Servant Leadership How a deep sense of caring for patients and team members has guided North American Dental Group and its CEO and Co-Founder Ken Cooper through a tumultuous year.
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Hu-Friedy is now a proud member of Contents > November/December : 2020
Servant Leadership How a deep sense of caring for patients and team members has guided North American Dental Group and its CEO and Co-Founder Ken Cooper through a tumultuous year. > pg 20
A Season of Gratitude ...... 2 ADA: Dentists have The Need for a Respiratory knowledge and skills to Protection Program Building Up deliver COVID vaccine...... 19 Dental group practices must have a clear Best practices for creating alliances, understanding of the standard and its and new owner buy-in, for DSOs...... 4 Emerging OSHA Guidance rationale to provide a sound respiratory COVID-19 has raised the stakes protection program for all employees...... 36 Bold Predictions for 2021 for providers and patients...... 26 Some trends to keep an eye on as you 14 Thoughts About formulate your plan for next year...... 8 2021 OSAP Dental Infection Building A Great Culture...... 40 Control Boot Camp™ Maximize Potential Registration Now Open...... 29 Health news and notes...... 42 Addressing the confidence gap...... 10 Year in Review...... 30 People/Dental News...... 44
EDITORIAL BOARD SENIOR EDITOR VICE PRESIDENT OF SALES A.J. Acierno, DDS, CEO, DecisionOne Dental Partners Graham Garrison • [email protected] Katie Educate [email protected] Kristine Berry, RDH, MSEC, NextLevel Practice Coach Brad Guyton, DDS, MBA, MPH, Vice President, CONTRIBUTING COLUMNIST Clinician Development, Dean, PDS University™ – PUBLISHER Institute of Dentistry, Pacific Dental Services Nick Partridge Scott Adams Brandon Halcott, Co-Founder and President, [email protected] Tru Family Dental CIRCULATION DeAnn McClain, Executive Vice President of Laura Gantert • [email protected] Operations, Heartland Dental Efficiency In Group Practice is published six times a year by Kasey Pickett, Sr. Director, Communications, Share Moving Media • 1735 N. Brown Rd. Ste. 140 Lawrenceville, GA 30043-8153 Aspen Dental Management, Inc ART DIRECTOR Phone: 770-263-5257 • Fax: 770-236-8023 Heather Walker, DDS, Mortenson Family Dental Brent Cashman • [email protected] www.dentalgrouppractice.com
Efficiency In Group Practice is published six times a year by Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Copyright 2020 by Share Moving Media All rights reserved. If you would like to subscribe or notify us of address changes, please contact us at the above numbers or address.
POSTMASTER: Send address changes to Share Moving Media, 1735 N. Brown Rd. Ste. 140, Lawrenceville, GA 30043-8153. Please note: The acceptance of advertising or products mentioned by contributing authors does not constitute endorsement by the publishers. Publishers cannot accept responsibility for the correctness of an opinion expressed by contributing authors. dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 1 > Publisher’s Note
A Season of Gratitude
I always look forward to this time of year. The holiday season gives us a time to reflect on the things that are important and that we need to be thankful for.
More than likely everyone reading this has said “I am ready for 2020 to be over.” I say it at least once a week. Given the year we’ve had, it may be difficult to think about the things that we should be thankful for and remember. Here are a few of mine: 1. I am thankful for the health of my family.
Scott Adams 2. I am thankful that I was able to shelter in place for a few months with my youngest son Nicolas. As much of a pain as it was being stuck at home, those few months with him will be with me forever.
3. I am thankful our business has survived the most difficult year in its 27 years of existence, and we are starting to thrive again thanks to you!
4. I am thankful 2020 is coming to a close and the “BLACKJACK” year 2021 is near.
Here’s hoping you have a happy, restful, and joyful close to the year. We believe next year is going to be an amazing year full of hope.
Happy Holidays, R. Scott Adams
2 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com
> DEO Case Study
Building Up Best practices for creating alliances, and new owner buy-in, for DSOs.
spoke with Aly about that growth and the keys to building a 19-loca- tion dental group. The following were some key takeaways from the case study intensive.
What kind of role team plays in one’s development “We’d be nothing without our team. We have the most wonderful team, hand selected. We have team members who’ve worked in multiple groups. We have team members that grew from the bottom up. We have team members that started with us and now they are amazing. They’re superstars. The team is everything. If you think about the train, we’re all in the train right now going to a destination and the team is the engine. Can you imagine an engine that is not being taken care of? If Tarek Aly has always taken a glass half full perspective to things. you neglect the team, if you fail to “Life’s too short not to enjoy it,” said Aly, BDS, MBA – Co-founder, Chief recognize their talent and address Operating Officer, OrthoDent. “With straight roads, you don’t need skillful their needs and utilize their talent, drivers. You really need those obstacles to grow and learn. So whatever life then of course your engine is going throws at you, use that to jump to the next level.” to leak and you’ll end up stopping somewhere in the desert where you’re stuck.” In dentistry, that positivity is a ton of demand. We noticed this more than justified by market trends. hole, though. What if we provide On approaching other “There is a huge demand for quality care at an affordable price dentists for alliances dentistry in general,” he said when to residents in rural towns in Texas? “Think of the train analogy again. describing the keys to OrthoDent Let’s see what happens.” We’re all on a train. All of us enter building itself into a 19 dental group Magic is what happened next, at a specific spot and we exit at a organization in Texas. “We saw a said Aly. “We grew very fast.” specific spot, but some of us have huge demand in the pediatric den- In a recent DEO Case Study, the same exact exit. We may go to tistry and orthodontics world in Jake Puhl, partner of CEO of The that same destination. So alliance Texas. Everywhere you go, there was Dentist Entrepreneur Organization, means that I hold hands with those
4 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com who have a very similar destination. a business that needs to be profit- I want to grow. I want to catch We’re trying to make the train as effi- able as much as it needs to be super momentum. Now it’s time to build cient and as productive as possible. compliant and high quality. Second, my own instead of working for [With alliances] I’ve picked it needs to grow. We need to care someone else. dentists who are very similar, like- about the team, we need to have suc- So, we have to first congratu- minded individuals – entrepreneurs cession planning, and because it’s a late them for taking that step. A lot who know that number one priority business, the clinic needs to have of us forget that part. ‘Thank you is patient care and quality of care. profit as well. We realize that busi- very much for thinking about this.’ Then, if they’re going with me to the ness is a part of what we do. That means you trust them. If you same destination, we can have an We’re all in the same boat; we just believe in us, you’re betting on a alliance. But an alliance doesn’t just have little differences here and there. winning horse and you think we necessarily mean that they could be Everyone’s a potential alliance.” are the winning horse. So that’s the going to the same destination. Even first thing. if they’re there for the next three or New partner buy-in The second step is, what is your four spaces, they’re still with us. “[New partner buy-in or associate mission? What do you really want So an alliance here is how we buy-in] really depends on the size to do? What’s your vision? Write it pick those dentists. Anyone who is of the DSO. Size does matter with down. What do you need? And then willing to grow, who has that growth this particular one. There’s a reason see if that matches in subsets and mentality, entrepreneurship, and why someone wants to buy-in to the if it goes to the core. Now let’s talk knows exactly what they want is a DSO. They see the vision. They know semantics. Let’s talk the structure potential alliance candidate. What where to go. Why would you want to of how that works. There are mul- we typically do is we say, ‘What is it bet on something that is moving? tiple ways of doing it; there’s no that you need in the next few years? You want to bet on something that perfect way of doing it. And like I What’s your destination? What does is winning. said, size does matter. So if you’re a the roadmap look like?’ If it’s very similar and coherent, we form an alliance. That’s how we all grow.” We need to care about the team, we need to have succession planning, and because Best practices for it’s a business, the clinic needs to have generating successful alliance candidates profit as well. We realize that business is “We don’t necessarily go and seek a part of what we do. alliance candidates. I feel that they typically come to you when they see your vision, and they see what you’re So they worked as an associate DSO with three units, or four units trying to do. for a while. They were either focus- or five, the structure may be signifi- If you think about COVID, when ing on finances – they wanted to cantly different than if you’re a DSO that happened we were all wonder- pay off debt – or they were focused with 50 units. ing what would happen to regula- on learning a little bit about the At the end, they all have to be tion. So there was a compliance alli- business, or wanting to do more aligned in that alliance, in order to ance. Then, an HR alliance formed critical growth before starting catch the momentum together and when people began wondering about their own. Once that’s done, they have the similar end goal.” layoffs, furloughs, etc. have a need. My immediate needs To watch the full DEO Case Study, So recently, dentists have become are satisfied, either I’ve made visit the DEO - Dentist Entrepreneur aware that, first of all, the clinic is money or paid off debt, and now Organization YouTube page.
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 5 > Practice Points
Bold Predictions for 2021 Some trends to keep an eye on as you formulate your plan for next year.
By Nick Partridge
6 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Prognostication is a tricky business. Pollsters are under fire for their inaccurate results this election season … and who could have possibly pre- dicted what 2020 had in store for us? While we cannot know the future, there is of course tremendous value in thinking about and preparing for it. Most organizations undertake an annual planning effort to allow for an examination of the business while preparing a plan for the road ahead. As a result, we endeavor to help guide you in your annual planning process, highlighting emerging trends and anticipating new ones. Therefore, here are my bold predictions for 2021.
Dental networks will shrink the ongoing costs to protect patients I believe dental networks will be and staff within new PPE guidelines. smaller in 2021 for a variety of reasons. Recognizing the overlapping nature Dental networks experienced record of networks and facing these finan- growth on the advent of network cial realities, dentists will likely shed leasing. The result is dental networks participation in some plans. now look very similar. There is signif- icant overlap as the average provider Suppression is now in over 9 networks. Moving As mentioned above, payers are forward, payers will be focusing on focusing on building more cost-ef- improving their networks to be more fective networks. One of the primary cost effective. ways to accomplish this, is to exercise
The good news for DSOs is that through 2020, patients have increasingly migrated to affiliated practices. DSOs are taking market share in an environment where patient visits have not returned to pre-COVID levels.
Dental networks’ focus on becom- discretion in picking up providers ing more cost-effective will force through leased networks. As network dental practices to make decisions leasing proliferated over the last 5-6 about insurance participation. More years, providers were largely certain active efforts to maintain or even to be picked up through partner- reduce reimbursements frustrate ships. Thus, while enduring some providers still grappling with staffing indigestion to make contracting turnover as a result of the shutdown changes, the outcome was usually in addition to reductions in capacity worth the effort. This effort to and demand. Plus, while nearly all selectively restrict access is called PPE reimbursement programs have suppression. Providers while avail- ended, dental practices are absorbing able through a leased partnership
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 7 > Practice Points
will be actively suppressed from management. For example, teams Practices that experienced turnover accessing that network based on tasked with case presentation, or were closed completely during criteria like cost and claims history. payment posting or other revenue the shutdown are at a greater risk Suppression stands to create cycle functions will need to be orga- for losing patients. Patients looking tremendous problems for practices nized and communicative about for new dental homes as a result of with meaningful provider turnover contracting inconsistencies between job loss, might also be looking for as new providers become contracted providers and fee schedule differ- more cost-effective options and/ differently from existing providers. ences between offices. or for in-network providers. With Certain providers may be picked up As part of the annual planning the benefits of scale and invest- through partners while others may process, revenue cycle teams should ments in technology, I believe DSOs not and the criteria for such deci- be evaluating participation deci- are well-positioned to compete for sions is proprietary and confiden- sions, fee schedules and contract- patients in 2021. tial. Contracting inconsistencies ing inconsistencies to improve the are problematic in building strong patient experience, reduce adminis- Delta Dental has peaked patient relationships as the cost of trative effort and ultimately to help There, I said it. In 10 years, when care for patients differs by treating formulate priorities in negotiations we look back … I believe 2019/2020 provider. At the same time, providers with payers. will be the apex of Delta Dental as should not acquiesce by accepting Likewise, these considerations an association of 39 independent lower reimbursement rates. should be part of the integration companies. I believe Delta is facing major headwinds that will require meaningful change. Many Delta While nearly all PPE reimbursement programs plans have worked to eliminate have ended, dental practices are absorbing a provider’s ability to participate the ongoing costs to protect patients and staff exclusively in their flagship Premier within new PPE guidelines. Recognizing the network with better reimburse- overlapping nature of networks and facing ments. This has forced providers into the PPO network with gener- these financial realities, dentists will likely ally lower rates. Secondly, in many shed participation in some plans. states, Delta has kept rates constant for most of the last decade where in others Delta has worked to actively Your team and your strategy of new practice acquisitions. More reduce rates. Collectively these matter more than ever than ever, dental groups are going efforts have eroded goodwill and As payers methodically enhance to need to be strategic about their pushed Delta to the breaking point their networks with cost-effective insurance participation. for many practices. Add in the class providers, each insurance company action lawsuit and I think they will will likely approach this challenge DSOs will continue slowly lose their ranking as the differently to meet the needs of to steal market share top dental network unless changes their clients. In addition, at least The good news for DSOs is that are made. four networks are in the process of through 2020, patients have increas- Regardless of the accuracy of building a national footprint. These ingly migrated to affiliated practices. my bold predictions, the business networks represent new opportuni- DSOs are taking market share in an of dentistry will be increasingly ties. With varying approaches and environment where patient visits have important in 2021 and beyond. Have new opportunities, navigating the not returned to pre-COVID levels. a safe and happy holidays and best insurance landscape requires active We expect this trend to continue. wishes for 2021.
