes impact the withdrawal strategy? These are only some of the difficult questions that must be addressed in order to maximize portfolio longevity and retirement income security. Finally, a comprehensive financial plan provides a scientifically sound portfolio design and management strategy for their retirement savings. Further, it establishes a clear and precise roadmap for how (and how not) to invest retirement assets. This last point cannot be overemphasized. Studies have shown consistently that investors succumb all too often to media noise, emotional biases and financial industry marketing gimmicks. Unfortunately, such investors subsequently pay an exceptionally high price in terms of lost dreams and dollars [Figure 1].
A Roadmap to Retirement Security
Portfolio design is the art and science of weaving together multiple asset classes into a balanced, integrated whole in order to
Extensive academic studies have demonstrated repeatedly that a portfolio’s returns — and subsequently its longevity — are largely a function of its design. On three separate occasions, Professors Brinson, Beebower, Singer and Hood1 conducted exhaustive examinations of the largest pension funds in the United States. They determined that portfolio design (i.e., the method of allocation across multiple asset classes) accounted for more than 90 percent of a portfolio’s return in any given year.
Diversification in Design
Diversification is the practice of investing across multiple asset classes with the goal of maximizing the portfolio’s long-term expected return while removing various, “uncompensated” risks. What are “uncompensated” risks? Studies have shown that portfolios concentrated in only a handful of stocks or asset classes do not earn higher returns commensurate with the risks associated with holding such a portfolio. Examples of “uncompensated” risk include individual company risk (investing in relatively few stocks), currency risk (investing in U.S. dollar-denominated assets only) and geopolitical risk (investing in one or two countries only). Fortunately, such risks can be “diversified away” by investing in multiple asset classes comprised of thousands of individual stocks and bonds, and by strategically investing in a globally diversified portfolio. Why is diversification so critical to portfolio longevity? While there is nothing inherently wrong with investing in bonds or dividend-paying stocks, the problem with such an approach is that a portfolio consisting of only bonds and/or dividend-paying stocks is
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The Power of Cross-Correlation
Why is asset class diversification so powerful? The answer lies in correlation. Correlation measures the movement of asset classes relative to one another within a portfolio. Asset classes may be co-correlated (they move up or down together in unison, though not necessarily in a one-to-one relationship), inversely-correlated (one moves up when the other goes down), or non-correlated (no relationship). When a portfolio is designed to incorporate multiple asset classes with differing correlations, the result is a retirement portfolio with higher expected return and lower overall risk level (as measured by standard deviation), and subsequently, greater portfolio longevity. Table 1 outlines the incremental gains achieved through the construction of a 10-asset class portfolio. To demonstrate this principle conceptually, consider two portfolios — a “risky” portfolio consisting of relatively few asset classes and a “stable” portfolio consisting of many asset classes. Each of these portfolios, while returning the same arithmetic mean annual return of 10 percent, contains very different levels of risk due to the correlation among the asset classes within each portfolio. [Table 2].
Portfolio Management: The Driver Portfolio management is the art and science of implementing your portfolio design and integrating it with your comprehensive financial plan. Get this wrong and even the best portfolio design will have been constructed in vain. Many components influence the successful portfolio implementation, some of which include: Fund Selection
Access to institutional funds is paramount. Unavailable to the average retail investor, these funds ensure lower overall portfolio operating costs, true asset class representation (i.e., no ‘style drift’), and the incorporation of the latest, peer-reviewed academic research. For example, the average retail mutual fund investing in U.S. large company stocks has an average annual expense ratio
th e wsda ne w s · issue 2, december · 2012 · www.wsda.org · 45
the source mercer advisors
exposed to “uncompensated” risk. This portfolio contains too few asset classes to be truly diversified. Consider Figure 2, which compares two retirement portfolios — one highly diversified (holding many asset classes) and the other undiversified (holding relatively few asset classes). Diversified portfolios can sustain periodic withdrawals throughout retirement more reliably and confidently.
Pacific Dental Conference Save these dates!
