gda action

ACTIONTHE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION JANUARY 2012

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AA Anesthesia, P.C. . . . . . . . . . . . . . . . . . . . . .23AFTCO Transition Consultants . . . . . . . . . . . . .31Atlanta Age Management Medicine /

Dr. Ana Casas . . . . . . . . . . . . . . . . . . . . . .29Center for TMJ Therapy . . . . . . . . . . . . . . . . . .17The Doctor’s Safety Net . . . . . . . . . . . . . . . . . .22Elite Dentistry—Dr. Ruth Clemans . . . . . . . . . .11GDA Dental Recovery Network . . . . . . . . . . . .15

Georgia Dental Insurance Services . . . . . . . . .32Georgia Academy of Cosmetic Dentistry . . . .15Great Expressions Dental Centers . . . . . . . . . . .9Hinman Dental Society . . . . . . . . . . . . . . . . . . . .2Law Office of Stuart J. Oberman . . . . . . . . . . .14Louisiana Dental Association . . . . . . . . . . . . . .10Officite . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .19PDQ Services . . . . . . . . . . . . . . . . . . . . . . . . . .30

Dr. Mark Padolsky—TMD Dentist . . . . . . . . . .13Paragon Dental Practice Transitions . . . . . . . .26Professional Practice Management . . . . . . . . .26Shaul Beckman Paige, LLC . . . . . . . . . . . . . . .30Southeast Transitions . . . . . . . . . . . . . . . . . . . .28UBS Financial Services, Inc, . . . . . . . . . . . . . . .6

index of advertisers

GDA ACTION (ISSN 0273-5989) The official publication ofthe Georgia Dental Association (GDA) is published monthly.POSTMASTER: Send address changes to GDA Action at7000 Peachtree Dunwoody Road N.E., Suite 200,Building 17, Atlanta, GA 30328. Phone numbers in state are(404) 636-7553 and (800) 432-4357. www.gadental.org.

Closing date for copy: first of the month preceding publicationmonth. Subscriptions: $17 of membership dues is for thenewsletter; all others, $75 per year. Periodicals postage paidat Atlanta, GA.

Dr. Jonathan Dubin Delaine HallGDA Editor GDA Managing Editor2970 Clairmont Rd 7000 Peachtree Dunwoody Rd NESuite 195 Suite 200, Building 17Atlanta, GA 30329 Atlanta, GA 30328

2011-2012 Georgia Dental Association Officers Michael O. Vernon, DMD, PresidentSidney R. Tourial, DDS, President ElectMarshall H. Mann, DDS, Vice PresidentJames B. Hall III, DDS, MS, Secretary/TreasurerJonathan S. Dubin, DMD, Editor

GDA/GDIS Executive Office Staff Members

Martha S. Phillips, Executive Director

Nelda Greene, MBA, Associate Executive Director

Delaine Hall, Director of Communications

Skip Jones, Director of Marketing (GDIS)

Courtney Layfield, Director of Member Services

Victoria LeMaire, Medical Accounts Manager

Judy Lively, Administrative Assistant (PT)

Melana Kopman McClatchey, General Counsel

Denis Mucha, Director of Operations (GDIS)

Margo Null, Property and Casualty Accounts Manager

Patrice Williams, Administrative Assistant

Phyllis Willich, Administrative Assistant

Pamela Yungk, Director of Membership & Finance

GDA Action seeks to be an issues-driven journal focusing on current mattersaffecting Georgia dentists, patients, and their treatment, accomplished throughdisseminating information and providing a forum for member commentary.

© Copyright 2012 by the Georgia Dental Association. All rights reserved. No partof this publication may be reproduced without written permission. Publicationof any article or advertisement should not be deemed an endorsement of theopinions expressed or products advertised. The Association expressly reservesthe right to refuse publication of any article, photograph, or advertisement.

10 Give Kids a Smile: Districts Gear Up for February 3

12 2012 Checklist: Complying withRegulations and Deadlines

16 Legislative Update: The GDA Sets Four Major Goals

18 Update on Medicaid Issues

25 GDA Annual Meeting Preview:Amazing in Amelia

4 Parting Shots

5 Editorial

7 News and Views

9 Calendar of Events

27 Classifieds

The Patient Protection and AffordableCare Act (PPACA) was signed into law onMarch 23, 2010, and since that time manyelements of the federal health care reformlegislation have been put into motion.Most people are unaware of the broadand far-reaching changes that will bemade when the PPACA is fully implementedby 2014. See page 20 for a series of articlesdiscussing the far-ranging scope of the Act;how the Act impacts dentistry; currentlyactive provisions; provisions on the horizon;and Georgia’s Health Insurance Exchangeproposal.

ACTIONTHE JOURNAL OF THE GEORGIA DENTAL ASSOCIATION JANUARY 2012

other features sections

on the cover

Member Publication American Association of Dental Editors

ACTION

V O L U M E 3 2 , N U M B E R 1 • J A N U A R Y 2 0 1 2

Note: Publication of an advertisement is not to be construed as anendorsement or approval by the GDA or any of its subsidiaries,committees, or task forces of the product or service offered in the

advertisement unless the advertisement specifically includes anauthorized statement that such approval or endorsement hasbeen granted.

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4 GDA ACTIONJANUARY 2012

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The biggest threat to dentistry is silent. If youhave been out of school for a while, or don’tcurrently know someone in dental school, youmight not be as aware of the threat. It’s thecost of educating a dentist.

The cost of dental education is steep.Think about it. The clinic at a school has thesame or even higher overhead costs as aprivate dental office considering technology,materials, and supplies. A clinic can typicallyaccept only a limited number of patients, andstudents receive reduced fees for theservices they provide. Compare that to ateaching hospital that can charge full fees.

The cost of education in general hasskyrocketed over the past couple of decades. Ihave two children in college and one inkindergarten. I fully expect I will pay more toeducate the one now in kindergarten than Ipaid to educate my two sons combined.Dental school costs are no different inthat they have risen dramatically since Imatriculated in 1979. I’m almost embarrassedto say how little my costs were when Iattended dental school, but in 1983, Igraduated with a debt of $27,000. Thatwas then.

A recent American Dental Associationsurvey* reveals that tuition for a first-yearin-state resident ranged from a low of $8,091per year (University of Puerto Rico) to a highof $76,832 per year (University of the Pacific).First-year non-resident tuition ranged from$16,991 to $76,832 (same two schools).

Keep in mind that those numbers areonly for tuition and not the many associatedcosts attached to the final bill. The samesurvey found that mandatory general feesfor all students averaged $2,425 per year,while other first year costs (instruments,textbooks, health services, other fixed costitems) averaged $10,377 per year. Add inadditional fees and the cost of room andboard and then multiply by four years. Is it

any wonder that many of today’s dentalstudents graduate with backbreaking debt?Put that on top of any undergraduate schooldebt a student may have.

I have talked to several students, recentgraduates from our state school, who aresaddled with debts ranging from $220,000to over $300,000. That’s a lot of debt tocarry just coming out of school. Think of thechoices you might have made entering theprofession’s workforce with that amount ofdebt. Think about the choices they will make.What is the final cost then?

The Emile T. Fisher Foundation forDental Education in Georgia, whose solepurpose is to provide scholarship money todental students in Georgia, has had to dip intoits corpus to keep the scholarship dollars givenat the same level as years’ past. Perhaps notthe most prudent measure, but the urge tohelp dental students however possible was themotivation. The economic downturn we areexperiencing pushed the Foundation’s boardto take this exceptional measure, as tuitionmoney sources are becoming more and moredifficult to identify.

The fact is that the future of our profession,the future of the GDA, and the future of theADA is reliant on students, on new dentists,on membership, on dues, and on donations.

What do dentists value? What do newlygraduated dentists value? Where would theprofession be without organization? Andorganization is nothing without membership.Fast forward 20 years. Picture our organizationsif new dentists can’t afford to be members ordo not perceive value in membership. You,who are reading this, know the value of theADA, GDA, and Districts. You can go therespective web sites for a refresher if need be.

The Cost of Education

5GDA ACTIONJANUARY 2012

Jonathan S. Dubin, DMD

editorialperspective

“We must educate

consumers as to

how to better care

for their health, but

is it not of even

more importance

to teach them the

value? If we cannot

change their

mindset on value,

how can we expect

the statistics

to change?” EDITORIALContinued on page 6

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But our organizations can be compared to a house of cards.Membership is the linchpin card. The stranglehold that debt canplace on a student or new dentist is the card leaning against themembership card.

Don’t we owe it to the students to help find ways to pay fortheir education? We owe it to ourselves. The bottom line is weneed to do more. At the 2011 ADA Annual Session, one ofthe resolutions that passed the House of Delegates directedthe ADA explore ways to alleviate the debt burden on ournew dentists. Perhaps legislators will link loan forgiveness withpracticing in dentist shortage areas. And there is a link on the GDAweb site where you can pledge to assist the Fisher Foundation. Itis easy. Just click.

* American Dental Association 2009-10 Survey of DentalEducation Academic Programs, Enrollment, and Graduates—Volume 1; and 2009-10 Survey of Dental Education Tuition,Admission, and Attrition—Volume 2.


EDITORIALContinued from page 5 What Are You Thinking?

Do you have an opinion about an article published in theGDA journal or observations about a GDA activity thatyou would like to share? Please email your comments toEditor Dr. Jonathan Dubin at [email protected] orManaging Editor Delaine Hall at [email protected]. Yourcomments may be selected for publication in the GDAjournal. Dr. Dubin’s term ends in July 2012, so if you havebeen waiting to tell him something, don’t wait too long.

