Wells Fargo Practice Finance is accepting entries for the 14th Annual Dental Office Design Competition.

A panel of dental industry and design experts will judge the entries, and winners will be announced in October at ADA 2014—America’s Dental Meeting in San Antonio, Texas.

All newly built offices and offices with leasehold improvements or renovations completed between Jan. 1, 2011, and Dec. 31, 2013, are eligible to enter. All practice types and sizes are welcome. Entries must be postmarked by July 31.

Comfortable setting: Drs. Jack Lewright and Brent Lewright, of Lewright Family & Cosmetic Dentistry in San Angelo, Texas, won Dental Office Design of the Year—Group Practice.

Area of practice: The operatory aisle at Lewright Family & Cosmetic Dentistry also got a makeover, helping the dentists win a dental office design award from Wells Fargo Practice Finance.

Designing for the future: Dr. John F. Dahm stands in his Hutchinson, Kansas, dental office, which won Dental Office Design of the Year—Small Practice.

A grand prize Dental Office Design of the Year winner will be selected from Small Practice and Group Practice categories.

Grand prize winners will receive a $2,500 bonus marketing fund, media exposure, an engraved plaque and more.

Awards and media coverage will also be presented to Outstanding Achievement award winners in the following categories:

• Outstanding New Dentist Practice recognizes the best new, remodeled or expanded facility for the first practice owned by a doctor or group of doctors who have graduated from dental school since 2004.
• Outstanding Specialty Practice recognizes the best new, remodeled or expanded facility for a specialty practice.
• Outstanding Design Efficiency recognizes the most effective space planning and use of square footage to meet practice needs and objectives.

For complete details, including award categories, prizes and other information, or to enter the competition, visit wellsfargo.com/dodc.

The website also includes a look at previous winners, including those announced at the 2013 ADA meeting in New Orleans. They are:

• Dental Office Design of the Year—Small Practice: Dr. John F. Dahm, Hutchinson, Kansas;
• Dental Office Design of the Year—Group Practice: Drs. Jack Lewright and Brent Lewright, Lewright Family & Cosmetic Dentistry, San Angelo, Texas;
• Outstanding Achievement for a New Dentist Practice: Drs. Charles Parrish and Jennifer Parrish, Parrish Dentistry, Llano, Texas.

During the New Orleans meeting, the Dental Office Design Center included a look at the year’s winning entries and insights into design concepts and approaches.

One visitor to the display, Dr. John Williams, said that as a dental educator, he was interested in taking information back to his students.

Sponsored by Wells Fargo Practice Finance, the design center also included a model of a dental operatory, complete with the latest equipment from Patterson Dental.

Wells Fargo professionals were on hand to provide information from a lender’s perspective on how to obtain loans for practice setup or projects.

Dr. Williams attended a continuing education course on that subject with the intention of bringing the information back to the students at the Indiana University School of Dentistry, where he is the dean.

“We have a lot of students and recent graduates who are interested in launching their own practice and they need capital to do that,” Dr. Williams said.

“I’m interested in the lender’s perspective on how they can best achieve their financial goals.”

Wells Fargo Practice Finance is the only practice lender selected especially for ADA members and endorsed by ADA Business Resources.

In addition to the ADA and Well Fargo Practice Finance, the competition is sponsored by ADA Business Resources and Dental Economics.

Casting a ballot: Members of the Code Maintenance Committee vote on a change to CDT 2014 at their meeting at ADA Headquarters in 2013. The CMC will meet Feb. 27-March 1 to discuss CDT 2015.

ADA member dentists and others in the dental community have the chance to weigh-in on proposed changes to the Code on Dental Procedures and Nomenclature at the Code Maintenance Committee meeting.

The CMC will meet at ADA Headquarters in Chicago Feb. 27-March 1 to address 119 requests for CDT Code additions and other changes. Accepted requests will be incorporated into CDT 2015. The meeting will begin with an open forum, where request submitters and other interested parties are invited to comment on any of the actions on the agenda.

“This is a great opportunity for members to contribute to one of the ADA’s most important pieces of intellectual property,” said Dr. Andrew Vorrasi, CMC chair.