March 7–9, 2013
Inspiring speakers Fantastic networking Unforgettable location! ä Three days of varied and contemporary continuing
education sessions are offered ä Over 130 speakers and 150 open sessions and hands-on courses to choose from, as well as the Live Dentistry Stage in the Exhibit Hall
Glenn van As Laser Dentistry
Marvin Berman Pediatric Dentistry
Oral Medicine/Oral Pathology
Other featured speakers of interest to Dentists include:
Barbara Bancroft Bill Blatchford Anthony (Rick) Cardoza Jeff Coil Shannon Nanne
Samson Ng Brian Nový Tricia Osuna Cliff Ruddle Toni Pieroni
Martin Trope Geza Terezhalmy Kirsten Warrer Michele Williams Cheri Wu
ä Over 300 exhibiting companies in the spacious PDC Exhibit Hall ä Excellent Spring skiing and snowboarding on local mountains or
drive the scenic Sea to Sky Highway to Whistler/Blackcomb
Save money by registering before January 11, 2013 at...
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of 1.21 percent per year, whereas an institutional-grade U.S. large company fund has an expense ratio of only 0.16 percent per year. For a retiree with $2,000,000 in retirement assets, this equates to a potential savings (extra return) of more than $20,000 per year.
Rebalancing your portfolio by selling “winners” to buy “losers” may sound counterintuitive, but doing so is fundamentally critical to long-term investment success and to maintaining your portfolio’s desired overall risk level. For example, if left unbalanced, a portfolio consisting of 60 percent stocks in early 2009 would now hold nearly 80 percent of its assets in stocks. This would result in the portfolio containing exceptionally more risk than originally intended. Studies have shown periodic rebalancing to provide an excess “bonus return”2 of anywhere from 0.50 percent to as much as 2 percent per year.3 At minimum, the retiree could earn an additional $10,000 per year in return.
Sound portfolio management, when properly integrated with your comprehensive financial plan, minimizes your income
tax exposure in retirement. For example, despite current federal income tax brackets as high as 35 percent, with strategic planning, retirees are often able to reduce their effective tax rate in retirement to as low as 15 percent (sometimes lower). Such tax management strategies may include “harvesting” tax losses (which reduce or eliminate future capital gains taxes) opportunistically and executing zero-tax Roth conversions to move retirement assets into tax-exempt accounts. For a retiree seeking to spend $150,000 per year in retirement, strategic tax management could provide potential tax savings of more than $55,000 per year.4 A comprehensive financial plan, a scientifically sound portfolio design and sophisticated, tax-sensitive portfolio management are the three most critical elements for maximizing portfolio longevity and establishing retirement income security. Is your portfolio optimally designed to meet your retirement expectations? 1 Brinson, Gary P., Brian D. Singer, and Gilbert L. Beebower, “Determinants of Portfolio Performance II: An Update,” Financial Analysts Journal, May-June 1991. 2 See Bernstein, William J. “Case Studies in Rebalancing”, Efficient Frontier (Fall 2002) and “The Rebalancing Bonus”, Efficient Frontier (Fall 1996) online at www.efficientfrontier.com. 3 Arnott, Robert D. and Plaxo, Lisa M. “Rebalancing a Global Policy Benchmark”, Journal of Portfolio Management, Winter 2002, p.9-22.
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4 $150,000/(1-0.35) = c.$231,000 in required portfolio withdrawals whereas $150,000/(1-0.15) = c.$176,500 in required portfolio withdrawals. Intended for demonstration purposes only. The unique tax circumstances of each individual investor will vary. References and Sourcing: Milevsky, Moshe A., and Thomas S. Salisbury, “Asset Allocation and the Transition to Income: The Importance of Product Allocation in the Retirement Risk Zone”, September 27, 2006. Figure 1: Indexes include: REITS: NAREIT Equity REIT Index; EAFE: MSCI EAFE; Oil: WTI Index; Bonds: Barclays Capital U.S. Aggregate Index; Gold: USD/troy oz.; Inflation: CPI. Average asset allocation investor return based a Dalbar Inc. analysis which utilizes the net of aggregate mutual fund sales, redemptions and exchanges each month as a measure of investor behavior. Returns are annualized (and total return where applicable) and represent the 20-year period ending 12/31/11 to match Dalbar Inc.’s most recent analysis. Figure 2: S&P 500, MSCI, Dimensional, CRSP, Bloomberg. Mercer Advisors Investment Committee. Diversified Portfolio is 60 percent diversified equity allocation mix consisting of U.S., International and Emerging Market Equities and 40 percent Short-term Fixed income. The Undiversified portfolio consists of 60 percent U.S. Large Equities and 40 percent Barclays Gov’t Bond Index. Beginning with $100,000 in 1973, $700 is distributed monthly from each portfolio. Table 1: “Diversification Returns and Asset Contributions,” David G. Booth & Eugene F. Fama. Financial Analysts Journal, May/Jun 93, Vol. 48 Issue 3, pps 26-32. Table 2: Mercer Advisors Investment Committee
Mercer Advisors, established in 1985, is a total wealth management firm that provides comprehensive financial planning, investment management and retirement plan services for the affluent individual. Mercer Advisors, a Registered Investment Advisor, manages more than $4 billion in assets under management (data as of September 15, 2012) and maintains a national presence with branch offices located in 14 major cities – including Seattle. For more information, please contact us at 800.898.4642 or visit our website at www.merceradvisors.com. Mercer Global Advisors Inc. is registered with the Securities and Exchange Commission and delivers all investment-related services. Mercer Advisors Inc. is the parent company of Mercer Global Advisors Inc. and is not involved with investment services.