What Are You Doing?Have you won a dental award? Accomplished a dentalgoal? Participated in a charitable dental event? Conductedan inspiring staff retreat? Recruited a non-memberdentist? Generally accomplished something notable anddental related? Let the GDA know! Please email yourinformation to Editor Dr. Jonathan Dubin at [email protected] Managing Editor Delaine Hall at [email protected].(Dentists with interesting “outside the profession” hobbiesare invited to contact the GDA journal as well. You couldbe featured in Breaking the Mold!)

Where Are You Going?Are you planning to attend a LAW Day? District legislativereception? Other GDA or district event? Feel free to shareyour photos from the event with the GDA journal or onthe GDA Facebook closed group page. Please emailyour photos to Managing Editor Delaine Hall [email protected] or visit the social networking site andsearch for “Georgia Dental.”

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Kudos to the participants in the inauguralGDA leadership development class:Drs. Jason Mann of Central; Brad Hall ofEastern; Evis Babo, Sarabess Baumrind,Ron Cavola, Brook Corbett, Ryan Vaughn,and Lee Whitesides of Northern; HankBradford, Casey Hart, Elizabeth Lewis,Freddie Padilla, and Kumar Patel ofNorthwestern; Cara DeLeon and MattRosenthal of Southeastern; and Bo Broadfootof Southwestern. President Mike Vernonnamed establishing a leadership pathwayas one of his goals during his July 2011inaugural speech and set up a Task Forceon Leadership with Dr. Bruce Camp aschair to help meet that goal.

“I want our GDA program to resemblethe leadership training that cities andother groups do to help members learnmore about the workings of theirorganizations and be more prepared toguide others,” said Dr. Vernon. “I amexcited we have identified dentists whowant to be in leadership positions and cangive them the opportunity to grow andhave their questions answered.”

The doctors selected for the initialprogram have been invited to attend a dinnerin January with the holding company andGDIS boards, the January 7 Board ofTrustees meeting, the January 8 Houseof Delegates, the January 9 DentalHealth Day at the Capitol, and theFebruary 22 LAW Day followed bylunch and orientation at the GDA office.

“We look forward to reporting theprogress of our class and seeing thembecome involved in our Association,”said Dr. Vernon. “Thank you to them andDr. Camp for working to make this projecta success.”

As of April 30, 2012, most private sectoremployers will be required to post anotice advising employees of theirrights under the National LaborRelations Act. This requirement applies

to a variety of entities, including hospitals,medical and dental offices, social servicesorganizations, child care centers, and resi-dential care centers with a gross annualvolume of at least $250,000.

Covered entities are required to postthe notice in a conspicuous place, whereother notifications of workplace rights andemployer rules and policies are posted.Employers also should publish a link to thenotice on an internal or external web site ifother personnel policies or workplacenotices are posted there.

The poster, which is available AT NOCHARGE from the National LaborRelations Board web site, is required to be11 x 17 inches, in color or in black-and-white. If printing the poster at full size, setyour printer output to 11 x 17. Or, you mayprint the two 8.5 x 11 pages and tape themtogether.

For further information about theposting, including details of whichemployers are covered, and to obtain theposter, visit https://www.nlrb.gov/poster.You may also call (202) 273-0064 andrequest a mailed copy of the poster, againAT NO CHARGE.

Don’t be fooled by high pressure salescalls, faxes, or mailers stating that you mustbuy a special poster to be in compliancewith federal law. This poster, like allfederal and state workplace posters, isavailable AT NO CHARGE. All youneed is a phone or an Internet connectionand a printer! The U.S. government isexceptionally good at producing paperand they are excited to share that paperwith you!

The GDA hosted its annual SpokespersonTraining event in November 2011 with abrand new format. Crisis communicationsexpert and “Georgia Gang” political com-mentator Jeff Dickerson was the instructor

for 26 dentists and dental student BobWilson. Feedback on the new format wassparkling. Fully 82.3 percent of the partic-ipants who completed a survey on theevent rated the event as excellent, while76.3 percent preferred the new format.All participants who completed the sur-vey thought that this training was effectivein helping them to understand and to con-vey the GDA’s messages.

Kudos to the following individualswho took part in the training:

generalnews

2012Leadership GDA

GDA EVENTSpokesperson Training

WORKPLACENew Poster

NEWSContinued on page 8

GDA President Mike Vernon and PublicRelations Committee Chair Robin Reichwith Spokesperson Training instructorJeff Dickerson of the Georgia Gang.The television personality and writertested GDA members’ knowledge ofdental issues and ability to conveyGDA messages.

Dr. Andy Allgood

Dr. Evis Babo

Dr. Jack Bickford

Dr. Bruce Camp

Dr. Keith Crummey

Dr. Jonathan Dubin

Dr. Nancy Gallagher

Dr. Brad Hall

Dr. Stan Halpern

Dr. Jay Harrington

Dr. Lindsay Holliday

Dr. Jim Hutson

Dr. Tom Jagor

Dr. Janice Joyce

Dr. Marshall Mann

Dr. Donald Nelson

Dr. Kumar Patel

Dr. Kent Percy

Dr. Annette Rainge

Dr. Robin Reich

Dr. Troy Schulman

Dr. Doug Torbush

Dr. Sidney Tourial

Dr. Mike Vernon

Dr. Donihue Waters

Dr. Carol Wolff

Bob Wilson(GHSU Student)

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The American Dental Association (ADA)is offering the newly revised ADA PracticalGuide to Creating an Employee OfficeManual that is chock full of sampleforms, checklists, policies and procedures.Obtain the guide for benefits including:

• Updated sample job descriptions andinterview questions

• New sample policies on using cellphones and social media on and off theclock

• New chapter on patient management

• Updated HIPAA and OSHA policies

• New employee performance evaluationforms

• Expanded section on natural disasterpreparation

The manual is available through theADA Catalog at www.adacatalog.org or calltoll free (800) 947-4746. The book with aCD-ROM is $89.95 for ADA membersand $134.95 for non-member dentists. Ane-book, available complete or in individualchapter downloads (prices vary accordingly)may be bought from www.adacatalog.orgor for the Amazon Kindle or Barnes andNoble Nook. (From www.ada.org.)

A new resource, Electronic HealthRecords—A Primer, has been posted inthe Dental Practice Hub on www.ada.org.The primer’s purpose is to update dentistson the growth of Electronic HealthRecords (EHR); provide information onEHR basics; present pros and cons onadopting EHRs, including the eligibilityrequirements to participate in the federalGovernment’s EHR incentive program;inform dentists on ADA EHR activities;and to provide sources for information onEHRs. (From www.ada.org.)

The board of the Georgia Department ofCommunity Health voted in December torescind a 0.5 percent reimbursement cutfor physicians, dentists, and other healthcare providers who treat Medicaidpatients. The agency, in recommendingthat the cut not go through, said it hadreceived financial relief from the stateOffice of Planning and Budget.

The story as reported in the GeorgiaHealth News included a quote fromAssociate Executive Director and LAWDay coordinator Nelda Greeneapplauding the board’s move. “Dentistryhas already had cuts,’’ she told thenews outlet. “We’re thrilled they don’thave to take any additional cut.’’ (Fromwww.georgiahealthnews.com.)

In a unanimous decision handed down inearly December 2011 the Federal TradeCommission (FTC) ruled that the NorthCarolina State Board of DentalExaminers illegally stifled competitionby stopping non-dentists from providingteeth whitening services. The dentalboard’s illegal actions led to higher pricesand reduced choices for consumers,according to the Commission.

The Commission’s Final Order requiresthe board to cease ordering non-dentists tostop providing teeth whitening products orservices. The Final Order also requires theboard to stop informing non-dentist teethwhitening providers and certain otherpersons that it is illegal for non-dentiststo provide teeth whitening products orservices.

An initial FTC administrative complaintissued in June 2010 alleged that the NorthCarolina board sent dozens of lettersinstructing non-dentist teeth whiteningproviders that they were practicingdentistry illegally, and ordering them tostop. The complaint also alleged that theboard sent letters to mall owners and prop-erty management companies urging themnot to lease space to non-dentist teethwhitening providers. According to thecomplaint, the board’s actions reduced theavailability of teeth-whitening services

in North Carolina and constituted ananticompetitive conspiracy among thedentists on the Dental Board. (Fromwww.ftc.gov.)

The American Dental Association joinedmore than 200 organizations in Novemberto thank Major League BaseballCommissioner Bud Selig and MichaelWeiner, executive director of the players’union, for their historic agreement to limitthe exposure smokeless tobacco receivesduring the baseball season.

Under the agreement, players, man-agers, and coaches will no longer be able tocarry tobacco tins or packages in their uni-forms during games, or any time that fansare in the ballpark. They will be prohibitedfrom using smokeless tobacco during tele-vised interviews, at autograph signings,at team-sponsored appearances, andother events where they meet fans. Therestrictions will become effective in thefive-year contract to take effect in 2012.

The agreement, while significant,does not affect the actual use of tobacco atgames or on camera. It does, however,bolster tobacco education programs forplayers, and creates a new MLBPA centeron cessation to help players quit. (Fromwww.ada.org; www.tobaccofreekids.org.)

