No surprise - Congress blocks midlevel dental providers

 

May 3, 2011

Congress Blocks Midlevel Dental Healthcare Provider Projects

No big surprise is it?  Midlevel care providers were simply out lobbied.

Full Medscape Story:

May 3, 2011 — After making strides in recent years, advocates for midlevel oral health provider programs ran into setbacks this year in both state legislatures and the US Congress.

The law allocating spending for the US government through September 30, 2011, prohibits spending on alternative oral health provider pilot programs, and some bills in state legislatures have stalled or died in committee in recent months.

Much of this legislation has pitted hygienists associations and oral health foundations against the largest organizations of dentists.

At the national level, proponents are pushing to fund the "alternative dental health care providers demonstration projects" authorized by last year's healthcare reform law. President Barack Obama has asked Congress to fund 6 such programs with $800,000 each in 2012.

The midlevel providers in these pilot programs could be community dental health coordinators, advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, or dental health aides.

They would be evaluated for their ability to "increase access to dental health care services in rural and other underserved communities."

Congress debated funding the pilot programs while working on the continuing resolution that allocated money for the US government through September, but in the end they specifically prohibited such funding.

In a written statement, American Dental Hygienists' Association (ADHA) President Caryn Solie, RDH, said her organization was working with "more than 60 others" to get the funding for 2012 "and beyond."

"ADHA is disappointed with the inclusion of a provision in the Continuing Resolution prohibiting funding for the Alternative Dental Health Care Provider Demonstration Grants this year," she said.

She argued that the programs would allow hygienists to help Americans who currently are not able to get oral healthcare.

The American Dental Association (ADA), in contrast, has lobbied against the pilot programs. "We have a long-standing position against any pilots for any program that involves nondentists doing irreversible procedures," said Matthew J Neary, DDS, a New York City periodontist who chairs the ADA's Council on Governmental Affairs.

He said there are better ways to improve access to oral health, such as preventive health programs and dental residency programs in underserved communities.

The ADA does support one model of new oral healthcare provider: the community dental health coordinator, trained to help people in underserved communities navigate through the healthcare system, Dr. Neary said.

However, that proposal falls short of a new practitioner "midlevel" between a hygienist and a dentist, as advocated by the ADHA and some activist groups.

"The more professionals look into folks' mouths and provide education the better, but the fact is that folks need treatment," said David Jordan, director of the Dental Access Project of Community Catalyst.

With funding from the W.K. Kellogg Foundation, Community Catalyst is organizing coalitions in 5 states to advocate for midlevel providers who can prepare and place fillings and extract teeth, in addition to doing educational and preventive work.

Such providers — dental health aide therapists — are already doing this kind of work in Alaska through a federal program for indigenous people, and dental therapists are also being trained along similar lines in Minnesota as a result of a 2009 law.

Community Catalyst supports new dental therapist legislation in 5 other states, Jordan said. He gave the following overview of state legislation:

• Kansas: A dental therapist bill is under consideration in both the state House of Representatives (HB 2280) and the (Senate SB 192).
• Washington: HB 1310 is stalled in the House of Representatives Healthcare and Wellness Committee and is unlikely to be heard until next session.
• New Mexico: HB 495 bill died in the business committee of the House of Representatives.
• Vermont: HB 398 is in the House of Representatives Human Services Committee, but is unlikely to be heard until next year.
• Ohio: A bill has not yet come to the legislature, but on April 27 a public opinion poll funded by Catalyst showed two thirds of Ohio voters in favor of starting a dental therapist program in that state.

Although the group could not claim any clear victories, "We're happy that there was attention, and the need was brought to light," said Jordan.

Corporate Dentistry–A history

One of the major birth places for corporate dentistry is Texas.  Around 1995, Texas allowed managed care programs or HMO's.  The  insurance companies quickly created and sold these dental programs to employers.  However, there was one big problem.  General dentists would not sign up to be a provider because the fees were too low and the dentist would be forced to do "managed neglect" not "managed care". 