8 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com
> Leadership
Maximize Potential Addressing the confidence gap : By Lisa Earle McLeod
Organizations are filled with untapped potential, undermined by the thousands of small slights that erode the confidence of anyone who doesn’t “fit in.” This is costly to everyone because when people aren’t confident, they’re not fully present and they don’t contribute as well as they could.
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Why confidence walks into the room or joins the a keynote or run a training program, erodes over time Zoom call, it may be just another I interact with the audience. It It’s easy to say, “Be Confident!” agenda item for us, yet for them, it’s can be an opportunity for people Yet how confident would you feel a high stakes situation. to shine. Yet I consistently notice, if every day of your working life, someone told you, directly or subtly, you don’t belong here? What if When someone who might be feeling less whenever you spoke in front of a than confident enters a meeting, saying, “I’m group people, they questioned your glad you’re here” can mean the world to them. credentials or paid more attention to Sitting back in judgment waiting for them to your appearance than your content? prove themselves erodes their confidence, and Sadly, this has often been the case for many women, and it’s even worse it keeps you from getting their best ideas. for people of color. Over time, it becomes harder and harder to rally yourself. Even if it’s Avoid sitting back when women and people of color are not happening right now, the baggage in judgment in the minority, as they typically are from past experiences puts you on When someone who might be in a corporate setting, they rarely guard. It’s like a death by a thousand feeling less than confident enters speak up. You can help people feel cuts. Several years of an insult here, a meeting, saying, “I’m glad you’re more confident by asking for their second-guessing there, makes it hard here” can mean the world to them. help in advance. I’ll find someone to walk into a room as your best self. Sitting back in judgment waiting for who I think might not speak up, and them to prove themselves erodes say, “I’m going to ask a question How you can help people their confidence, and it keeps you about X during the session, if you’re show up as their best selves from getting their best ideas. Even a comfortable, could you raise your I’ll never forget a meeting several seemingly confident exterior may be hand to answer?” This gives them years ago when I was presenting to covering some inner fears. I was 45 time to think about their answer and an Executive team. They were all years old and had already authored the option to say no. They almost men, and all (seemingly) Type-A. two books when that CEO’s words always say yes, because people don’t The old drip, drip, you don’t belong gave me a boost. If they’re the want the speaker to experience an here, you’re not good enough was only “whatever” in the room, your awkward silence. They’re helping ignited. Yet as I entered the room, the words can help them put forth their me get all the voices into the room, CEO stood up, shook my hand, gave best ideas. and in the process, they can shine in me a big smile, and said, “I’m really front of their peers. intrigued by your work, and we’re Set people up for Helping other people feel more delighted you’re here.” That was all it success (in advance) confident is the nice thing to do. It’s took, I no longer had to pretend to be Years ago, I adopted a technique also the smart thing to do. When confident, I was confident! to spotlight people who might not everyone feels seen and heard, you This is something every single otherwise take center stage. It’s produce better results, and you have one of us can do. When someone something anyone can do. When I do more fun.
Lisa Earle McLeod is a leading authority on sales leadership and the author of four provocative books including the bestseller, “Selling with Noble Purpose.” Companies like Apple, Kimberly-Clark and Pfizer hire her to help them create passionate, purpose- driven sales organization. Her NSP is to help leaders drive revenue and do work that makes them proud.
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The Future is Now Teledentistry is here to stay. What do group practices need to know in order to get started?
this, they were able to advertise their being open for consultations and emergency evaluations without any risk to their patients and office team. For those requiring visits for emergency treatment, practices could prescribe medications, explain the appointment visit process and make for a more effective follow up without requiring a second visit. They promoted this on social In today’s dental practice environment, consultations that used to be media to their community, not only simple aren’t so simple anymore. For instance, pre-COVID, how many doctors for emergency consults but also would go from the restorative operatory to the hygiene operatory for a consul- cosmetic consults (to make the most tation, and then back again, in the same white coat and little if no PPE? Now of downtime). They also utilized the the process involves a change of gloves, masks, and gowns – which puts a strain platform to have their team look on the doctor’s time, as well as an added cost for PPE exchange. into restorative cases where they may have been a need for follow up. “Through invitations to the Fortunately, with the right “With the COVID inspired imple- patient portal and scheduled post-op teledentistry platform, those con- mentation of teledentistry, initially follow ups, the practice generated sults, and other similar interactions, for emergency consultations and revenue and reassured patients of can occur without the dental group evaluations, we have now seen prac- their concern and availability,” Her- practice missing a beat. tices getting on board with the range man said. “In some cases, this was Teledentistry has skyrocketed, of other uses, including intra-office home care instruction, product rec- both in awareness and implemen- teledentistry to preserve PPE, col- ommendations and more.” tation by the full spectrum of care laboration with specialists, post-op As offices reopened, it became providers. The pandemic closing evaluations done virtually, and a shift for communications prior and restricting access to physical many other exciting, time saving to appointments, consultations post locations, combined with policies and convenient approaches to effec- appointment, moving periodic exams that allowed for easier reimburse- tive patient care,” Herman said. to the cloud and making things eas- ment for services provided via ier for the staff regarding timing, teledentistry has brought it out Opportunities patient exposure and preservation of the innovative dental models amid a pandemic of limited PPE. “This has contin- and public health programs and Despite shelter-in-place orders and ued, and practices are now using it into private practices, DSOs and many businesses shut down, some for collaboration, more patient mes- just about every care setting, said practices kept in touch with patients saging and easier communications – Brant Herman, founder and CEO of by effectively implementing teleden- meeting the convenience needs that MouthWatch, makers of TeleDent, a tistry during the initial quarantine patients are asking for and comfort- leading teledentistry platform. stage of the pandemic. Through able with,” Herman said.
14 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Selecting the right “Teledentistry is not just having Dental EHRs these past few years, I teledentistry platform a video consult one on one between very much feel that how a teleden- Mike Uretz is a nationally recognized patient and provider, but also the tistry solution performs clinical doc- dental and medical group practice ability to collaborate with other pro- umentation is key. If the teleden- software consultant, educator, and viders on that consult whether using tistry platform can’t capture clinical founder of dentalsoftwareadvisor. both real-time video and asynchro- documentation and notes very well, com. Mike offers the following nous processes,” Uretz said. then that’s going to be tough and multi-step process for group prac- Group practices should shy you’re always going to be going back tices and DSOs to use when selecting away from hooking up numerous and forth between two applications a teledentistry platform. disparate applications themselves – your practice management sys- and trying to make it all work. tem and teledentistry system. Unless No. 1: Look for a true That’s a recipe for disaster. Uretz there is a high level of clinical inte- teledentistry solution said DSOs and groups should also gration between the two.” There is a misconception that dentists can take an off-the-shelf video product, like Zoom or Google Meet, hook it up to a payment bridge, then a scheduling service, and finally 1-2 other software products and cull together a solution for teledentistry. “That’s really unwieldy, especially for a group or DSO, because you have all these disparate applications and nothing talks to a common database,” said Uretz. When you cull together different types of solutions, none of the data is standardized and saved in one place. That’s an issue, especially for a group or DSO. Some software companies will bolt on something like a videoconfer- encing solution for a very basic level beware of vendors that aren’t really No. 2: Processes in of teledentistry consult, but teleden- committed to teledentistry and just evaluation and selection tistry is much more than that. The bolt on videoconferencing to make After years of helping group prac- video consult is typically referred to a buck. That type of application is tices select, purchase, and imple- as synchronous teledentistry. There’s going to be limited. “I would have ment software solutions, Uretz’s also the asynchronous part, behind- a group or DSO focus on looking at clients have learned that instead the-scenes functions. For example, to teledentistry companies that provide of just shooting from the hip with get ready for a visit, you can take and a level of video virtual visits, asyn- no plan, group practices and DSOs send images, and then get responses chronous processes, collaboration, would be well served to use more from a provider on the other end. Or document and image sharing and analytical stepwise processes when you can share notes and information. patient engagement and communi- selecting the right teledentistry solu- With asynchronous functions, the cations. These should all be wrapped tion for their situation. What features general practice dentist can do a con- in easy-to-use workflows. Also, hav- and functionality do you want? Are sult with a specialist. ing helped lead the movement in you going to be using it for second
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 15 > Sponsored : MouthWatch
opinions from other providers in The next step in selecting a teleden- No. 4: Put the vendor your office? Are you going to be using tistry solution would be to take those demos to the test it to help with treatment acceptance needs and requirements, – what Once a group practice has invited or patient education? Are you doing you’re trying to do, what you expect a vendor in, the practitioners and case collaboration with your dental of a teledentistry solution – and team members need to be involved and medical colleagues? There are share that in the form of a Request in the demo. Uretz advises his clients many factors to take into consider- For Proposal with the teledentistry to develop cases and scenarios for ation when analyzing your needs. companies. The goal of this process everyday applications of the product. “Because every group is a lit- is to filter down from several teleden- “In the case of teledentistry, it would tle different, every group is going to tistry solutions to a smaller, more be collaboration, virtual consults, use teledentistry a little differently,” manageable number which ulti- second opinions, and various work- Uretz said. “And every group probably mately will streamline the process flows,” he said. “Instead of letting the has innovative ideas for how they’re and save you time. RFPs can be very vendor control the demo and show the going to use teledentistry both now detailed documents and can take a group or DSO what the vendor wants and into the future post COVID.” little time to put together correctly, to show them, the group or DSO is but none the less are powerful essen- taking charge of what they want to No. 3: Share your needs in tial tools when trying to make soft- review. They’re seeing how the partic- Request For Proposals (RFPs) ware and IT purchase decisions. ular vendor’s teledentistry solution works with their specific needs.” Besides features and functional- ity, other factors to inquire about are how the vendor does implementa- Patient and practice tion and training. And most impor- benefits of teledentistry tantly, how does their support work? Are there support guarantees, known Practice benefits include: as SLAs? When selecting a teleden- > > > Convenience Time preservation Efficient scheduling tistry solution, don’t forget how crit- for patients by shifting certain of emergencies ical the contract is in these areas. > Billable exams evals to the cloud > Supporting patients without chair time (some post op, and improving Newfound expectations > PPE preservation some periodic patient trust Uretz said he sees a sea change coming > > Marketing value exams, case Improved lab with teledentistry in group practices. > Enhanced presentations communication “I think that teledentistry will be > collaboration and new patient Messaging that an important part of a workflow of with specialists consults) includes patients any group or DSO in the future. If I > > High touch, Revenue coming and/or other thought teledentistry was just for this digital referrals from evaluations specialists COVID era and not a powerful tool for the future, I wouldn’t be spending Patient benefits include: all the time I have been helping my > Convenience without the doctor > Time savings DSO and group clients evaluate how > Access to dental in a mask, shield, for physical teledentistry can fit into their overall expertise anywhere loupes, etc. appointments business strategies.” > Ability to discuss > Potential insurance For example, the information their treatment coverage gathered through a virtual teleden- tistry visit is going to be critical
16 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com
> Sponsored : MouthWatch
for knowing ahead of time how to treat the patient. Group practices can diagnose a lot virtually before Features and benefits patients come in. Secondly, the Key features that practices need to consider when selecting patient becomes more educated. a teledentistry platform Instead of sitting in the chair and in > Combination of synchronous and asynchronous messaging – many cases 30 seconds having to have an inter- can be handled without live video action, the patient has a chance to > HIPAA and enterprise security think about the information, talk to > Video conferencing with recording capabilities and snapshots saved the dentist or hygienist, and have to patient records that discussion before they even > CDT Code capturing and reporting come into the clinic. > Multiparty/multi-camera video conferencing Herman believes that patients > Screen sharing have a newfound expectation of > Integration and roadmap for PM integrations convenience from their provider, > SMS notifications and teledentistry will be the key to > Patient education presentation bringing this convenience to them. > User friendly multi-party collaboration “Insurance carriers will see value in > Streamlined patient engagement and communication workflows the shift of some evaluation services and consultative services to being Functionalities that specifically benefit groups and DSOs provided via teledentistry and there > Top tier security will be reimbursement for these > Practice/User/Data management and siloing (eg: provider and patient in consults,” he said. “Additionally, practice #1 aren’t seen by provider in practice #2, unless we want them insurance will begin offering these to see them) services directly to their members as > Multi-party chat and video a value add and tool to drive patients > Recording and archiving of video and images to the physical locations.” > Integrations Uretz anticipates more collab- > Custom development capabilities oration as a result of teledentistry. This will be especially true as den- tal medical oral health collabo- ration becomes more standard in healthcare. With the asynchronous able to capitalize on will become group or DSO and become part of processes where people can share more common, Herman said. These their workflow.” and collaborate with information groups will also be able to utilize AI behind the scenes, now you can for pre-screening and assessment For more information on Teledent, bring in all kinds of providers to dis- of teledentistry consultations with visit www.mouthwatch.com. cuss and make decisions, along with a seamless integration into practice the patient, outside of the context management software. To contact Brant Herman, email him at of clinic. The provider can get sec- “Because of all these factors, I [email protected] ond opinions, as well as the patient. think the train has left the station,” or visit www.mouthwatch.com. Integration with practice man- Uretz said. “As you can see through agement, mobile programs, com- some of these features and func- To contact Mike Uretz, email him at munity outreach and other ser- tionality, I think they’ll become [email protected], vices that DSOs and groups will be staples in the future within a or visit dentalsoftwareadvisor.com.