NEWSContinued from page 7

ADAOffice Manual

MEDICAIDFee Cut Averted

TOBACCOBaseball Acts

WHITENINGFTC Ruling

EHRsADA Resources

February 3, 2012www.gadental.org

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FEBRUARY 2012Feb 3 (Fri): Give Kids a Smile Day.

Feb 8 (Wed): LAW Day—EasternDistrict / Northern District Southern Branch.

Feb 9 (Thu): Northern District CEMeeting, Villa Christina, Atlanta.

Feb 15 (Wed): LAW Day—Central District.

Feb 22 (Wed): LAW Day—WesternDistrict / Northern District Eastern and Central Branches / LeadershipGDA Participants.

Feb 29 (Wed): LAW Day—Northwestern District.

MARCH 2012Mar 7 (Wed): LAW Day—SoutheasternDistrict, Ga Dental Society, N. GaDental Society.

Mar 14 (Wed): LAW Day—Northern District Northern Branch.

Mar 21 (Wed): LAW Day—Southwestern District.

Mar 22-24 (Thu-Sat): Hinman DentalSociety Meeting, Atlanta.

Mar 26 (Mon): Northern DistrictExecutive Council, GDA Office, Atlanta.

Mar 28 (Wed): LAW Day—Alliance,Northern District Hall County.

Mar 30-31 (Fri-Sat): ADA MembershipConference, Chicago.

APRIL 2012Apr 10-14 (Wed-Sat): Alliance of the ADA Spring Conference, Stone Mountain.

Apr 18 (Wed): Northern District CE Meeting, Villa Christina, Atlanta.

Apr 21 (Sat): GDA Board of TrusteesMeeting, Atlanta.

Apr 26-29 (Thu-Sun): GHSUHomecoming Festivities.

MAY 2012May 3-6 (Thu-Sun): Ga. Academy ofDental Practice Meeting, Ponte Vedra.

May 7-9 (Mon-Wed): ADA WashingtonLeadership Conference, Chicago.

May 18-19 (Fri-Sat): GDA Presidents’Elect Conference, Banning Mills.

May 21 (Mon): Northern DistrictExecutive Council, GDA Office,Atlanta.

May 26-June 2: GDA President’s Cruiseto Canada / New England.

May 28 (Mon): GDA Office Closed for Memorial Day Holiday.

JUNE 2012June 8 (Fri): Finance CommitteeMeeting, GDA Office.

June 16 (Sat): GDA Board of TrusteesMeeting, Atlanta.

JULY 2012July 4 (Wed): GDA Office Closed forJuly Fourth Holiday.

July 19-22 (Thu-Sun): GDA AnnualMeeting, Amelia Island, Florida.

General News:Upcoming Dental Events

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February is Children’s Dental HealthMonth (CDHM) in Georgia. While dentaloffices will conduct volunteer careand education activities all month forchildren regardless of their economicstatus, a big focus will be on February 3—Give Kids a Smile (GKAS) Day. This isan annual one-day volunteer initiativeto provide preventive and restorativeservices to children from low-incomefamilies. On February 3, the GDA inconjunction with the district dentalsocieties will coordinate free dental carefor less fortunate children around thestate. Georgia’s program needs thehelp of GDA member dentists, theirspouses, and staff and there are twoways you can help (see below).

After you conduct your CDHMand / or GKAS activities, please sendinformation about your accomplish-ments to Courtney Layfield at the GDAOffice ([email protected]). Thisinformation is critical in educatingdecision makers and elected officialsabout the efforts of Georgia’s dentists.You are welcome to send photos! However,please ensure that you have signedphoto releases for persons in the photos,especially if the photo includes children.The GDA can provide you with a photorelease to use at your event.

The GDA appreciates all the volunteerefforts of dentists and their staff membersin providing care for disadvantagedGeorgia children and for helping to callattention to the oral health care needs ofthis patient population. We hope to seeyou at an event in February.

Volunteer at a DistrictGKAS ProgramOver the last couple of years the GDAhas moved to broaden its GKAS effortsso that dentists may reach out to low-income children in their own communities.Districts will hold at least one GKAS eventas listed below. The GDA encourages

members to review the list, pick a location,and volunteer! Bring your staff membersand family members as well. Take thefirst step by calling or emailing the con-tact dentist listed below for each districtand mark February 3 off on your calendar.

Central DistrictLocation: Several Private Dental Offices

Contact: Dr. Shirley [email protected](478) 929-0296

Eastern District (Athens)Location: Dental Office of Drs. Erik and Jennifer Wells

Contact: Dr. Jennifer [email protected](706) 548-7373

Eastern District (Augusta)Location: GHSU Department of Pediatric Dentistry

Contact: Dr. John [email protected](706) 863-7351

This event is at GHSU, but any GDA dentistsinterested in volunteering are welcome!

Council on Dental Health EncouragesGDA Members to Give Kids a Smile in FebruaryByron Colley, DMDChair, Council on Dental Health

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Northern DistrictLocation: Several Private Dental Offices

Contact: Dr. Robin [email protected](770) 602-1138

Northwestern DistrictLocation: West Georgia Technical College HygieneSchool in Douglasville

Contact: Dr. Denise [email protected](770) 321-9494

Southeastern DistrictLocation: Armstrong Dental Hygiene School in Savannah

Contact: Dr. Stephanie [email protected](912) 925-6613

Southwestern DistrictLocation: Wiregrass Technical College in Valdosta

Contact: Dr. Carly [email protected](229) 247-3200

Western DistrictLocation: Several Private Dental Offices

Contact: Dr. Alex [email protected](770) 251-4444

Conduct Your Own GKAS EventSome dentists may prefer to coordinateevents in their offices rather than partici-pating in a larger GDA district sponsoredevent. If you wish to have a GKAS event atyour practice, please log on to the ADA’s

web site at www.ada.org and download theplanning kit you will find on the GKASpage to assist with the logistics ofhosting a program in your office. Schoolnurses and the local health department inyour area are wonderful resources toidentify children who truly need dentalcare and families that cannot afford itotherwise. Please register your independentprogram at the ADA’s web site as well sothat they are aware of your efforts.

Please send yourChildren’s Dental Health Monthand / or Give Kids a Smile Day

activity details and photosto Courtney Layfield [email protected].

This information is critical ineducating decision makers

and elected officials about theefforts of Georgia’s dentists and

may be published in GDA Action.

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Happy New Year! The GDA is using thesepages to remind you of recent regulatorychanges and other important issues tokeep track of in 2012. Stay on track withthe GDA! And visit the GDA web site atwww.gadental.org for more coverage onbreaking news and upcoming deadlines.

The One Where Dentists UseCurrent CDT CodesThe 2011 / 2012 ADA Current DentalTerminology (CDT) code book contains 8new dental procedure codes and 19 revisionsto procedure code nomenclatures ordescriptors that became effective January1, 2011. To order call (800) 947-4746 orvisit www.adacatalog.org.

The One Where the ADA DentalClaim Form is UpdatedBeginning on January 1, 2012, the updatedversion of the American DentalAssociation’s dental electronic claim formwill include a field to report diagnosticcodes. Dentists will not have to use diag-nostic codes for typical claims. However,some insurers may cover services thatrequire reporting of a diagnosis code(ICD-9-CM) when specific dental pro-cedures may minimize some health risksassociated with a systemic condition.Dentists should work with their softwarevendors to ensure that systems flag thesespecific claims and auto-populate therecord with the appropriate diagnosiscode.

The One Where Dentists Comply with CDC RegulationsA dentist’s license can be sanctioned forfailing to comply with Centers for DiseaseControl and Prevention recommendationsfor preventing the transmission of certaindiseases. Visit www.cdc.gov to obtain a currentcopy of the CDC Guidelines for InfectionControl in Dental Health Care Settings.

The One Where Dentists Use BMPsThe ADA has developed “Best ManagementPractices for Amalgam Waste” and encourages

all dentists who use this restorativematerial to adhere to them. The BMPsinclude using chair side traps, installingamalgam separators, and proper disposalor recycling. Visit www.ada.org for moredetails.

The One Where Dental EmployeesInsult the Practice on FacebookAll dental offices should have an employeemanual. Recognizing that an up-to-datemanual should address matters such as anemployee’s use of social media both in andout of the dental practice, the AmericanDental Association has revised its ADAPractical Guide to Creating an EmployeeOffice Manual to address that issue. Thismanual is chock full of sample forms,checklists, policies and procedures and isavailable from www.adacatalog.org or tollfree (800) 947-4746.

The One Where Dental MedicaidGets a Complete OverhaulThe Georgia Department of CommunityHealth (DCH) is undertaking a compre-hensive assessment and redesign of thestate’s Medicaid and PeachCare for Kidsprograms. In January 2012, Navigant, thecompany selected by DCH to perform thisundertaking, will submit a report thatdiscusses options for service modelsand their projected savings and costs andassesses federal and state regulatoryand operational requirements for theproposed solution(s). DCH’s goal is tobegin a year-long implementation of asuggested program in 2013 and debut afully redesigned program in 2014. TheGDA will study this document to calculatethe impact on dental Medicaid and willcontinue to effectively advocate for dentalMedicaid and PeachCare patients anddentists accordingly.

The One Where Electronic HealthRecords Come to PlayThe Medicaid Electronic Health Record(EHR) Initiative is meant to entice alleligible Medicaid professionals, includingdentists, who meet certain criteria to

register and potentially receive up to$63,750 in federal funds over six yearsto participate in “meaningful use” of acertified EHR system. On September 5,2011, the state Department of CommunityHealth (DCH), in coordination with theCenters for Medicare and MedicaidServices (CMS), opened registration forthis initiative in Georgia.