the source mercer advisors
mercer advisors, continued from page 43
guest editorial continued
guest editorial, from page 5
insurance. Medical insurance carriers who do not offer dental insurance will have to subcontract with a dental insurance provider to provide the pediatric dental coverage. Since pediatric dental is an EHB, all insurance purchasers will have to buy the coverage regardless of whether or not they have children (more on this later).
Pediatric dental benefits inside of the exchange.
Pediatric dental benefits inside the exchange will operate a little differently. An additional requirement to “price” and “offer” pediatric dental benefits separately inside of the exchange was included in Washington state’s exchange legislation (HB 2319, 2012). This requirement prohibits medical insurance providers from embedding pediatric dental benefits into plans offered inside of the exchange. Instead, consumers will be given the option of purchasing a dental rider from their medical insurance provider (if available) or select a stand-alone dental plan offered by a dental insurance provider. Insurance purchasers with children will be able to select the dental rider of the medical insurance provider or a different stand-alone option. Purchasers without children will simply purchase the dental rider of the medical insurance provider (if a medical insurance company does not have their own dental network, they will have to designate another carrier to provide their dental rider).
Adults without children and pediatric dental coverage.
All medical insurance purchasers in the individual and small
group markets must purchase pediatric dental coverage starting in 2014. This requirement includes all adults who do not have children. At this point in time it is unclear how much adults without children will have to pay for the pediatric dental benefit, but, the cost of purchasing this coverage should be much cheaper than those with children. This same principle is applied with other medical coverage. For instance, all medical insurance purchasers are required to purchase maternity coverage regardless of their sex or ability to have children. Additional federal rules on this topic are expected soon.
How does this impact dental insurance?
Beginning in 2014, more individuals will be making dental insurance purchasing decisions in conjunction with their medical insurance purchasing decisions. This means more children will likely have dental insurance with the same insurer that provides their medical insurance. As a result, a stand-alone dental plan such as Washington Dental Service could see its market share in the individual and small group markets may decrease as the market share of Regence and Premera dental plans increases. As 2014 approaches, WSDA will provide more member updates on this important issue. Health care reform questions can be referred to Bracken Killpack at firstname.lastname@example.org or by calling WSDA at 800-448-3368. WSDA is also offering a free member webinar on health care reform on Tuesday, December 18 at noon. To register go to https://www3.gotomeeting.com/register/504654718.
DENTAL PRACTICE EXPERTS READY TO HELP YOU BUILD YOUR PRACTICE We offer a banking partnership built on the best service and the most experienced Dental lending experts in the region. Working together, we can create smart banking solutions that help our practice partners reach their financial and business goals.
Scott Harvey, email@example.com 866-914-5700 // www.fortunebankwa.com
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PART TIME GP ASSOCIATE IN ELLENSBURG — We are looking for a associate in Ellensburg, Wash, to work 2.5 days Wed-Fri. We are an easy-going office where you will be allowed to treat as you see fit. Lodging available to stay overnight. Please email resume to firstname.lastname@example.org.
ASSOCIATE NEEDED — Part-time Associate dentist needed for Wednesday’s in our wellestablished practice in Redmond. Experienced dentist preferred. Comfortable doing surgical extractions and molar root canals. Please email resume to email@example.com.
