Focus Magazine

by Dr. Jon Copeland, MDA President

Earlier this year, you might have noticed an email in your inbox from the MDA asking you to tell us if you have had any issues with third party payers. Many of you responded that you have. We received 319 responses with a distribution across 57 different Missouri counties. Of those 319 responses, 186 reported issues with pre-paid plans, specifically Delta Dental. The next highest listed insurer at 75 responses was Anthem. The leadership of the MDA is very aware of Missouri dentists’ ongoing frustrations with insurers, particularly Delta, and is looking for avenues to ease those frustrations.

Similarly, Delta Dental of Missouri is aware of your frustrations. Delta implemented a new claim processing system over the last few years and, admittedly, that integration has been rocky.

Delta leadership held open town hall meetings across the state earlier this year where providers were able to air their concerns, ask questions and get some answers. It was at one of these meetings in St. Louis that I met Jon Jennings, the new COO of Delta Dental of Missouri. Jon has been in leadership at Delta for several years and previously at Ameritas Insurance Company in Lincoln, Neb. After our first meeting in the Delta board room, Jon agreed to meet me on neutral territory for a cup of coffee and a conversation.

One thing I want to let the reader know off the bat is that Delta (Jon J.) and the MDA (Jon C.) do not, and likely will not, agree on Assignment of Benefits language. So, at the onset, we agreed to put that in a box and set it aside. You should also understand the MDA is not looking to negotiate any sort of fee schedule changes for individual practices. We all understand we would like to be paid more for doing the same thing and that is not unique to Delta. That said, there are areas we both agreed can be improved. One such is related to claims processing.

In the MDA survey, one of the most common complaints expressed was customer service. This could be long wait times when calling, dropped or unreturned calls, lost claims and representatives’ lack of knowledge of the process. I was very pleased to hear from Jon J. about the steps he and his team already have implemented, creating drastic improvement in this area. Over the next few months as Delta continues to onboard, train and stratify their team, it should continue to improve.

In forthcoming conversations, Jon and I will continue to talk about issues facing all of us and do our best to come up with solutions to some of the ongoing problems. Some of the areas we plan to cover are downcoding, lower alternate benefit, uncovered codes and other ways the MDA and Delta can better coordinate their efforts. I also plan to give Jon the opportunity to be a take the reins and contribute his perspective in future articles. More to come.

by Halie Payne, MDA Professional Affairs Director

by Vicki Wilbers, MDA Executive Director

The ADA House passed a series of resolutions that aim to address the dental workforce shortage, which is a top priority for the ADA/MDA members and leaders. Current data continues to show there is an insufficient workforce to deliver care to patients. ADA Health Policy Institute survey data tracks dental team recruitment challenges. In the third quarter of 2024, for instance, 33.9 percent of dentists indicated they were currently recruiting or had recruited a dental hygienist in the prior three months. Among those dentists, 91.7 percent indicated recruitment was very challenging or extremely challenging.

Included are three resolutions that cover: allowing internationally trained dentists a path to U.S. licensure (514H-2024); letting active dental students and residents practice hygiene if they’ve met certain competency requirements (513H-2024); and, increasing the number of faculty and students in allied dental education programs by a revision of CODA accreditation standards for predoctoral dental education programs (401H-2024).

The American Dental Hygienists’ Association (ADHA) has expressed concern for each of the resolutions, however, the ADA has noted in a letter from President Dr. Brett Kessler, that each resolution upholds stringent licensure standards and ensures only qualified professionals practice in roles that match their training. In addition, Dr. Brett Kessler has stated, “The ADA also shares ADHA’s commitment to enhancing workplace culture, professional development, and support for all members of the dental workforce. These resolutions are intended not only to help address the staffing shortage, but also to reduce the strain on current dental teams” … “We value and respect the essential role of dental hygienists in providing quality care, and we see these new policies as ways to complement — not replace — the vital role of hygienists on the dental team.”