There are still many unknownsregarding this voluntary program as itpertains to dentistry. For instance,participants accepted into this initiativemust use a certified EHR technology froma vendor approved by the Office of theNational Coordinator. At this time,there is only ONE certified dental EHRtechnology vendor. However, most majordental practice management softwarecompanies are expected to pursue cer-tification once the quality measures fordentistry have been defined. The GDAwill continue to monitor and report on thisissue as appropriate.

The One Where the GDA LovesAddress ChangesKeep your membership records currentby informing the GDA if you move youroffice or home, or change your phone,email, or fax number. Call (404) 636-7553or (800) 432-4357, visit www.gadental.org fora change form, or email [email protected].

The One Where HIPAA Sets a Jan1, 2012 Deadline for DentistsThe Health Insurance Portability andAccountability Act (HIPAA) mandates thatthe health care industry use standardizedformats for electronic claims and claims-related transactions. Those formats arebeing updated with 5010 and ICD-10coding systems. As of January 1, 2012,all HIPAA-compliant electronic transmissionclaims and code sets from all providersmust be tested and ready for transmission asa 5010 transaction. Visit www.dch.georgia.gov/ICD10 or www.cms.gov/ICD10 for additionaldetails. The ADA sells a “Practical Guideto HIPAA Compliance: Privacy andSecurity Kit” with details on 5010 and

Did You Know:“Important Stuff” Checklist for the New Year

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other recent HIPAA requirements. Call(800) 947-4746 or visit www.adacatalog.org.

The One Where the Dentist LosesInsurance CoverageTell your Business Owner’s andProfessional Liability insurance carriers atleast two weeks before you move yourpractice about your move and newlocation. You will not be covered atyour new location until you notifyyour insurer AND they accept the risk.This happens far more than it should!Georgia Dental Insurance Services clients:Call (800) 432-4357 or (404) 636-7553with your changes. And if you receivedadditional training in dental procedures ordiscontinued doing certain procedures,notify your liability carrier, as you justchanged the risk the company is insuring.The same goes if you changed from fulltime to part time or vice versa.

The One Where Dentists’Insurance Policies are Up to DateGreet 2012 with all of your policies in asecure location. Keep a separate list ofpolicy numbers, renewal dates, and claimsdepartment contact details in case youmake a claim. Pay your premiums prompt-ly this year. If you have moved, notify all ofyour carriers so bills arrive at the correctplace. Remember to increase your insuredexposure limits if the value of your proper-ty has increased from last year. And reviewyour medical plan if you recently utilized itso you are aware of any limitations orrequirements.

The One Where Dentists Don’tDock Employees for Jury DutyEmployees are entitled to receive theirsalary during the time they are on officialjury duty. Georgia law prohibits anemployer from discharging, disciplining,or otherwise penalizing an employee forserving on jury duty. For a copy of theGeorgia Attorney General Opinion regard-ing this matter, contact GDA GeneralCounsel Melana McClatchey [email protected].

The One Where OSHA is StillAlive and KickingDentists must meet a whole host of OSHArequirements—scheduling annual OSHAupdates, documenting training, completing

MSDS sheets, ensuring employee medicalrecords are up to date—includingHepatitis B vaccinations and a history ofexposure incidents—labeling hazardouschemicals, explaining the HazardCommunication Program to staff, anddisplaying the proper workplace posters.The ADA sells an OSHA Compliance Kitto assist you with these matters. Buy yourkit by calling (800) 947-4746 or visitwww.adacatalog.org. Please contactNelda Greene at the GDA office [email protected] with questionsas well.

The One Where PCI ComplianceFees are Not a ScamThe major credit card brands (Visa,MasterCard, Discover, American Express)recently formed Payment Card Industry-Data Security Standards (PCI-DSS) toprevent fraud at the merchant level. Whenyou accept credit cards from your patients,you also accept the responsibility toprotect and secure their information underPCI-DSS. The payment gateway companyyou work with should have discussedPCI-DSS with you. If not, talk to them.

Every payment processor is requiredby PCI-DSS to hire an outside firm toconduct / coordinate a Self AssessmentQuestionnaire of their merchants. When aclient of GDA endorsed processerTransFirst completes their annual ques-tionnaire, they receive a discounted rateon the quarterly PCI fee that TransFirstcharges ($18.80 versus $28.80). In general,TransFirst’s PCI fees are much lower thanthe ones charged by competing processors(and they all charge some sort of PCI fee).

The One Where You Have Until2013 to Renew Your LicenseThe next renewal period for dentists anddental hygienists is December 2013.Renewal happens every two years, whichmeans you should have renewed yourlicense by December 2011. You can verifyrenewals at http://sos.georgia.gov/plb/den-tistry. Remember to maintain your CEdocumentation for at least three years. You

CHECKLISTContinued on page 14

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now have two years to obtain 40 hours ofCE (22 hours for dental hygienists) andensure you have current CPR certification.You can only obtain online CE for up toone-half of the total hours required forrenewal.

The One Where Dentists Need toBuy Security Prescription PaperAs of March 31, 2012, health careproviders must provide Schedule IIControlled Substance prescriptions topatients on state-approved security paper.This includes providers who use paperprescription pads as well as providers whouse software to generate prescriptions.Georgia’s legislature passed this regulationto curb the growth of pill mills, wherepatients often receive prescriptions forpain medicines without significant scruti-ny. All approved paper must be affixedwith the Georgia Pharmacy Board’s seal of

approval. A list of vendors selling approvedpaper is available on the Pharmacy Board’sweb site at www.sos.ga.gov/plb/pharmacy.(The previous deadline was December 31,2011, but the Board of Pharmacy voted foran extension in mid-December.)

The One Where Use Taxis Still RequiredThe Georgia Department of Revenuerequires businesses to pay a use tax on anyitems purchased from an out-of-state ven-dor that did not collect Georgia sales tax.You must complete Form ST-3 for pay-ment to comply. Contact the GeorgiaDepartment of Revenue at (877)-602-8477or www.etax.dor.ga.gov for additional help.

The One Where the Feds Issue a(New But Free) Workplace PosterAs of April 30, 2012, most private sectoremployers will be required to post a noticeadvising employees of their rights underthe National Labor Relations Act. Thisrequirement applies to a variety of entities,including dental offices, with a grossannual volume of at least $250,000.

The poster is available for free athttps://www.nlrb.gov/poster or by calling(202) 273-0064. Don’t be fooled by highpressure sales calls, faxes, or mailersstating that you must buy a special posterto be in compliance with federal law.This poster, like all federal and stateworkplace posters, is available AT NOCHARGE. All you need is a phone or anInternet connection and a printer!

The One Where You Must PostOther Fed Workplace PostersIn addition to the NLRA poster, the U.S.government requires the posting of theseworkplace posters: 1) Employee PolygraphProtection, 2) Equal Employment Opportunity,3) Fair Labor Standards Act, 4) Job Safetyand Health Protection, 5) Rights Underthe Family and Medical Leave Act (foremployers of 50 or more individuals), and6) Uniformed Services Employment andReemployment Rights Act. Obtain themfor free from the U.S. Department ofLabor Web site www.dol.gov/compliance/topics/posters.htm.

CHECKLISTContinued from page 13

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The One Where Workplace Postersare Required by Georgia TooGeorgia requires dentists to post theseworkplace posters: 1) DOL-154(Employer Vacation), 2) DOL-4107(Equal Pay for Equal Work Act), and 3)DOL-810 (Unemployment Insurance forEmployees). Obtain these posters at thestate Department of Labor Web sitewww.dol.state.ga.us/em/required_posters.htm.The state also requires you to post twoWorkers’ Comp notice posters: 1) WC-P1“Panel of Physicians” with a list of sixphysicians (one must be an orthopedicsurgeon and one a minority, if feasible)and WC-BOR “Bill of Rights for theInjured Worker.” Obtain them athttp://sbwc.georgia.gov (click on “Forms”and then “Board Forms”).

The One Where X-ray Certification is DifficultThe Health Care Section of the Office ofRegulatory Services (ORS) no longer per-forms routine periodic surveys of x-raymachines, but does perform initial stateregistration surveys and shielding design

reviews. Dentists must have x-ray equip-ment inspected by the state before anynew equipment may be used. Planahead—this process can take monthsbecause the state has few inspectors.Dentists may contract with a qualifiedphysicist to complete a shielding designreview and initial on-site survey. Thisphysicist submit a report to ORS in supportof your application. Regardless of if youchoose ORS or a qualified physicist toperform your initial state registrationsurvey and shielding design review, youCANNOT operate your x-ray machinesuntil the initial inspection is successful andyou receive a state of Georgia certificateof registration. Visit http://dch.georgia.govfor additional information on registeringyour equipment.

An expanded version of this

“important stuff” article complete

with links to referenced agencies

is posted at www.gadental.org.

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Your GDA will pursue numerous legislativeobjectives this year—see the full list in thebox on page 17. However, yourGovernmental Affairs Committee andGDA leadership have identified fouritems of primary focus for theAssociation:

• Advocating for an appropriate dentalMedicaid budget for children andadult dental services.

• Lobbying for 12-month eligibility forMedicaid, which will allow children tohave uninterrupted dental care andlessen the administrative burden fordentists.

• Supporting legislation that would allowdentists licensed outside Georgiato practice for a specific volunteerprogram approved by the GeorgiaBoard of Dentistry.

