Will Dentists Find Dealing with Insurance Exchanges a Disaster?

Will Dentists Find Dealing with Insurance Exchanges a Disaster?As of the first of this year, dentists and health care providers have been closely monitoring the changes being implemented due to the Affordable Care Act.

Under the Act, as of January 1 all U.S. states were supposed to notify the U.S. Department of Health and Human Services if they are creating online exchanges for the October 1, 2013, deadline when Exchanges are to be made available to anyone without insurance and small businesses throughout the U.S.

The Exchanges will allow the general public to go online to compare health insurance plans and buy health insurance from the state-operated health Exchanges, as well as insurance plans being offered by the federal government.

Stand-alone dental insurance plans and pediatric dental coverage will be offered by these Exchanges, but it is still not known if adult dental coverage will be offered separately from health insurance on these Exchanges and what the requirements for dental coverage will be within the Exchanges themselves.

The New York Times reported last week that Health and Human Services Secretary Kathleen Sebelius will extend the deadline for any states that expressed interest in creating their own exchanges or overseeing insurance sold through a federal exchange.

Thus far, only 18 states and the District of Columbia intend to run their own health insurance Exchange. In the states that decide not to set up their own Exchange the federal government will implement federal health insurance Exchanges.

According to the U.S. Department of Health and Human Services, the Affordable Care Act will ensure that Americans will have access to quality, affordable health insurance.

To achieve this goal, the law ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, will offer a comprehensive package of items and services, known as “Essential Health Benefits.”

Essential Health Benefits must include items and services within at least the following 10 categories:

1. Ambulatory patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management, and

10. Pediatric services, including oral health and vision care

States will have the flexibility to select a benchmark plan for insurance coverage that reflects the scope of services offered by a “typical employer plan.” This approach is intended to give states the flexibility to select a benchmark plan that will best meet the health insurance needs of their citizens.

The health insurance plans must offer benefits that are “substantially equal” to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories.

Health insurance plans will have flexibility to adjust benefits, including both the specific services covered and any quantitative limits, provided they continue to offer coverage for all 10 statutory essential health benefit categories listed above and the coverage has the same value.

Dentists are deeply concerned how these changes will impact their dental practice.

Dentists who in the past have accepted a percentage of Medicaid dental patients understand all too well what it is like to deal with a government-run dental care benefit provider.

Medicaid dental care reimbursements have always been low, even before Medicaid began eliminating adult dental care from its benefit plan. Private employer dental insurance plans have offered dentists more new dental patients with better reimbursement rates.

More than 5 million children will become eligible for dental coverage under the Affordable Care Act and pediatric dentists are concerned the insurance changes implemented by the Act could result in fewer insurance companies offering dental health plans to families, thus leaving dental practices treating children with a state or government-based dental benefit plan.

The National Association of Dental Plans have made dentists aware of the rule that families who buy dental coverage on an Exchange may be subject to an annual out-of-pocket cost-sharing limit (possibly up to $1,000) for dental care.

This could have a very real impact on many dental practices’ bottom line.

The PricewaterhouseCoopers report “Patients or Paperwork” revealed that the Medicare and Medicaid “rules and instructions” are more than 130,000 pages (three times larger than the IRS code and its associated regulations), and “medical records must be reviewed by at least four people to ensure compliance” with Medicare program requirements.

No wonder dentists are concerned about federally-run health Exchanges.

The only thing certain about the Affordable Care Act is that its implementation will bring changes to dental care, dentists and their dental practices.

What are your thoughts on the future of dentistry and the Affordable Care Act?

To read more about the Essential Health Benefits see: HHS Informational Bulletin

Negative Online Review Allowed To Stay by Supreme Court

Negative Online Review Allowed To Stay by Supreme CourtIn December, The Wealthy Dentist reported on a story that first appeared in the New York Daily News which told the story of Virginia contractor, Christopher Dietz, who was suing his former customer, Jane Perez, for negative online reviews she wrote on Yelp and Angie’s list.

At the time, a judge had granted Dietz a temporary injunction against Perez and ordered the ex-client to change her online reviews, especially the part where she accused Dietz of stealing jewelry.

It seemed reasonable and encouraging to many small business owners and most especially dentists, who have been dealing with questionable tactics by some negative online reviewers for several years now.

Then Public Citizen and the American Civil Liberties Union stepped in. Late in December they filed a 21-page petition calling the judges prior decision “censorship.” What followed was a quick decision by the Virginia Supreme Court to reverse the injunction against Perez.

All is not lost, the ruling only specifically addresses whether a judge can order a revision or censorship of online speech while a lawsuit is pending. The ruling says no, and the libel lawsuit is moving forward. A jury trial will decide if there are damages.

The Wealthy Dentist has advised dentists to not sue in these cases but instead use the money to initiate an aggressive Internet dental marketing campaign to counter the review. Immediately addressing the review in a calm manner can also help quickly counter what the reviewer has said.

Typically, the general public does not search past page two of online search results and this is where a dental practice’s online engagement can help bury a negative review. Facebook Pages, Twitter pages, YouTube videos, and Pinterest pages all show up high in search.

