This question is being raised in the Northwest where a Washington state dental practitioner bill passed through the Senate Health Committee.  The Senate version of this legislation moves out of committee and can potentially be considered by the full Senate.

If this bill passes in the Senate, Washington will be the next U.S. state to adopt a mid-level dental provider model to create both dental hygiene practitioners and dental practitioners, who will be supervised (offsite) by a dentist.

These practitioners will be allowed to provide various levels of dental care “pursuant to a written practice plan with a dentist.”

Dental hygiene practitioners would expand the scope of practice of the state’s hygienists, who can now place fillings after a dentist has done the prep work. They would receive specialized training to do extractions, handle medical emergencies, and administer some drugs.

Dental practitioners would be permitted to do everything that hygienists can do except scaling and cleanings. They could also do restorations, administer anesthesia, and extract primary teeth as well as loose permanent teeth (+3 to +4 mobility).

Both types of practitioners could work with offsite supervision if approved by their supervising dentist, but neither could do dental crowns, bridges, or complicated procedures. (Dr Bicuspid)

The Washington Academy of General Dentistry and the Washington State Dental Association oppose this bill siting, “insufficient training for diagnosis and a lack of direct supervision.”

What are your thoughts on mid-level dentist practitioners? Are they bad for dentistry?

For more: Washington Lawmakers Mull Dental Therapist Bills

Behind the times and not up-to-date on current dental issues, that’s where they’d be without continuing education.

One dentist, who does one hundred hours of continuing education a year says, “The State shouldn’t have to dictate a minimum number of hours of continuing education, but dentists should take much more that fifteen hours mandated by the State of Virginia!”

An Illinois dentist, who completes one hundred and seventy-five hours a year scoffed, “The State continuing education requirements are ridiculously low. Illinois only requires thirty-two hours every two years, and they don’t have to all be health care topics!”

The Wealthy Dentist conducted a survey that asked dentists how many hours of formal dental continuing education they logged each year.

Dentists are often required to do only about ten hours a year. The dentists who responded to this survey do more. How much? Click on Play to watch the video and find out –

How many hours of dental continuing education do you complete each year?

Last week, he visited Hillsborough County Circuit Court to ask a judge to issue an injunction to bar the odors from his neighbor’s Twisted Cigar lounge from crossing over into his dental practice.

The Tampa Bay Times reports that the cigar lounge opened three months ago right next door to the dental practice and ever since Dr. Rahal’s patients have complained that his dental practice now smells like an ash tray.

The Times further reports that the court filing by Dr. Rahal alleges “noxious, unhealthful, damaging, disagreeable and offensive odors and stenches,” making the dental practice “unpleasant, uncomfortable, unhealthy and unfit for human habitation.”

In his own defense cigar lounge owner Jim Brown told the Times that he has tried to contain odors by resealing drywall and putting a smoke filter in the dental practice air conditioning unit. It was supposed to catch particles even tinier than smoke.

However, Dr. Rahal and his dental patients still feel where there’s smoke, there’s sink.

Fore more: Valrico Dentist Asks Judge to Clear the Air With Next-door Cigar Shop

Only 5% charge a fee for the first offense, while 39% charge a fee after the second missed appointment. 20% of dentists charge after the 3rd missed appointment.

With the current economic conditions, The Wealthy Dentist decided to ask dentists if they have been charging for missed appointments.

Boston’s Pilgrim Hospital is in the news this week for reveling that in the first 10 months of 2011 patients failed to attend almost 17,000 appointments. Thats about 49 missed medical appointments for every day of the year.

“Time is money!” complained one dentist, and he is right. A missed appointment is an appointment that can be filled by other patients. Missed appointment fees ranged from $25.00 for the first no-show to $2,500.00 after the third missed appointment. The average fee is $75.00.