• Advocating for autonomy of a dentistfrom being required to participate in anyspecific insurance plan as a condition oflicensure.

“Conducting the Georgia Mission ofMercy in 2011 helped us realize theimportance of enabling as many dentists aspossible to provide care in a volunteercapacity in our state,” said President MikeVernon. “So the GDA has chosen tosupport a bill that will allow dentistslicensed in other states to providecare at Board-approved volunteerprograms. We have many non-Georgiadentists who are eager to take part inGMOM and volunteer at our charitableclinics, but who are relegated to non-primary care functions due to our laws.”

“Members have watched the GDAlobby on Medicaid issues for many years,”said Dr. Jack Bickford, Chair of theGovernmental Affairs Committee. “Not all

of our dentists participate in this program,but hundreds do. If health care reformmoves forward, this program willexpand tremendously in our state. Notpaying close attention to the financingand structure of Medicaid could haveconsequences for all dentists, andGeorgia’s poor children. So, the GDA willlobby for an appropriate dentalMedicaid budget for children andcovered adult services. We will also lobbyfor 12-month Medicaid eligibility,which keeps kids on the program to accesscare, and makes keeping up with patientseasier on dentists.”

Both doctors also say the GDAwill support legislation to support theautonomy of a dentist from beingrequired to participate in any specificinsurance plan as a condition of licensure.

For additional information on theseissues, consult the GDA PositionPapers as approved by the House ofDelegates and posted on the GDA website www.gadental.org.

Take Part in a LAW Day—Despite ButterfliesEven if you get tongue-tied thinking aboutrelaying dental viewpoints face-to-facewith a legislator, a LAW Day is an eye-opening, don’t miss, amazing experiencefor dentists, and dental spouses. Thisaward-winning GDA advocacy activityfeatures breakfast (usually everyone isgood at breakfast), an “extreme insider”issues overview from GDA ExecutiveDirector Martha Phillips (usuallyeveryone is good at enjoying the behindthe scenes news), and a visit to theCapitol (always cool to see the statemuseum artifacts and the historic build-ing).

LAW Day visitors are welcome to stayin a group of volunteers designated tocommunicate with a particular legislator,and allow a LAW Day veteran to actually

talk. Please note that your presence—youstanding inside the Capitol on a workday tocarry a patient-friendly message—speaksVOLUMES. Maybe you can even workup the gumption to speak to your ownlegislators, even if they are not on a dental-centered committee. Despite the presenceof LAW Day veterans, your actual voicewill be put to use if you want to speak!

Don’t miss your chance to see Georgialaw being made. Contact Nelda Greene [email protected] to sign up for any ofthe 2012 LAW Day dates:

February 8: Eastern District / NorthernDistrict Southern Branch.

February 15: Central District.

February 22: Western District / NorthernDistrict Eastern, Central Branches/ Leadership GDA.

February 29: NorthwesternDistrict.

March 7: Southeastern District,Ga Dental Society, N. Ga DentalSociety.

March 14: Northern District Northern Branch.

March 21: SouthwesternDistrict.

March 28: Alliance, NorthernDistrict Hall County.

GDA Legislative Priorities for 2012:Practice Freedom, Third Party Issues, and VolunteersMichael Vernon, DDS, PresidentJack Bickford, DDS, Governmental Affairs ChairMartha Phillips, Executive Director

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Medicaid and PeachCare:The GDA Supports

• Legislation that provides access todental care for adults, the elderly andthe developmentally disabled eitherthrough inclusion in the Medicaidbudget or other means.

• Maintaining an appropriate Medicaidbudget for dental care.

• Legislation to carve out the dentalportion of the Medicaid andPeachCare programs.

• 12-month eligibility for Medicaid.

Access to Care: The GDA Supports

• Legislation for a student loan forgive-ness program for dentists and dentalhygienists who agree to serve inunderserved areas.

• Legislation that would allow state taxcredit for dentists who provide docu-mented charitable care in excess of$5,000 annually.

• Revitalizing the dental public healthprogram so that oral health is a prior-ity in the Department of PublicHealth, the fluoridation monitoringand surveillance program is funded,and dentists’ and dental hygienists’salaries are increased.

• Amending Georgia law to allow den-tists licensed outside Georgia topractice for a specific volunteer pro-gram approved by the Georgia Boardof Dentistry.

Dental Practice: The GDA Supports

• Legislation that would allow anyprovider who is willing to abide bythe terms of an insurance plan toparticipate in that plan.

• Legislation to allow a tax credit forsmall business owners who provide

and pay for medical benefits for theiremployees.

• Maintaining tort reform provisionsenacted with SB3 in 2005.

• Pursuing insurance reform wherebydentists can compete fairly by requir-ing full disclosure of insurance rate-setting information and wherebypersons reviewing insurance claimsare licensed in Georgia in the samefield.

• Autonomy of a dentist from beingrequired to participate in any specificinsurance plan as a condition oflicensure.

• Legislation that would provide trans-parency and regulation of so called“silent PPOs” and rental networks.

Patient Care: The GDA Supports

• The dental team concept and oppos-es efforts to remove the delivery ofdental hygiene services from thedirect supervision of dentists andcontinue the administration of localanesthesia by dentists.

• Oral health education and preven-tion programs that enable Georgiansto be informed about optimal oralhealth and children to access basicprevention services, such as sealantsand fluoride.

GDA Sets Numerous Objectivesfor 2012 Legislative Session

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Our Task Force* continues to monitor the activity taking place inand around the Medicaid and PeachCare programs. With the roll-out of federal health care reform, and the re-design of the stateMedicaid program, there is a great deal of activity to track.

Georgia Medicaid Re-DesignThe Department of Community Health (DCH) is studyinga re-design of the state Medicaid and SCHIP (PeachCare)programs in partnership with its hired consultant Navigant.Here is a timeline of major activities:

• DCH has completed its “Assessment Phase” after holding a seriesof stakeholder focus groups, including two dental-only groups.(GDA members and staff participated in these focus groups.)

• DCH is now moving into the “Recommendation Phase.” Navigantis expected to submit a report in January that will include optionsfor service models and projected savings / costs of any proposedmodels; an assessment of federal and state regulatory and oper-ational requirements for the proposed solution(s); a considera-tion of how to accommodate the PPACA-created Medicaidexpansion slated for 2014; and some contractual provisions toconsider for new CMO contracts.

• For the “Procurement Phase,” by June 2012, DCH plans to finalizeall documents and post them for public review and submission.On or about July 1, 2012, DCH expects to issue RFP(s) for theredesign procurement.

• By January 2013, DCH anticipates awarding contracts to selectedvendors and moving into the “Implementation Phase.” DCH isplanning a yearlong implementation phase and expects to fullyimplement redesigned Medicaid and SCHIP programs byFebruary 1, 2014. (Note: these dates and details were taken fromthe DCH web site www.dch.georgia.gov and are subject tochange by the Department.)

CMO Provider Network ExpansionThe GDA has confirmed that the Medicaid Care ManagementOrganizations Peach State and Amerigroup both plan to expandtheir network of providers statewide starting in January 2012upon approval by DCH. The contract has been re-negotiatedbetween DCH and the CMOs and is awaiting signatures byall parties involved.This Task Force will monitor the expansion andreport as new developments are made public next early next year.

New Companies in Medicaid?Over the last few months we have met with representatives fromtwo companies that are interested in expanding into the Medicaid

managed care system in Georgia as part of the DCH redesign men-tioned above. Molina Healthcare and Aetna Better Health are look-ing to enter the Georgia Medicaid market, develop a dentalprovider network, and offer services statewide. Both companieshave hired public affairs firms to assist them with the DCH contractbidding and procurement phases.

Electronic Health RecordsThe Medicaid Electronic Health Record (EHR) Initiative is meant toentice all eligible Medicaid professionals, including dentists, whomeet certain criteria to register and potentially receive up to$63,750 in federal funds over six years to participate in “meaning-ful use” of a certified EHR system. On September 5, the stateDepartment of Community Health (DCH), in coordination with theCenters for Medicare and Medicaid Services (CMS), opened regis-tration for this initiative in Georgia.

There are still many unknowns regarding this voluntary pro-gram as it pertains to dentistry. We do know that eligible profes-sionals must have at least 30 percent patient volume attributableto Medicaid, which includes fee-for-service and managed carepatients. However, PeachCare for Kids enrollees do not counttoward the Medicaid patient volume which may disqualify manydental offices.

“Meaningful Use” measures an eligible professional’s use ofEHRs to improve the quality, safety, and efficiency of patient care.One criterion is the use of EHRs to report clinical quality measures;however, no dental clinical quality measures have been estab-lished.The American Dental Association is working with the Officeof the National Coordinator to define the framework for EHR clini-cal quality measures. The ADA has also provided comments toCMS regarding proposed rules defining meaningful use.

Participants accepted into this initiative must use a certifiedEHR technology from an approved vendor list. At this time, thereis only ONE certified dental EHR technology vendor. Mostmajor dental practice management software companies areexpected to pursue certification once the quality measures fordentistry have been defined.

Meetings and MonitoringIn addition to tracking all of the above issues, the Task Force con-tinues to monitor GDA staff reports from regular DCH, DentaQuestAdvisory Board, SCION Dental Advisory Board, and HP EnterprisesMMIS meetings. The GDA offers input at each of these meetingsas necessary.