If a dental practice has taken the time to develop an Internet dental marketing plan for their online presence (using the dentist’s name and the dental practice name) they can fill the first page of Google with their own social media presence.

The Wealthy Dentist continues to argue that no business should have to deal with slanderous, vindictive online reviews and believe that eventually online review sites will have to find ways to deal with the libelous reviews, regardless of anti-SLAPP. Eventually a business owner will win big over a slanderous review and online review sites will be forced to set stricter review guidelines.  In the meantime, everyone is watching how the Dietz- Perez will play out.

What are your thoughts on this latest ruling in favor of keeping the review as it was written until the libel case is settled?

For more on this story see: VA Supreme Court: Judge Can’t Force Yelp User To Redact Review 

Dental Therapist Controversy Heats Up in Minnesota

Dental Therapist Controversy Heats Up in MinnesotaThe first of nine dental therapist graduates of the University of Minnesota School of Dentistry’s dental therapy program are now filling cavities, pulling teeth and placing crowns at dental clinics in Minnesota.

Minnesota and Alaska are currently the only states where dental therapists are licensed to practice under the general direction of a dentist.

A shortage of dentists prompted Minnesota to license dental therapists to meet the growing demand for dental care, especially in rural areas. Dental therapists cover the gap between the dental hygienist and the dentist, much like a nurse practitioner does in a medical office.

However, Minnesota dental therapists are only allowed to work in dental practices where at least 50% of the dental patients are low-income.

The first Alaskan dental therapists began working there in 2005; the program was created via congressional board to improve access to dental care in rural Alaska. As no American dental school offered dental therapist credentials at that time, the very first dental therapists to practice in the U.S. trained for two years in New Zealand.

Since then, states who report a shortage of dentists have been pushing legislation for dental therapists. Vermont, Kansas, New Mexico, Ohio, and Washington are the latest states to introduce legislation to allow dental therapists to begin practicing in their state. California, New Hampshire, Maine, and Kansas are considering legislation to introduce the dental therapist model.

A report published in January in the peer-reviewed Journal of the American Dental Association details a nearly year-long systematic review of scientific papers about the use of mid-level dental providers to perform such irreversible surgical procedures as restorations and extractions.

The systematic review sought to answer this question: “In populations where non-dentists conduct diagnostic, treatment planning, and/or irreversible surgical dental procedures, is there a change in disease increment, untreated dental disease and/or cost-effectiveness of dental care?” (Source ADA)

According to J. Timothy Wright, DDS, MS, the report’s principal author, the analysis showed that surgical treatment by mid-level providers does not result in reduced rates of dental caries in the population. Oral health disparities exist regardless of the provider workforce model.

Caries rates do decline over time in populations treated by dental therapists, as measured by DMFT scores. And similar decreases have occurred in countries that do not employ dental therapists, further fueling the dental therapist controversy whether mid-level providers are truly needed. (Source ADA)

The Dental Crisis in America report by the U.S. Senate found that approximately 130 million Americans don’t have any dental insurance, more than 47 million people in the U.S. live in places where it is difficult to access dental care, and that there were over 830,000 visits to emergency rooms across the country for preventable dental conditions in 2009 – a 16% increase since 2006.

The dental therapist model is being touted as a possible solution for the under-served in the dental population.

A 2012 The Wealthy Dentist survey of dentists showed 53% believe that alternative dental providers are a bad idea and 59% of the dentists who responded to the survey challenge thought that there should be fewer alternative providers than there already are.

Dentists questioned whether mid-level oral health providers can sustain the same standard of care as a licensed dentist.

As one California dentist put it, “I went to college and dental school for eight years in order to receive the education necessary to safely perform irreversible procedures upon the human body. It is clear that this level of education cannot be achieved in two or three years. Isn’t it interesting that the proponents of the low-level provider scheme intend that it be used for OTHER people’s healthcare, and not for their own?”

What are your thoughts on this dental therapist trend? Do you think that it is a good idea?

For more on this story see: Coming Soon To Massachusetts’ Dental Offices—Maybe

Dental Marketing: Lawsuit Looks at Slander in Negative Online Reviews

Dental Marketing: Lawsuit Looks at Slander in Negative Online ReviewsDentists, just when you thought there was no hope for combating negative online reviews, Virginia contractor, Christopher Dietz is suing a former customer, Jane Perez for a negative online reviews she wrote on Yelp and Angie’s list.

What makes this case encouraging is that the judge has already granted Dietz a temporary injunction against Perez and has ordered the ex-client to change her online reviews.

Perez had written online that the contractor not only performed shoddy workmanship, but some of her jewelry had also disappeared. She further wrote, “Bottom line do not put yourself through this nightmare of a contractor.”

Dietz didn’t take her negative posts lightly, and sued Perez, stating that not only had he completed the job as contracted, but performed more work than was agreed upon and still has not been paid.

Deitz further contends that the negative online reviews have cost him about $350,000.00 in business.