Under 514H-2024, the ADA would encourage states to adopt policies allowing dentists who have completed a dental education program outside the U.S., subject to state licensing board requirements, to obtain a license to practice dental hygiene. Dr. Kessler reiterated in his letter that the ADA would not encourage states to adopt any policy allowing internationally trained dentists to work as dental hygienists unless that policy required applicants to pass board examinations demonstrating their competency.

The ADA said this new policy would allow it to give dentists a seat at the table on dental workforce issues, as some states already license internationally trained dentists as dental hygienists and other states are considering similar legislative proposals.

Under 513H-2024, the ADA would encourage states to adopt policies allowing active dental students and residents who have completed all their required hygiene competencies to practice dental hygiene, or to practice as other dentist-supervised allied dental team members, subject to state licensure requirements. Dr. Kessler noted in his response that any policy under consideration would have to require dental students to meet state licensure requirements for hygiene before the ADA would encourage states to allow them to be licensed to practice hygiene.

Under 401H-2024, the ADA urges the Commission on Dental Accreditation to revise the accreditation standards for each of the allied dental education programs regarding faculty-student ratios to align with the accreditation standards for predoctoral dental education programs. Dr. Kessler said updating the standard would allow allied dental training programs more flexibility to increase class sizes, which are currently restricted due to the need to hire additional faculty.

In related workforce news, the Health and Human Services Task Force of the American Legislative Exchange Council (ALEC) adopted the ADA-crafted Dental Access Model Act at its meeting in Washington, D.C. on December 4 in a declaration of its priorities. The model legislation will serve as a guide for legislators looking to address dental workforce issues. Chair of the ADA Council on Government Affairs, Dr. James Tauberg, along with ADA staff, presented the policy to the task force, which consists of three parts:

• Authorization of expanded function dental auxiliaries, based on the legislation enacted in Wisconsin.
• Authorization of oral preventive assistants, based on a pilot program created by the Missouri Dental Association, which took effect December 1.
• Model teledentistry regulations, based on current Iowa law.

“The proposed model is in the best interests of the public and promotes improvements for those seeking to support quality oral health care,” said Dr. Kessler.

ALEC is a free-market, limited-government think tank with influence among conservative legislators around the country. Membership consists of private sector groups like the ADA, as well as public sector members like legislators and state elected officials. Passage of this model, which still requires final approval by the ALEC board, constitutes official ALEC policy.

Or do you let a sleeping baby lie?

by Jerri Wildhaber, MDIS Operations Director

Just like parents are the safety net for those sleeping babies — willing to do anything to keep them secure and provide for their well-being — so too, insurance is a critical safety net that helps protect your financial well-being against unexpected events. But just as children grow and needs change, life evolves and so do your insurance needs. Reviewing your insurance coverage regularly is essential to ensure that you are adequately protected and not overpaying for unnecessary coverage. Here’s why you should review your insurance and how to do it effectively.

WHY YOU SHOULD REVIEW YOUR INSURANCE

Life Changes // Major life events such as marriage, the birth of a child, purchasing a practice, changing jobs or hiring an associate can significantly impact your insurance needs. For example, a new baby may require you to update your health or life insurance policy, while buying a practice could mean you need to be sure you have Business Owners insurance coverage, and hiring an associate can bring new liability issues you never thought about.

Coverage Gaps // As circumstances change, it’s possible your current insurance policy might not cover all the risks you face. A review can help identify gaps in coverage, ensuring you are adequately protected from potential financial burdens.

Changes in the Market // The insurance market is dynamic, and new policies or updated plans may provide better coverage at a lower cost. By reviewing your insurance, you can take advantage of newer options that fit your current needs and budget.

Cost Savings // Insurance premiums are often based on factors such as age, health, practice location, payroll, revenues or even the procedures you are performing in your practice. Over time, your situation may change, and you may qualify for discounts or lower premiums. Reviewing your policy can uncover opportunities to save money.

Regulatory Changes // Laws and regulations governing insurance can change, impacting how much coverage you need or how your policy is structured. A regular review helps you stay compliant and aware of any new requirements.