* Task Force members are Drs. Jim Hall, Alfred Peters, AnnetteRainge, Kaneta Lott, Alfred Wyatt, Jason Oyler, Antwan Treadway,Byron Colley, and Ed Green.

Update on Medicaid Issues from the GDA Medicaid Task ForceDr. Jimmy TalbotTask Force Chair

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The Patient Protection and AffordableCare Act (PPACA) was signed into law onMarch 23, 2010, and since that time manyelements of the federal health care reformlegislation have been put into motion.Most people are unaware of the broad andfar-reaching changes that will be madewhen the PPACA is fully implemented by2014. This article and its sidebar articleswill attempt to show the far-ranging scopeof the Act; how the Act impacts dentistry;currently active provisions; and provisionson the horizon.

PPACA and Dentistry:Essential BenefitsPPACA laid out 10 general areas of healthcare services that should form what wastermed an “Essential Benefits Package”(EBP). The areas mentioned were ambu-latory patient services, emergency servic-es, hospitalization, maternity and newborncare, mental health and substance use dis-order services, prescription drugs, rehabil-itative and habilitative services anddevices, lab services and devices, lab serv-ices, preventive and wellness services andchronic disease management and pedi-atric services, including oral andvision care. This EBP, PPACA directed,must be offered beginning in 2014 as partof any health plan providing coverage inthe individual or group market. However,the reform bill kept its language very gen-eral. Instead, the bill directed the U.S.Department of Health and HumanServices (HHS) to define the details ofwhat services will be offered withinthe EBP.

HHS requested that the Institute ofMedicine (IOM) recommend a processthat would help HHS define the benefitsthat should be included in the package.IOM was not to decide what was to be cov-ered, but rather propose a set of criteriaand methods that should be used in decid-ing what benefits are most important forcoverage. The American DentalAssociation (ADA) and the American

Academy of Pediatric Dentistry (AAPD)offered recommendations to IOM on thedental services the essential dental benefitpackage should cover. The AAPD’s writtenstatement supported their Model DentalBenefits policy which delineates the diag-nostic, preventive, and restorative servicesthat are essential to children:

• Diagnostic procedures, which only adentist can provide.

• Preventive services, including fluoridevarnish, sealants, prescriptions.

• Restorative and endodontic services torelieve pain and infection and restoreand maintain function.

• Orthodontic services to prevent, inter-cept, and treat malocclusions – includingmanagement of children with cleft lip orpalate and/or congenital or developmen-tal defects – consistent with program cri-teria for medically necessary services.

Some children, especially those withearly childhood caries, special health careneeds, or medically compromising condi-tions are more likely to require additionalservices such as:

• Behavior guidance services, includingboth pharmacologic and non-pharmaco-logic management techniques.

• Dental and oral surgery under sedation /general anesthesia, in outpatient or inpa-tient hospital facilities.

• Periodontal services.

• Prosthodontic services, includingimplants to restore oral function.

The IOM released initial guidance forHHS in October 2011, directing HHS tochoose an essential health benefits pack-age that costs about the same as an averagesmall group health plan would in 2014,provides a range of services backed by evi-dence of their medical effectiveness, andbalances the competing needs of healthplan affordability and covered benefits.

The IOM also said that HHS should leadan effort to limit the growth of healthcosts. The IOM panel suggested that HHSfinalize the benefits list by May 1, 2012,after seeking extensive public input. Sincethe IOM was not to decide what wascovered and what was not, no specificcoverage recommendations were includedin the report. However, the indexesdelineated dental services typicallyincluded and excluded by establishedhealth care plans. The report may be readat www.iom.edu/Reports/2011/Essential-Health-Benefits-Balancing-Coverage-and-Cost.aspx.

In a somewhat surprising December2011 move, HHS elected to move deci-sions on covered essential benefits to thestates. An HHS memo stated that theagency intends to define essential healthbenefits using a benchmark approach andgive states the flexibility to select a bench-mark plan that reflects the scope of servic-es offered by a “typical employer plan.”According to HHS, states would chooseone of the following benchmark healthinsurance plans:

• One of the three largest small groupplans in the state by enrollment;

• One of the three largest state employeehealth plans by enrollment;

• One of the three largest federal employeehealth plan options by enrollment;

• The largest HMO plan offered in thestate’s commercial market by enrollment.

If states choose not to select a bench-mark, HHS intends to propose that thedefault benchmark will be the small groupplan with the largest enrollment in thestate.

To prevent federal dollars going tostate benefit mandates, the health reformlaw requires states to defray the cost ofbenefits required by state law in excess ofessential health benefits for individualsenrolled in any plan offered through aHeath Insurance Exchange. These bench-

New Year, New Developments in Federal Health Care ReformMartha Phillips, Executive Director

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marks are generally regulated by the stateand would be subject to state mandatesapplicable to the small group market.Thus, those mandates would be includedin the state essential health benefits pack-age if the state elected one of the threelargest small group plans in that state as itsbenchmark.

Essential health benefits must includecoverage of services and items in all 10statutory categories. HHS intends torequire that a health plan offer benefitsthat are “substantially equal” to the bench-mark plan selected by the state and modi-fied as necessary to reflect the 10 coveragecategories. Health plans would have theability to adjust benefits, including boththe specific services covered and anyquantitative limits, provided they continueto offer coverage for all 10 statutory cate-gories and the coverage has the samevalue. Insurers would also define the costsharing features of the plans such asdeductibles, copayments, and coinsurance.(From www.pnhp.org.)

PPACA and Dentistry:Medicaid ExpansionPPACA would expand Medicaid eligibilityto include all individuals and families withincomes up to 133% of the FederalPoverty Level as well as provide for a sim-plified SCHIP (PeachCare for Kids)enrollment process. This expansion wouldadd more than 600,000 Georgia residentsto the Medicaid program by 2014 if healthreform is fully implemented. The dentalcomponent of Georgia’s Medicaid programhas been beset by administrative red tape,service cuts, and fee schedule upheavalssince becoming part of the CareManagement Organization system in2005. The state is currently planning for are-design of the Medicaid program, withan eye towards the expected influx of newenrollees. The GDA has testified at thestate’s focus groups on the re-designprocess, and has prepared a long list ofimprovements that should be made to thedental component if this safety net forGeorgia’s poor children is to survive.

Health Insurance Exchanges: How They May Look in Georgia

Despite opposing PPACA, and filing a federal lawsuit to stop its implementation,Georgia’s leadership established a Health Insurance Exchange AdvisoryCommittee in June 2011 to determine how the state wants to proceed with aHealth Insurance Exchange as mandated by PPACA. The committee is due toissue a report about Georgia’s exchange structure in January 2012.

If PPACA is not overturned by the Supreme Court or repealed, Georgia hastwo choices: comply with the law and formulate a customized exchange, orwait for the federal government to force an exchange system on them.Georgia’s decision to establish parameters for a state exchange instead ofwaiting for a federal exchange to be forced on them appears to acknowledgethat in some form, PPACA and health care reform is here to stay.

No one knows what exchanges will look like. States have a great deal offlexibility in establishing an exchange once they meet required basic settings.Exchanges will serve as clearinghouses and some will have some quasi-regulatoryfunctions. They will help facilitate the purchase of private insurance andwill serve as the vehicle for enrolling Medicaid and SCHIP (PeachCare) eligibleindividuals. In general terms the market will be divided into three segments:(1) State public programs (Medicaid, CHIP, and State Health Benefit Plan);(2) Exchanges (individual and small groups); and (3) everyone else.

The exchanges may make dental benefits available to more individuals,but also may require dentists who want to participate as providers signcontracts for fees much different than they have charged previously.According to a 2005 ADA-funded dental economics analysis, “carriers withgreater levels of concentration in a local area effectively depress reimbursementfees to general practitioners.” A 2011 paper by the Deloitte Center for HealthSolutions listed among its projected implications of heath care exchanges forhospitals and physicians that “payments by Qualified Health Plans might belower than traditional commercial rates, reducing margins for providers.”

How a single powerful entity can easily control dental fees may beshown by the actions of Delta Dental of Idaho in November 2011. Accordingto Kym Browning, spokeswoman for Delta Dental, Delta cut their reimbursementfees to dentists on a regional basis by an average of 8%. Dr. Greg Bengtson,President of the Idaho State Dental Association, said the cuts will range from4% to 13%.

Ms. Browning stated, “We are making PPO fee adjustments to remaincompetitive in a changing market and to respond to concerns from employeesabout the rising cost of employee health benefits. By making changes to ourPPO fee structure, we can help ensure employers are able to continue offeringaccess to quality, affordable dental benefits for their employees and ourmembers receive optimal savings when covered by Delta Dental of Idaho.”

Dr. Bengtson said, “The dentists’ relationship to Delta Dental is similar tothat of David and Goliath. Delta says it’s the largest stand-alone dentalbenefit carrier providing employer coverage in Idaho, with about 380,000members statewide. With that market share, it’s hard to contemplate dentistsnot accepting their plan.”

Quality reporting requirements will likely be a part of the exchanges’quasi-regulatory authority. Insurance companies will be required to providedata on outcomes and it is not hard to imagine that this could lead to pay-for-performance initiatives.