The insurance companies, primarily Aetna, decided that they could establish needed offices by guaranteeing a monthly income to a practice in Aetna's preferred location.  There were a couple of dentists in Texas who took them up on the offer. 

They did stock offerings and corporate dentistry was born in Texas even though it was and is still illegal. This relationship continues today.

Under these corporate practices, the insurance companies lists the dental provider as the corporate entity, not a licensed dentist.  Under your HMO dental plan, if you call for your free or low fee cleaning, you are told there is a one to two year waiting list.  If you complain to the Dental Board, their response is they only control licensed dentists not corporate practices. 

If you go in for an exam, you are suddenly told you need hundreds to thousands of dollars worth of work, much of which is barely covered by insurance. The dental work may not even be needed.  Check the complaints on Monarch Dental as an example.  You would think the Dental Board would have stopped the damage by now.

The insurance companies will try to further enhance their profits by using these offices to keep costs low in this economy.  In this economy employers are dropping their PPO dental insurance for the cheaper HMO policies.  Dental insurance companies can then assign these PPO patients, who use to have freedom to chose their dentist, to these corporate offices.  Dental insurance is always beneficial to the insurance companies..  It is non catastrophic unlike health insurance.  It is rarely cost effective for the insured.

Medicaid in the corporate practice has been a recent addition.  Mainly because state and federal agencies have allowed them to see Medicaid patients when it is against many of the state laws. 

To stop the corporate practice of dentistry, you must stop the dental insurance companies from funding it.  Can you imagine the potential liability of assigning and paying insurance monies to illegal corporate practices? 

They are fully aware of the liability, however, to date no one has challenged them.  The potential liability was mentioned to one national dental director now that the public is waking up and complaining.  He is in the process of having the actuaries calculate what it will take to convert the HMO policies to in-network PPOs.
 
Bottom line is that the economy and media exposure like the Ortho story will cause Medicaid to begin to correct itself.  Medicaid was there before corporate dentistry and will be there after. However, the slow economy will fuel the insurance companies to want to foster more corporate dentistry. 

If litigation is contemplated, then the insurance companies have the most to lose.  There is no argument that they are guilty of paying illegal corporate practices and also have large potential antitrust violations. 
a Concerned Texas Dentist

Dental Treatment Codes- Sections

I. Diagnostic                                 D0100-D0999
II. Preventive                                D1000-D1999
III. Restorative                              D2000-D2999
IV. Endodontics                            D3000-D3999
V. Periodontics                             D4000-D4999
VI. Prosthodontics, removable      D5000-D5899
VII. Maxillofacial Prosthetics          D5900-D5999
VIII. Implant Services                     D6000-D6199
IX. Prosthodontics, fixed                D6200-D6999
X. Oral and Maxillofacial Surgery  D7000-D7999
XI. Orthodontics                            D8000-D8999
XII. Adjunctive General Services   D9000-D9999

Another BS study that will only lead to more dental deaths?!

 

Who Paid for the study?

 

Children can be safely sedated by nonanesthesiologists

April 25, 2011 -- NEW YORK (Reuters Health) - Many specialties perform pediatric procedural sedation with no differences in major complication rates, according to findings published online today in Pediatrics.

Intensivists, emergency medicine physicians, radiologists, and hospitalists, among others, have increasingly been providing pediatric sedation, but whether complications are more or less associated with any particular group of specialists has been unclear.

Dr. James H. Hertzog from Alfred I. DuPont Hospital for Children, Wilmington, Delaware, and colleagues in the Pediatric Sedation Research Consortium investigated that question using data from 38 sites on patients who ranged in age from newborn to 18 years. The research team defined major complications as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesiology consult.

Out of 131,751 cases of sedation given outside of the operating room, there were no deaths, and other major complications were rare (122 total).

Sedation was most often administered by intensivists (58,222), emergency physicians (38,293), anesthesiologists (18,343), and pediatricians (12,113). Children were also sedated by pediatric residents or fellows, radiologists, surgeons, dentists, advanced practice nurses, certified registered nurse anesthetists, or registered nurses.

There was no statistical difference between providers' major complication rates either before or after adjustment for possible confounding variables.