18 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com > Trends
ADA: Dentists have knowledge and skills to deliver COVID vaccine
The American Dental Association offered its support to dentists who testing in practices are that it makes are seeking to administer vaccines, including – when it becomes available – a it quick and easy for patients to be safe and effective vaccine for COVID-19, according to a resolution passed by the tested and provides staff members ADA House of Delegates on Oct. 19 and reported by ADA News. with some reassurance about the health status of the patients they treat, the toolkit states. Resolution 91H-2020 states that the Clinical Laboratory Improvement The toolkit features an FAQ on dentists have the requisite knowl- Amendments law, according to the in-office testing and CLIA require- edge and skills to administer crit- toolkit. The law establishes quality ments, an interactive map with addi- ical vaccines that prevent life- or standards for all laboratory testing to tional laboratory testing require- health-threatening conditions and ensure accuracy, reliability and time- ments by state and steps to follow protect the life and health of patients liness of patient test results regard- when applying for a federal certifi- and staff at the point of care. less of where the test was performed. cate of waiver to offer patients point- “The pandemic has highlighted Some dentists have expressed of-care testing. The toolkit also the potential benefits of an expanded interest in offering patients rapid includes compliance requirements, role for dentists in preventive health response COVID-19 testing in their tips for developing a waived testing care, including access to and the practices once reliable point-of-care program in dental practices, COVID- administration of vaccinations,” said testing is available at a level that 19 test reporting requirements, an Duc M. Ho, D.D.S, chair of the ADA makes it feasible for it to be used in FAQ on responding to patient ques- Council on Dental Practice. individual dental practices, accord- tions and guidance on medical ben- ing to the toolkit, the ADA News efit plan claim filing for in-office COVID-19 & Lab Testing report said. Two benefits of offering COVID-19 testing. Requirements Toolkit The ADA also announced that in consultation with its Advisory Task Force on Dental Practice Recovery, it has released a toolkit to help guide dentists interested in offering their patients rapid response, point-of- care COVID-19 testing within their practices, according to ADA News. The COVID-19 & Lab Testing Requirements Toolkit includes infor- mation for dentists on applying for the federal certification required to offer this type of testing. Any dental practice that performs tests on human tissue, including saliva, plaque, blood or hard or soft tissue, must comply with regulations set by
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 19 Servant Leadership How a deep sense of caring for patients and team members has guided North American Dental Group and its CEO and Co-Founder Ken Cooper through a tumultuous year.
20 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com > North American Dental Group
The COVID-19 pandemic hit organizations across all
industries hard. The North American Dental Group (NADG) was no different. NADG was forced to close 80% of its den- tal practices during the spring to comply with local govern- ment orders shuttering non-essential, non-urgent services. “That obviously led to a significant impact in our reve- nue and forced us to make some difficult decisions,” said Ken Cooper, CEO and Co-Founder of NADG.
However, NADG never strayed Our core values of being Emo- from its servant leadership mind- tionally Intelligent, Approachable set and the values that remain the Educators who carry a Healthy Bra- foundation of the company, Cooper vado are designed to be differentia- said. “Our top concern was for the tors in how we show up. I often refer health and safety of our patients to the importance of “how we show and team members.” up” matters substantially more than Efficiency in Group Practice asked “what we are doing” on any given Cooper how his organization was day. Our cultural norms of compas- able to support its team members sion, accountability, integrity, and ser- and patients amid the pandemic, as vice aim to remind us daily to live up well as how this year’s lessons can to those ideals in everything we do. position group practices for success Our motto is “Caring people, in the future. caring for people.” We train our teams on self-awareness, and I per- Efficiency in Group Practice: Can sonally believe everyone is responsi- you describe to us the tenets/keys ble for investing in their own leader- of your leadership philosophy? ship development journey. Ken Cooper: Our culture is defined by a servant leadership mindset, Efficiency:How were these tenets which guides our day-to-day oper- put to the test in 2020? ations and decision-making. I try Cooper: Without question, the to infuse empathy and vulnera- COVID-19 pandemic caused tremen- bility within our leadership team dous challenges for our company. and create a deep sense of caring We were forced to close 80% of our for our patients and team members. dental practices during the spring We look for these same values in the to comply with local government people we hire and the dental prac- orders shuttering non-essential, tices we are fortunate enough to be non-urgent services. That obviously affiliated with. led to a significant impact in our
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 21 > Servant Leadership
revenue and forced us to make some were being put in place, so that efforts by turning some of our tem- difficult decisions. when they were able to return to porarily closed dental offices into But we never strayed from our work they felt comfortable and reas- COVID-19 testing sites to relieve servant leadership mindset and the sured in their changing work envi- the burden on medical facilities and values that remain the foundation ronment. When guidelines allowed help satisfy high demand for testing. of our company. Our top concern dental practices to reopen, local Meanwhile, we were making was for the health and safety of our teams had a voice in deciding when plans to reopen safer office envi- patients and team members. We com- NADG supported practices would ronments for our patients and team plied with orders to temporarily close re-open based on their comfort members. We appointed an inter- many of our practices, keeping just 50 level with new safety protocols. nal committee that worked to practices open to provide emergency dental care in the communities we serve and to help alleviate the pres- sure on overcrowded hospitals and emergency rooms. This decision also About North American helped to minimize the spread of the virus and keep our patients and team Dental Group members safe. North American Dental Group (NADG), based in Pittsburgh, Pennsylvania, Financially, with our business was cofounded by Ken Cooper and Dr. Andrew Matta in 2008. NADG largely dormant, we were forced to was created to transform the dental experience for its patients, clinicians, make the difficult decision to - fur and its support teams and today consists of a network of over 230 dental lough team members during practice practices in 15 states. The values of maintaining an emotionally intelligent closures. But, again, our concern was approach, being thoughtful educators, and displaying a healthy bravado caring for them even while they were fuel our day-to-day patient care and operations. These founding values unable to work. Our team members are alive and well as NADG celebrates its pioneer spirit by solidifying its continued to receive healthcare and partnership with Jacobs Holding AG. dental benefits through the furlough period with NADG paying the team member’s portion of the premium. Additionally, team members could borrow up to two weeks of paid time off (PTO) against future balances to Also, while keenly aware of the establish new safety procedures bridge any income gap before they devastating impact this pandemic – which includes head-to-toe per- started receiving unemployment was having on other healthcare sonal protective equipment (PPE), benefits. A low-interest loan pro- workers and first-responders, we enhanced infection controls with gram was also established, and many were called to a stronger sense of frequent cleaning and sanitiz- NADG team members voluntarily community. To address the wide- ing, comprehensive screening of contributed to our Smile With Heart spread shortage of N95 respirator team members and patients, and Foundation’s Employee Relief Fund masks needed for physicians, hos- updated visit protocols to encour- to assist team members experienc- pital workers, police officers, para- age social distancing and minimize ing economic hardship. medics and others, NADG donated risk. These procedures were above We kept the lines of commu- about 6,000 masks to hospitals and and beyond those eventually estab- nication open with our furloughed law enforcement agencies in hard hit lished by the Centers for Disease team members, keeping them informed areas of Pennsylvania and Ohio. We Control & Prevention (CDC) and of changes and new protocols that also assisted with COVID-19 testing the American Dental Association
22 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com CONFIDENCE COMES FIRST
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EGP Ad_8 375 x 10 875_13July2020_ASL.indd 1 7/16/20 9:01 AM > Servant Leadership
(ADA). In the interest of public organization (DSO). The pandemic patients about the extensive safety health, we shared these innovative has put a spotlight on the benefits of protocols that are now in place and guidelines and related resources being part of a DSO where dentists the overall importance of essential, across the entire dental industry can rely on administrative support proper oral care has been the key in by publishing them on our website. to navigate challenges brought on regaining that comfort level. by the pandemic – maintaining new Efficiency: What were your overall safety protocols, patient communica- Efficiency: How did you strive expectations heading into 2020? tion, access to deeper supply chains, to maintain a caring work envi- How were you able to adjust? and managing financial stress – while ronment amid the pandemic? Cooper: In general, our expecta- collaborating with fellow doctors on Cooper: Not only did we care for the tions for 2020 were for continued clinical topics. As a result, we still financial health of our furloughed growth through gaining new prac- have an opportunity to achieve some team members by continuing tice affiliations across the country of our growth expectations for 2020 their benefits and covering their and continued support of our teams despite the devastating impact of the premiums, allowing them to acquire to provide best-in-class oral care for pandemic on our industry. additional time off, and setting up our patients. As mentioned before, As for our patients, with the funds to assist with financial hard- we carefully seek to partner with temporary closure of many of our ships, but it was equally important dental practices that fit with our practices and understandable con- they remained confident as a member company’s values and demonstrate cerns and fear over the spread of of the NADG family. We kept the a patient-focused approach. the virus, we were forced to cancel lines of communication open with both our furloughed team members and those who were still in their The pandemic has put a spotlight on the traditional roles, shifting to remote benefits of being part of a DSO where work and flexible working hours. dentists can rely on administrative support It was important to keep everyone to navigate challenges brought on by engaged during this period so they would be prepared and confident the pandemic – maintaining new safety enough to provide the dental care protocols, patient communication, access our patients needed the moment our to deeper supply chains, and managing practices were able to reopen. financial stress – while collaborating with We sent communications to all of our team members several times a fellow doctors on clinical topics. week, keeping them apprised of the new protocols we were establishing, the assistance we were providing in The pandemic obviously slowed nearly all dental appointments for a the community, and the information some opportunities for us during two-month period during the spring. we were sharing with our patients to the first half of the year. But in other And even when we were able to help reassure them of our efforts. ways, it has created new business reopen, it still took time for patients Furthermore, to maintain our prospects for us to explore that we to become comfortable enough to sense of community internally, are very excited about. Since the return to the dentist for the oral NADG invested in development con- emergence of the pandemic, we have care they need. I’m pleased to say tent and programming to keep our fielded more inquiries than we antic- that we’ve seen a healthy return in team members engaged and hosted ipated from dentists who are consid- patient activity as our practices have interactive webinars designed to ering affiliating with a dental service reopened. Communicating to our support our team members through
24 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com the stress of the pandemic. The pro- pandemic a better company, with routine oral services and emergency grams ranged in titles from “How new ideas and new fortitude. care to return to pre-pandemic levels to Be Happy” to “NADG’s Secret and beyond. We’re not that far from Sauce.” We also organized online Efficiency: What long-term chal- that point now. Proper oral care is yoga classes and virtual happy hours. lenges will dental group practices essential. It is scientifically verifiable Finally, when the message was have to continue to navigate? that your oral health is connected to delivered by local governments that Cooper: From a business perspec- your body’s overall systemic health. non-urgent services could resume, tive, we’re probably no different than Our patients are keenly aware of we left it up to individual practices most other industries who are facing this and it is important that dentists to decide when they were comfort- a great number of challenges and remain prepared to provide patients able with reopening and seeing an unpredictable outlook. How long the care they want and deserve. patients again for routine oral care will the pandemic last? What’s the I also believe the pandemic has and elective procedures. long-term impact of the pandemic reminded us that dentistry is a form on our industry? How do we keep our of essential healthcare, and we will Efficiency: What did you learn team members and patients safe? continue to push to assure that it is about your organization amid the pandemic? What things are you doing differently as a result? To address the widespread shortage Cooper: I am deeply impressed and of N95 respirator masks needed for owe heartfelt gratitude to our entire team for the resilience everyone physicians, hospital workers, police has demonstrated. As stated at our officers, paramedics and others, NADG recent virtual Partner Meeting: Indi- donated about 6,000 masks to hospitals vidual team members are only as and law enforcement agencies in hard hit good as their team and a team is only as good as its individual members. areas of Pennsylvania and Ohio. We had to make difficult decisions to see our way through this pandemic, and we’re fighting our way through Additionally, the cost of safety recognized as such going forward. it. There are many routes we could – the additional PPE, screening NADG played a major role early on in have taken, but we followed the standards, and cleanliness protocols this pandemic by providing necessary route that is the foundation of our – will have an impact because these emergency dental care that helped company. We showed empathy and measures were put in place for us to patients in need and alleviated pres- invested in our team members so that safely reopen our practices and will sure on hospitals and physician we could all see our way through this remain long after the pandemic ends. offices that were beyond capacity. pandemic. We reverted to our motto: The answers to these questions must Also, dentists will continue to be ‘Caring people, caring for people.’ now be factored into every dental recognized as the infectious disease The pandemic is not over. Trials office and DSO’s day-to-day opera- control experts they are. Dentists will remain. But I like the approach and tions from this point forward. play a major role in helping our coun- the path we have chosen to com- try continue to combat COVID-19 by bat a pandemic that has had a deep Efficiency: What are your expec- being available to assist with COVID- and pervasive impact no one could tations for 2021? 19 testing and administering its vac- have predicted. The challenge for Cooper: As our safety protocols cine, when available. us internally now is to imagine how continue to take hold, I expect The future for dentistry is bright, we can eventually emerge from the demand for dental appointments and rewarding and essential.
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 25 > Training and Compliance
Emerging OSHA Guidance COVID-19 has raised the stakes for providers and patients.