The following dentist’s comments were selected to share how dentists are handling missed appointments –

Pre-paying is popular …

“We ask the patient to pre-pay for future appointments.” (Illinois dentist)

“Repeat offenders are put on ‘probation’ where they must pre-pay (the full price, non-refundable) before we will schedule them again. This way we don’t ‘fire’ them, they either pre-pay or leave the practice. They are usually on ‘probation’ until they consistently show up.” (Kentucky dentist)

“We have them pay before the appointment and if they break the appointment, the fee is deducted from their account.” (Missouri dentist)

“After three missed appts we will not reschedule unless they prepay in full for whatever the appointment is for. It works great. We have a great practice and people know the value that they receive here.” (Colorado dentist)

“We ask the patients who no show for 2 appts or more to prepay for further visits.” (General dentist)

“We just charge them little more when they come next. Also if they are entitled for any offers or discounts don’t give them that.” (General dentist)

Confirming helps …

“Confirm. Confirm. Confirm.” (General dentist)

“Have your patients give you the cell number where they receive texts and text them their appointment. Works like a charm.” (California dentist)

“We confirm by phone, email and text message.” (General dentist)

“We double book or call patient the morning of appointment.” (California dentist)

“We send a sms reminder the day before the scheduled appointment.” (General dentist)

Same day or on-call appointments only …

“After the second time we choose the option of putting the patient on our short call list only.” (Georgia dentist)

“We don’t give 3rd time offenders the opportunity to schedule in advance. We put them in our ‘Short Notice Club’ and call them when we have an opening or they can call to see if they can get in that day.” (Oklahoma dentist)

“After 3 missed, the patient must call on a day they would like to come in and see if there is an appointment available.” (Pennsylvania dentist)

“We don’t “fire” them but put them on a VIP list where we call them when we have a same day appointment available.” (New Hampshire dentist)

Fire them …

“My letter to the patient who I am dismissing is actually very nice. It states that our priorities do not match and that they would be better served by another dentist and to please let us know where to forward their records. A lot of times, the patient begs us to let them come back to the practice and they become our best patients ever about being there for their appointments even in bad weather, etc.!” (Alabama dentist)

“We send three letters and then dismiss patient with a 30 day emergency window so they have ample time to find a new dentist that will be more conducive to their schedule.” (Missouri dentist)

“You must get rid of them because you can not afford them. The other thought is to give them a stand-by appt. They may have to wait a while to be seen.” (North Carolina dentist)

“After a new patient reschedules/misses an appointment twice, we fire/do not reschedule. When existing patients break numerous appointments we notify them to call us on a day when they have extra /free time on their schedule and we will see if we can work them in at that time (this way we are not blocking an actual appointment for them). The best approach would be to require a credit card at time of scheduling to hold the appointment.” (General dentist)

How do you handle missed appointments? Have you ever “fired” a patient?

Deborah Lynn Kessler, 45, pleaded guilty to four counts of grand theft over charges that she embezzled more than $100,000 in dental insurance payments at the dental practice where where was manager.

The Orange County Register reports that Kessler signed dental insurance payments over to her personal bank accounts over the course of about three years. Investigators initially said she may have used the money to pay for an RV, boats and trips, and to cover her personal bills.

She was sentenced to two years in jail, plus an additional two more years of community supervision.

According to a 2010 Association of Certified Fraud Examiners report almost one-fourth of all embezzlement cases report losses of at least $1 million with smaller businesses being the most susceptible to fraud.

The average embezzlement scheme lasts for 18 months before detection.

The U.S Chamber of Commerce estimates that employee embezzlement costs American companies $20 billion to $40 billion a year. A long-term employee is 15 times more likely than a stranger to steal from a company.

Some of the best ways to prevent dental office embezzlement is by implementing a segregation of duties, keeping petty cash to a minimum and requiring dual signatures on checks.

Has your dental practice ever been the victim of employee embezzlement? What happened, and how did you handle it?

For more on the Orange County Register story see: Dental worker guilty of stealing more than $100,000

Of the 20 fastest growing occupations in the US economy, half are related to healthcare.

Healthcare is experiencing rapid growth, due in large part to the aging of the baby-boom generation, which will require more medical care. As healthcare costs continue to rise, work is increasingly being delegated to lower paid workers in order to cut costs.

For example, tasks that were previously performed by dentists are now beginning to be performed by dental hygienists and dental assistants.

As dentists‘ workloads continue to increase from treating the aging boomer population, it is expected that the demand to hire more hygienists to perform preventive dental care will grow as dentists will want to spend more time working on more complex dental procedures.

There is also the growing situation of not enough dentists to provide adequate care in rural areas where hygienists are needed to fill in the gap. According to the Center for Rural Affairs, in 2007, approximately 15 percent of rural residents were 65 years of age or older, 25 percent greater than in the nation as a whole.

The U.S. population of those 65 or older is predicted to double by 2030, reaching 20 percent of the U.S. total population, and the fastest group age living in rural America are residents 85 and older.