The National Association of Dental Plans reports that currently 30% ofconsumers get dental coverage through small groups with 2% obtainingcoverage via individual markets. They state that more than 44% of householdswith dental benefits have incomes below $50,000 and could potentiallybenefit from the subsidies offered in the exchanges.FEDERAL HEALTH CARE REFORM

Continued on page 22

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PPACA and ElectronicHealth Records (EHR)The move toward mandatory use ofElectronic Health Records (EHR) by allhealth care practitioners is a part of thePPACA and is well into being implement-ed. Billions of dollars have already goneinto this process. The federal governmentis subsidizing the EHR transition ofMedicaid and Medicare providers whosepractices provide care to at least 30 per-cent Medicaid or Medicare recipients. Themove to EHRs is a necessary part of theoverall reform of the delivery of healthcare. The government will have access todata it can use to drive policy and paymentdecisions. The data will also provide neces-sary information in the evaluation of “bestpractices,” evidence-based care, and otherchanges to benefits and payment practices.

PPACA and New Methodsof Health Care DeliveryThe use of EHRs and other sorts of healthinformation technology (HIT) to achievecertain health reform goals is emphasizedin PPACA. The phrase “health informationtechnology” or “HIT” is used more than 40times in PPACA pertaining to measuringand enhancing quality, establishing newmethods and models for delivering care,and achieving other goals. And new meth-ods of coordinating and delivering care areon the drawing board throughout thehealth care field. For instance, telemedi-cine is an emerging model to deliver carein rural areas that are deemed to have ashortage of health care providers. Inresponse to requests from the AmericanMedical Association and others, theCenters for Medicare and MedicaidServices (CMS) has announced that itintends to eliminate outdated qualitymeasures and standardize reporting meth-ods by aligning the federal electronic med-ical record incentive program with otherinitiatives. CMS will allow for more accessto telemedicine services for patients in

rural and critical access areas. CMS hasalready published a rule permitting hospi-tals to use telemedicine to obtain servicesfrom a “credentialed practitioner” at a dis-tance hospital as long as the hospital also isparticipating in Medicare and a writtenagreement between both facilities exists.

PPACA and Dentistry: The FutureIt is difficult for me to believe that thePPACA will be repealed in whole no mat-ter who is sitting in the White House inJanuary 2013 or which party is in control ofthe House and Senate. Too many of thepolicies relating to the PPACA havealready been put into place (see the side-bars on pages 21 and 23) and many of theprovisions of the Act are supported byDemocrats and Republicans. If theRepublicans are in control of the WhiteHouse and the Senate, the most contro-

FEDERAL HEALTH CARE REFORMContinued from page 21

FEDERAL HEALTH CARE REFORMContinued on page 30

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The Act requires:

• Insurers to offer the same premium to all applicantsof the same age and geographical location withoutregard to most pre-existing conditions (excludingtobacco use).

• That nearly all persons not covered by Medicaid,Medicare, or other public insurance programspurchase an approved private insurance policy orpay a penalty, unless the applicable individual is amember of a recognized religious sect, exempted bythe IRS, or waived in cases of financial hardship. Thisprovision is commonly called the individual mandate.

• Medicaid eligibility to expand to include allindividuals and families with incomes up to 133% ofthe poverty level along with a simplified SCHIPenrollment process.

• The creation of state Health Insurance Exchanges—marketplaces where individuals and small businessescan compare policies and premiums, and buy insurance(with a government subsidy if eligible based onFederal Poverty Level incomes).

• The establishment of minimum standards for healthinsurance policies and prohibition of lifetimecoverage caps.

• That firms employing 50 or more people but notoffering health insurance pay a “shared responsibility”requirement if the government ends up subsidizingan employee’s health care.

• Insurance companies to spend a certain percentageof premium dollars on medical care improvementand issue rebates to policy holders if failing to meetthis requirement.

• Elimination of co-payments, co-insurance, anddeductibles for select health care insurance benefitsconsidered to be part of an “essential benefitspackage.” (Pediatric vision and dental care areconsidered as part of the essential benefit package,but specific services for pediatric patients have yet tobe defined).

Selective Overview: Provisions of the PPACA

PROVISIONS OF THE PPACAContinued on page 24

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Provisions Currently Effective• Insurers are prohibited from imposing lifetime dollar

limits on essential benefits; excluding pre-existing medicalconditions for children under the age of 19 except ingrandfathered individual health plans; chargingco-payments, co-insurance, or deductibles for certainpreventive care and medical screenings on all newinsurance plans; and dropping policy holders when theybecome sick.

• Insurers’ abilities to enforce annual spending caps arenow restricted, and will be prohibited by 2014.

• Insurers are required to reveal details about administrativeand executive expenditures, and non-profit Blue Crossinsurers are required to maintain a loss ratio (moneyspent on procedures over money incoming) of 85% orhigher to take advantage of IRS tax benefits.

• Insurers are required to spend 85% of large-group and80% of small-group and individual plan premiums (withcertain adjustments) on health care or to improve healthcare quality, or return the difference to the customer asa rebate. (Georgia applied for and received a waiverthat will allow state insurance companies on a slidingpercentage up to three years to meet this requirement.)

Provisions Effective in 2012• Starting January 1, employers must disclose the value of

the benefits they provide for each employee’shealth insurance coverage on the employees’ annualForm W-2.

Provisions Effective in 2013Income from self-employment and wages of single indi-viduals in excess of $200,000 annually will be subject to anadditional tax of 0.9%. The threshold amount is $250,000for a married couple filing jointly (threshold applies tojoin compensation of the two spouses), or $125,000 for amarried person filing separately. In addition, an additionaltax of 3.8% will apply to the lesser of net investmentincome or the amount by which adjusted income exceeds$200,000 ($250,000 for a married couple filing jointly;$125,000 for a married person filing separately.)

Provisions Effective in 2014• Insurers will be prohibited from discriminating against

or charging higher rates for any individuals based onpre-existing medical conditions.

• Two years of tax credits will be offered to qualifiedsmall businesses. To receive the full benefit of a 50%premium subsidy, the small business must have an

average payroll per fulltime equivalent (FTE) employee,excluding the owner of the business, of less than$25,000 and have fewer than 11 FTEs. The subsidy isreduced by 6.7% per additional employee and 4% peradditional $1,000 of average compensation.

• Chain restaurants and food vendors with 20 or morelocations will be required to display the caloric contentof their foods on menus, drive-through menus, andvending machines. Additional information, such assaturated fat, carbohydrate and sodium content, mustalso be made available upon request.

• Health Insurance Exchanges and subsidization ofinsurance premiums for certain individuals will be inplace.

• Members of Congress and their staff members may onlyaccess health care plans through the exchange or plansotherwise established by the bill (instead of the FederalEmployees Health Benefits Program that they currentlyuse.)

• An excise tax goes into effect on pharmaceutical companiesbased on market share of the company.

• Most medical devices will become subject to a 2.3%excise tax collected at the time of purchase.

• Health insurance companies will become subject to anew excise tax based on their market share; the rategradually rises between 2014 and 2018 and thereafterincreases at the rate of inflation.

Provisions Effective in 2017A state may apply to HHS for a “waiver for state innovation”provided that the state passes legislation implementingan alternative health care plan that meets certain criteriaestablished by PPACA.

Provisions Effective in 2018• All existing health insurance plans must cover approved

preventive care and checkups without co-payment.

• A 40% excise tax on high cost (“Cadillac”) insuranceplans will be introduced. The tax is on the cost ofcoverage in excess of $27,500 (family coverage) and$10,200 (individual coverage), and it is increased to$30,950 (family) and $11,850 (individual) for retireesand employees in high risk professions. The dollarthresholds are indexed with inflation; employerswith higher costs on account of the age or genderdemographics of their employees may value theircoverage using the age and gender demographics of anational risk pool.

PPACA Provisions in Force and Upcoming

PROVISIONS OF THE PPACAContinued from page 23

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Dental Related Services

X-RAY SAFETY CERTIFICATION forassistants is required by Georgia law.This up-to-date take-home course haseffectively certified thousands of x-raymachine operators. Send $149.99 per reg-istrant with name(s) to: Dr. Rick Waters,385 Pinewood Circle, Athens, GA 30606.Visit www.gaxray.com for credit card pay-ment or to use the immediate-accessonline version. Call (706) 255-4499 formore information.

Supplies for sale—Dentist retiring!Everything 20% below retail. DispersalloyAmalgam 500 2-spill capsules $1,000; 2x2gauze, 5000 / case $46.00; Bibs 13x19, 500/ case $22.40; Disposable Prophy Angles,144 / box $48.00 or case of 8 boxes$360.00. Too many to list here. To requestcomplete list with prices, call (770) 456-2550 or email [email protected] products guaranteed or full refund.

For sale or assumable loan—2 year oldE4D crown milling machine, excellentcondition with three year warrantyremaining. Great investment, inquiries call(229) 344-5636.

Dental StaffCandidates Available

Looking for a new dental staff? [email protected] and we canhelp you place a great match for youroffice! Whether you are looking for arecent graduate or one who has been outworking already, we have extensive files ofqualified dental staff from all over the statewho are looking for work. All have trainingin Dentrix, Eaglesoft, digital x-ray certifi-cation, and crown and bridge training.Some candidates have also formal frontdesk training. There is no fee for place-ment service. Also available are currentstudents willing to work short-term probono in sterilization, doctor and hygieneassisting, making radiographs, answeringphones, etc. Email or call (678) 819-3919!

Dentists Availablefor Locum Tenens

Dentist will fill in for illness, vacation, orcontinuing education. Licensed, insured,DEA #. Call (404) 786-0229 or [email protected].

