State Board of Dentistry Committee Meeting Summary December 12, 2013 Practice Ownership Committee

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State Board of Dentistry

Committee Meeting Summary

December 12, 2013
Practice Ownership Committee

Dr. John DeFinnis, committee chair, invited representatives from corporate dentistry entities to present information about themselves. Below is a summation of their respective presentations.

Aspen Dental

  • 425 locations in 27 states.

  • The average age of the 900 dentists involved is 39.

  • All dental practices are “organic” in that they are started from the ground up and are branded as Aspen Dental.

  • In Pennsylvania, there are 36 practices with 65 dentists, treating more than 300,000 patients.

  • Aspen provides business and administrative services so that dentists can focus on the clinical aspect of their practice and patient care. Examples of the services offered include accounting, billing, human resources, laboratory fee negotiation, procurement, maintenance, PR/advertising and continuing education.

  • Generally, the dental boards in states that have Aspen Dental practices are “okay” with this practice model. North Carolina (which does not have any Aspen Dental practices) has not been receptive to this model.

  • Aspen Dental does not buy practices. Dentists are NOT employees of Aspen. All practices are owned by dentists.

  • Aspen Dental does not accept Medicaid patients, mostly due to practitioners not wanting to become participating providers.

  • In order to leave Aspen Dental, a dentist states that he or she would like to sell, which is not much different than the traditional practice model. They usually sell to partners already in the practice.

  • Aspen does not require dentists to meet any financial quotas. It does not dictate treatment decisions or interfere with dentists’ clinical judgments.

  • Aspen does aggregate data from each practice to share with each other.

  • Dentists maintain 100 percent control of patient records.

  • Aspen uses Fair Health Data to recommend pricing for services in the dentist’s particular market, and it usually recommends setting fees 20 percent below market. Ultimately, the dentist sets the fees.

  • Aspen is aware of the complaint that dentists have to provide a high volume of work that may be impossible, recommended or ethical. According to Aspen, there is no directive from the company to the dentist to do so. Aspen contends that dentists produce at a higher volume because they don’t have to focus on practice management.

  • Aspen is aware of the perception that treatment plans are altered so that the practice can meet financial benchmarks, whether that treatment was needed or not. Aspen responded that there are examples of unethical practice in all practice models. Aspen cannot fire the owner dentist, but it can withdraw services because the dentist’s action may hurt the brand.

Heartland Dental

  • 525 locations in 26 states.

  • Heartland has the same parameters as Aspen Dental for the most part.

  • Heartland does not own dental practices. It just provides support services. However, in Pennsylvania only one dentist owns the 10 Heartland Dental facilities. Heartland may have ownership of some assets like equipment.

  • The biggest misnomer on the issue of corporate dentistry is that dentists have to meet quotas and/or financial benchmarks. It simply offers services better and quicker that solo practitioners may struggle to do on their own.

Dr. Anthony Skiadas, SmileBuilderz

  • He owns a company with more than 350 employees.

  • Because of this practice model, he can more easily afford advanced technology such as electronic health records.

  • SmileBuilderz is open seven days a week, which is more convenient for patients and keeps them out of the emergency room for unnecessary reasons.

  • SmileBuilderz has Human Resources department to manage employees and offer them opportunities for growth.

  • SmileBuilders has sales representatives selling an internal dental benefits plan to businesses.

  • The practice accepts Medicaid because it is large enough to handle the lower reimbursement rates.

  • SmileBuilders associates work on commission.

At the full board meeting the following day, Dr. DeFinnis announced that he would submit a full report to the board at its January meeting, and that he plans to do more research and contact other knowledgeable individuals for more information.

Anesthesia Committee

Dr. James Robbins, Chairman of the PSOMS Committee on Anesthesia was present to discuss PSOMS’s suggestions for changes to current anesthesia regulations.

  • §33.333 – According to ADA guidelines for the use of sedation and general anesthesia, using nitrous oxide along with sedative agents may produce minimal, moderate or even deep sedation or general anesthesia. PSOMS is recommending that any dentists who are “stacking” medications, including oral medications or nitrous oxide with either oral or parenteral medications should be required to hold a restricted permit I.

  • §33.340- PSOMS has received reports of dentists seeking permits to administer anesthesia borrowing equipment from other offices to pass their inspections and then returning it; should an emergency occur the office does not possess the required monitoring or emergency equipment. PSOMS is recommending that the regulation be changed requiring monitoring and emergency equipment to be present with the permit holder at all times.

  • § 33.332(a)- PSOMS is suggesting that this section be revised to read that “A dentist shall possess a current permit issued by the Board under this subchapter before administering, or supervising the administration of, general anesthesia, deep sedation, conscious sedation or nitrous oxide/oxygen analgesia in a dental office or dental clinic.” The committee also discussed possibly making the change read: dental office or dental school clinic.

  • Capnography- AAMOS Guidelines require the use of capnography by January 1, 2014. Due to the new requirement, the devices are on back order, and those that do not have a device by January 1, are required to possess a bill of sale. The committee held brief discussion on the use of capnography.

  • Dr. Robbins asked for clarification on a few situations involving permit holders:

- Dentists with more than one office, in more than one state: If their out of state office has been inspected, is Pennsylvania inspection also required? Ms. Montgomery, SBOD legal counsel, clarified that inspections conducted in New Jersey or Maryland are deemed acceptable by the SBOD and a Pennsylvania inspection is not required.

- Situations in which a permit holder’s office inspection has expired prior to their anesthesia permits expiring: Are those dentists are practicing beyond the scope of their permit? Ms. Burns, SBOD Administrator, informed the committee that when the board discovers that these situations have occurred, they are reported to the prosecutor for review.
- Offices with more than one dentist: Dentist 1 passes inspection, but dentist 2 does not due to an insufficient facility. Is dentist 1 now practicing beyond the scope of their permit? Ms. Montgomery, SBOD legal counsel said that dentist 1 is now indeed practicing beyond the scope of their permit and they should be reported to prosecutor.

  • The committee also briefly discussed requiring AED’s in all dental offices and whether or not this would require a legislative change, or if this falls within the power of the SBOD,

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