“The CDT Code touches every dentist in every practice, and a robust, unambiguous code set supports accurate patient records and claims submissions.”

Following the public forum, the CMC will move into its business session, which is open to observers.

The 21 voting members of the CMC will then decide which requests to accept and which to decline.

“More than a third of the change requests came from practicing dentists,” Dr. Vorrasi said. “This is a living, breathing document that we want members and other interested groups to be a part of maintaining.”

The CDT Code is ADA intellectual property and named by the federal government as the Health Insurance Portability and Accountability Act standard for reporting dental services on claims.

The ADA Council on Dental Benefit Programs established the CMC to ensure that all stakeholders have an active role in evaluating and voting on CDT Code changes.

For more information vist the CMC page.

At the 2013 CMC meeting, 58 changes were voted on to incorporate into CDT 2014: 32 additions, 22 revisions and four deletions.

To purchase a copy of CDT 2014, visit catalog.ada.org. The hard copy book (J014) is $39.95 for members and $59.95 for nonmembers; the e-book (J014D) is $29.95 for members and $44.95 for nonmembers; and the book and e-book bundle (J014D) is $49.95 for members and $69.95 for nonmembers.

Dr. Licking

Microsoft will discontinue its technical support for Windows XP as of April 8, which could put covered dental practices that still use the operating system at increased risk of serious security problems.

For dental practices covered under the Health Insurance Portability and Accountability Act, that could lead to violations of the law.

Security updates that help protect PCs against newly discovered vulnerabilities will no longer be provided for Windows XP as of that date. The operating system will still work after April 8 but computers may become more vulnerable to security risks, according to Microsoft.

The antivirus software for Windows XP called Microsoft Security Essentials will continue to receive regular updates until July 14, 2015.

Other antivirus vendors are also expected to continue to provide updates.

These security risks could lead to data breaches that would require covered dental practices to notify their patients and the federal government and could expose them to liability for violating state data security laws.

They could also be at risk of violating the Payment Card Industry Data Security Standards, a set of standards developed by the payment card industry to protect credit and debit card data.

But it may be an oversimplification to state that any health care provider using an XP work station or server after April 8 is automatically violating the HIPAA Security Rule, according to Dr. Mary A. Licking, chair of a working group of the Standards Committee on Dental Informatics.

The HIPAA Security Rule includes two standards that should prompt covered dental practices that are currently using Windows XP to develop a transition plan to Windows 7 or 8, Dr. Licking said. The “Risk Analysis” standard requires a covered dental practice to conduct an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity and availability of electronic protected health information held by the covered practice.

The “Security Management Process” standard requires covered practices to implement security measures sufficient to reduce risks and vulnerabilities to a reasonable and appropriate level to comply with general requirements of the Security Rule.

“These requirements basically mean that covered entities must be aware of privacy threats and adjust their policies, procedures, and, sometimes, their office computer networks to respond to changes in their threat environments in an appropriate manner,” Dr. Licking said.

Older computer operating systems, like Windows XP, may be more vulnerable to hacking attacks over open networks and to computer viruses, Dr. Licking said. They can also crash without warning, exposing data to possible loss, she said.

Once a developer like Microsoft stops offering support for an operating system, no more security patches or bug fixes will be available.

“Vendors of products that run on the old operating system, like dental practice management software, may cease support for those products as well, exposing the client to the risks posed by bugs, crashes, data loss and other security problems,” Dr. Licking said.

“It’s more prudent to use a reasonably current operating system that’s supported so that the organization can continue to receive security patches, software updates and technical support necessary for meeting the HIPAA Security Rule’s technical requirements.”

Microsoft encourages its customers to upgrade their operating system to Windows 8.1, if their PC can handle it. Windows 7 is also an option.

Dental practices that are planning to transition away from Windows XP should consult with their technology vendors to devise a prudent and appropriate migration path.

For more information on HIPAA requirements, visit ADA.org. The Office for Civil Rights also has information on the law at hhs.gov/ocr/privacy. To learn more about the Payment Card Industry Security Standards Council, visit pcisecuritystandards.org.

The ADA Complete HIPAA Compliance Kit (J598) is available from the ADA Catalog, catalog.ada.org, and includes a manual, the training CD-ROM and a three-year update service.