Moreover, there was no significant difference between the types of major complication among providers.

"The rapid growth in the use of sedation services by nonanesthesiologists has been the subject of some concern," the researchers conclude. "Our data reveal that, within our consortium, there was no increased danger associated with pediatric procedural sedation provided by nonanesthesiologists."

"The application of our data to sites outside of our consortium will require rigorous evaluation of the skill level of the providers and the institution's systemic safeguards for the care of a sedated pediatric patient," they caution.

Source: http://bit.ly/ggVsDk

Pediatrics 2011;127:e1154-e1160.

Last Updated: 2011-04-25 14:56:07 -0400 (Reuters Health)

 

 

 

Impact of Provider Specialty on Pediatric Procedural Sedation Complication Rates

Kevin G. Couloures, DO, MPH^a, Michael Beach, MD^b, Joseph P. Cravero, MD^b,c, Kimberly K. Monroe, MD^d, James H. Hertzog, MD^a

^aDepartment of Anesthesiology and Critical Care Medicine, Nemours Children's Clinic-Wilmington, Alfred I. duPont Hospital for Children, Wilmington, Delaware;
Departments of ^bAnesthesiology and
^cPediatrics, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire; and
^dDepartment of Hospital-Based Medicine, Children's Memorial Hospital and Northwestern University, Chicago, Illinois

Objective To determine if pediatric procedural sedation-provider medical specialty affects major complication rates when sedation-providers are part of an organized sedation service.

Methods The 38 self-selected members of the Pediatric Sedation Research Consortium prospectively collected data under institutional review board approval. Demographic data, primary and coexisting illness, procedure, medications used, outcomes, airway interventions, provider specialty, and adverse events were reported on a self-audited, Web-based data collection tool. Major complications were defined as aspiration, death, cardiac arrest, unplanned hospital admission or level-of-care increase, or emergency anesthesia consultation. Event rates per 10 000 sedations, 95% confidence intervals, and odds ratios were calculated using anesthesiologists as the reference group and were then adjusted for age, emergency status, American Society of Anesthesiologists physical status > 2, nil per os for solids, propofol use, and clustering by site.

Results Between July 1, 2004, and December 31, 2008, 131 751 pediatric procedural sedation cases were recorded; there were 122 major complications and no deaths. Major complication rates and 95% confidence intervals per 10 000 sedations were as follows: anesthesiologists, 7.6 (4.6–12.8); emergency medicine, 7.8 (5.5–11.2); intensivist, 9.6 (7.3–12.6); pediatrician, 12.4 (6.9–20.4); and other, 10.2 (5.1–18.3). There was no statistical difference (P > .05) among provider's complication rates before or after adjustment for potential confounding variables.

Conclusions In our sedation services consortium, pediatric procedural sedation performed outside the operating room is unlikely to yield serious adverse outcomes. Within this framework, no differences were evident in either the adjusted or unadjusted rates of major complications among different pediatric specialists.

Key Words: pediatric sedation • pediatric anesthesia • procedural sedation • patient safety

Abbreviations: ASA = American Society of Anesthesiologists • PPS = pediatric procedural sedation • PSRC = Pediatric Sedation Research Consortium • OR = odds ratio • CI = confidence interval • NPO = nil per os

---

Accepted Jan 24, 2011.

Aspen Dental Fix it: Toothache Becomes Headache

Published in The Daily Journal print book April 16, 2011

Nicole Leonhardt
nleonhardt@daily-journal.com

Michael Christ, of farming Grant Park, had a toothache so he went to the dentist to put together the problem, but assumingly the caring he received landed him in the crisis room — twice, his doctor told him.

On Mar 18, Christ’s 21st birthday, he went to the appointment his father, Ron Christ, done for him at Aspen Dental, 1501 N. Illinois Route 50, Bourbonnais.

The dentist took X-rays, wrote him a medication for amoxicillin and told him to make an appointment for possibly an descent or base waterway when the infection settled. The subsequent to week the infection had gotten worse so Michael called for other appointment.