In years past, dental providers have generally been adamant about nature, informational in content, utilizing personal protective equipment and adhering to OSHA and CDC guid- and are intended to assist employers ance. The onset of COVID-19, however, has raised the stakes for providers and in providing a safe and healthful patients. As new safety protocols have emerged, infection control leaders are workplace.” (www.osha.gov/SLTC/ working hard to keep the industry informed. covid-19/dentistry.html) Although dentistry has always dealt with respiratory hazards in the Efficiency in Group Practice spoke Dr. Katherine Schrubbe: OSHA workplace (i.e., spray, spatter and with training and compliance expert has issued guidance on COVID-19 aerosols), SARS-CoV-2 has gener- Katherine Schrubbe, RDH, BS, MEd, for dentistry on a new page entitled ated a new level of concern given the PhD, about evolving OSHA guide- Dentistry Workers and Employers. high infectivity of the virus and the lines and how they will continue to OSHA states that “this guidance is known risk of droplet transmission, impact dental practices. not a standard or regulation, and as well as the potential for airborne it creates no new legal obligations. transmission. Dental providers are Efficiency in Group Practice: How It contains recommendations as the best at utilizing personal protec- has COVID-19 changed OSHA’s well as descriptions of mandatory tive equipment (PPE) and have been concerns about potential safety safety and health standards. The taught to consider every patient hazards in the dental setting? recommendations are advisory in infectious; but now they must utilize
26 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com a higher level of PPE per OSHA and Dr. Katherine Schrubbe: This is proper use of a respirator, and CDC guidance. difficult to say, given that OSHA is personal protective equipment. On October 5, 2020, the CDC a complaint-driven agency and does > Report an injury, illness or fatality. issued an update on their page, How not have the manpower to check up > Record an injury or illness on COVID-19 is Spread. According to on every healthcare facility without OSHA recordkeeping forms. the update, “under certain condi- good cause. However, there seem to > Comply with General Duty tions, people with COVID-19 seem be a new crop of OSHA citations and Clause of the Occupational to have infected others who were fines related to COVID-19, and many Safety and Health Act of 1970. more than 6 feet away. These trans- have to do with lack of compliance missions occurred within enclosed to the Respiratory Protection Stan- As an example, on September spaces that had inadequate ventila- dard, 1910.134. Since the start of the 16, 2020, OSHA cited Georgetown tion. Sometimes the infected person coronavirus pandemic, OSHA has Dental LLC for violating respira- was breathing heavily, for example cited 85 establishments for viola- tory protection and other standards while singing or exercising. Under tions, resulting in proposed penalties at the Georgetown, Massachusetts, these circumstances, scientists totaling $1,222,156. (These figures location. OSHA cited the dental believe that the amount of infec- were current at press time and may practice for six serious, and one oth- tious smaller droplet and particles continue to change. Providers can er-than-serious, violations, with produced by the people with COVID- stay current by visiting https:// proposed penalties totaling $9,500. 19 became concentrated enough www.osha.gov/news/newsreleases/ OSHA cited the dental practice for to spread the virus to other people. national/10022020-0.) failing to provide medical evaluations The people who were infected were in the same space during the same time or shortly after the person with “Although dentistry has always COVID-19 had left. However, avail- able data indicate that it is much dealt with respiratory hazards in more common for the virus that the workplace (i.e., spray, spatter causes COVID-19 to spread through and aerosols), SARS-CoV-2 has close contact with a person who has COVID-19 than through airborne generated a new level of concern transmission.” (www.cdc.gov/coro- given the high infectivity of navirus/2019-ncov/prevent-get- ting-sick/how-covid-spreads.html) the virus and the known risk of OSHA – as well as the CDC – points droplet transmission, as well as the out that respirators (NIOSH-certified, disposable N95 filtering facepiece res- potential for airborne transmission.” pirator or better) should be worn if dental providers are completing aero- sol-generating procedures (AGPs) to Recent OSHA inspections have re- and fit testing for employees ensure the highest level of protection. sulted in the agency citing employers required to wear N95 respirators for a number of violations, including as protection against coronavirus; Efficiency in Group Practice: failures to: lack of written programs related to Has OSHA changed its approach > Implement a written respiratory respiratory protection, bloodborne to conducting inspections, re- protection program. pathogen exposure control and sponding to complaints or issuing > Provide a medical evaluation, chemical hazard communication; citations as a result of COVID-19? respirator fit test, training on the insufficient bloodborne pathogen
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 27 > Training and Compliance
training and controls; and inade- Efficiency in Group Practice: pandemic. Dental practices have had quate eyewash stations. In addition to the coronavirus to step up their compliance to safety (https://www.osha.gov/news/ pandemic, the U.S. continues guidance very quickly, and many did newsreleases/national/09162020) to experience climate-related not plan ahead for extraordinary disasters, such as hurricanes, natural disasters. If this pandemic Efficiency in Group Practice: flooding and wildfires. Moving has taught us anything, it’s that it’s What are the most significant forward, how can dental practic- not if, but when, the next thing will changes dental practices or DSOs es better prepare for pandemics happen! That said, there are already have made, as a result of new or natural disasters? tools in place for future planning. OSHA guidance and citations? OSHA has an excellent webpage Dr. Katherine Schrubbe: In my on Emergency Preparedness and experience, the most significant “If this pandemic Response and states, “preparing changes to dental practices and before an emergency incident plays a DSOs have been the incorporation of has taught us vital role in ensuring that employers OSHA’s Respiratory Protection Stan- anything, it’s that and workers have the necessary dard and its requirements. If dental equipment, know where to go, and providers are utilizing respirators, it’s not if, but know how to keep themselves safe they need to be worn in the context when, the next when an emergency occurs.” The site of the Respiratory Protection Stan- thing will happen!” addresses how to prepare and train for dard. A written plan is now required emergencies, as well as the hazards to as part of the practice’s compliance be aware of when an emergency occurs, manual, and dental practices must and offers e-tools, fact sheets, quick incorporate the various elements of Dr. Katherine Schrubbe: The cards and guidance documents for the standard as part of their SOPs, United States has had a horren- everything from disease pandemics to as well as train all team members on dous 2020 thus far, with wildfires, nuclear threats. (www.osha.gov/SLTC/ this standard and its requirements. hurricanes, flooding and a global emergencypreparedness/)
Dentistry work tasks associated with exposure risk levels
Lower (caution) Medium High Very high
Performing administrative Providing urgent or emer- Entering a known or Performing aerosol-gener- duties in non-public areas of gency dental care, not suspected COVID-19 patient’s ating procedures on known or dentistry facilities, away from involving aerosol-generating room or care area. suspected COVID-19 patients. other staff members. procedures, to well patients (i.e., to members of the Providing emergency dental Collecting or handling Note: For activities in the general public who are not care, not involving aerosol-gen- specimens from known or lower (caution) risk category, known or suspected erating procedures, to a known suspected COVID-19 patients. OSHA’s Interim Guidance for COVID-19 patients). or suspected COVID-19 patient. Workers and Employers of Workers at Lower Risk of Expo- Working at busy staff work Performing aerosol-generating sure may be most appropriate. areas within a dentistry facility. procedures on well patients.
Source: OSHA website, www.osha.gov/SLTC/covid-19/dentistry.html
28 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com > OSAP
2021 OSAP Dental Infection Control Boot Camp™ Registration Now Open
The Organization for Safety, Asepsis and Prevention (OSAP) an- Upon completion of this course, nounced registration is now open for the 2021 OSAP Dental Infection Control participants will be able to: Boot Camp™. OSAP will host the course virtually from January 25 – 28, 2021. > Describe disease transmission and principles of infection pre- vention and control in a variety The 2021 OSAP Dental Infection products, equipment, or ser- of oral healthcare settings Control Boot Camp™ will provide vices to the dental profession > Identify relevant infection a comprehensive review of all the > Those who inspect or investi- control laws, regulations, basics in dental infection prevention gate dental settings for com- guidelines, standards, and best and control, including employee and pliance with the guidelines and practices patient safety. Due to the continued standards on behalf of the gov- > Use quality assurance mea- COVID-19 pandemic, the curriculum ernment, regulatory, accrediting, sures (e.g., direct observation will also cover interim guidance and or public health authorities and feedback) to ensure accu- any related regulations. OSAP has rate implementation of rec- designed this course for: “This year, participants will leave with ommended infection control > Infection Control Coordinators a deeper understanding of Standard practices and Dental Practice Managers Precautions as addressed in guid- > Educators/Program Directors ance documents for dental providers “Our goal is to ensure that par- > Consultants/Lecturers published by CDC in 2003 and 2016 ticipants leave Boot Camp feeling > Military/Federal Service Personnel and the OSHA Bloodborne Pathogens educated and empowered to be infec- > Federally Qualified Health Standard. Additionally, speakers will tion control champions when they Center (FQHC)/Public address the most up-to-date interim return to their dental offices. We also Health Personnel guidance and any related regulations understand that everyone in the den- > IHS/Tribal Health Organization/ in each topic area,” states OSAP Exec- tal community has been affected by Tribal Urban Clinic Personnel utive Director, Michelle Lee, CPC. COVID-19. With this in mind, OSAP > Sales representatives, customer “The 2021 agenda includes several is offering a 30% discount on regis- service personnel, service tech- new sessions focusing on topics such tration fees to help make this import- nicians, and other professionals as transmission-based precautions, ant education accessible!” Lee said. who work for the companies optimization of PPE, and developing a For more information, visit: that manufacture or distribute respiratory protection program.” www.osap.org/2021BootCamp
About OSAP The Organization for Safety, Asepsis and Prevention (OSAP) is a growing community of individual clinicians, group practices, educa- tors, researchers, consultants, trainers, compliance directors, policymakers, and industry representatives who advocate for safe and infection-free delivery of oral healthcare. OSAP focuses on strategies to improve compliance with safe practices and on building a strong network of recognized infection control experts. OSAP offers an extensive online collection of resources, publications, FAQs, checklists, and toolkits that help dental professionals deliver the Safest Dental Visit for their patients. Plus, online and live courses help advance the level of knowledge and skill for every member of the dental team. For additional information, visit osap.org.
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 29 > Year in Review
Year in Review
2020 has been a year like no other. While the pandemic grabbed most of the attention, dental group practices none the less continued to grow their businesses and find new ways to solve old industry challenges. The following are some of the highlights from Efficiency in Group Practices interviews this year.
30 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com A game changer up to focus on my patients and facil- for hire. Depending on the prac- (January/February) itate their care at the highest pos- tice culture or the compensation sible level. While I had great expe- offered, employees may feel under-
> DSO Profile riences as a practice owner in the appreciated. At the same time, A game changer past, I’ve discovered the lower stress each dental model inevitably has a With access to new technology and the ability to connect with – and educate – patients, Advanced Dental Solutions helps patients discover a new reason to smile. : BY LAURA THILL level associated with being affiliated lot to offer new employees. Larger
The first prosthodontic specialty level practice to join Mortenson “Belonging to a dental service Dental Partners, Louisville, KY-based Advanced Dental Solutions provides organization has helped alleviate to a DSO – together with the ser- practices and DSOs often can offer life-changing care to patients who often mistakenly believe their treatment the non-clinical tasks generally is out of reach. To a large extent, belonging to a dental service organization required to run a dental office,” Dr. has made this possible, according to prosthodontist Mark C. Nation, DMD, Nation continues. “It has freed me who heads the practice. In addition to full-mouth reconstruction on teeth and up to focus on my patients and facil- vices they provide – have enabled employees more working hours. In implants, Nation and his team offer grafting procedures to facilitate these itate their care at the highest pos- treatments, as well as general anesthesia for bigger cases. “A large part of our sible level. While I had great expe- practice involves helping patients with existing dental implants who require riences as a practice owner in the additional restoration, repair or replacements,” he explains. past, I’ve discovered the lower stress me to improve my well-being and addition, DSOs usually have the level associated with being affiliated to a DSO – together with the ser- vices they provide – have enabled me to improve my well-being and spend more time with my family.” means to provide employees with spend more time with my family.” Indeed, while the experience has not impacted his staff’s day-to-day responsibilities, the support Morten- Indeed, while the experience has better compensation packages. On son Dental Partners provides around managing finances and training team members has made life easier for everyone in the office, he adds. not impacted his staff’s day-to-day the other hand, clinicians and staff
Better for patients The DSO experience has led to an overall improved patient experience responsibilities, the support Morten- at smaller practices may feel in as well, notes Dr. Nation. “Mortenson Dental Partners has multiple special- ists, which is a huge advantage for our patients,” he explains. “We are able son Dental Partners provides around greater control of their treatment to render multiple treatments in one clinic. For instance, in our group, we have maxillofacial surgeons who come to my clinic to help facilitate managing finances and training plans, making it attractive to stay care on very difficult implant recon- structions and bone augmentations. Patients appreciate comprehen- Mark C. Nation, DMD sive care in one clinic instead of team members has made life easier for the long-term.