The kit is $300 for members and $450 for nonmembers.

Meeting of importance: Dr. W. Ken Rich, Dental Quality Alliance chair, listens at the Dec. 6 meeting, where a resolution to validate three measures related to the use of emergency rooms and caries-related treatment was passed.

The Dental Quality Alliance will test a new set of measures that evaluate the use of emergency rooms for caries-related reasons.

At its Dec. 6 meeting at ADA Headquarters in Chicago, the DQA approved a resolution that funds a proposal from the University of Florida to validate three measures related to the advanced caries management and pediatric health status project. The measures include the use of ERs by patients with problems related to caries; a follow-up after a visit to the ER; and the use of general anesthesia for caries-related treatment.

The University of Florida will use Medicaid data from Florida and Texas to determine if the ER measures are appropriate.

“Inappropriate use of health care has become a major concern in this era of health care reform, especially the inappropriate use of emergency rooms. This care is not only inappropriate but also very expensive,” said Dr. W. Ken Rich, DQA chair. “It has long been known that people with dental pain will seek relief by presenting to an emergency room. The extent of this problem can only be determined if we have a way to evaluate it. These measures will not only quantify but will hopefully lead to a solution to this problem of inappropriate use of our health care system.”

“Testing and developing measures on the use of emergency rooms, especially follow-up after such use compliments the ADA’s Action for Dental Health, a major campaign aimed at ending the dental health crisis affecting tens of millions of Americans,” said Dr. David Schirmer, representing the ADA Council on Access, Prevention and Interprofessional Relations on the DQA. “One of the major pillars of the Action for Dental Health is to provide care now to people who are suffering.”

The measures are programmatic measures and are meant for use by the Medicaid programs and health plans to identify the extent to which their enrolled population uses the ER inappropriately. Overcoming this problem will require programs and plans to encourage patients to seek timely preventive and restorative care within office settings. In addition to evaluating ER measures, the DQA will continue its work in validating new oral health measures, thanks to a grant from the ADA Foundation.

“We’re seeing an increasing focus on quality measurement in both Medicaid programs and in emerging marketplaces,” said Dr. Jim Crall, DQA chair-elect. “This shows us how important the work of the DQA is and reaffirms that we need to continue moving forward to develop and promote measures that can help guide improvements in oral health care programs.”

This year, the DQA will look into measures for adults. For more information, visit the DQA website.

Sacramento, Calif.—The California Dental Association wants patients to get what they pay for.

The state dental association is sponsoring a patient protection bill that would require a minimum percentage of consumer premiums be spent on patients’ dental care instead of benefit company overhead and administration costs.

If passed, the bill would provide dental patients with the same minimum loss ratio protections that they have with their medical plans. It would require dental plans to spend a minimum percentage of premium revenues, either 80 or 85 percent, directly on patient care.

“We believe there’s a lack of clarity among patients and the plan purchasers about what patients are getting for their money,” said Dr. James Stephens, CDA president.

Under California state law and the federal Affordable Care Act, all medical plans must adhere to a minimum loss ratio. But the same standard doesn’t exist for dental plans, leaving patients without the same assurances that their premium dollars will be used mostly toward their dental care.

“Patients and employers need to know that they’re getting value out of their premium dollars dedicated to dental care,” Dr. Stephens said. “This bill provides greater transparency for consumers when purchasing dental plans.”

Under the bill, dental plans that fail to meet the minimum loss ratio standards would be required to provide rebates or lower premiums to dental plan purchasers as medical plans currently do.

“Our dental patients are our health care patients and they should be protected the same way as they are on the medical side,” Dr. Stephens said.

CDA commissioned a report, “Dental Loss Ratio: Factors to Consider in Establishing a Minimum Loss Ratio for Dental Insurance in California,” which indicates dental plans have varying loss ratios—some as high as 80.8 percent and as low as 38.1 percent. The report also states that during the first year of the mandated minimum loss ratio for medical plans, consumers were provided $1.2 billion in rebates and premium savings.

“We know on the medical side that the minimum loss ratio produced substantial consumer benefits as well as administrative efficiencies for insurance companies,” said Dr. Stephens. “We’re confident these same protections can be provided to all patients with dental coverage. In fact, the state’s Healthy Families Program required benefit companies to adhere to minimum loss ratios for the dental coverage they offered.”