GENERAL DENTIST — Peninsula Community Health Services (PCHS) is a non-profit, Federally Qualified Health Center dedicated to providing our patients with quality, compassionate and affordable health care services. PCHS has an excellent opportunity for a fulltime General Dentist in Bremerton, Wash. Applicants must be comfortable working with children and the underserved. We offer a competitive salary with excellent benefits including CME, relocation assistance, paid vacation and more. The site is eligible for Federal loan repayment. Please e-mail your CV to firstname.lastname@example.org/fax (360) 373-2096/or call (360 478-2366.
ASSOCIATE DENTIST — Full-time West Olympia affiliated Bright Now! Dental office. This opportunity is in a new office opening soon offering the safety and security of a large group practice. Requires 2-3 years experience, must be comfortable with Molar Endo and Surgical Extractions. The professional staff allows a doctor to focus solely on dentistry. Help us with our mission to promote Smiles for Everyone. Please submit your resume www.jobs.smilebrands.com/careers or email your resume to sherrie.dean@smilebrands. com A comprehensive benefits package is offered for full-time positions, which includes: Medical, Vision, Life Insurance, 401K, Malpractice Insurance and In-House CE opportunities. Equal Opportunity Employer. GREAT DENTIST OPPORTUNITY — Three lady doctors. One got married and is moving away. Are you a charming doctor who does quality work? We have patients who need you! Growing family and cosmetic practice in Olympia Washington seeks associate to join us. Outstanding staff in modern facility. Four days a week, great compensation. Two years experience needed. E-mail resume to email@example.com. ASSOCIATE DENTIST — needed for a growing private practice. Six+ years with a loyal patient following, a hygienist and a great team to work with, we are seeking a dynamic and driven associate to grow with us. Opportunity is what you make of it here, anything is possible. Contact our office manager via email at firstname.lastname@example.org. DENTIST JOBS — Aspen Dental offers tremendous earning potential and a practice support model that empowers dentists. We eliminate obstacles for dentists to own their own practice. Call: (866) 748-4261. www. AspenDentalJobs.com. EOE.
DENTIST NEEDED — Our modern dental facility provides our team of eight dentists and well trained support staff the opportunity to provide quality, comprehensive general and restorative dental care to our patients. Position available November 2012. Comprehensive health benefits, Employer paid Life & LTD, sign on bonus, 401(k), relocation, generous paid leave and CME. Potential loan repayment. Contact Colleen Hazel, HR Generalist at (509) 764-6105 / email@example.com. Moses Lake Community Health Center, 605 Coolidge St, Moses Lake, WA 98837/mlchc.org. PART-TIME GP IN BELLEVUE — We are looking for an associate in Bellevue to work 2.5 days Wed-Fri. More days possible. We are a top office in our area. Beautiful modern office with state of the art technology. Fantastic patients and team. Fully digital. Must be highly skilled and experienced. Please email resume to firstname.lastname@example.org. DENTIST OPPORTUNITY IN GRAHAM, WASH. — Seeking experienced dentist for busy, well established, successful, fee for service, group dental practice. Full-time position available. Excellent immediate income opportunity ($180,000 to $375,000 + per year) depending on productive ability and hours worked. Secure, long-term position. You can concentrate on optimum patient treatment without practice management duties. Modern well-equipped office with excellent staff, and lab services provided. If you are bright, energetic with a desire to be productive, very personable, and people oriented, and have great general and specialty clinical skills, Fax resume to Dr. Hanssen at (425) 484-2110.
PEDIATRIC OPPORTUNITY AVAILABLE — Pediatric dentist opportunity. South King County, multiple office sites. Solid seven figure practice. Existing patient base. Part time but will eventually lead to full time. Potential to buy in. Email CV to email@example.com.
GENERAL DENTIST WANTED — At Sunrise Dental of Ellensburg and Yakima we are looking to add an exceptional dentist to our team. We are known to provide the best patient experience and dental care. We need a team player with the same vision! Candidate should have excellent chair side manner and project sunny personality! Great opportunity for the right individual. Part time or full time. Must be able to work one weekend day (Saturday OR Sunday) Please email your CV to firstname.lastname@example.org.
OPPORTUNITY AVAILABLE — Opportunity for dentist interested in T.M.D. / facial pain practice. Poulsbo Wa. Call (360) 981-8796, email@example.com.