28 Efficiency In Group Practice : ISSUE 1 • 2020 for everyone in the office, he adds. “It’s all about creating the right environment and a sense of unity by Hiring and retention making employees feel like they are The first prosthodontic specialty level best practices part of a winning team,” says Steve practice to join Mortenson Dental (January/February) Desautel, vice president, sales and Partners, Louisville, Kentucky-based marketing, Dental Health Products,
Advanced Dental Solutions provides > Trends Inc. (DHPI). “Dental offices that life-changing care to patients who Hiring in a competitive market typically have the greatest turnover often mistakenly believe their treat- It’s important to find the right person to fill a position – and then convince them to stay. : BY LAURA THILL issues are those where the owner ment is out of reach. To a large is not overly staff centric, can’t extent, belonging to a dental service clearly communicate performance organization has made this possible, targets and goals, makes unrealistic according to prosthodontist Mark C. demands and is hard to please.” Nation, DMD, who heads the prac- tice. In addition to full-mouth recon- Embracing diversity The national unemployment rate is low – a good thing for most peo- Avoiding pitfalls ple. For dental service organizations (DSOs) looking to hire and retain In a competitive market, organiza- employees, however, it’s becoming increasingly competitive to attract dental tions must offer attractive packages, struction on teeth and implants, professionals. There’s a definite supply-and-demand problem, according to including a substantial benefits and (March/April) Jacqueline Guinn and Rupinder Kaur, both doctor recruiters with Mortenson salary package, according to Guinn Dental Partners. and Kaur. When the organization asks a dental professional to relocate, Nation and his team offer grafting “people generally are more willing to For Mortenson Dental Partners, In addition, whereas years to attract and retain hygienists,” accept the offer if a relocation allow- ago, women traditionally pur- says Sherri Toohey-Taylor, direc- ance is provided,” they point out. sued careers as hygienists, rather tor of human resources, Morten- “During the initial site visit, if we procedures to facilitate these treat- than as dentists, that’s no longer son Dental Partners. Together, know a candidate plans to relocate, cultivating a culture of diversity is the case. “As more women elect Guinn, Kaur and Toohey-Taylor we connect them with a relocation to go to dental school, rather help Mortenson on-board talented specialist in that area.” Candidates will than hygiene school, it’s becom- individuals, despite obstacles such also be more likely to join – and remain ments, as well as general anesthesia ing more challenging nationwide as these. at – a dental practice that offers: an ongoing process. “While diver- for bigger cases. “A large part of our 44 Efficiency In Group Practice : ISSUE 1 • 2020 sity has always been a mainstay practice involves helping patients for MDP, we are in the early stages with existing dental implants who of formulating new protocols,” require additional restoration, repair All practices, from solo offices to says Bryan Hildreth, chief human or replacements,” he explains. large dental service organizations, resources officer at MDP. “All of our “Belonging to a dental service are bound to encounter challenges team members complete diversity organization has helped alleviate around hiring and staff reten- training as part of our orientation the non-clinical tasks generally tion. In some geographic areas, for and are certified annually there- required to run a dental office,” Dr. instance, there is a shortage of qual- after. We are beginning to measure Nation continues. “It has freed me ified dental professionals available and track diversity indicators to
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 31 > Year in Review
help us assess where we stand and That said, changes such as the “Our patients see more of their identify opportunities for improve- above require buy-in from lead- hygienists than any other healthcare ment, such as our diversity in senior ership, notes Hildreth. “Our lead- provider,” she continues. As such, leadership. We also are exploring ership team is the linchpin to the they make it a point to educate their new options to attract more diverse ultimate success of our diversity patients and form long lasting rela- applicants through alternative efforts,” he says. “We depend on tionships with them. “For example, websites and virtual communities, them to collectively and consis- we all take blood pressure readings and we are more intentional about tently apply the principles of diver- on all our patients, at every visit,” utilizing diverse interviewing panels sity across the organization.” she says. As a hygienist, I am more in our recruitment process.” As with other operational initia- likely to catch high blood pressure tives, Hildreth believes it’s equally than their regular physician is. It’s important for the entire organi- a great feeling to know I am directly zation to embrace the principles involved in improving my patients’ handed down by leadership and overall life.” follow through with best practices. “In the case of diversity, if we fail to properly embrace best practices, we may find ourselves at a compet- Ready for itive disadvantage – not only with prime time Hygienists today play a lead role in patient care.
respect to other DSOs but also other Advances in technology have opened a host of opportunities for dental hygienists in recent years. Particularly for those working in a large group practice or dental service organization, where the cost of new Embracing businesses in the communities we technology is less prohibitive than it is for solo offices, hygienists can – and often are expected to – play an diversity increasingly greater role in patient care. Diversity within DSOs and group practices can lead serve.” Indeed, by incorporating a to greater team satisfaction and better patient care.
Just as communities across the country have grown to reflect an increasingly diverse broad spectrum of backgrounds and population, so too has the dental industry. From the dental team to the patients they serve, human interactions must embrace a multitude of experiences and perspectives. perspectives, DSOs can more closely understand their patients’ needs and
20 Efficiency In Group Practice : ISSUE 2 • 2020 provide better care, he adds.
Hygienists today play a The DSO makes it a point to: lead role in patient care
> Seek applicants from more (May/June) 20 Efficiency In Group Practice : ISSUE 3 • 2020 dentalgrouppractice.com diverse sites and partner Many hygienists today are a signif- with professional icant part of the dental team, organizations that cater to according to Jennifer Rush, RDH, Rush credits advances in tech- underrepresented groups. BSDH, director of dental hygiene, nology for helping hygienists expand > Create marketing materials DecisionOne Dental Partners. “At their role in recent years. For that that better reflect the group’s DecisionOne Dental Partners we reason, hygienists must stay current diverse team and patients. look at the hygienist not just as a on the latest and greatest products > Expand eligibility for bereave- team member, but as a clinician,” in order to provide the best possi- ment leave to reflect a broader she says. “We value the hygienist ble care, she adds. “Hygienists must and more inclusive definition like we value a doctor. In addition constantly grow in their profession,” of family. to providing outstanding customer she points out. “As a primary health- > Incorporate many different service, our hygienists provide care care provider, hygienists must keep backgrounds and perspectives to their patients; they are taught current on new technology, together into its cross-functional to look at their patients’ systemic with doctors,” she explains. As she work teams. health, not just their oral health. discovered after joining DecisionOne
32 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Dental Partners, the closer in touch Furthermore, DSOs emphasize Scott asks himself one question she is with new services and technol- infection control throughout the – What does the customer want? ogy, the better able she is to develop organization, she notes. “Many of “If I want to know what the her skills and care for her patients. our groups employ quality assur- future is going to hold, I look to my ance officers who ensure the entire customers, namely their lives, needs, DSOs continue to present dental team complies with OSHA and wants,” Scott said. new opportunities for guidelines,” she says. “Since those hygienists (May/June) guidelines are always evolving, we Efficiency: Speaking on behalf rely on these officers to keep us of DSOs across the nation, has abreast of important changes. Our the pandemic made DSO offer- Mobility & growth hygiene trainers and mentors, as ings more valuable to the inde- DSOs continue to present new opportunities for hygienists. well as other professionals, ensure pendent dental office? The dental industry has been a hub of growth these past couple of to resources and new product educa- decades. Shaped by new diagnostic tools and therapies, as well as the growth tion, which a smaller practice may of dental service organizations, dentistry places more and more demands on not have,” she explains. “Some DSOs all of our hygienists follow clinical Scott: Yes. I think this was already clinicians – hygienists included. Once considered the masters of pick and use proprietary software, which has polish, hygienists have kept pace with these changes, taking on more and been created especially for them more responsibility, while taking advantage of efficiencies afforded by new and often is more robust to software and better technology. available to private offices. guidelines in order to provide great starting to happen. Even dentists “Within some of our groups, hygiene committees have been cre- “Today, we have so many new ated that include clinical hygienists diagnostic tools, therapies and who treat patients with new products and safe care.” who were kind of wary on DSOs are knowledge at our disposal that we and therapies, and then evaluate them didn’t have 10 or 20 years ago,” says for future use,” Kowalczyk continues. Andrea Kowalczyk, RDH, BS, lead tal- “It’s a great way to be involved.” ent acquisition partner for a leading Furthermore, DSOs emphasize seeing that these DSOs are willing DSO. “While we have taken on more infection control throughout the responsibility as we’ve adopted these organization, she notes. “Many of new technologies, some of these our groups employ quality assur- tools have enabled us to save time ance officers who ensure the entire Smile Magic (July/August) to provide more capital to them and effort.” Successful hygienists dental team complies with OSHA must be trained on such technologies guidelines,” she says. “Since those as laser, intra-oral cameras and dig- guidelines are always evolving, we ital diagnostic tools, she points out. Andrea Kowalczyk rely on these officers to keep us if they want to exit or if they’re In many cases, hygienists have abreast of important changes. Our moved to DSOs, which support the hygiene trainers and mentors, as training and education necessary to “Our hygiene well as other professionals, ensure adopt new technology, she says. But, trainers and all of our hygienists follow clinical looking for a partnership. That’s even when the move has been less mentors, as well as guidelines in order to provide great than intentional – for instance, when and safe care.” private practices are sold to DSOs other professionals, Because hygienists employed by – the transition can be positive for ensure all of our DSOs have an opportunity to work interesting to them. hygienists who are open to change. hygienists follow with so many professionals, includ- clinical guidelines ing recruiters, marketing specialists, Resources and education in order to infection control specialists, etc., In Kowalczyk’s experience, hygien- provide great they often go on to fill these posi- They have teams that can help ists working in a DSO setting have and safe care.” tions at their organization, Kowal- career-building opportunities that czyk points out. These are oppor- those in the private sector some- – Andrea Kowalczyk, RDH, BS, lead talent tunities they may miss out on in times lack. “DSO’s often have access acquisition partner for a leading DSO private practices, she adds. them navigate all this complexity.
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 3 • 2020 23 All great athletes, even if they look Smile Magic like they’re alone, have huge teams. By focusing on the customer, dental service organizations This complexity, having a team, have an opportunity to make great gains in the marketplace – In Andrea Kowalczyk’s experience, even amid a pandemic. network, and support system, I think hygienists working in a DSO setting everyone’s saying, “Yes, at this level you have career-building opportunities do need a team. You do need support.” that those in the private sector some- That leads me into how we times lack. “DSOs often have access to evolved and became what we are
resources and new product education, Emmet Scott today, National Dental Partners, which a smaller practice may not have,” 4 Efficiency In Group Practice : ISSUE 4 • 2020 dentalgrouppractice.com which happened before we knew says Kowalczyk, RDH, BS, lead talent there was going to be a global pan- acquisition partner for a leading DSO. demic. That said, the state of our “Some DSOs use proprietary software, Emmet Scott, CEO and co-founder country has shown us and partic- which has been created especially of National Dental Partners™ and ipating (and interested) members for them and often is more robust to Smile Magic Dentistry, and the that there has never been a better software available to private offices. newly elected president of the Amer- time for partnerships and collabora- “Within some of our groups, ican Dental Service Organizations tion like this in our industry. hygiene committees have been cre- (ADSO) said he’s tried simplifying ated that include clinical hygienists things during challenging times PPE demand has turned who treat patients with new products with a guiding principle. He calls the supply chain upside and therapies, and then evaluate them it his North Star, and it’s kept him down (July/August) for future use,” Kowalczyk continues. on course, even amid the changing Editor’s note: Billy Harris, CEO of Sri “It’s a great way to be involved.” marketplace and a global pandemic. Trang USA, Inc., spoke with Efficiency
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 33 > Year in Review
in Group Practice Publisher Scott of the market.’” Anybody that was tactical aspects of dentistry. You Adams on the history of the glove in the food service business saw a are providing the ultimate quality business as it relates to public health decline for a short period of time. of clinical care for your patients. scares, how demand spiked during But their glove sales and mask sales However, you don’t dedicate enough COVID-19, the challenges of bringing remained because they started sell- time and attention to the busi- manufacturing of gloves to the United ing it to customers who were not in ness aspect, which is also serving States, and more. their traditional wheelhouse. patients, by making sure that you The dental market did the same provide top quality of care, you have thing, Harris said. For seven to eight less waiting time, you’re efficient
> PPE weeks, they went from 100% utiliza- and effective, you have happy, satis- PPE Past, Present and Future tion in dentistry down to maybe 15%. fied team members, and returning A PPE leader examines how the spike in demand due to COVID-19 compares to other historical markers, and how it could reshape the industry moving forward. It was only the dentist and maybe one patients with a positive impact. That
Editor’s note: Billy Harris, CEO of Sri Trang USA, Inc., spoke with Efficiency in Group Practice Publisher Scott Adams on the history of the glove business as it relates to public health scares, how demand spiked during COVID-19, the challenges other person in the office during that in itself is difficult because you are of bringing manufacturing of gloves to the United States, and more. The following were ten insights from the interview.
This isn’t the first time the time would’ve been latex.” In the because none of the workers would we’ve faced a PPE shortage 1980s and up until about 2000, latex use them, and the whole anthrax period of time. The dental supply peo- In 1989, the Food and Drug Adminis- would have been the first choice of scare went away due to good law tration (FDA) issued universal precau- product, then vinyl, and then nitrile, enforcement practices to get to the tions because of AIDS. The universal Harris said. Today it’s nitrile, vinyl, root cause of it.” precautions were just a simple state- and then latex. > 2002: A West Nile Virus out- ple were sitting on inventories and ment: if you encounter bodily fluid, break occurred, “but it really you should glove, gown, and mask. didn’t have an impact on the “That took the whole industry by a U.S. market in terms of any little bit of surprise,” said Harris. unusual demands outside of the having inventories coming in, so they For the glove business, the uni- normal demand.” versal precautions of 1989 meant > 2003: SARS. “It didn’t really explosive growth. In that particular impact availability of product.” year in Malaysia alone, the Malay- > 2005: The system was chal- started selling gloves, masks, gowns sian government issued 300 permits lenged with bird flu. “When for the manufacturing of gloves, I say the system, I mean the Harris said, “though not all of those manufacturing community,” permits were fulfilled, or factories Harris said, “which needed and hand sanitizer to everybody. They built.” At the time, there was still a Following the universal to make sure we had enough fair amount of domestic production precautions in 1989, there’s gloves not just in the U.S., but in the United States. been an event every few other hot spots of the world. However, since then, manufactur- years that felt like it was So, there was a demand issue.” even went to the market to try to get ing has migrated to places like China, going to have an impact on > 2006: An E. coli scare, “but that Indonesia, Thailand, and Vietnam. infection prevention and PPE did not negatively affect the For instance, in 2001, you had the glove business,” Harris said. Tarek Aly: Glove manufacturing anthrax scare with the U.S. Postal > 2008: An economic downturn. more. Some of the dental distribu- didn’t leave the U.S. Service, Harris said. “At one point, “Interesting enough, at least in Great changes, because of cheap labor the U.S. Postal Service wanted the glove business, when there When the gloves produced in the everybody to glove and have some were tough economic times, we great opportunity United States migrated to South Asia form of protection, but that lasted tended to thrive better both in tion business is now trying to figure With the right mindset, and and China, it wasn’t because of cheap for about three months. The U.S. volume to the market and in skillsets, dental group practices labor, Harris said. “Gloves left because Postal Service went out and bought profitability for the company.” that’s where the raw material is, and millions of gloves. Three months > 2009: H1N1, or swine flu, “and can create a high quality of the raw material most in demand at later they were trying to return them again that was a global issue out how to leverage that long-term in service for their clients amid a challenging environment. 16 Efficiency In Group Practice : ISSUE 4 • 2020 dentalgrouppractice.com healthcare and the medical side, not just the dental side, Harris said. So, unless you were specializing in cancer Yes, there will be higher demand, treatments and things of that nature, because more people across all indus- you saw no decline. But the general tries are going to glove, gown, and practitioner certainly saw a big decline.
