District Meeting
February 5th, 2008
Location:  WRAFB Officers Club
 6:00 Social 
7:00 Dinner
8:00 Program Speaker:

Dr. Daron C. Praetzel, Maj, USAF, DC, Chief, Oral and
Maxillofacial Surgery Wright Patterson AFB, OH

Class is FREE, but a basket for monetary donations to help offset the
conference costs will be available. Thank-you! 

Tuesday, Feb 3rd at 7:00 PM 
***Change in location - Lindsay Holliday's office - 360 Spring St., Macon

All Committee Chairpersons, Delegates, and Officers are members of the Executive Committee and are required to attend. Other interested district members are welcome to attend.

GADPAC

 

Paul Fraysure

PFraysure@aol.com

ACCESS TO CARE

In the last district bulletin, I wrote my last report as your ADA Delegate. Now, because I eat lunch with the Editor on most Wednesdays and he has promised to buy me a free lunch for each “guest editorial” that I write, I am writing you on the subject that I told you we would discuss in the next CDDS Newsletter - ACCESS TO CARE!

Let us first ask what is Access to Care? Who decides what Access to Care is? Then let us ask the question - What it will mean to each of us?

It appears once you put the term under scrutiny, that there is no definition of Access to Care. (I could at this point offer the anagram of Access to Care as AC, but I want us to focus of the written term.) How on earth could the term Access to Care have been used as much as it has without someone knowing what it is? It seems that Access to Care means whatever you want it to mean. And yes, that means that it can mean one thing to you and something quite different for someone else, especially if that someone works for some government entity. For good reason, your ADA delegation in San Antonio was instrumental in stopping the ADA from defining mid level provider and that is a part of the efforts that we have been discussing in the last newsletters on Access to Care. This is because if you define it, you have to live by it and this may not be something that we want defined. And that includes Access to Care and Mid Level Provider.

Now let us answer the question, who gets to define Access to Care. Apparently, it has already been unofficially defined in the minds of anyone who wants to use the term, regardless of what other people think that the term means. In short, as we have already said, it may mean different things to different people. This is real and this is double talk.

Now, what does it mean to each of us? Well, now we have to make an assumption of a definition. Let us assume that it means that everyone has the ability to get to a dentist (gain ACCESS) to get care (that would be DENTAL CARE to you and me) when they need it. This would imply that Access to Care means that there are enough dentist available to deliver care when people need it. Simple enough? Well, nothing in this sentence says anything about who would pay for the care. Now some people think that Access to Care means that this care is paid for by someone. This assumption is generally held by the providers. The serious side of this starts to show when we put light on the fact that health care has gone up in cost and a lot of people have trouble paying for their dental care. (Remember, we are only talking about what affects you and that would be dental care.) Very little testing of how many ATV’s the kids have in this population, but in Georgia today it is assumed that every child in a family whose income is 235% of the established poverty level is at a disadvantage and needs public assistance. In some states the threshold for this assistance is 400% above the poverty level. This would be an income of $80-90,000 in our state. The problem is that the government feels that it is their responsibility to assist in caring for this section of the general population by mandating dental care. Another problem is that the government doesn’t really want to pay for this care it only wants to mandate it. This to me means that if Access to Care means being able to afford care and an entirely different set of parameters come into play.

You have read what I said in previous reports about the Alaska Dental Health Therapist. It has always been clear to me (this is a euphemism for, in my opinion) that the U.S. Public Health service who cannot attract a sufficient number of dentist because it doesn’t pay a high enough salary in this period of economic plenty in our country had set out to solve the Access to Care problem that they faced since they are the front line of dealing with underserved and underprivileged populations. They are doing this by creating a junior dentist; also know in our world as a midlevel provider. We learned just in the last two weeks that the tribes in Alaska with the aide of the USPHS are continuing to run an unaccredited school in Alaska to provide dentists who have not gone to dental school. This is their version of dealing with Access to Care. Now, the question is what is going to keep people from doing the same thing in the lower forty eight states. And the answer once again in my opinion is what indeed? The USPHS service in ten years has rewritten the book on dental accreditation and now with economic clouds brewing that would help them compete with salaries; they have demonstrated how “effective” government can be when handling a problem. If the economy remains weak, they will be able to recruit dentists, but what will the midlevel providers do? Or if the midlevel providers continue to be created, what will the dentists of the future do??