Dr. Torbush

The meaning of the term “group practice” has evolved.

The number of dental group practices in the United States is increasing; the existing ones are expanding, new ones are being added and many are changing in character and structure. The term “group practice” isn’t a one-size-fits all classification.

The ADA Health Policy Resources Center published a brief suggesting group practices be categorized based on their commonalities. In “A Proposed Classification of Dental Group Practices,” authors Dr. Albert Guay, ADA chief policy advisor, Matthew Warren, senior manager of health policy and analytics at the ADA, Rebecca Starkel, HPRC research analyst, and Marko Vujicic, Ph.D., managing vice president of HPRC, identify and describe six basic types of group practices.

“Group practices have existed in the profession for many years,” said Dr. Douglas Torbush, chair of the ADA Council on Dental Practice Subcommittee on Practice Patterns and the Economy and chair of the ADA’s Interagency Workgroup on Dental Practice. “This classification system is needed as the first step in understanding the differences between groups, and the differences between each type of group and solo dentists.”

HPRC proposes classifying dental group practices into six categories:

• Dentist owned and operated group practice: Dentists in a single practice that may be located at one or multiple sites. The group practice is completely owned and operated by dentists, usually organized as a partnership or professional corporation.

• Dental management organization affiliated group practice: A group practice that has contracted with a dental management organization to conduct all the business activities of the practice that do not involve the statutory practice of dentistry, sometimes including the ownership of the physical assets of the practice.

• Insurer-provider group practice: A group practice that is part of an organization that both insures the health care of an enrolled population and provides their health care services.

• Not-for-profit group practice: A group practice that is operated by a charitable, educational or quasi-governmental organization that often focuses on providing treatment for disadvantaged populations or training health care professionals.

• Government agency group practice: A group practice that is part of a government agency, which organizes and manages it. All dentists are government employees or contractors and operate according to agency policies.

• Hybrid group practice: A group practice that does not clearly fit into any of the above categories and can exhibit some characteristics of several of them.

According to the 2012 HPRC survey “Distribution of Dentists,” the percentage of dentists who were owners decreased from 91 percent in 1991 to 84.8 percent in 2012 and the proportion of dentists who were solo practitioners decreased from 67 percent to 57.5 percent. Data from the U.S. Census Bureau from 2007 show the number of office sites controlled by multi-unit dental companies increased by 49 percent to 8,442 in 2007. For dental firms with more than 10 offices, the number of offices they controlled increased from 157 in 1992 to 3,009 in 2007.

“As the dental marketplace and dental group practices evolve, it will be interesting to observe which types expand and which types do not,” the authors wrote in the brief. “It seems unlikely that any one form of dental practice will overwhelm the market. More likely, a variety of practices will evolve to satisfy the varied demands of patients and other stakeholders in the dental care system. Changes will inevitably occur; key factors for successful innovation are the changes that will enhance the quality of care, efficiency of care delivery and availability of care for all who seek it.”

To read the full research brief, visit the website.

Consumers have their pick of dental benefit choices through the new health insurance marketplaces but finding information on covered services is difficult, according to the ADA Health Policy Resources Center.

In their brief, “Health Insurance Marketplaces Offer a Variety of Dental Benefit Options, but Information Availability is an Issue,” HPRC authors Cassandra Yarbrough, health policy researcher; Marko Vujicic, Ph.D., ADA managing vice president; and Kamyar Nasseh, Ph.D., economist, analyzed the level of information that is available to consumers when shopping for dental benefits within the marketplace.

The Affordable Care Act requires small group and individual marketplaces to offer pediatric dental benefits to consumers. Dental benefits for adults are not an essential health benefit but some health or dental insurance plans may offer them.

“Our findings provide early insights into how the establishment of health insurance marketplaces under the ACA could affect dental benefits coverage for children, and, ultimately, access to dental care,” the authors wrote in the brief. “The fact that there is often limited information available for consumers to make more meaningful comparisons across plans has important implications. With less-than-full information it is challenging for consumers to make optimal choices.”