SEPTEMBER/OCTOBER : 2020 mask. Some will be more short-term. There’s going to be a change in DENTALGROUPPRACTICE.COM For instance, some of the inquiries the supply chain, Harris said. The that Sri Trang received over the past market’s going to look very differ- few weeks are mostly coming from ent, and the demand will probably functioning with two minds. You industry. “They’re trying to get their jump from 70 billion to maybe 90 have the dentist’s mind, and you employees back to work, whether it billion when it all starts to settle out, have the business mind. And that be in a factory or a restaurant.” “because we’re all going to be doing is definitely hard. In the begin- Another example was the cruise more cleaning, deep cleaning, things ning you are handling everything. ship industry. When it was shut of that nature.” You’re doing all these things. But down during COVID, those compa- as you grow, you have the ability to nies buying gloves for cruise ships Tarek Aly, chief operating break down some of these functions found themselves sitting on idle officer at OrthoDent, and give them to a specialist, who inventory. “Well, that idle inventory on building business has the formal education, knowl- was only idle until somebody fig- expertise while practicing edge and the experience to tackle ured out that, ‘Oh, there’s some idle (September/October) one piece at a time. It is definitely inventory, let’s go buy it because we “When you are practicing dentistry, challenging, but, as you scale, it can use it over here in other parts you are completely focused on the becomes easier.”
34 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Location, location, location on trying to cater to and draw in that > DEO Case Study (September/October) population. For Timber Dental, that Timber Dental Dr. Matt Kathan and the leadership How discarding more traditional models for growth and rethinking their approach to target population is millennials, the business side of dentistry has led to success for one dental group practice in the Pacific Northwest. of Timber Dental say that they try with most of the practice’s patients to think of their business as being being in the 30-45 age range. “retail.” This has meant going after Timber Dental’s focus on ap- a narrowly defined target population proaching dentistry as a retail busi- and investing a lot of resources into ness can be seen simply by looking
Dr. Matt Kathan (right) speaking to other getting and maintaining visibility dental group leaders at a recent event. at the practice’s four locations
with that population. Timber Dental was founded in Dr. Kathan says he and his team The practice offers general den- around Portland. All of the locations Northeast Portland in 2014 by the had to discard more traditional tistry to all patients, but the practice husband and wife team of Dr. Matt models for growth and rethink has rejected the mindset of trying Kathan and Dr. Molly Kathan. their approach to the business side to be all things to all people. The The practice offers general den- Now, the practice has 8 dentists of dentistry. leadership team worked to create a are within 2 miles of another Timber and around 50 employees across “patient avatar” and focus its efforts its four Portland-area locations. Location, location, location on trying to cater to and draw in that Despite the hardships created earlier Dr. Kathan and the leadership of population. For Timber Dental, that tistry to all patients, but the practice in the year, Dr. Matt Kathan says that Timber Dental say that they try target population is millennials, Dental office. All locations are on each location is thriving again, with to think of their business as being with most of the practice’s patients patient volumes close to what they “retail.” This has meant going after being in the 30-45 age range. were pre-COVID-19. a narrowly defined target population Timber Dental’s focus on approach- has rejected the mindset of trying In order to grow from the orig- and investing a lot of resources into ing dentistry as a retail business can street corners and highly visible. The inal, single location into the prom- getting and maintaining visibility be seen simply by looking at the prac- to be all things to all people. The inent group practice that it is now, with that population. tice’s four locations around Portland. downtown location even has a 30-ft 10 Efficiency In Group Practice : ISSUE 5 • 2020 dentalgrouppractice.com leadership team worked to create a marquee sign to draw even attention “patient avatar” and focus its efforts to the practice.
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The Need for a Respiratory Protection Program Dental group practices must have a clear understanding of the standard and its rationale to provide a sound respiratory protection program for all employees.
The global pandemic of SARS-CoV-2 has had a huge impact on the dental profession regarding dental health care personnel (DHCP) safety and the safe delivery of dental care to patients. On March 16, 2020, the American Dental Association (ADA) recommended dentists nationwide postpone elective procedures for the next three weeks, stating that concentrating on emergency dental care will allow dentists to care for emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.1 The closures went for much longer than three weeks and the recommendation that dentists restrict their practices to all but urgent and emergency care finally expired on April 30 and was not extended. At that point, the By Katherine Schrubbe, ADA stated, “oral health is an integral part of overall health and treatment of dental RDH, BS, M.Ed, PhD disease, as well as prevention, is important to help keep people healthy. The longer Dr. Katherine Schrubbe, RDH, BS, M.Ed, dental practices remain closed to preventive care and treatment for early forms of den- PhD, is an independent compliance consultant with expertise in OSHA, dental tal disease, the more likely that patients’ untreated disease will progress, increasing the infection control, quality assurance and complexity and cost for treatment down the road.”2 risk management. She is an invited speaker for continuing education and training programs for local and national dental organizations, schools of dentistry Dental practices were not only in states where government mandates and private dental groups. She has guided by ADA, but also had to follow began to lift. But it was not business as held positions in corporate as well as state and local guidelines and mandates usual. Due to the many unknowns of the academic dentistry and continues to prior to reopening. However, in early SARS-CoV-2 virus came new interim contribute to the scientific literature. Dr. Schrubbe can be reached at to mid-May dental practices began to guidance from the Centers for Disease [email protected]. reopen to comprehensive procedures Control and Prevention (CDC) as well as
36 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com the ADA on everything from patient powered air-purifying respirators Although OSHA standards are screening, to operatory protocols (PAPRs), or elastomeric respirators; federal law where employers must and new recommendations for per- > Respirators should be used in comply in order to maintain a safe sonal protective equipment (PPE). the context of a comprehensive workplace, during this unprec- New interim guidance built upon the respiratory protection program edented pandemic, in May, the already strong infection control pro- (RPP), which includes medical agency created a webpage specifically tocols in place in dental offices and evaluations, fit testing and for Dentistry Workers and Employers, called for the highest level of PPE to training in accordance with stating, “this guidance is not a stan- help protect patients and the dental OSHA’s Respiratory Protection dard or regulation, and it creates no team when re-engaging in providing standard (29 CFR 1910.134).4 new legal obligations. It contains the full range of oral health care.2 Since May 2020, there have been numerous revisions of interim As always, training is a vital guidance from the CDC, ADA and the Occupational Safety and Health component of any safety program, Administration (OSHA) making and the Respiratory Protection compliance to new recommenda- Standard mandates respirator tions and protocols an ongoing daily activity – and challenge. The most training be provided prior to significant change to dentistry prac- requiring an employee to use a tice during the SARs-CoV-2 pan- demic is related to PPE and respi- respirator in the workplace. ratory protection. Dental providers have always dealt with respiratory hazards in the workplace (i.e., spray, In March, OSHA released Guid- recommendations as well as descrip- spatter and aerosols) and are the ance on Preparing Workplaces for tions of mandatory safety and health best at utilizing PPE under the prem- COVID-19 and outlined very high standards; the recommendations are ise that every patient is infectious. exposure risk jobs as those with high advisory in nature, informational in However, SARS-CoV-2 has gener- potential for exposure to known content, and are intended to assist ated a new level of concern given or suspected sources of COVID-19 employers in providing a safe and the high infectivity of the virus, the during specific medical, postmor- healthful workplace.”6 With that, known risk of droplet transmission, tem, or laboratory procedures; work- OSHA’s current respiratory protection as well as the potential for airborne ers in this category include health- PPE for dentistry during procedures transmission,3 thus, a higher level of care workers (e.g., doctors, nurses, that may or are known to generate PPE is recommended. dentists, paramedics, emergency aerosols include a NIOSH-certified, medical technicians) performing disposable N95 filtering facepiece Current guidance aerosol-generating procedures (e.g., respirator or better used as part of a At the time of this writing, the most intubation, cough induction proce- comprehensive respiratory protec- current CDC guidance for dentistry dures, bronchoscopies, some dental tion program that meets the require- states, during aerosol generating procedures and exams, or invasive ments of OSHA’s Respiratory Protec- procedures DHCP should use an specimen collection) on known or tion Standard and includes medical N95 respirator or a respirator that suspected COVID-19 patients.5 This exams, fit testing, and training.5,6 The offers an equivalent or higher level guidance document highlighted the ADA also refers to OSHA guidance for of protection such as other dispos- risk of transmission of SARS-CoV-2 selection of respiratory PPE during able filtering facepiece respirators, to DHCP. the COVID-19 pandemic.6,7
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 37 > Infection Control
The incorporation of OSHA’s The RPP includes the following OSHA guidance and practices are Respiratory Protection Standard elements: now finding there are additional and the implementation of a Respi- > Procedure for selecting respira- tasks that need to be completed to ratory Protection Program (RPP) tors for use in the workplace, comply with this standard. OSHA is a new area for dentistry and has > Medical evaluation of employ- requires initial and annual fit-test- created the need for more educa- ees required to wear respirators, ing of respirators to ensure proper tion, training as well as administra- > Fit testing procedures for tight fit and seal, however, to preserve tive tasks in the practice. If DHCP fitting respirators, and prioritize the supply of respira- are donning respirators for aero- > Procedures for proper use tors, OSHA has currently suspended sol generating procedures, then as of respirators in routine its annual fit-test requirement, OSHA has indicated, they must be and reasonably foreseeable but continues to enforce an ini- used in the context of the standard emergency situations, tial fit-test.10 Even before fit-test- and RPP.5,6,7 > Procedures and schedules ing is accomplished, DHCP must for cleaning, disinfecting, complete a medical evaluation to Reviewing the program storing, inspecting, repairing, determine their eligibility of wear- Without going into a great deal of and discarding and otherwise ing a respirator.8,9 This medical discussion, let’s review the elements maintaining respirators, evaluation consists of a lengthy of a respiratory protection program > Procedure to ensure adequate health questionnaire evaluated for dental practice. According to quality, quantity, and flow by a physician or other licensed OSHA, a respiratory protection of breathing air for atmo- healthcare professional who pro- program is a written program that sphere-supplying air respirators, vides a written recommendation includes procedures specific to the > Training of employees in the regarding the ability to use respi- worksite to prevent inhalation of proper use of respirators, includ- rators.9 For instance, if the DHCP hazardous materials that cannot ing putting on and removing has respiratory conditions such be controlled by other measures them, any limitations on their as asthma or severe allergies, they (i.e., engineering, or administrative use and their maintenance, may not be able to obtain eligibil- controls).8,9 Along with the written > Procedures for regularly eval- ity to wear a respirator. The practice RPP, OSHA requires the dental uating the effectiveness of the should make every effort to comply practice to designate the RPP program, and with the fit-testing requirements to administrator. This staff person > Procedures for ensuring that ensure DHCP safety. However, if it may also be the safety officer for workers who voluntarily wear is difficult to obtain a fit-test, the practice and must be familiar respirators (excluding filtering the practice should document all with the Respiratory Protection facepieces) comply with the attempts made to secure fit-testing Standard and the use and appli- medical evaluation, and clean- services and continue to seek out cation of respirators in the work- ing, storing, and maintenance this assistance. place. Also, they are responsible requirements of the standard.8,9 As always, training is a vital to ensure DHCP are provided with component of any safety program, an appropriate and suitable respi- There are a few key items that and the Respiratory Protection rator that is provided at no cost should be emphasized within the Standard mandates respirator train- by the employer to the employee, RPP. A written plan is required and ing be provided prior to requiring training, and medical evaluations to should reside in the practice’s office an employee to use a respirator in protect DHCP from inhaling harmful compliance manual; with the pro- the workplace. The training must contaminants (contaminants could gram being reviewed regularly.8 be comprehensive, understandable, include biologic agents such as DHCP have been sort-of thrown in and recur at least annually – or more bacteria and viruses).8,9 to using respirators per CDC and often if necessary.8,9
38 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com OSHA identifies the following as establishments for violations, result- Dentistry has been driven into a minimum knowledge a respirator ing in proposed penalties totaling new “normal” of providing patient user should have upon completing $484,069 where employers failed to care that has added another layer respirator training: implement a written respiratory pro- of OSHA compliance to daily prac- > Why the use of a respirator is tection program, provide a medical tice – the utilization of respirators necessary (e.g., the respiratory evaluation, respirator fit test, training for aerosol generating procedures hazards and how improper on the proper use of a respirator, and requires the implementation of a fit, usage, or maintenance can personal protective equipment.11 In respiratory protection program per compromise the protective effect of the respirator), > Limitations and capabilities of Since May 2020, there have been the respirator, > How to use the respirator numerous revisions of interim effectively in emergency guidance from the CDC, ADA and situations, including when the respirator malfunctions, the Occupational Safety and Health > How to inspect, don (put on) and Administration (OSHA) making doff (remove), use, and check the seals of the respirator, compliance to new recommendations > The procedures for mainte- and protocols an ongoing daily nance and storage, and activity – and challenge. > How to recognize medical signs and symptoms that may limit or prevent the effective use of the respirator.9 September, OSHA cited a dental prac- the Respiratory Protection Stan- tice in Georgetown, Massachusetts for dard. Employers and management There has been a lot of conver- violating respiratory protection and teams must have a clear under- sation in dentistry regarding OSHA’s other standards with proposed pen- standing of the standard and its enforcement of the Respiratory Pro- alties of $9,500. The citation included rationale to provide a sound respi- tection Standard since the start of failure to provide medical evaluations ratory protection program for all the pandemic. Although OSHA is a and fit testing for employees required employees. It should not be the complaint-driven agency, based on to wear N95 respirators as protection potential for an OSHA citation that current information as of October against coronavirus and lack of writ- drives a dental practice to compli- 2, 2020, there appears to be plenty ten programs related to respiratory ance, rather, it is the right thing to of complaints as OSHA has cited 37 protection among other violations.12 do to ensure DHCP safety.