General Dentist Associate Partnership Opportunity, Tacoma Washington. Please contact Luda Munoz: lmunoz@stratusdental. com or 360-553-7812.
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GIG HARBOR — Opportunity in the beautiful Pacific Northwest. Associate needed for busy Gig Harbor office. Great staff, set your own hours. Also, other specialists needed. Call Carol at (360) 779-7219. DENTIST OPPORTUNITY IN PORTLAND, OR — Do the clinical dentistry you want to do. We offer paths in which you can manage or open your own practice with profit sharing. Pdxdentist@yahoo.com.
OFFICE FOR SALE OR LEASE LYNNWOOD, NORTH SEATTLE — Dental office condo for sale or rent. Owner financing or four months free rent. 1,300 square feet. Three ops. Dr. Hertl (206) 300-7060. Email firstname.lastname@example.org. FOR SALE — Beautiful stand alone redecorated 2,000 sq ft, open concept bldg with five ops and plumbed with N2O. This practice is nestled in the foothills of Mt Rainier, just a 50-minute drive from Seattle. The area offers a recreational paradise, with skiing just 40 min away and great schools. 0ngoing practice for over 25 years with loyal patients and a experienced staff. For more details call (253) 797-1353. DENTAL OFFICE SPACE AVAILABLE NOW — Newly remodeled dental office in the Southcenter area, 1,350 Square Feet. Oxygen, nitrous, water, air already plumbed in so it’s ready for you to start practicing! Some dental equipment is available. Growth area, large traffic. Call Medical Centers Management (253) 508-1293. OFFICE FOR LEASE — Richland, Wash. Golf course frontage. 4,900 sq. ft. (can be divided) dental office suitable for large practice. Extremely competitive lease rate. Call or email for floor plan. Mary Etter (509) 5210673 or email@example.com
classifieds issue 2, december 2012
Obiora E. Nkwonta, D.D.S. has acquired the practice of Judith B. Zantua, D.D.S. - Seattle, Washington
Paul E. Kulits, D.M.D. has acquired the practice of
Call 1-800-232-3826 or visit us online at www.aftco.net for a free practice appraisal, a $2,500 value!
Jeff E. Theis, D.M.D. - Arlington, Washington AFTCO is pleased to have represented all parties in these transactions.
AFTCO is the oldest and largest dental practice transition consulting firm in the United States. AFTCO assists dentists with associateships, purchasing and selling of practices, and retirement plans. We are there to serve you through all stages of your career.
Helping dentists buy & sell practices for over 40 years.
9/26/12 3:07 PM
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EQUIPMENT FOR SALE
SPACE SHARING OPPORTUNITY - Presently working three days/ week and have ample room to share space in our five chair downtown Seattle general practice office with in-house lab and technician. Bring your patients and staff and share the rent, utilities and supplies. Contact Rick Nicolini DDS at 206-310-5709 or firstname.lastname@example.org
FOR LEASE, BURIEN, WASH — Brand new, 2,700 foot, six op dental office with pano room, lab, break room, two restrooms and private offices. Completely wired and plumbed for state of the art digital dental office. $10/ft, NNN or $2,200/mo. Must see to believe and appreciate. Great opportunity for start up or relocation. Contact (206) 909-3863.
OFFICE SPACE TO SHARE — Excellent opportunity for specialist who wants to work one or two days a week or a start-up practice for any practitioner. Front office support. Contact Melissa at (425) 481-1038 or email email@example.com.
EQUIPMENT FOR SALE
THINKING OF SELLING YOUR PRACTICE? — And need a broker? Before you pick up the phone, there’s someone you should call first. Norm Culver, DDS has been seminaring and consulting with dentists on practice transitions for years. With this expertise, he knows how to help you find the best broker for the sale of your particular practice. Dr. Culver is an independent consultant and not a broker — so there is no cost to you. (206) 784-6941 or email firstname.lastname@example.org.