The ACA gives states the authority to customize many key aspects of their health insurance marketplaces, including how pediatric dental benefits are offered which leads to variation in plan types across the states, according to the brief. In some states, all of the offered medical plans include pediatric dental benefits. In other states, none do. Stand-alone dental plans are offered in every state, with some only covering pediatric services and others covering services for a family.

While consumers have a choice, the authors expressed concern about the information available to make that choice. Many of the offered medical plans and stand-alone dental plans have deductibles or coinsurance amounts that apply to preventive pediatric dental services, meaning the consumer has to pay out-of-pocket.

“We feel that this issue needs to be revisited in the next round of health insurance marketplace regulation changes,” the authors wrote. “Pediatric dental care is an important component of primary care. But the lack of first dollar coverage for basic preventive dental services for children in some plans could impose financial barriers to care, counteracting the purpose of making pediatric dental benefits an essential health benefit.”

Thirty-four percent of medical plans with embedded pediatric dental benefits do not have a separate dental deductible, meaning the consumer will have to meet a higher medical deductible before the plan starts paying for some services. The authors expressed concern that there is a lot of information that remains unclear about the plans, even after more in-depth research.

The researchers acknowledged that some transparency issues are understandable at this point because the marketplaces are so new.

“As these marketplaces continue to evolve, however, effort should be given to improving the information base and presenting dental benefit plan comparisons in a user-friendly, easy-to-understand way,” the authors wrote.

Understanding how dental benefits are offered in each state is important because it provides insight into how expanded coverage may increase access to dental care in the future, according to HPRC. HPRC plans to examine how dental provider networks and how different marketplace setups impact consumer purchase decisions and access to dental care.

“As the ACA continues to reshape the U.S. health care system, it is important to generate evidence on these and other issues in the dental care sector to help guide policy.”

The ADA continues to analyze the Affordable Care Act and has lobbied for the government to provide more information to consumers about what it offers.

“The ADA made dental plan transparency a centerpiece of our lobbying efforts with regard to ACA implementation, with the goal of ensuring that consumers truly understand what they are buying,” said Dr. Carmine LoMonaco, chair of the ADA Council on Government Affairs. “Obviously, many dental products currently offered on the marketplaces fail to meet that test. Greater transparency will continue to be a high priority going forward as ACA ‘fixes’ are discussed at the national and state levels.”

Dr. Sampeck

Dallas—Dr. Adrian Sampeck, who his family says helped establish the endodontics department at the Baylor College of Dentistry at Texas A&M University has died. He was 93.

Dr. Sampeck was named chair of the department of endodontics at the Baylor College of Dentistry in 1963 and worked in private practice.

He received his dental degree from the University of Nebraska and received a master of science in dentistry from the University of Michigan School of Dentistry.

“He was one of the first practitioners of modern endodontics in this region, and his patients came to use from virtually every corner of the United States,” his daughter, Carole Sampeck, said. “His practice lasted well over 60 years; he retired only three years ago. He genuinely loved his work. His goal was to relieve pain whenever possible.”

Dr. Sampeck was married nearly 70 years to his wife, Kathryne Sampeck. He is survived by his wife and his children, Carole Sampeck, Vicki Sampeck, Paul Sampeck, Patrick Sampeck, Timothy Sampeck, Daniel Sampeck and Dr. Kathryn E. Sampeck; 14 grandchildren and four great-grandchildren. He was preceded in death by his son, Dr. Philip Sampeck, who followed him into the family business as an endodontist in Beaumont, Texas.

Dr. Stephens

Sacramento, Calif.—California may soon have a state dental director, a position long sought after by the state dental association.

Gov. Jerry Brown’s 2014-15 budget includes funding for a state dental director, who must be a licensed dentist and an epidemiologist in the department of public health, to establish a state oral health program. The program will receive $474,000 the first year and include assessing oral health needs in the state, developing and managing a state oral health plan and applying for and managing federal and private grants to support oral health.

“There is money from the federal government for oral health programs that the state of California has consistently left on the table,” said Dr. James Stephens, president of the California Dental Association. “A state dental director will be instrumental in actively applying for and securing those funds.”