References: 1. American Dental Association. ADA news. Available at https://www.ada.org/en/publications/ada-news/2020-archive/march/ada-recommending-dentists-postpone-elective-procedures. Accessed November 6, 2020. 2. American Dental Association. Available at https://www.ada.org/en/press-room/news-releases/2020-archives/may/as-dental-practices-resume-operations-ada-offers-continued-guidance. Accessed November 6, 2020. 3. Centers for Disease Control and Prevention. How covid-19 spreads. Available at https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/how-covid-spreads.html. Accessed November 6, 2020. 4. Centers for Disease Control and Prevention. Guidance for dental settings. Available at https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html. Accessed November 6, 2020. 5. US Department of Labor. Occupational Safety and Health Administration. Guidance on preparing workplaces for covid-19; March 2020. Available at https://www.osha.gov/Publications/OSHA3990.pdf. Accessed November 6, 2020. 6. US Department of Labor. Occupational Safety and Health Administration. Dentistry workers and employers. Available at https://www.osha.gov/SLTC/covid-19/dentistry.html. Accessed November 6, 2020. 7. American Dental Association. OSHA guidance summary: dentistry workers and employers; September 21, 2020. Available at https://success.ada.org/~/media/CPS/Files/COVID/OSHA_Guidance_Summary_Dentistry_Workers_ And_Employers.pdf?utm_source=cpsorg&utm_medium=covid-resources-lp-safety&utm_content=cv-safety-osha-guidelines-dentistry&utm_campaign=covid-19. Accessed November 6, 2020. 8. US Department of Labor. Occupational Safety and Health Administration. Respiratory protection. Available at https://www.osha.gov/laws-regs/regulations/standardnumber/1910/1910.134. Accessed November 6, 2020. 9. Centers for Disease Control and Prevention. The national personal protective technology laboratory; respirator trusted source information. Available at https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part/resp- source3respirator.html#respb. Accessed November 6, 2020. 10. US Department of Labor. Occupational Safety and Health Administration. Temporary enforcement guidance - healthcare respiratory protection annual fit-testing for N95 filtering facepieces during the COVID-19 outbreak. Available at https://www.osha.gov/memos/2020-03-14/temporary-enforcement-guidance-healthcare-respiratory-protection-annual-fit. Accessed November 6, 2020. 11. US Department of Labor. Occupational Safety and Health Administration. OSHA national news release. Available at https://www.osha.gov/news/newsreleases/national/10022020-0. Accessed November 7, 2020. 12. US Department of Labor. Occupational Safety and Health Administration. OSHA national news release. Available at https://www.osha.gov/news/newsreleases/national/09162020. Accessed November 7, 2020. dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 39 > Culture
14 Thoughts About Building A Great Culture By Jon Gordon
1. Great leaders build and drive great cultures. They know it’s their number one priority. They can’t dele- gate it. They must lead and be engaged in the process.
2. Culture is the reason why great organizations have sustained success. Culture drives expectations and beliefs. Expectations and beliefs drive behavior. Behavior drives habits. Habits create the future.
3. Culture beats strategy. Strategy is important but it is your culture that will determine whether your strategy is successful.
4. If you focus on the fruit of the tree (outcomes and numbers) and ignore the root (culture) your tree will die. But if you focus on and nourish the root you always have a great supply of fruit.
5. When building a team and organization you must shape your culture before it shapes you. A culture is forming whether you like it or not. The key is to identify what you want your culture and organization to stand for. Once you know the values and principles that you stand for, every decision is easy to make; including the people you recruit and hire.
6. A culture of greatness doesn’t happen by accident. It happens when a leader expects greatness and each person in the organization builds it, lives it, values it, reinforces it and fights for it.
40 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Culture is like a tree. It takes years to cultivate and grow and yet it can be chopped down in a minute
7. Culture is dynamic, not static. let a few energy vampires off Everyone in your organization the bus. creates your culture by what they think, say and do each 11. Creating a culture where day. Culture is led from the top people are afraid to fail leads to down, but it comes to life from the failure. Allowing people to fail bottom up. and learn from failure ulti- mately leads to success. 8. “Your culture is not just your tradition. It is the people in 12. Change is a part of every your building who carry it on.” culture and organization. – Brad Stevens, Head Coach, Embracing change and inno- Boston Celtics vating will ensure that your organization thrives. 9. When leading a new team or organization, it will take longer 13. Progress is important but when to build a new culture if you innovating and driving change allow negative people from the make sure you honor your previous culture to contaminate tradition, purpose and culture. the process. This generates power from your past to create your future. 10. When you build a strong, posi- tive culture most of the energy 14. Culture is like a tree. It takes vampires will leave by them- years to cultivate and grow and selves because they don’t fit yet it can be chopped down in a in. But you may also have to minute. Protect your culture.
Jon Gordon’s best-selling books and talks have inspired readers and audiences around the world. His principles have been put to the test by numerous Fortune 500 compa- nies, professional and college sports teams, school districts, hospitals, and non-profits. He is the author of 20 books including 8 best-sellers: The Energy Bus, The Carpenter, Training Camp, You Win in the Locker Room First, The Power of Positive Leadership, The Power of a Positive Team, The Coffee Bean and his latest Stay Positive. His clients include The Los Angeles Dodgers, Campbell’s Soup, Dell, Publix, Southwest Airlines, Miami Heat, The Los Angeles Rams, Snapchat, BB&T Bank, Clemson Football, Northwestern Mutual, West Point Academy and more.
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 41 > Health News
Health news and notes
Teeth grinding prevalent mount the response it needs to in election season fight the infection.” This year’s political arguing has > Sleep. “Lack of sleep can nega- apparently contributed a signif- tively impact your immune sys- icant amount to teeth gnashing, tem,” says Dr. Richards-Boyd. according to the Washingtonian. “It is important to practice According to dentists interviewed, good sleep hygiene to make America, overwrought and under- sure you avoid common pitfalls rested, is grinding its choppers away. that disrupt your ability to get “The collateral damage has just been restful sleep.” incredible,” says DC dentist Brian > Get a flu shot. “Getting a flu Gray of the pandemic-meets-election shot during the pandemic is season’s effect. Part of that damage important because it is possi- is due to stress-related clenching ble to get both influenza and and grinding, which causes people to COVID-19, as they are two sepa- come in complaining of headaches, rate viruses,” she explains. jaw pain, or cracked or broken teeth. > Wash your hands regularly. Antidepressant medications can > Stay home if you are sick. cause teeth-grinding too. Gray esti- mates he’s making about 30 percent Read the full recommendations more night guards than he usually at: www.piedmont.org/living-better/ would. And it’s not just adults. Half how-to-boost-your-immunity- of orthodontist Jill Bruno’s clients are during-covid teenagers, and their teeth are taking a Better blog. Jemese Richards-Boyd, beating, too. “I’m not a psychologist MD, a Piedmont primary care physician, Sniffing out COVID or psychiatrist, but the stress of this shared ways you can boost your im- A recent Time article highlighted how time period, it manifests in different mune system and protect your health: dogs might play a role in detecting people in different ways,” says Bruno. > Exercise. “Moderate exercise COVID-19 infections. One hint – their “The oral cavity, the mouth, takes can boost immunity by increas- noses. Steve Lindsay, a public health a lot of the brunt.” Bruno estimates ing blood flow and helping to entomologist at Durham Univer- that about 25-to-30 percent of her reduce chronic stress,” says Dr. sity, along with collaborators at the patients have come in after grinding Richards-Boyd. London School of Hygiene & Trop- through their night guards, retainers, > Proper diet. “In general, a poor ical Medicine (LSHTM) and the U.K.- or aligners. diet and lack of nutrients can based nonprofit Medical Detection interfere with the activity of Dogs, are working on a U.K. govern- Protect your your immune cells and possibly ment-funded study that will test dogs’ immune system even the production of different ability to detect COVID-19. Their It’s critical to protect your immune immune cells,” she says. “If you goal: to train coronavirus-sniffing system as we face both the COVID-19 lack the necessary nutrition and dogs, which could then be deployed pandemic and the 2020-2021 flu sea- become exposed to an infection, at schools, airports and other public son, according to a Piedmont Living your body may not be able to venues to reinforce existing nasal
42 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com swab testing programs. A similar with several musculoskeletal injuries with all things, the golf swing’s fre- study is underway at the University due to its repetitive nature, according quent repetition – compounded over of Pennsylvania. “We’re not just doing to U.S. News and World Report. One years of playing the sport – places the proof of concept work, we’re also of the most common complaints significant stress on those muscles, working out actively how to deploy reported by golfers is low back pain, joints, and tendons. Over time, this this and scale it up as well, because we with reported rates varying from 26% may result in injury. want to hit the ground running once to 52%. Low back pain is also a major Understanding the mechanics we’ve gotten our results,” says James health issue among adults in the of the golf swing, along with educa- Logan, the head of LSHTM’s Depart- general population. Given the high tion and training, can help prevent ment of Disease Control and the prevalence and high cost of low back golf injuries. It’s important to use project lead on the U.K. study. Read pain care, it’s worthwhile to consider proper posture and proper sequenc- about the studies at: https://time. how to prevent golf-associated low ing, and not to over-swing. Swing- com/5898049/covid-19-sniffing-dogs. back pain. ing too hard may increase the stress While the golf swing seems like placed on the spine and surrounding A golfer’s guide a relatively easy motion, it is actu- structures… Read the full article at: to low back pain ally an extremely complex series https://health.usnews.com/health- Golf is often thought of as a low-im- of motions that involve most of the care/for-better/articles/a-golfers- pact sport, but it can be associated muscles and joints in the body. As guide-to-low-back-pain > People
People News
Founder, former CEO smiles, I am confident that Jeff sincerely look forward to contribut- of Mortenson Dental has the experience and vision to ing to and taking this already great Partners retires lead Dental Care Alliance into the organization to the next level.” Wayne Mortenson, DMD, who next stage of growth,” stated Jerry founded Mortenson Dental Part- Rhodes, Chief Executive Officer Hinman Dental Meeting ners with his wife, said he would for DCA. “The demonstrated way executive director retiring in May retire from the DSO September 30. in which he cares for the business The Thomas P. Hinman Dental Dr. Mortenson and his wife, Sue and its people are distinctively Meeting announced that its longtime Mortenson, opened their first dental aligned with our mission and val- executive director, Sylvia Ratchford, practice, Mortenson Family Dental, ues. He has an unbridled passion will retire in May 2021, following her in Middletown, Kentucky, in 1979. for healthcare and innovation, and 25th Hinman meeting. Ratchford has The DSO now includes 140 prac- is committed to driving results for led the Hinman Dental Meeting and tices across nine states and employs the future at DCA.” Hinman Dental Society since 1996, nearly 1,800 people. The retirement growing it to its peak of more than announcement comes two years 23,000 attendees and 430 exhibiting after Dr. Mortenson stepped down companies, according to the orga- from his CEO role to serve as an nization. She will be succeeded by executive adviser. He plans to stay Annette Sullivan. an active member of the DSO’s board “For the past 24 years, Sylvia of directors and lead the Mortenson has been the lifeblood of Hinman Charitable Foundation’s efforts with and has played a very critical role his wife, the company says. DSOs, in making Hinman the success it is Dental Providers, & Insurance today. She has been a tremendous leader who has been instrumental Dental Care Alliance in growing Hinman and maintaining names former Walgreens Jeffrey Koziel its position as the premiere dental exec as new president meeting in the country,” said Dr. L. Dental Care Alliance named Jeffrey “I’m thrilled to join the Dental Maxwell Ferguson, Chair of the Hin- Koziel as its new president. Most Care Alliance family,” Jeff shared. man Board of Trustees. “We are sad recently, he served as senior vice pres- “We are undoubtedly in challenging to see her retire, but greatly appreci- ident, pharmacy and retail operations, times, but as it goes, I believe it will ate her many contributions over the with responsibility for day-to-day enable our greatest opportunities. years, including the capable team operations supporting Walgreens’s Already, I’ve learned much about the she has developed. We are fortunate more than 9,300 locations. commitment and dedication of DCA’s that she is able to stay on through “As DCA looks ahead to our affiliated practices and the patients May to work alongside and share her fourth decade of creating healthy and team members that we serve. I experience with Annette.”