Slander is a legal term for stating a falsehood and presenting it as true which could harm the reputation of a person or business. In the case of Perez, if contractor Dietz did not steal any jewelry (and apparently there is no police report stating that he did) then Perez could be found libel for defamation of character and Dietz would be able to collect damages.

Some might argue that the lawsuit seeks to squash Perez’s right to free speech, but freedom of speech does not protect you from the consequences of free speech.

Perez can offer an opinion like, “I was not happy with the quality of work.” But she cannot say things like “He is a ripoff artist who steals from his clients.” One statement is an opinion based on feelings the other is a statement that she’d have to provide proof that he is a “ripoff artist who has been convicted of stealing from clients.” Technically, you can’t bear false witness, so when leaving an online review, the review must stick to the facts, like “I had to wait two hours for my appointment,” or “My steak was medium when I asked for rare,” or “The toy broke the minute my son picked it up,” and so forth.

It’s been difficult for dentists, as well as business owners to get used to the idea that a dental patient or a patron can complain about their business in such a permanent, public way and the courts are scrambling to legally catch up to this new technology.

And lawsuits themselves can bring more unwanted negative publicity.

Deciding to sue can paint a dentist into a more negative light with the general public than the damage done by the negative review, but what does a dentist do if the online review is truly defamatory?

Hiring an attorney to manage the process of suing the reviewer in court can be extremely costly, so a dentist would need to weigh the costs against any revenue loss directly attributed to the negative review.

The Wealthy Dentist has advised dentists to instead use the money to initiate an aggressive Internet dental marketing campaign to counter the review. Immediately addressing the review in a calm manner can also help quickly counter what the reviewer has said.

Typically the general public does not search past page two of online search results and this is where a dental practice’s online engagement can help bury a negative review. Facebook Pages, Twitter pages, YouTube videos, and Pinterest pages all show up high in search.

If a dental practice has taken the time to develop an internet dental marketing plan for their online presence (using the dentist’s name and the dental practice name) they can fill the first page of Google with their own social media presence.

Regularly updating a blog and writing press releases can also help control what dental patients find when they search for a dental practice online.

If need be, dentists can use the money they would spend on an attorney to buy Google ad space for their dental practice covering the dental practice name, the dentist’s name and a geo-targeted search term like “North Beach dentist.” This will place the dental practice at the very top of search for a period of time. If a dental practice can push the negative review site from the first page of search with content and social media they’ve created specifically for dental patients, they can begin to counter the damage caused by a negative online review.

Recent publicity surrounding negative online review sites and their vulnerability to false negative reviews by competition, or personal vendettas have caused people to question the validity and trustworthiness of consumer review sites. Parodies like Joe Plummer’s “Real Actors Read Yelp Reviews” have further shown just how ridiculous online reviews can be and the lack of oversight by the review sites themselves.

Bodyform even got into the act by responding to a Facebook rant with a video parody making fun of the cliches surrounding women’s use of their feminine products while directly answering the review. Their humorous video response quickly went viral.

Keep in mind that a negative online review can add validity to the positive online reviews. It can make a dental practice appear more balanced and one negative online review in the mix will make most people think it was a difficult dental patient instead of a bad dental practice.

But no business should have to deal with slanderous, vindictive reviews and eventually online review sites are going to have to figure out a way to deal with the libelous reviews, regardless of anti-SLAPP. Eventually a business owner will win big over a slanderous review and online review sites will be forced to set stricter review guidelines.

Would you have sued if a dental patient made the same type of claims against your dental practice that Perez made about Deitz?

To read more about contractor Deitz’s lawsuit see: Virginia Contractor Sues Woman for $750,000 for Bad Yelp Review.

Dentist Studies Link Between Vitamin D and Fewer Dental Cavities

Dentist Studies Link Between Vitamin D and Fewer Dental CavitiesA new study review by Dr. Philippe Hujoel of the University of Washington in Seattle reveals a link between vitamin D and a 50% reduction in the incidence of dental cavities among approximately 3,000 children ages 2 – 16.

According to United Press International, the study review included clinical trials from the 1920s to the 1980s on approximately 3,000 children between the ages of 2 and 16, from United States, Britain, Canada, Austria, New Zealand, and Sweden.

The review showed that vitamin D was associated with decreased levels of tooth decay.

The UPI further states that the American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental cavities. However, the American Dental Association disagreed based on the same evidence. In 1989, the National Research Council, despite new evidence supporting vitamin D’s cavities-fighting benefits, called the issue “unresolved.”

Dr. Hujoel told Medical Daily, “My main goal was to summarize the clinical trial database so that we could take a fresh look at this vitamin D question. Whether this is more than just a coincidence is open to debate. In the meantime, pregnant women or young mothers can do little harm by realizing that vitamin D is essential to their offspring’s health. Vitamin D does lead to teeth and bones that are better mineralized. One has to be careful with the interpretation of this systematic review. The trials had weaknesses which could have biased the result, and most of the trial participants lived in an era that differs profoundly from today’s environment.”

Dentists, what are your thoughts on vitamin D and tooth decay?

For more on this story see: Vitamin D Helps Prevent Tooth Decay

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