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Learn how to identify drug-seeking patients in upcoming webinar

An upcoming webinar aims to educate dentists on how to interview patients with addiction problems and identify those who are just seeking drugs.

prescription drugsInterviewing and Counseling Patients with Substance Use Disorders and Drug-Seeking Patients is scheduled for Feb. 18 from 2-3 p.m. Central time. Michael O’Neil, Pharm.D., professor of pharmacy practice at South College in Knoxville, Tennessee, will lead the webinar and review basic interview and counseling skills that help optimize patient care and protect dentists from patients who may have criminal intent.

Dentists may find themselves the targets of prescription drug diversion scams and schemes and the webinar will provide tips on how to talk to patients about their intentions and counseling that will help minimize risks to the patient and dentist.

To register, contact Alison Siwek at siweka@ada.org. Registration closes Feb. 16.

Integrating checklists into your practice is key to get things right

Time outs are performed minutes before a procedure begins. In dentistry, this is commonly done before an extraction or a root canal. Do I have the right patient? Is the correct radiograph displayed? Is the necessary equipment present? Do I know which tooth? How often do we breeze through this checklist or not read it at all?

Dr. Carolyn Norton

Dr. Carolyn Norton

The Checklist Manifesto by Atul Gawande shows how checklists which identify critical steps or points of failure can make up for our own human inadequacies. Checklists don’t stop at the example above. As the volume of dental procedures I preform increases every day, I have developed my own mental checklists to make sure I’m working efficiently and producing quality dentistry. Even your morning huddle is a checklist.

In 2001, a central line placement checklist was implemented at Johns Hopkins Hospital by critical care specialist Peter Pronovost. Nurses were allowed to intervene if they saw a doctor not following the checklist. After two years of data collection, the central line infection rate went from 11 percent to zero. Dr. Pronovost found that checklists, “establish a higher standard of baseline performance, help with memory recall, and set the minimum necessary steps in a process.”

When the World Health Organization (WHO) contacted Gawande in 2006 to help create a solution to prevent death and/or harm in surgery throughout the world with no funding, Gawande went to visit a master of checklists, Daniel Boorman from the Boeing Company. Aviation heavily relies on checklists. “Only 1 in 500,000 flights ever suffers an accident of any kind.” Was your last flight delayed for 45 minutes due to maintenance? Someone was using a checklist.

Mr. Boorman says checklists must be “precise and to the point. They do not try to spell out everything — a checklist cannot fly a plane.” He suggests keeping the list between five and nine items. It should take no more than 60 to 90 seconds to run the list. “You must define a clear pause point at which the checklist is supposed to be used.” My favorite part of this book: a checklist for making checklists is provided in the appendix.

Dr. Gawande’s WHO safe surgery checklist included seven checks before anesthesia, seven checks before the first incision, and five checks before removing the patient from the operatory. The effect of their safe surgery checklist was studied in eight hospitals around the world. In every hospital, complication rates fell 36 percent and deaths fell 47 percent. Seventy eight percent of hospital staff “actually observed the checklist to have prevented an error in the operating room.” When asked if they wanted the checklist used if they were to have surgery, 93 percent of hospital staff said “yes.”

After reading Dr. Gawande’s book I see checklists all around me, and I believe they work. No one is perfect, and checklists are great tools to help even doctors to get things right. “The volume and complexity of what we know has exceeded our individual ability to deliver its benefits correctly, safely, or reliably. Knowledge has both saved us and burdened us.”

How do you use checklists in your dental practice? Share your best ideas and checklists with us below.

 

Dr. Carolyn Norton is a New Dentist Now guest blogger and a 2014 graduate of the University of Florida College of Dentistry. She is half way through a 12-month general practice residency at the North Shore University Hospital in Evanston, Ill., affiliated with the University of Chicago. Dr. Norton was a contributing editor for the American Student Dental Association from 2012-14.

 

Dental spending growth slower

According to ADA News, government actuaries cited slower growth in dental spending than projected just three months earlier in a study revising the post-recession National Health Expenditures narrative from “low rates of growth” to “slowdown.”