44 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Ratchford has more than 40 with the goal of transitioning many effective October 19. Dr. Klemmed- years of experience in the hospi- of Ratchford’s duties by the end of son has been actively involved at tality, meeting planning and asso- year. Sullivan brings more than 20 the ADA for many years, serving on ciation management industries. years of experience in the hospital- the ADA Council on Dental Benefit Prior to assuming the role of Exec- ity and meeting planning industry. Programs from 2007 to 2011 and a utive Director at Hinman, Ratchford Her most recent position was with strategic planning committee from worked in sales management for the Georgia World Congress Center 2009 to 2012. From 2019 to 2020, nine years at The Westin Peachtree where she was a member of the Dr. Klemmedson served as presi- Plaza. She then worked another national convention sales team. She dent-elect of the ADA. nine years at AmericasMart, includ- also has worked on the sales team In addition to Dr. Klemmedson’s ing the pre-opening of INFORUM, for the Atlanta Convention & Vis- achievements at the ADA, he is a where she was responsible for the itors Bureau in Atlanta and spent past president of the Arizona Den- marketing and sales of the exhib- 10 years in Washington, D.C. work- tal Association, Southern Arizona its and meeting space in all four ing with associations. She worked Dental Society, Western Society of buildings. Ratchford has served for the Sacramento Convention & Oral and Maxillofacial Surgeons on the board of the Atlanta Con- Visitors Bureau and Chicago Con- and Arizona Society of Oral and vention and Visitors Bureau and vention & Tourism Bureau bringing Maxillofacial Surgeons. Through- as President of the Southeastern associations to each of those desti- out his career, Dr. Klemmedson has Chapter of the Professional Con- nations. Prior to being on the sales earned multiple awards, including vention Management Association. side, her association experience the Dentist of the Year Award and She is also a long-time member of includes management roles with the the Hall of Fame Service Award the International Association of National Association of Computer from the Arizona Dental Associa- Exhibitions and Events. She earned Consultant Businesses and Associ- tion. In 2018, he received the Ger- her bachelor’s degree in fine arts at ated Builders & Contractors. “We ald E. Hanson Outstanding Service the University of Georgia. Ratch- are thrilled to have Annette join Award from the Oral and Maxillofa- ford looks forward to moving near Hinman as our new Executive Direc- cial Surgery Foundation. her hometown of Gastonia, N.C. tor and lead the meeting into the Dr. Klemmedson is a fellow of and spending time on Lake Wylie future. Her experience and unique the American Board of Oral and with family and friends. “The past perspective will play an important Maxillofacial Surgery, as well as a 24 years have been a blessing for me role in positioning Hinman for years member of the Academy of Den- both professionally and personally. to come,” said Dr. J. Sedgie Newsom, tistry International, American Cleft My hope is that the many relation- President of the Hinman Dental Palate-Craniofacial Association and ships I’ve formed with colleagues Society. “While she certainly has big American Medical Association. He and friends, as a result of Hinman shoes to fill, we are confident that has received fellowships from the and my career in Atlanta, will be Annette has the expertise to guide American College of Dentists, Inter- lifelong,” said Ratchford. “Annette and shape Hinman and successfully national College of Dentists and is well respected in the Atlanta hos- navigate the challenges that the Pierre Fauchard Academy. pitality community and I feel confi- pandemic has created.” President-elect Cesar R. Sabates, dent that Hinman is in very capable Second Vice President Maria Maranga, hands going forward. I know that ADA installs Daniel and five new trustees also assumed the Hinman leadership, members Klemmedson as office on October 19. and staff will support her as well as new president they have me over the years. Daniel J. Klemmedson, DDS, MD, AAOMS names new president Native Atlantan Annette Sulli- assumed the position as president The American Association of Oral van began working full-time recently of the American Dental Association, and Maxillofacial Surgeons (AAOMS)
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 45 > People
(Irving, TX) named Dr. B.D. Tiner, Dental, she headed her own con- dle East, from Oakland University DDS, MD, as its new president. He sulting firm where she worked with in Rochester, Michigan. As a former officially began his one-year term DSOs and solo practices to analyze executive of one of the country’s larg- on Oct. 11. Dr. Tiner served as pres- all aspects of the revenue cycle. est DSOs, Holder has been a member ident-elect for AAOMS last year, of ADSO, NDEDIC, AADGP, NADP serving as VP the year prior to that. and sat on the DSO Advisory board He has been an active member of for NADP. In 2015, Holder was a Ste- the organization for 37 years. Dr. vie Bronze Medal winner for National Tiner is a surgeon with Alamo Max- Businesswoman of the Year and a illofacial Surgical Associates, a Rising Star Award nominee for the partner practice of U.S. Oral Surgery National Dental EDI Council in 2016. Management (USOSM). Western Dental promotes Mid-Atlantic Dental Patricia Himpelmann to SVP, Partners promotes Specialty Services Pamela Holder to Western Dental appointed Patricia chief revenue officer Pamela Holder Himpelmann as SVP, Specialty Mid-Atlantic Dental Partners an- Services. Himpelmannis expanding nounced the promotion of Pame- “Pam is one of the best examples her role to include responsibility la Holder to chief revenue officer. of how you can accomplish anything for operational support of all dental In her new role, Holder will oversee you desire if you are dedicated, hum- specialties, including oral surgery, revenue operations companywide ble and willing to work hard,” said periodontics, endodontics and pedi- and the growth and expansion of Leigh Feenburg, Chief Operating atric dentistry. Himpelmann joined Mid-Atlantic Dental. Holder brings Officer of Mid-Atlantic Dental - Part Western Dental in 2015 as VP of Soft more than 12 years of dental and ners. “Pam has touched the lives of Tissue Management, a role in which healthcare revenue experience to literally thousands in her career, leav- she developed a hygiene program her role at Mid-Atlantic Dental. ing the most positive impressions on and recruited and deployed nearly She joined the company in Janu- those she supports and advancing so 150 hygienists across the company. ary 2019 as VP of revenue cycle and many careers of those she has led.” She has also developed and launched was promoted to SVP of Revenue Holder holds a Bachelor’s Degree key initiatives for dental implants Cycle Management the following in Political Science, with a concen- and a variety of other oral health year. Prior to joining Mid-Atlantic tration in Foreign Policy of the Mid- care products and services.
Dental News
Heartland Dental celebrates doctors choosing the company so far administrative management relief, record growth of newly this calendar year. or plan their transition as they think supported practices “We have seen an incredible about retirement,” said Patrick Bauer, Heartland Dental has welcomed a response in our recent doctor affili- Heartland Dental President and CEO. record number of supported prac- ations, many of whom want to grow “Others are simply seeking support tices in 2020 with more than 100 their practice, gain non-clinical and connection during this time.”
46 Efficiency In Group Practice : ISSUE 6 • 2020 dentalgrouppractice.com Heartland Dental provides necessary. Individuals who receive Western Dental opens non-clinical administrative sup- services through the Division of new office in California port so dentists and their teams Developmental Disabilities Services Western Dental & Orthodontics can focus on delivering high-quali- (DDDS) may be eligible for addi- announced the opening of a new ty clinical care and excellent patient tional dental coverage once they Western Dental & Orthodontics experiences. Heartland’s support exhaust their Medicaid benefit. office in Lemon Grove, California. includes assistance with human The new 4,500-square-foot office resources, marketing, IT, supplies, USOSM announces new provides a full range of dental insurance credentialing, account- partnership in Georgia services, including general dentistry, ing, and more. The company also U.S. Oral Surgery Management orthodontics, oral surgery, dental provides supported doctors and (USOSM) (Irving, TX) has formed implants and oral hygiene services. hygienists with an abundance of a new partnership in the Atlanta, It has 12 operatory and exam rooms, continuing education programs and Georgia, area. The newest partner including four treatment rooms leadership development opportu- is Richard E. Paul, DMD, PC, Oral dedicated to endodontics and pedi- nities. Heartland Dental says its and Maxillofacial Surgery, which atric dentistry. With the addition of growth trajectory also includes its has locations in McDonough and the new office, Western Dental now recent expansion of support into Griffin. With more than 25 years operates 234 offices in California. A the state of Idaho. of experience in oral surgery, Dr. virtual open house and ribbon-cut- Paul practices a full scope of oral ting ceremony are planned. Delaware adds dental coverage and maxillofacial surgery with for adults on Medicaid particular expertise in dental North American Dental Group As of October 1, adults in Dela- extractions and dental implants. adds 17 affiliated practices ware who receive Medicaid will He also treats patients with oral North American Dental Group (NADG) get dental coverage as part of pathology and maxillofacial inju- has welcomed 17 new dental offices their plan. Governor John Carney ries. This new partnership comes across six states since the start of the signed legislation establishing the on the heels of USOSM’s recent fall season. NADG now supports more Medicaid adult dental benefit in announcement of a new partner- than 240 dental practices and nearly August 2019. Implementation was ship with Oral Surgery Associates & 500 full-time dentists across 15 states. originally scheduled for April 2020, Dental Implant Centers, also in the The 17 newly affiliated practices, but was delayed by the coronavirus Atlanta, Georgia, area. DSOs, Dental which employ over 30 doctors, repre- pandemic. Beginning Oct. 1, indi- Providers, & Insurance. sent partnerships with six different viduals ages 19-65 who are enrolled dental groups, including: in a managed care Medicaid plan PepperPointe DSO nearly > Aura Smile Dental with two will receive their adult dental doubles through practice buys Cleveland, Ohio area locations. services through that plan and can PepperPointe Partnerships (Lexington, > Three practices in the Pensac- obtain a list of providers from their KY), a dental service organization, ola, Florida area – Sorrento managed care organization. The has added 37 independent dental Dental Care, Aggie Dental benefit will cover a wide variety of practices in Kentucky to its busi- Center and Bright Downtown services, including exams, clean- ness, growing its network to include Dental Arts. ings, fillings, sedation, and regular 92 office locations, 85 doctors, and > Two Dallas, Texas area implant tooth extractions. It will cover $1,000 more than $100 million in revenue. and orthodontic practices in of dental care per year; an addi- Founded in 2017, PepperPointe Southlake and Watauga. tional $1,500 per year may be avail- offers its practices support with > Snodgrass-King Dental with four able for qualifying emergency or nonclinical tasks; practice owner- Nashville, Tennessee area prac- supplemental care when medically ship is maintained by doctors. tices in Cool Springs, Mt. Juliet,
dentalgrouppractice.com Efficiency In Group Practice : ISSUE 6 • 2020 47 > News
Murfreesboro and Spring Hill. dental programs that want masks pediatric and oral surgery dental > Southeast Orthodontics with are only being charged by ADEA faculty and residents, anesthesiolo- five Southeast Massachusetts for shipping and handling —not the gists, a social worker, auxiliary staff practices located in Dartmouth, masks themselves. Neither ADEA and a nurse, among others. The out- Lakeville, Mansfield, Nantucket nor Henry Schein is profiting finan- patient care center is shared with and Raynham. cially from this initiative. In total, the Department of Pediatric Den- > BWS Oral and Maxillofacial ADEA and Henry Schein are distrib- tistry and the Department of Oral Surgery in New City, New York. uting close to 3 million masks to and Maxillofacial Surgery and rep- 290 U.S. dental schools and allied resents a collaboration to support NADG also welcomed the following dental programs. the communities seeking complex principals from these new groups oral health care at UIC. A dedication into servant leadership roles at NADG Pacific Dental Services and formal opening for the ILCHF as Group Founders, lending their now has 600 supported PD-OCC is planned for spring 2021. clinical expertise to other supported owner dentists doctors at affiliated practices: Pacific Dental Services (Irvine, CA) 5 Dentists elected to Congress > Dr. Douglas Voiers at Aura has partnered with Mehran Khan- In the November election, five Smile Dental. babapour, DDS, of Trails Dentistry dentists were elected to Congress, > Dr. Christopher Campus at Sor- (Scottsdale, AZ). Dr. Khanbabapour the Advisory Board and the Amer- rento Dental Care, Aggie Dental is the 600th supported owner ican Dental Association reported. Center and Bright Downtown dentist to join the DSO. “Welcoming The dentists elected to the House of Dental Arts. our 600th supported owner dentist Representatives are: > Dr. David Snodgrass and Dr. John is an incredible achievement,” said > Rep. Drew Ferguson, DMD, R-Ga. King at Snodgrass-King Dental. Stephen Thorne IV, CEO and > Rep. Mike Simpson, DMD, R-Idaho > Dr. Brian Gaudreault at South- founder of Pacific Dental Services. > Rep. Paul Gosar, DDS, R-Ariz. east Orthodontics. “We’re honored that so many owner > Rep. Brian Babin, DDS, R-Texas > Dr. Bart Silverman at BWS Oral dentists have trusted us to provide > Rep. Jeff Van Drew, DMD, R-N.J. and Maxillofacial Surgery. support services to them and their clinical practices.” Benevis acquired by ADEA, Henry Schein, and New Mountain Capital FEMA partner to donate PDIC opens Pediatric Dentistry LT Smile Corporation (known as masks to U.S. dental schools Outpatient Care Center “Benevis”) was acquired by New The American Dental Education The University of Illinois Chicago Mountain Capital under Section 363 Association (ADEA), Henry Schein, College of Dentistry recently opened of the U.S. Bankruptcy Code. Benevis Inc. (Melville, NY), and the Federal the Illinois Children’s Healthcare provides non-clinical business Emergency Management Agency Foundation Pediatric Dentistry Out- support services to over 150dental (FEMA) are partnering on an patient Care Center (ILCHF PD-OCC). offices in more than 15 states, initiative that will provide dental The new center plans to serve 1,000 treating over two million patients schools and allied dental educa- children annually from ages 3 to annually. Benevis’ supported dental tion programs with KN95 masks 17 years who need oral healthcare practices offer patients general to be used for patient care. Henry under general anesthesia. The cen- dentistry and specialty care, including Schein will distribute the FEMA-do- ter includes four procedure rooms orthodontics and oral surgery and nated masks to dental schools and for oral surgery procedures and primarily serve the pediatric State programs within the U.S. that two general anesthesia suites for Medicaid and commercial payer request an allotment from the pediatric dental care. The center’s markets. Terms of the acquisition ADEA. Dental schools and allied inter-professional teams consist of were not disclosed.
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