HOW TO EFFECTIVELY REVIEW YOUR INSURANCE

Assess Your Life Changes // Start by reviewing any personal, financial or professional changes that may have occurred. Ask yourself:

• Have I recently bought a practice or major equipment to use in my practice?
• Have I hired or reduced my staff size?
• Am I working part time, or doing new/stopped doing any procedures?
• Has there been a change in my marital status or family size?
• Have I taken on more debt or made significant investments?

Answering these questions will give you a clearer idea of whether you need to update your coverage.

Evaluate Your Coverage Needs // With your life changes in mind, consider if your existing policies still meet your needs. Do you have enough health insurance to cover medical expenses, or have your deductibles and co-pays changed? Is your practice insurance sufficient to protect against the risk of natural disasters, fire or theft? What about your malpractice — are you paying for coverage you don’t need or are you missing any easy discounts?

Check Your Deductibles and Limits // Reviewing your policy’s deductibles and coverage limits can help you decide whether they still make sense for your practice or financial situation.

Review Policy Exclusions // Policies can have exclusions, and it’s crucial to be aware of them. For instance, most Business Owners policies may not cover flood damage, and Malpractice policies may exclude certain procedures unless you add coverage back into your policy. By reviewing your exclusions, you can decide whether you need additional coverage or if certain clauses should be adjusted.

Check for Policy Riders or Add-Ons // Some insurance policies offer riders or add-ons that enhance the coverage. Such as an “own occupation” endorsement on a disability policy. (Do you have that on your disability policy?)

Consult with MDIS // Any of the agents at MDIS can help you understand the details of your current policy and suggest better options based on your needs.

Document and Organize Your Policies // As you review your insurance policies, ensure that you keep them organized and document any changes made. This makes it easier to track your insurance coverage over time and ensures you can quickly access any policy details in an emergency.

Reviewing your insurance is not just about renewing policies every year — it’s about ensuring your coverage aligns with your current life, financial situation and practice goals. Make it a habit to review your policies regularly (at least once a year or after major life events) to ensure you’re getting the best possible protection at the best possible price.

The MDIS team can help with your insurance review. Call 800-944-7550 or email info@mdis4dds.com.

MedPro Risk Solutions offers a variety of on-demand educational programs on a range of risk management topics. These are for both office- and hospital-based healthcare providers and are available to both insureds and noninsureds. Insureds who successfully complete on-demand programs may be eligible for a risk management premium credit at their next policy renewal. Learn more about CE topics and contact MDIS to inquire about a policy discount if you are a Med Pro insured.

by Marc R. Leffler, DDS, Esq

In these days of every restaurant, hotel and concert — where you eat, stay, or attend — asking for online reviews of your experiences, it is neither unusual nor surprising for dental offices to do the same. And even when dental offices don’t seek online reviews, that does not stop patients from posting them. But beware of HIPAA constraints before responding, no matter how terrible or how glowing that review might be. Not only can an investigation and penalty ensue following an unauthorized disclosure based upon responding to a negative online review, but the same result might come to pass even when responding to positive ratings given online, as counterintuitive as that might seem. Patients “own” their HIPAA rights, so they are free to disclose/post anything they choose about their health, but that disclosure does not then constitute a waiver to allow the dentist to disclose about them about almost anything.

Dentists are not traditional vendors, but instead health professionals who are vested with the obligation of protecting their patients’ privacy, not only ethically, but statutorily as well. As such, dentists must not divulge any information about their patients, absent explicit written authority from the patient or a rule exception, which usually — but not exclusively — involves the sharing of health information among multiple providers who are treating the patient and who have a need to know.

Therefore, it cannot be emphasized enough that, before releasing or disclosing anything about any patient, the dentist must be in possession of a HIPAA-compliant document authorizing the release; in situations where a dentist might believe that sharing medical/dental information with another provider is warranted, the safest approach is a consultation with an attorney familiar with this subject matter. That extra step might be the difference between compliance and a large fine. And even when sharing information appropriately, HIPAA requires the methods for doing so include reasonable protections against the dissemination of that information to any person or entity other than specifically intended.