This time Christ was then seen by a not similar dentist, a woman. She suggested him to go to the crisis room, since she mentioned Michael had been prescribed the incorrect antibiotic.

Christ went to Provena St. Mary’s Hospital, where they administered a not similar antibiotic, clindamycin.

“She mentioned he should have been on clindamycin when he was seen the initial time. She mentioned it was it was improper to be on amoxicillin,” mentioned Christ’s father.

After Christ was administered the scold antibiotic he proposed to feel better, but struggled to secure an appointment to have the tooth fixed. The infection came back and this time his eye proposed to swell. On April 9, Christ’s parent called Aspen Dental for an crisis appointment for his son. He was told there was no permanent dentist at the trickery and nothing could be done that day.

But that dusk Christ’s parent received a call from Dr. Shamohammadi, a proxy dentist hired April 5 by Aspen. Shamohammadi suggested the parent to ensure Christ went back to the crisis room. The dentist betrothed to see the group initial thing this past Monday.

Christ received a stronger sip of verbal clindamycin and an injection during his second crisis room revisit and the lump subsided.

This past Monday, Shamohammadi saw Christ and endorsed two other area dentists for a base canal. Because Shamohammadi’s location at Aspen was temporary, he would be leaving the trickery on Friday and longed for Michael to be seen by a veteran who could follow by with his care.

Christ’s parent asked the front table receptionist for a return for his son’s two appointments — the first, that cost $19 and the second, that was $50.

Instead of a return being issued, the military were called. Shamohammadi told military the parent had done nothing incorrect and the situation was dropped. Later that day Shamohammadi left the trickery for good, 4 days before his appointment at Aspen was ostensible to end.

Christ’s father, Ron, contacted Fix It! that evening.

He longed for his allowance back since his son had not received proper care. He suggested Fix It! to verbalize with Shamohammadi. Shamohammadi told Fix It! he was essay a e-mail to the Illinois Department of Financial and Professional Regulation, Aspen Dental Management, Inc., the Better Business Bureau, and the Illinois Department of Human Rights to inform multi-part instances of bad high quality caring he’d witnessed during his partial time at Aspen, inclusive the Christs’ situation. He sent Fix It! a duplicate of the complaint.

“The military subdepartment forthcoming to a dental use due to your pacifist activities is about as far as we can take it,” Shamohammadi mentioned in the letter.

Present at the rumpus that resulted in military involvement, Shamohammadi told Fix It! Ron Christ had not acted inappropriately — he acted similar to a parent whose son received bad caring that could have lead to serious complications such as blindness.

“In my veteran viewpoint a stronger antibiotic indispensable to be used and a follow-up fast was vital to ensure safety,” mentioned Shamohammadi. Because of that he endorsed a return is to Christs.

Referring to the complaints about Aspen minute in his letter, Shamohammadi mentioned he believed many patients deserved refunds since similar to Christ they received reduction than preferred caring after being seen by multi-part proxy doctors.

Shamohammadi mentioned in his e-mail it was clear at least 8 or 9 doctors had been “providing not similar diagnoses” and modifying and varying treatment plans. He told Fix It! he could not pick out the dentists who saw Christ by his map out since there were “so many scribbled signatures.” The bills the Christs received did not add doctor names.

When Fix It! spoke Wednesday with Kasey Pickett, executive of communications at Aspen Dental Management, Inc., she mentioned both doctors whose licenses are related with Aspen’s Bourbonnais location — Isam F. Hamati and Nadia Z. Chowhan Iqbal — did not work at the location.

“They are seeking for a new full-time dentist,” mentioned Pickett.

To keep Aspen open after Shamohammadi’s leaving a one-time proxy dentist was called back to the location, mentioned Pickett.

Pickett mentioned an scrutiny had been non-stop at the Bourbonnais Aspen location to look in to the problems Shamohammadi spoke of in his letter.

She moreover had great headlines is to Christs.

“We are refunding allowance related with caring at Aspen together with casing the ER bills,” mentioned Pickett. “The studious didn’t have a great experience and that’s what the use is striving for.”