Annual growth of dental servicesThe 3.6 percent increase in the 2013 rate of growth in the overall health economy is the lowest on record since NHE record keeping began in 1960, the Centers for Medicare & Medicaid Services Office of the Actuary said.

CMS actuaries in a September 2014 report had projected that 2013 dental spending would total $113 billion at a 1.9 percent annual growth rate. The study published in December 2014 by the journal Health Affairs said actual dental spending increased by just 0.9 percent to $111 billion.

Dental services spendingDental spending and the annual growth rate had been inching upward since 2009 when it increased minimally from $102.4 billion to $102.5 billion or 0.1 percent over 2008. The 2013 growth rate is the lowest since then.

To read the full article, click here.

IHS dental externship applications due Feb. 28

For dental students wondering whether a career with the Indian Health Service Division of Oral Health or a position at a specific IHS or Tribal site is right for you, an IHS externship can give you the experience to help make your decision.

IHSThe IHS Division of Oral Health (DOH) is currently accepting applications for 2015 Dental Externships. If you are seeking a life-changing cultural and pre-professional experience, we encourage you to apply. The application cycle is open from Jan. 2 to Feb. 28.

According to IHS.gov, externs will have the opportunities to work in the state-of-the-art facilities, in a career position with excellent pay and benefits, Loan Repayment Program, job stability, potential for advancement and mentoring by experienced staff, and the opportunity to provide much-needed care to appreciative patients.

For more information on IHS dental externships and how to apply, click here.

Dentist ranked top 2015 occupation

“Dentist” is number one on U.S. News & World Report’s list of best occupations of 2015 for offering “a comfortable salary, low unemployment rate and agreeable work-life balance.” Dentists also top the publication’s list of best health care occupations.

“Dental hygienist” is number 5 on the top 100 list and number 4 on the health care list, which has “dental assistant” at number 67.

“Today’s students want it all. And dentistry really does deliver that. What other profession allows you to care for patients, make a good living, work as part of a team and have flexibility?” said Dr. Richard W. Valachovic, president and chief executive officer of the American Dental Education Association.

The U.S. News & World Report quoted Dr. Ada S. Cooper, an ADA consumer adviser, on the process of becoming a dentist and professional opportunities that “will find you – you won’t need to hunt them down.” It’s also a good idea to get involved in local and state dental associations for networking purposes, the report said.

To read U.S. News and World Report’s full review on dentists, click here.

Know anyone who has volunteered internationally?

Do you know a dentist who has generously given their time, talents and skills by volunteering internationally?

Int'l Volunteer Svc LogoApplications are due April for the Certificate for International Volunteer Service, a program that recognizes ADA members who have volunteered in developing countries to improve the oral health and overall health of individuals.

Criteria for applying for and receiving the certificate include:

  • Be an active, life, student or retired member of the American Dental Association.
  • Have served in an international location with a program sponsored by a dental school or recognized nonprofit organization for a minimum of 14 days, either in one period or in several visits, in any 24-month period.
  • Have provided clinical dental service and/or taught local dental personnel or assisted in training initiatives to improve the local oral healthcare infrastructure.
  • Supply evidence of the dates of the service with a comprehensive, detailed breakdown of activities and the value of the contribution by means of a letter or testimonial from the director of the program or other appropriate official (for student members working in a dental school program this requirement shall be the responsibility of the dean or director of the outreach program).
  • Be nominated by a component or constituent society, federal dental service or dental school.
  • Be verified in writing to be a member in good standing by the component society, if such exists, or by the constituent society, commanding officer or dean of the dental school as appropriate.

Nominations are reviewed by the ADA Board of Trustees at the June meeting. Recipients will be announced within 30 days of the meeting and the certificates will be distributed to the recipient, or to the nominating component or constituent societies upon request. A certificate may be awarded to the same individual more than once.

For more information on the Certificate for International Volunteer Service or to submit a nomination, click here.