It also should be noted that, when situations which trigger online reviews involve claimed negligent treatment which injured the patient, leading to a malpractice lawsuit, the entire set of online events, and potentially the government actions in response, might be a source of intra-lawsuit litigation as to whether the issue could be explored in the usual discovery process and whether a jury might be able to be made aware of the events. That is not to say that it is a given that this issue would become a (distracting) part of a trial, but it is a potential unhelpful wrench that can be eliminated with due consideration in advance. Online responses to online stimuli might feel justified at the moment, but silence is often the better approach to take; a patient’s review does not constitute authorization for a response.

Online platforms have become realities of life, affecting virtually every aspect of our daily activities. For most of those activities, it is perfectly fine to give in to the temptations that set in motion various types of online posts. But doing so in the context of dental practice is entirely different, and it carries with it potential consequences that likely do not exist elsewhere. So, taking a step back, before publicly celebrating a patient’s satisfaction or defending a patient’s criticism, is a wise risk management tool. Finally, dentists ought to be aware that what office staff members post online in the name of the dentist is as though the dentist had personally done it: in this regard, dentists might wish to consider limiting who in the office — with a full understanding of ramifications — has such access to “speak” on the dentist’s behalf.

Marc Leffler is the MedPro Group Dental Risk Solutions Lead and Head of the Dental Advisory Board.

Change will not come if we wait for some other person or some other time. We are the ones we have been waiting for. We are the change that we seek. — Barack Obama

by Halie Payne

Although we are in the middle of the legislative interim, the MDA’s advocacy work never stops. 

Recently, you received an email notifying you of a Dental Insurance Reform Survey. The MDA has not done an insurance survey in four years, and it was due time to reach out to MDA members to inquire about potential insurance issues the advocacy team might not be aware of. The survey received an incredible response from 319 dentists. To share just a few highlights: 

• 91 percent of respondents experience regular occurring issues with third-party payers
• 78 percent experience issues with customer service and long wait times or unreturned calls
• 71 percent experience issues with downcoding
  

Thank you to all our members who completed the survey. These results will help drive much-needed action in future sessions to help fight major insurance issues. 

The Legislative Session officially begins January 8, 2025, and the MDA Board of Trustees approved the 2025 legislative agenda at its August 2024 Board Meeting. The MDA’s top two priority items for 2025 will be Dental Loss Ratio (DLR) and the Oral Preventive Expanded Functions Dental Assistant (OPA). 

In 2024, MDA introduced legislation in Missouri establishing a DLR at 85 percent for both large and small group plans. This legislation was filed later in session, and due to facing great opposition from insurance carriers as well as the climate in the legislature, it did not pass. In 2025, we will re-file the legislation. Sponsors are being secured during the interim and hopefully the bill will be pre-filed in December, giving it a head start. 

In 2021, the MDA formed an exploratory workforce committee charged with investigating workforce shortages within Missouri’s dental community and finding possible solutions. One solution discussed by the MDA for many years, with similar models successful in other neighboring states like Kansas and Illinois, is a type of expanded function dental assistant who can provide scaling on patients with specific types of periodontal health.

The creation of this new health care role — called “Oral Preventative Assistant/Expanded Function Dental Assistant” (OPA/OPA EFDA) — must be done through the legislative process. You can see this issue's article for an update on the status of the pilot project, which directly correlates to the creation of legislation. In 2025, the MDA will pursue legislative action to create a permanent OPA EFDA in the State of Missouri after enough data has been collected from the project. Like DLR, we are working to secure sponsors and looking forward to this next step. 

The MDA Board of Trustees also approved the possibility of supporting the Dentist and Dental Hygienist Compact should it again be filed by the American Dental Service Organization. MDA supported the legislation last year, but it was ultimately defeated due to a stalemate in the Senate. The advocacy team will also continue to support and push for maintaining and increasing appropriations such as the dental Medicaid reimbursement rates, Donated Dental Services and Elks Mobile Dental Services.

Of course, everyone will be watching election results in November. Your MODentPAC has been engaged on the frontlines by delivering more than 60 contribution checks to candidates, as well as volunteering and having conversations with various candidates. It is important to remember the MDA’s legislative success does not happen without a strong PAC. With the new ADA membership login system, it will be easier than ever to contribute monthly or one-time. I encourage you to contribute and invest in your profession. And  please remember to vote on November 5!