In closing, please look at the complex sentence in the last paragraph. Long and convoluted as it is, it doesn’t compare to the complexities of the Access to Care problem and what it will mean to your practice and the ability of patients to get and afford dental care in this country in the future unless they are very very well off. My suggestion is that when you see Access to Care in print, stop and read the message, it could be more relevant to your family’s future that you ever imagined. Finally, when you ask yourself why you belong to organized dentistry, this is a good example. You have to have a voice. Even though I have criticized some of the actions of the ADA Board of Trustees in recent years, they are the only act in town.

Ty Ivey

Now that I have been reduced to being a committee member, John Bowman has indicated that he will buy me a free lunch for every guest editorial that I write. I have already written one on Access to Care as promised in the last newsletter. However, after I sent it to John, a lightning bolt hit me and led me to write something else and postpone the Access to Care article.

This one has to do with the economy. I would guess that the percentage of you who have paid at least a little more attention to the economy in 2008 is close to 100%. One year ago, the wheels began to come off of the economy. I had two guys each with parts of my future under their control. One of them answered my question about selling JP Morgan Chase with the question, why would you want to sell one of the best banks in America? The other kept sending me information from a well known brokerage house economic advisor saying the markets were going down based on earnings. In typical fashion, I hung in there until I had fully participated in the stock anguish of 2008 and then and only then did I consolidate my investment advisors into one voice.

So I took this as a message from God that I needed to work longer. I didn’t think that retirement suited me anyway because I have seen an awful lot of bored retirees. Since I have been in the worry business like many of you I have noticed something very interesting. I am getting a lot of mail from insurance companies who must have know that my schedules looked similar to Swiss cheese. It was touching that their capacity for clairvoyance had looked into my personal situation and brought them to the conclusion that they could show me how to get more patients into my practice thanks to their networks that are designed to solve all of my problems. For those of you too young to remember, this is not the first time the insurance industry has tried to help out the dental profession by seeking to solve a busyness problem.

In the early 1980’s following the “glory” years of the 1970’s when inflation hit 19-20% for a while and dental care was placed on hold by a lot of patients, it was the insurance industry who offered us PPO’s to take up the slack. I have just read two different popular dental sources. The Collier, Sarner and Associates Newsletter dated December 15, 2008 says “With the knowledge that we are in one of the worst recessions since the Great Depression, it’s easy to think that the rules of investing have changed – but they haven’t.” In the December Clinicians Report by Gordon Christensen, 75% and 71% of the dentists surveyed thought that the current economic situation was caused by the press/media and politics in that order. Regardless of the cause of the circumstances, there are a lot of dentists that I am encountering that are complaining about slack schedules. Gordon Christensen says be positive and it will have a positive effect on the patients. That is easier said that done when the gross production and the expenses are coming a lot closer together that one might wish.

But, to return to the white knights from the insurance industry, we must ask what they are offering. Medicine long ago fell prey to the control of the insurance companies. They are subtly trying to gain control of dentistry as well. In central Georgia, we have lost Brown and Williamson, Keebler, Bass Furniture and a couple of other medium size industries that account for approximately 4500 jobs that all had dental insurance. There is not much debate on whether this has had an effect on our bottom lines. So what is one to do when the schedules look like Swiss cheese?

I certainly can not tell you how to approach these agents from the insurance industry who would solve your problems. However, there were two points that were considered important the last time we had this many PPO opportunities in dentistry. First, assess the bottom line effect that occurs when you reduce your fees. Reducing your fees doesn’t necessarily reduce your expenses. This is a bit different for everyone. However, it is of equal importance to exercise caution when you sign contracts that are associated with these types of arrangements. Legal advice concerning these contracts is one of the most valuable member benefits established by the American Dental Association and the Georgia Dental Association. The ADA and the GDA both offer FREE contract analysis. The contracts that you sign when you agree to accept patients in the PPO arrangement are not insignificant and meaningless pieces of paper. These are legally binding documents that have produced some interesting surprises for the participants in the past.

So, as we sail these interesting waters of economic concern, everyone needs to make sure that he or she understands the ramifications of all of the choices that are available to us. DON’T FORGET TO USE THE BENEFITS OF YOUR MEMBERSHIP IN YOUR DENTAL ASSOCIATION TO KEEP YOU OUT OF THE QUICKSAND.

Happy New Year

Ty Ivey

Action Items and Other Information from 11-8-08