Ron Christ mentioned he received a examine Thursday for $300 to cover Michael’s visits and mislaid wages. It had been sent overnight mail. He mentioned he will send Aspen the crisis room bills when he receives them. He estimated the complete at around $1,200. The Christs mentioned they feel Aspen done its most appropriate bid to pill the situation, but Shamohammadi is not satisfied.

He mentioned he has right away sent the e-mail that includes other complaint from his time at Aspen — a managerial staff that pushes dentists to see too many patients in a day to be able to enlarge profits — to dental regulatory bodies in every state that has Aspen locations since he believes the same problems are widespread.

“I am abashed for my colleagues of the contention that act for your organization. we am moreover abashed of what you have done to my profession. You have managed to take this prestigious industrial specialization and have incited it in to a reason for profiteering,” mentioned Shamohammadi in his letter.

Pickett mentioned whilst the firm will look in to the allegations done about the Bourbonnais location “the things that are summarized are of course not indicative” of how other Aspen offices operate.

Who Wrote This? Superman Cape Technique

 

Anyone want to take credit for writing this?

Comments are open, let’s hear it.

 

PROTECTIVE STABILIZATION

Protective stabilization, broadly defined, is the restriction of a patient’s freedom of movement to decrease the likelihood of injury to the patient or the dental personnel while allowing safe completion of the dental procedure.

Protective stabilization may involve another human (dentist, dental team member, or parent), a stabilization device (protective wrap, mouth prop, towel), or a combination. Use of a mouth prop as an aid for a cooperative

patient is not considered to be stabilization.

In your discussions with parents regarding protective stabilization, remind them that active stabilization - stabilization by the dentist and/or dental assistant – is described in the list of behavior management methods that they approved when they signed the health history form. Review this type of stabilization with the parent again, if necessary.

Dental staff who stabilize children should use their hands to limit the patient’s movement. Lying next to the child or partially on the child is not acceptable. The dental team should use the least restrictive stabilization that is safe and effective.

One example of a less restrictive form of stabilization is the use of a pillowcase to restrain hand and arm movements in a patient who is otherwise compliant.

The pillowcase is held open behind the patient; the child inserts his arms into the pillowcase, the pillowcase is pulled up to the child’s armpits, and he is then assisted into the dental chair. Once the patient is supine and lying on the pillowcase, his arms are stabilized.

Colorful children’s pillowcases are available, and can be described as a “Superman cape” or other child appropriate analogy.

Dr. Paul Casamassimo Happy Medicaid Dental Coffers Still Open For Business - Small Smiles

Well of course he's a happy man.  He's on the advisory board of Small Smiles & Church Street Health Management.  The Governor kept the coffer open for him and his buddies today! 

There are 7 Small Smiles locations in Ohio~

Maybe Dr. Casamassimo didn't have this run across his desk.

Burns Ohio Complaint

Dr. Paul Casamassimo has been with Church Street Health Management since 2007 when it was FORBA Holdings, LLC, along with Dr. Arthur Nowak, and Dr. Joe Bernat. Other than adding Dr. Anupama Rao Tate. Dr. Tate was the only addition to the board after the $24 million fraud settlement and Corporate Integrity Agreement was implemented.

With the budget crunch in so many states, to get Governor Kasich, whom I really like, to NOT cut some of the wasted funding to adult and children Medicaid dental programs is astounding. However, like us all, he is a layperson when it comes to "dental" needs, and can't tell fact from fiction. No fault of his own. It's the perfect example of letting the "professional" take the reins.

Now, if Ohio, like all states, would cut the reimbursement fee just for stainless steel crowns by 30% it might, just might, get the Medicaid fraud from these dental mills back under control.

No, I do NOT apologize to Dr. Paul Casamassimo, he was the fool who put out this video, he's the fool who hooked up with Dr. Adair and Small Smiles all by himself.  In this video statement what was he trying to suck or kiss?

Related:

Small Smiles Quality Initiatives are Rubbish

Allison Luke - No longer Chief Compliance Officer at Church Street Health Management

Lorri Steiner has been with Church Street Health Management for a very long time.  I would say at least 4 years, maybe a little longer.