FOR SALE BELLEVUE — Beautiful Bellevue dental practice near Crossroads Mall. Open and spacious with three existing operative rooms, and room to expand. Pano and Ceph machine in office. Digital x-ray system in place. Convenient location on a main street near Microsoft. For more information, please call (425) 213-6606. NEXT/ANNIE MILLER & ASSOCIATES — Providing consulting services to the dental community for the past 35 years. New practice start-ups, practice transitions, sales and valuations. Dental space planning and architecture; real estate leasing and acquisitions, employment benefits; staffing resources and training; financing. Call today for your free consultation…we can’t mint money for you, but we can sure save what you have now! Annie Miller (206) 715-1444. Email: annie@ nextnw.com. NEXT/ANNIE MILLER & ASSOCIATES — New dental practice listings and sites for sale in Bellevue, Kirkland, Federal Way, Renton and Tukwila. Call today for tours and info. Annie Miller, Re Max Eastside Broker’s Inc. (206) 7151444 or email at email@example.com. FOR LEASE — 300 Pelly Ave N. Dental suite available in Renton, walking distance to the prestigious Landing, as well as Boeing. 1,361 sq. ft. on 2nd floor, with only two other dentists in building. Three operatories, open configuration, plumbed with electrical, air, vacuum, and plumbing. Corner lot with heavy traffic flow. Rate is $23.26/SF/Y NNN, Triple Net is $5.60 (incl utilities). Contact Dennis Schmuland (425) 417-1206. GREAT OPPORTUNITY! OLYMPIA, WASH — Great opportunity for GP or a specialist. A well designed turnkey four-op practice on the street with all the equipment to start and run a practice. Low rent, great potential, low investment. Contact Dr. Yathi Lingam at (360) 2367885 or email firstname.lastname@example.org.
USED/REFURBISHED EQUIPMENT — ADEC, Gendex, Pelton Crane, Dentalez, Porter, Air Tech, Midwest, Midmark and etc. Lab equipment. Parts are also available for almost all equipment. Call Dental Warehouse at 800-488-2446 or http://cascade-dental.net. MOBILE DENTAL SYSTEMS — Mobile dental operatory suitable for a variety of locations ie..assisted living, missionaries. Excellent condition stackable containers. approximately 45 lbs Contact (360) 981-8796.
EQUIPMENT WANTED EQUIPMENT WANTED — Looking for w ide ra nge of used equipment. Adec, Kavo, Midmark, Pelton Crane, Midwest, Gendex, Air Techniques, Apollo, Porter, Cerec, Sirona. If you want to sell equipment, call (206) 260-3563.
SERVICES PAC I F IC PROF E S SION A L PR AC T IC E SERV ICES — PN W PPS has been ser ving the dental community since 1998 by providing specialized services including practice transistions, practice consulting for marketing, cost control, startup and construction or remodeling. We also act as buyer representative, perform fraud investigation and lending services. When we say full service we mean full service. 206.3995677 or 425.246.0734 linda@ pnwpps.net or email@example.com LOCUM TENENS DENTIST — Want to take a vacation? Need a knowledgeable, reliable ad personable dentist to help with your practice while you’re away? Experienced locum tenens dentist will provide exceptional care to your patients. Over 25 years of private practice general dentistry. Serving all of Washington and Oregon. References available upon request. Contact Bob Houtz, DDS at (360) 457-9568. MOBILE I.V. SEDATION — Have your patients treated in your office with safe and proven techniques. Set your practice apart from others. Attract new patients. Increase quality referrals. Neil E. Bergstrom, DDS (360) 825-6596.
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PAC I F IC PROF E S SION A L PR AC T IC E SERV ICES — PN W PPS has been ser ving the dental community since 1998 by providing specialized services including practice transistions, practice consulting for marketing, cost control, startup and construction or remodeling. We also act as buyer representative, perform fraud investigation and lending services. When we say full service we mean full service. (206) 399-5677 or (425) 246-0734 linda@ pnwpps.net or firstname.lastname@example.org. GUEST DENTIST — Time off, vacation, maternity leave? Temporary placement for day, week, or longer. Experienced, team and patient-oriented GP. Joe Schneider, DDS, FAGD. (206) 878-1237. GUEST DENTIST — Will fill in at your practice for maternity leave, injury, illness, family emergency, etc. 35 years of general dental practice experience. Personable and patient oriented. Dr. Ed Kardong (206) 842-6300.