Establishing a dental director was the top priority of the CDA in its 2011 access to care plan, “Phased Strategies for Reducing the Barriers to Dental Care in California,” which can be found at cda.org/portals/0/pdfs/access_report.pdf.

“I think from everything we learned when we studied the access to care issue is that states that make this commitment to oral health and hire a state dental director have much improved outcomes over states that do not,” Dr. Stephens said.

In the governor’s outline for the position, which is modeled after CDA’s proposal, the dental director will be charged with developing a burden of disease report, leading the collaborative process to create a state oral health plan and managing the implementation of the plan. The role will also include establishing prevention and oral health literacy projects and working to secure funding for prevention-focused oral health and essential disease prevention services, particularly for children.

The California legislature must approve the 2014-15 budget package by June 15 before it goes into effect July 1. CDA promises to keep its members informed about the hiring and progress of the state dental director through its regular communications and its website cda.org.

“There are nearly 40 million people in California and 8-9 million experience some kind of barrier to oral health care,” Dr. Stephens said. “It’s got to be better. I believe this will make a significant difference.”

Dr. Jurkovich

Dentists will have more time to implement the latest version of the International Classification of Diseases, thanks to an extension the U.S. Senate passed March 31.

The Protecting Access to Medicare Act of 2014 moves the deadline for complying with the 10th version of the ICD from Oct. 1, 2014, to no earlier than Oct. 1, 2015.

The additional time gives the health care industry an opportunity assess the challenges of implementing ICD-10 and to develop consensus in the industry on how to be overcome those challenges, according to a news release from the Workgroup for Electronic Data Interchange, which was formed by the Secretary of Health and Human Services in 1991 to be a leading authority on the use of health information technology to improve health care information exchange.

“WEDI believes that the delay in the ICD-10 CM compliance date will help avoid potential disruptions in the health care system by allowing all affected entities more time to complete the necessary work and conduct extensive testing. IT is not a reason to pause,” said Devin Jopp, WEDI president and CEO.

ICD-10 CM will be the latest version of the disease classification used in the United States to record many types of health and vital records, including death certificates. Europe is already using ICD-10 and is working to implement ICD-11.

“The parts of the dental community most affected by diagnostic codes remains the oral surgeons; those treating temporomandibular disorders, facial pain and sleep apnea,” said Dr. Mark Jurkovich, who chairs the International Health Terminology Standards Development Organization’s Dental Specialty Interest Group and is also a member of the ADA Council on Dental Benefit Programs. “It also affects our smaller specialty groups like oral pathologists and oral radiologists, pediatric dentists and others who may treat patients in a hospital or outpatient surgical center and those who do more specialized services such a periodontal surgeries. Some of these services are paid for by medical plans in certain areas of the country. Still, this is just a small percentage of all claims filed by dentists in any year.”

Some of the state Medicaid programs may require ICD-9 CM or ICD-10 CM diagnosis codes for dental claims in the future. But those diagnosis codes may only be necessary to report to all other payers when the diagnosis may have an impact on the adjudication of the claim in cases where specific dental procedures may minimize the risks associated with the connection between the patient’s oral and systemic health conditions.

Educational materials regarding ICD codes are being developed to include in the ADA’s CDT Companion guide, which will be available this fall.

ICD-10 was endorsed by the World Health Assembly in 1990 and WHO Member States began using it in 1994. The WHO worked with the ADA to use its Systematized Nomenclature of Dentistry, also known as SNODENT, to determine if the oral health codes within ICD-11 were complete, comparable and compatible.

SNODENT is a vocabulary designed for use in the electronic health records environment. Any dentist who uses electronic health records or who plans to in the future should be aware that the use of diagnostic codes is on the horizon.

SNODENT will be an important component within certified Electronic Health Records Systems for the federal and state governments’ Medicaid and Medicare EHR Incentive Programs—known as the meaningful use of certified EHR technology. SNODENT has been mapped to both ICD-9 CM and ICD-10 CM. In addition, a subset of SNODENT has been developed with mappings to ICD-9 CM, ICD-10 CM and the CDT. SNODENT is distributed by the ADA as a set of downloadable files, which are available to the oral health community under license.

For more information on SNODENT, visit ADA.org/snodent.