Know the difference between accidents and signs of domestic violence?

In a year where high-profile accusations of family violence have rocked the National Football League, the ADA House of Delegates streamlined Association policy on family violence during its meetings at ADA 2014 — America’s Dental Meeting in San Antonio, according to ADA News.

An employee crying

Resolution 89H-2014, Educating Dental Professionals in Recognizing and Reporting Abuse, states that “the ADA supports educating dental professionals to recognize abuse and neglect across all age groups and reporting such incidences to the proper authorities as required by state law.” The House rescinded policies from 1993 and 1996.

“Family violence has been a hot topic in the news media as high-profile players in the NFL have been accused of violence against children or partners,” said Dr. Lynn Douglas Mouden, chief dental officer for the Centers for Medicare & Medicaid Services. “There is a universal mandate for U. S. dentists to report suspected cases of abuse or neglect of children, but dentists should also be aware that some states also mandate reporting cases that deal with adults and elders as well.”

Are you able to discern the difference between accidents and intentional injuries or signs of violence? Do you know what your state’s law in regards to reporting family violence?

If your answer is “no,” Dr. Mouden suggests attending the 7th Biennial National Conference on Health and Domestic Violence, set for March 19-21, at the Renaissance Washington, D.C. Downtown Hotel.

“With training, dentists are better able to discern the difference between accidents and intentional injuries, or between otherwise normal conditions and the signs of violence,” Dr. Mouden said. “Because laws vary from state to state, dentists should work with their state dental association to learn more about the laws regarding reporting of family violence and about opportunities to learn more about preventing family violence.”

For more details on the conference, hotel accommodations or to register, click here.

10 steps to increase provider participation in Medicaid/streamline administration

Here are 10 steps to increase provider participation in Medicaid and to streamline the administrative process from Action for Dental Health, a nationwide, community-based movement aimed at ending the dental health crisis facing America today.

Action for Dental Health

  • Step 1: Talk with the manager of Provider Enrollment for your state and review the process for enrolling in the Medicaid program. Confirm basic information such as documentation expectations, electronic filing and ability to participate on a limited basis.
  • Step 2: Identify populations of interest that your practice will serve. Determine how those patients will access your practice, whether via local community outreach or referrals from the local community health center after being triaged.
  • Step 3: Discuss with your state dental association the current baseline of provider participation and the data that will be coordinated as reported by your state to the Centers for Medicare and Medicaid Services in its CMS 416 report. This information is the basis for determining what positive results are being seen due to increased provider participation.
  • Step 4: Participate in a state Dental Medicaid Advisory Committee or form a committee if one does not exist in your state. Invite other Medicaid providers, both private practice dentists and those working within community health centers, to participate.
  • Step 5: Review Medicaid rates, prior authorization and enrollment processes for your state. Are adult Medicaid benefits available? Was there an increase in providers if rates were increased? Learn what negotiation and compromise efforts were performed.
  • Step 6: To streamline your credentialing and provider eligibility process, review those states making a positive difference (Oklahoma, California, Maryland and Kentucky). Invite the people who perform the enrolling process to your Medicaid advisory committee to investigate what might be done in your state to expedite credentialing.
  • Step 7: Meet with the manager of your state Medicaid Integrity Program to learn of the processes they follow for chart audits and review. Explain the need for uniform compliance training for auditors for reviews. Discuss with your Medicaid Advisory Committee.
  • Step 8: Maintain strong lines of communication with the state Medicaid program, the state oral health program, the ADA and Medicaid-CHIP Dental Association who can be resources for you.
  • Step 9: Share program successes and failures with your local dental society.
  • Step 10: Write an article for your state dental association journal about your Dental Medicaid Advisory Committee, your experiences in treating the underserved and the value that dentistry can provide in communicating with the local medical community about the importance of integrating oral health for patient overall health.

To view the full 10-step process, click here. For more information about the ADA’s Action for Dental Health, visit ADA.org/action.

Life as a new dentist — Pediatric dentist

Dentistry is made up of individuals. Here’s one of them.