Before we wrap up the year, Vicki, me and our Gamble & Schlemeier lobby team of Jorgen, Nikki and Grace, will attend the ADA Lobbyist Conference in December. This annual event is important because it allows states to hear valuable information from the ADA regarding issues on the federal level, such as ERISA. It also allows states to share results and experiences from previous legislative sessions, which is helpful as we look to the next. We always come back with new ideas and strategies to tackle dental insurance reform, workforce, Medicaid and other hot-button issues in the dental profession.

The MDA has a long-standing successful legislative history, and our agenda items show a full plate is in store for 2025. We cannot be successful without the involvement and support from our members and their teams. Be sure to save the date for 2025 Dental Day at the Capitol on March 5! We had an outstanding attendance record last year with 80 plus attendees and hope to be as or more successful in 2025. We’ll provide more details as we move into the new year. Please reach out to me with any questions regarding our legislative efforts. 

This summer, the Oral Preventive Assistant (OPA EFDA) pilot project advanced through another significant hurdle: rule promulgation.

During this period, the MDA engaged in significant advocacy and communication efforts to its members, who resoundingly responded with letters of support which were instrumental in this moving forward successfully. There are numerous members who, for months, have met and communicated consistently with their representatives and senators to explain the OPA project and what this type of EFDA can provide for the benefit of the dental workforce, dental practices and patient care.

The OPA EFDA rule is now in the process of moving to a final order of rulemaking and will be published in the October 1 register with a November 30 effective date, with the pilot to begin as of December 1. While this process has taken longer than the MDA had wished — we began working with supervising doctors from the clinical sites participating in the pilot in November 2023 and trained OPA candidates in January, February and March of this year — we are grateful to finally begin the pilot and report on its outcomes.

“I can’t say enough about the MDA EFDA program and all the work related to it,” said Wilbers. “I am grateful for the members who are so committed to developing curriculum, training assistants and advocating as needed to continue moving this program forward. We know how important the entire dental team is to practice success and excellence in patient care — and the MDA EFDA program is one of the integral dental team pieces.” 

The 2025 year arrives less like the uncanny result of a series of vague, subtle shifts over time than the hazy aftermath of a meteor strike ... The beginning of a new era that everyone has seen coming, with varying levels of dread, from a hundred miles away.

by Paul Roberts

Sage advice says to write about what you know and love. For me, that’s often football and dentistry. Hopefully you like one, or both, as well. It’s October now so what better time to combine the two?

In late August I read a college football preview article by Matt Hinton on my favorite SEC football media site, Saturday Down South. I give props to both the author and the site. Strangely Mr. Hinton’s article made me think of organized dentistry. Funny how similar challenges and themes show up in every walk of life. 

For fun, I took the liberty to use the structure of his article and paraphrase parts of it to comment on dentistry today while keeping many of the well-appointed words of a professional writer. Consider it my 2025 Dental Profession Preview. Like any prognostic work, it’s imperfect and there will be those with different opinions or loyalties. Kind of like me preferring to yell “War Eagle” over “Roll Tide”. See what you think and feel free to yell at me! 

When we talk about distinct eras, it’s usually in the past tense. One day you stop, take a look around, and realize everything that was once familiar has changed so slowly you barely noticed. Not so for the MDA or for organized dentistry, in general. Instead, the 2025 year arrives less like the uncanny result of a series of vague, subtle shifts over time than the hazy aftermath of a meteor strike. Quakes, fissures and extinctions have convulsed the profession, culminating in a dramatically altered landscape that has rapidly taken shape before our eyes. It feels palpably different: The beginning of a new era that everyone has seen coming, with varying levels of dread, from a hundred miles away. Consider how much has changed recently. 

Practice Modalities

Gone Bonkers. Remember when most dentists were solo private practice providers? For the first time we are seeing a proliferation of franchise practices and boutique specialties. The FQHC delivery model has exploded. And now you are dealing with DIY online solutions that often mislead the public into worse dental health.