Dentist Available Daily (DAD): Dentistavailable during vacations, emergencies,and CE courses. Leave your practice inwell-trained hands. I am licensed, insured,and have a DEA registration number so Ican write prescriptions. Call Dr. RichardPatrick at (770) 993-8838.

DENTIST: Need Part Time Fill In?Vacation, Illness, Maternity? GENERALDENTIST SOLD LONG ESTAB-LISHED PRACTICE. GA & DEALICENSED. (Available Expanded AtlantaArea.) Cell: (404) 219-4097. Home: (404)842-1196. Jesse Hader, DDS.

Dentist available during emergencies,vacation, CDE courses. I have a currentlicense, DEA certificate, and insurance.Contact me at (706) 291-2254 or cell (706)802-7760. I hope I can be of service to you.Patrick A. Parrino, DDS, MAGD.

Positions Available

A Brand New Busy Private MariettaPractice is looking to bring in a pedi-atric dentist & an oral surgeon who islooking to establish and grow with ourPractice. Currently have about 500 pedi-atric patients and 4,000 adult patients.Looking for a competent, proficient, andenergetic doctor to add to our team to takecare of the large pediatric and adolescentpatient pool that we have in our communi-ty. Rewarding compensation packages withadditional pay as you grow the practice.Feel free to contact Dr. Mansouri if youhave any further questions at (267) 441-2565, [email protected], or visitour web site to see both of our office loca-tion at www.NaturalSmile.biz.

classified ads

How GDA members canplace classified ads

AD FORM: Submit all ads on a GDA ClassifiedAdvertisement Form. To obtain a form,call Skip Jones at (800) 432-4357 or (404)636-7553, or email [email protected].(Note: The GDA may accept or reject anyad for any reason and in its sole discretion.)

AD DEADLINE: Ads and ad check payments are due by thefirst of the month before the publicationmonth (i.e., Dec. 1 for January).

AD RATES: ADA member dentists pay $75.00 per60-word ad per month. There is a 25 centsper-word charge for each word over 60.Non-dentist-owned companies (real estatefirms, etc.) pay $195 per 60-word ad permonth (additional word charges as above).Non-member dentists may notplace ads.

LATE FEE:Ads for which full prepayment is notreceived by the first day of the ad’spublication month (i.e.; Nov. 1 for aNovember ad) will incur a $25 late fee inaddition to the ad rate.

FORMS OF PAYMENT: Submit a check or money order with the adform. (Make checks payable to GDA.)Credit cards are not accepted as payment.

WEB SITE PLACEMENT: Prepaid ads will appear on the GDA Website www.gadental.org for the month thead appears in print. Non-prepaid ads willNOT be placed online.

CLASSIFIEDSContinued on page 28

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Associate Dentist: Buford / Sugar Hill.State of the Art digital practice in busyGwinnett Co. Full-time. Fax resume to(770) 945-1449 or email [email protected] or call (770) 845-9159

Dentist Jobs: Aspen Dental offers tremendousearning potential and a practice supportmodel that empowers dentists to achievegoals. We eliminate obstacles for dentiststo own their own practice. To learn moreabout our compelling proposition and toapply, please call (877) 332-9154 or visitwww.AspenDentalJobs.com. EOE

Delta Dental—Dental Consultant(Alpharetta, Georgia): DDS / DMDdegree from a dental school accredited bythe ADA; minimum of five years in clinicalpractice of dentistry; active and unencum-bered license issued by the Georgia Boardof Dentistry. For full job details visitwww.deltadentalins.com and click onCareers. To apply, submit resume [email protected].

Busy Pediatric Practice seeking associate,either pediatric dentist or general dentistthat specializes in children. Ownershippotential. High income area in West Cobbwith great growth. Please send CV [email protected] or fax to(770) 952-0199.

Georgia—Cartersville, Hiram andEast Point: Opportunity available forgeneral dentist in an established familypractice. We are a multi-specialty groupproviding quality patient care. Locations inthe Atlanta area. State-of-the-art offices.Excellent incentive packages. Requirements:One plus year of experience and activeGeorgia license. Email resume [email protected].

Dentist Jobs Columbus / Albany /Macon / Valdosta. FT/PT base salaryover $100K per year with tremendouscommission and profit share upside. NoHMOs. Join our network of affiliated privatefamily practices. Benefits include medical,vacation, 401K. Call Dr. Todd Christie at(321) 432-5922 (confidential) or [email protected]; fax (321)254-6800.

Exceptional Opportunity for AssociateDentists. Join Dr. Mark Shurett’s AssociateTeam to provide treatment to childrenthroughout Georgia. Well equipped andmaintained offices. Positions include F/T,P/T, and Locum Tenens. Multiple locationsavailable. Friendly staff with no daily office/ overhead challenges. Contact TinaTitshaw at [email protected], call (678)413-8130, or fax resume to (770) 760-1375.

Practices /Office Space Available

STOCKBRIDGE: DON’T WAIT! Fiveoperatory, bread-and-butter generaldentistry practice for sale. The practice ison track to collect $620K this year Formore information call (678) 482-7305,email [email protected], orvisit www.southeasttransitions.com.

28

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Smyrna / Cumberland Mall / Viningsarea. Completely equipped dental officefor rent. 3 operatories, Panorex, newequipment. Present dentist uses the officeone day a week. Great place to start apractice with no equipment to purchase.There has been a Dental practice at thislocation since 1978. Free standing building.Go to www.Pickrondental.com to seebuilding. (770) 265-0201.

DULUTH: All FFS practice on track tocollect $400K this year. Beautiful officewith 4 equipped operatories loaded withtechnology. Practice has great visibility!For more information call (678) 482-7305,email [email protected], orvisit www.southeasttransitions.com.

NORTH OF GAINESVILLE—NorthGA MOUNTAINS: This practice has con-sistently collected $1M for the last 5 years.No Recession here! 5 operatories, updatedequipment, Digital X-Rays. The seller wouldlike to retire. The building is also for sale.For more information call (678) 482-7305,email [email protected], orvisit www.southeasttransitions.com.

TIRED OF THE RAT RACE? Well-established practice and building in themountains for sale. 10,000 sq ft building isa great investment—high image glassarchitecture and well located for publicawareness. Friendly patients who appreci-ate what you do for them. Motivatedcross-trained staff. Modern equipment.Computers in all operatories. Ideal for soloor group practice. Growing community.NO long commute and NO 8-lane free-ways. Excellent school system. Low crimerate. Tons of family / sportsman outdoorrecreational opportunities. Close enoughto larger towns to go to the mall, but farenough away to avoid all the big city has-sles. (706) 745-6848.

FLOWERY BRANCH / HOSCHTON /BRASELTON, GA: 20,000 square footdental office building for lease in the #4most economically developing area in thecountry! Now Leasing and Interior BuildOut Can Begin Immediately! Great leaserates & TI allowance available. Looking forPERIO, ENDO & ORAL SURGEON. Ina highly visible area where NO specialistsare located at this time! Be the first in thearea for a promising long term career loca-tion. Whether you want 1,500 or 5,000square feet, space will be tailored to eachindividual’s needs. Perfect location for anew practice startup or a 2nd satellite loca-tion! Close to the newly approved satellitelocation for Northeast Georgia MedicalCenter. Demographics are off the chartsand schools are unbelievable … literallyone of the most sought after locationsaround! Priority will be given on a firstcome / first serve basis. Please e-mail:[email protected] more information or call (678) 612-2277.

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versial portions that are likely to see sometype of change or total repeal would be theprovisions that deal with individual man-dates and government subsidies.

As it stands now, a majority of thestates, and numerous organizations andindividual persons, have filed actions infederal court challenging the constitution-ality of PPACA. As of October 2011, theconstitutionality of PPACA has beenupheld by three out of four federal appel-late courts, with the fourth declaring thelaw’s individual mandate alone as unconsti-tutional. The Supreme Court has agreed toreview the suits and has scheduled over fivehours for oral arguments on the matter inMarch 2012. It would appear from this thatwe could have a ruling on the constitution-ality of the PPACA before the November2012 election.

Many believe that the system is trans-forming itself and that the outcome of thecourt challenges or the elections will beanticlimactic to what will have already hap-pened in the marketplace. Insurance com-panies have already taken hits on some ofthe most contested elements of the PPACAlegislation and have begun to adopt policiesto adapt to the changes. One such changeinvolves agent reimbursement. Agents’commissions will no longer be automatical-ly included in the premium. Instead thepremiums will be minus any commissionsand agents will have to sell their services tothe consumers as consultants and have theconsumers agree to pay them for their serv-ices.

Many hospital administrators, insur-ers, and doctors are counting on federalsubsidies and coverage expansion thatwould result in a surge of patients withinsurance to offset cuts in government pro-grams. Consolidations of health careproviders and new delivery models willhave more of an impact on the way healthcare is delivered in the future. Large healthsystems (hospitals and large monopolyproviders) could use their newfound cloutto demand higher prices from privateinsurers even as federal and state govern-ments pay less. Specific PPACA provisionsmay fall by the wayside, but our future isdefinitely a PPACA-influenced one.

FEDERAL HEALTH CARE REFORMContinued from page 22

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Suite 200, Building 17, 7000 Peachtree Dunwoody RoadAtlanta, Georgia 30328-1655

www.gadental.org

ACTIONInside This Issue

• 2012 Legislative Update: GDA Sets Major Goals

• Gear Up For Give Kids A Smile Day February 3

DATED MATERIALPLEASE DELIVER AS SOON AS POSSIBLE

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