Dr. Colleen Greene

Dr. Colleen Greene

Who are you?

I’m Dr. Colleen Greene, a second year resident in pediatric dentistry at Children’s Hospital of Wisconsin. In 2013 I graduated from the Harvard Schools of Dental Medicine and Public Health with DMD and MPH degrees, respectively. I remain actively involved in ASDA as a past president and, most recently, co-chaired the National Leadership Conference in Chicago. This summer I will transition from resident to full-time attending in our hospital-based residency program. Fun fact: My husband was also my senior prom date in high school.

How did you get into dentistry?

My high school chemistry teacher encouraged me to consider aiming for medical school. I’ll never forget coming home and telling my mom about this exciting encouragement. Her response:  “Well, you could, but you’d be in school until you’re 30!” We laugh now at the accuracy of her prediction, since I am now exactly 30 years old and almost done with residency. Her larger point was to consider the work-life balance between a traditional career in medicine and other rigorous health care professions. To me, dentistry combined the community impact of working as a physician with the joys of working with my hands, business responsibilities and work-life flexibility.

Dr. Green (far left) celebrates her 30th birthday with coworkers.

Dr. Greene (far right) celebrates her 30th birthday with coworkers.

What attracted you to pediatric dentistry?

Growing up in a low-income family covered by Medicaid, my parents struggled to find a dental home for us. I remain really concerned about the limited access to pediatric dental care. These frustrations still fuel my drive to minimize barriers to care and I’m really optimistic about the growing public health consciousness of dental school graduates. Whether in a pediatric or general practice, there is a critical need for enthusiastic providers for children from low-income families. I want to fill that gap.

What do you say to new dentists who may be interested, but will rule out a position in working at a hospital, as oppose to working at or starting a practice?

It’s hard to balance out an interest in public health with the competing need to avoid personal bankruptcy! Student debt is a giant factor for many dental students, myself included. The benefit of pursuing hospital dentistry is that large health care systems tend to be financially more stable than independent community health clinics and therefore compensate very fairly while handling lower reimbursements. I’m impressed with the comprehensive benefits package at my hospital and thrilled to help fill a big need for more dental providers in our state. It’s the best of all worlds at this point in my career.

Any advice for someone wanting to follow your career path?

Remain as open-minded as possible to every opportunity that comes your way. Get involved in activities you enjoy that you believe will make a meaningful impact in your community, for patients and colleagues. Take it one year, one semester or one day at a time. Avoid the regret of playing it safe and not exploring the chances to serve that will come your way.

If you could have any job other than dentistry, what would it be? Why?

It’s honestly hard to think of a different job that would better blend all of the things I love to do: talk, write, educate, comprehensively manage cases, surgically restore health, etc. It’s a great gig! I love the varied responsibilities. You’ve stumped me.

Dr. Greene recently participated in the new ADA Practical Guide to Internet Marketing, co-authoring a chapter on blogging. Interested in sharing your experience as a new dentist? If you are fewer than 10 years out of dental school we’d love to hear from you! Contact us at newdentist@ada.org

Millenials in dentistry: When generations collide

In a Dental Economics article, Dr. Ryan Dulde asks and explores the question: What happens when tech-savvy, hyperconnected narcissists take over the dental profession?

“As more baby boomers plan retirement, millennials are arriving in dental practices as associates or partners,” according to Dr. Dulde, who co-founded the National Leadership Conference for the American Student Dental Association. “Generations clash when millennial dentists must share their work environments with hiring/selling dentists who are often of the baby boomer generation and an office staff that can span across two or even three different generations.”

Dr. Dulde also explored the stereotyping of millenials, their work-life integration, their use of technology and their optimism.

“Make no mistake: Millennials are anything but lazy,” Dr. Dulde said. “We’re a creative, entrepreneurial, high-achieving generation ready to work hard for our ambitious goals and a sense of purpose. It may not be a perfectly smooth transition, but dentistry can look forward to strong leadership from the next generation.”

To read the full article, click here.