Up until last Friday, April 8, 2011, she has been SVP of Financial Operations.  Currently she is carrying the title of Chief Compliance Officer!

Well, at least she is going into this eyes wide open!  She's been around long enough in the financial operations to know how much they need to make each day and how to get it done.  Now, does she know how to cover it up so that it goes unnoticed?  Time will tell.

Anyone notice Lorri was put into this position just about the same time they were able to land an in house attorney, Erika Ruiz.  I'm sure Lorri and Erika can get the job done.

(By the way, there is NO Erika Ruiz listed at the Tennessee Bar Association.  There is only one Ruiz and it's not Erika when you search the Board of Professional Responsibility here )

What happened to Allison Luke, you ask?  

Allison Luke was hired in November 2008, according to Church Street Health Management's own press release, dated 11-5-2008.

Lately her job has been more of that of "fireman" putting out fires created by Small Smiles dentists, staff and corporate heads who are determined to continue on with their bad ways.  After just over a year into the Corporate Integrity Agreement you would think things would be getting a bit better, well, not so much.

Did she figure out it was a lost cause trying to maintain any kind of "Compliance" with Small Smiles Dental Centers?  

Did she get tired of stretching the truth?  Was she tired of rounding 4.2 percent to 5 when it benefited the companies appearance.  Did she tire of rounding a 3.9 to 3.0 when told to do so?

Well, maybe she will do the right thing now and spill her guts to the OIG.  Keeping crimes a secret kind of makes you guilty doesn't it?  Especially when it's you that writes that quarterly report and you sign it, Allison Luke, SVP of Compliance.

Keeping big secrets and covering up fraud will sure weigh heavy on your mind.

Lorri, do you really know what you are in for here?  Me thinks you are in way over your head and guess whose head will role when the rubber meets the road.  Yours.

Related:

Quality Initiatives Are Rubbish

Moriarty-Leyendecker: Spotlight on Small Smiles

 

Spotlight on: Small Smiles

In 1967, Small Smiles was one of the first clinics in the nation to extend dental services to Medicaid patients - a generous and welcome gesture, since Medicaid paid far less than insurance or out-of-pocket payments for dental procedures.

By 2010, Small Smiles was churning through patients at the impossible rate of one every ten minutes. The company's dentists strapped children as young as two into a straitjacket-like device to perform dental procedures. Parents are no longer permitted in the waiting rooms and cannot watch their children as they go through multiple fillings or even intense dental surgery.

Worst of all, the procedures being performed are frequently not medically necessary.

How did this happen? How did such unethical methods spring out of a community-serving dental practice generously willing to take Medicaid patients at a time when few dentists were? Where did it all go wrong?

The answer lies in the owner. Who, it turns out, is remarkably difficult to locate.

Read the full article here
Recently filed lawsuits against Small Smiles Dental brings media attention

Read all the other Small Smiles Articles at Moriarty.com

 

Related:

Should dentists use restraints on kids?
Syracuse area families sue Small Smiles dental clinic for mistreatment of children

New York Dental Malpractice Lawyers Sue Syracuse Small Smiles Dental Clinic–From Central New York Injury Lawyer Blog

 

New York Dental Malpractice Lawyers Sue Syracuse Dental Clinic - Central New York Injury Lawyer Blog

Michael Bersani wrote a passionate post on his blog.   He referred to this as “Dental Battery” not “Dental Malpractice”.    I agree.  Yes, “Battery” is included.

Here is a snippet:

By Michael Bersani on April 8, 2011 9:45 PM | Permalink

New York dental malpractice lawyers agree on one thing: You have to turn down most calls about dental malpractice. Most alleged dental malpractice cases are going nowhere. We get calls from people all the time. They got a bad result from their dentistry work, and they want to sue. But usually the bad result was a "known risk" of the procedure. When it's a known risk, usually there's no case. Sometimes there really was dental negligence, but then the injury is too small to really warrant a dental malpractice lawsuit. Getting a case with provable negligence, plus a significant injury, well, that doesn't happen every day.

Read the full blog post here.