OFFICE CONSTRUCTION CONSTANTINE BUILDERS INC. (CBI)-WSDA endorses CBI as their preferred builder of Dental facilities with over 25 years of experience from ground up buildings, renovations, remodels, and interior tenant improvement projects. All projects are completed on time and within budget. CBI provides the highest level of quality service with integrity that exceeds our client’s expectation. Please see our display ad on page two and website at www. constantinebuilders.com for additional information and how you can become another satisfied client. Telephone (206) 957-4400, O. George Constantine.
CONTINUING EDUCATION MODERATE SEDATION COURSE — Instructor: Steven Ganzberg, D.M.D., M.S. Dates: April 19-21 at UCLA and May 15-19 at Wendel Family Dental Centre (Vancouver, WA), 2013. Cost: $11,995. A deposit of $5,000 due by February 1, 2013. Course is 80+ hours with 20 patient cases. Contact: Lori, 360-944-3813 or loris@wendeldental. com. Space is limited. AGD #218643.
classifieds issue 2, december 2012
OFFICES FOR SALE OR LEASE
clinical corner issue 2, december 2012
Well demarcated mixed radiolucent/radiopaque mass, right posterior maxilla
History of present illness:
This is a 30-year-old female who selfreferred for wisdom tooth removal. The oral surgeon noted a swelling in the right posterior maxilla of unknown duration which was confirmed by a panoramic radiograph. The radiograph shows a welldemarcated mixed radiolucent/radiopaque lesion between teeth numbers 3 and 4. It is
buccally and palatally expansile, pushing superiorly into the right maxillary sinus. It is displacing teeth numbers 3 and 4 apart and is described to be 2 x 2 x 1.7 cm in size. It is otherwise asymptomatic and the involved teeth are vital. This “Clinical Corner” case was contributed by Dr. Tracy Johnson of Oral & Maxillofacial Surgery, Lakewood, Wash.
Test your knowledge!
An answer to this case study can be found on the University of Washington’s Web site at http://www.dental.washington. edu/departments/oral-surgery/case-of-themonth.html. Click on “Case of the Month” and look for the November 2012 entry.
educate | inspire | connect
Featuring: Betsy Bakeman, DDS, Newton Fahl, Jr., DDS, David Garber, DMD, John Kois, DMD, Jacinthe Paquette, DDS, Maurice Salama, DMD, Cherilyn Sheets, DDS, Frank Spear, DDS, and more!
www.AACDconference.com April 24 - 27, 2013 29th Annual AACD Scientific Session 5 2 · th e wsda ne w s · issue 2, december · 2012 · www.wsda.org
W a s h i n g t o n
sChooL of Dentistry
D e n taL
eDUCation December 8
Computers and Your Dental Office - Learning to Live in Harmony Marcus Bing, IT Expert
WSDHA Annual Course Morning Topic: To Sleep or Not to Sleep: Snoring & Obstructive Sleep Apnea Afternoon Topic: Shine The Light And They Will Come - Patient Treatment Acceptance And Laser Assisted Hygiene Steve Marinkovich, DDS, ABDSM and Janet Press, RDH This course is co-sponsored by Washington State Dental Hygienists’ Association
Perio Decision Making: Make Your Practice Thrive, Not Just Survive Timothy G. Donley, DDS, MSD
Medicine and Pharmacology Review for Dentistry: Day 2 of 6 - Cardiology (part 2 of 2) Bart Johnson, DDS, MS
Open Wide! Clinical Pathologic Correlations for Today’s Dentist Darren Cox, DDS, MBA and Jasjit K. Dillon, DDS, MD, BDS, FDSRCS
Law/Lewis Lectureship in Pediatric Dentistry Morning Topic: What Early Childhood Caries is Doing to Children and How to Really Fix the Problem Afternoon Topic: Dental and Maxillofacial Radiology in Pediatric Dentistry Paul S. Casamassimo, DDS, MS and Johan Aps, DDS, MSc, PhD
Restoration of the Worn Dentition Terry Donovan, DDS
Medicine and Pharmacology Review for Dentistry: Day 3 of 6 - Hepatic and Renal Bart Johnson, DDS, MS
Medicine and Pharmacology Review for Dentistry: Day 4 of 6 - Gastrointestinal and Endocrine Bart Johnson, DDS, MS
Ernest Jones Memorial Lecture Smile Design, Esthetic and Occlusal Techniques Gerard Chiche, DDS New Online Courses at www.uwcde.com including Bloodborne Pathogens!