The average median wage for dental hygienists is $32.81 hourly, $68,250 annually with the best employment opportunities following the population size of states. New York, Texas, California, Michigan and Florida employ the most dental hygienists.

See: Occupational Outlook Handbook, 2010-11 Edition — Dental Hygienists

This is a heads up to all dental providers across the county. As states near bankruptcy, they will do everything in their power to raid healthcare benefits.

This all started when past California state Governor Arnold Schwarzenegger and law makers approved a state budget that eliminated all non-emergency dental care in the state Medi-Cal program.

The California dental clinics retaliated by suing the state because they felt the state did not follow the correct legal procedures in making the cuts to the state dental program. A federal judge blocked the Medi-Cal cuts from taking effect and California appealed the case to the U.S. Supreme Court.

In May of this year, the state of California met all the legal requirements to implement the cuts and won the right to eliminate all non-emergency dental care. Now the state of California wants back the reimbursements paid to clinics during the temporary reinstatement period from October 2010 – May 2011.

According to California Watch, Norman Williams, spokesman for the Department of Health Care Services, said in an e-mail that providers were warned during the court-order period that they may have to send back the money.

Jennette Lawrence Shea, director of government and community relations for Family Health Centers of San Diego told California Watch that their clinics provided 5,300 dental visits from October to May at sites throughout San Diego County and expects to be on the hook for about $850,000.

Dental clinics state-wide are bracing for the bills to arrive from the state –

What are your thoughts? Do you think dentists should have to repay the stat of California for the dental treatments they provided during the reinstatement period?

For more on this story see: State asking clinics to send back payments for dental care

Having the right dental associate relationship can ease a dentist’s workload considerably and help add to the bottom line, but the wrong dental associate can lead to disaster and financial ruin.

The Wealthy Dentist conducted a survey asking dentists if they have had bad experiences with dental associates.

One dentist summed up his dental associate disaster as, “Greedy. Dishonest. Stole patients. Stole leases.”

Some dentists love their dental associates, while other dentists hate them. Click on Play to hear what the remaining dentists in our survey had to say about dental associates –

What has been your experience with dental associates?

In a report by Sageworks, a leader in the financial analysis of privately-held companies, privately-held dentist offices have seen sales in 2011 decline about 3 percent after posting ongoing-though-shrinking gains in their top lines throughout the recent recession.

Sales growth rates for dentists in 2008 and 2009 were 5 percent and 15 percent, respectively, but dipped to 1 percent growth in 2010 before this year’s decrease.

Forbes.com reports that profit growth, too, has weakened.

Dentists have worked to keep costs and overhead down which has helped them maintain one of the highest net profit margins of private industries over the last 12 months, according to Sageworks data. Dentist offices had a 13.84 percent net profit margin in the 12 months ending Sept. 3, 2010, compared to the net profit margin of 14.15 percent in 2010.

The “2011 Survey of Dental Care Affordability and Accessibility” reported that 77% of the US are without dental care and put off visits to the dentist because of the cost of that care.

As the economy continues to crawl, more people may further opt to skip regular check-ups with their dentist because of increasing out-of-pocket expenses. Dentists will continue to struggle to maintain their profit margins, while trying to attract new dental patients.

It’s a vicious cycle that doesn’t look like it will be ending anytime soon.

For more on the Sageworks report see U.S. Recession Effects Gnaw at Dentists’ Business.

The Journal reports that FHSU president Ed Hammond testified during a meeting of the Home-and-Community-Based Services Oversight Committee that the university would develop a baccalaureate degree program to train registered dental practitioners in Kansas.

These “registered dental practitioners” would be responsible for routine dental treatments such as teeth cleanings, fillings and preventive care.

Previous bills written to establish a dentistry career track, similar to nurse practitioners working with physicians, have not been passed by Kansas House or Senate committees.

The Journal further states that this time around the Kansas Health Foundation is funding the Kansas Dental Project, a campaign to convince Kansas lawmakers that registered dental practitioners would improve services to Kansas by working in conjunction with dentists and dental hygienists.

They claim that currently 93 counties in Kansas do not enough dentists to serve their residents.

Fort Hays State University is the fastest growing of the Kansas Board of Regents universities. It is located in Hays, Kansas, and is a state, tax-assisted institution.

For more on this story in The Topeka Capital-Journal see: FHSU endorses new dental career path