Registration Information: REGISTER Telephone: (206) 543-5448 Toll Free: (866) 791-1278 NOW! For more detailed course information and to register online visit www.uwcde.com
SCHOOL OF DENTISTRY UNIVERSITY of WASHINGTON
University of Washington is an aDa CerP reCogniZeD ProviDer ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
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parrish, continued from page 52
The Crocodile’s Toothache The Crocodile Went to the dentist And sat down in the chair, And the dentist said, “Now tell me, sir, Why does it hurt and where?” And the Crocodile said, “I’ll tell you the truth, I have a terrible ache in my tooth,” And he opened his jaws so wide, so wide, That the dentist, he climbed right inside, And the dentist laughed, “ Oh isn’t this fun?” As he pulled the teeth out, one by one. And the Crocodile cried, “You’re hurting me so! Please put down your pliers and let me go.” But the dentist laughed with a Ho Ho Ho, And he said, “I still have twelve to goOops, that’s the wrong one, I confess, But what’s one crocodile’s tooth more or less?” Then suddenly, the jaws went SNAP, And the dentist was gone, right off the map, And where he went one could only guess... To North or South or East or West... He left no forwarding address. But what’s one dentist, more or less? — Shel Silverstein
Teeth English Teeth, English Teeth! Shining in the sun A part of British heritage Aye, each and every one. English Teeth, Happy Teeth! Always having fun Clamping down on bits of fish And sausages half done. English Teeth! HEROES’ Teeth! Hear them click! and clack! Let’s sing a song of praise to them Three Cheers for the Brown, Grey and Black. — Spike Milligan This concludes our intellectual interlude for today. Support for NPR is provided by: Washington Dental Service, whose income greatly exceeds outgo, by the Bellevue Chamber of Commerce who promises great weather June 13 and 14 for PNDC, and by the legislative offices of Rep Eileen Cody who assures the passage of a DHAT bill this session.
parrish or perish continued
U n i v e r s i t y
parrish or perish
this issue: haiku,
bon mots, poems, witty verse parrish as gangnam? This month I’m going all NPR and providing an intellectual interlude with a fine selection of appropriate poetry. First we begin with some original compositions in the time-honored genre of Haiku—every seventh grader’s introduction to poetry, at least back in the day. Look it up!
Dr. Jeffrey Parrish “If everyone is thinking alike, then somebody isn’t thinking.” — George Patton
WDS Future Elections spark rebellion Uncertainty certain
Legal cannabis Many election allies Children’s Alliance?
Legislature tough Never know who’s in control Tune in in April
Politics scary Enough without imagining President Roseanne Barr
McKenna Gangnam? Check out mash up on YouTube Republicans rock!
New Dean, New Day, Yay! UW SOD needs help Get out your checkbook
Critical endorsements For any President race: LiLo, Honey Boo Boo
Compensation “cut” To 1.1 million dollars Dental “insurance”—what a gig!
Elections over For this season anyhow Nation’s future bleak
Greg’s life a whirlwind But laid low at the moment Prayers for you, Man
Oh, Danny Boy Your term looks quite challenging Hang tight in Oly And now for some “professional” selections by real poets: The moon shines brightly Upon the glass of water Where Grandma’s teeth rest — Unknown author When I got braces You made such fun of my teeth Now mine real yours false From Louise in England: Sore gums, tender teeth If your smile reflects the sun You must have braces. — Kathy C in Maryland I climbed the mountain, The meaning of life to find. “Floss!” was all he said.
The views expressed are those of the writer and do not necessarily reflect the opinion or official policy of the WSDA.
— DanEnglish@flossing.org continued on page 53
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“On a positive note, the video of the incident has gone on to become an internet sensation”
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Washington Dentists’ Insurance Agency: DISABILITY INSURANCE
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Sole broker for:
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CHANGE SERVICE REQUESTED
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You may never really know how good your insurance company is until a claim is filed against you. At NORDIC, we’re invested in you and the business of insuring you and your practice. When you call with a question, you’ll speak directly with the person handling that aspect of your policy, not a random operator. In fact, you’ll always speak with a live person unless you call after hours. We think that’s important. Those big companies? Not so much. NORDIC prides itself in excellent customer service before, during, and after a claim is filed against our customers.
800-662-4075 · www.nordicins.com 206-343-7800 · 206-441-6824
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Published on Nov 26, 2012