FYI

Dentist blog from Delta Dental

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Your dental policy brief: News updates as of August 2

From the latest on Medicare to recent court rulings affecting dentistry, FYI brings you the biggest dental policy stories.

CMS proposes Medicare dental coverage expansion after push from Congress

The U.S. Centers for Medicare and Medicaid Services (CMS) has released a proposed physician fee schedule rule for 2023 that would expand access to dental care services for Medicare beneficiaries. The proposal came after lawmakers in the U.S. House of Representatives and the U.S. Senate requested that the agency broaden the definition of medically necessary dental coverage as a way to expand access for Medicare recipients.

Currently, Medicare Part B only pays for dental services when it is deemed medically necessary to treat a recipient’s primary medical condition. The proposed changes for payments could become effective as early as January 1, 2023.

ADA says ransomware behind recent cyberattack, confirms data theft

The American Dental Association (ADA) has said that the cybersecurity incident it first reported in April was actually a ransomware attack, which ultimately led to the theft of member data. Although the ADA initially claimed that there was no data breach, a recent notice from the organization confirms that data theft occurred.

The notice does not share the precise data impacted, just that it was personal information tied to member names. Impacted members will receive complimentary credit monitoring and identity protection services. The ADA says it has assessed system security and reset relevant account passwords while it works to review and bolster existing policies and procedures.

Federal judge rejects Colorado inmate’s request for change in prison dental policy

A federal judge has denied an inmate’s request to order prison officials to halt their alleged unofficial policy of denying dental crowns to detainees. Beginning in November 2019, an inmate at the U.S. Penitentiary Administrative Maximum Facility in Florence, Colorado, sought treatment for broken and painful teeth. The prison dentist allegedly informed the inmate he needed a crown and teeth fillings, but the dentist could only “do one procedure per inmate per visit.”

The inmate, Peter George Noe, filed suit against the government and multiple medical personnel, claiming delayed and inadequate treatment. He asked for a preliminary injunction that would order the Bureau of Prisons to provide crowns generally, and to specifically perform his needed dental work. The district judge denied the motion, finding Noe had not shown he would suffer irreparable harm in the absence of a court order.

Supreme Court rejects dental hygienist’s medical marijuana workers’ comp case

The U.S. Supreme Court declined to hear the case of a Minnesota dental hygienist challenging denial of workers’ compensation for medical marijuana. The hygienist, Susan K. Musta, began purchasing cannabis to treat chronic pain due to work-related injuries in 2019 under Minnesota’s legal medical cannabis program and was not reimbursed for it under her workers’ compensation coverage for workplace injuries. Minnesota courts ruled that the federal Controlled Substances Act (CSA) prevented her insurer from paying for medical cannabis.

Musta appealed the decision to the U.S. Supreme Court alongside a similar Minnesota case. The U.S. Supreme Court indicated that fewer than four justices believed the legal challenge warranted the court’s consideration. State supreme courts in New Jersey and New Hampshire have ruled the CSA doesn’t preempt their workers’ compensation laws. However, like Minnesota, Maine’s high court reached the opposite conclusion.

New conference schedule announced

After two years of absence due to the COVID-19 pandemic, Delta Dental representatives are back out on the conference circuit. We’ll be at several notable events this fall.

Look for us at the following conferences:

ConferenceDateLocation
American Association of Dental Office Management (AADOM)September 8–10, 2022Scottsdale, AZ (Booth #628)
American Dental Association – SmileConOctober 13–15, 2022Houston, TX (Booth #904)
Greater NY Dental MeetingNovember 27–30, 2022New York, NY (Booth #2308)

Stop by our booth at the ADA’s SmileCon to talk to Dr. Jessica Buehler, our director of dental affairs.

We’d love to see you at one of these upcoming events! Please visit our booth to meet local provider network ambassadors, learn about Delta Dental’s online services, hear the latest news and trends, get your questions answered and pick up cool swag.

The dental office and mental health: what you need to know

Dentistry can be a stressful and challenging profession. Teams like yours can often face depression, anxiety and other mental health issues. For Mental Health Awareness Month this May, take some time to get a closer look at why many dentists and their staff face mental health problems and what you can do to improve overall well-being in your office.

Dentistry and mental health

The percent of dentists diagnosed with anxiety more than tripled in 2021 compared to 2003, according to the 2021 Dentist Health and Well-Being Survey Report from the American Dental Association (ADA). The ADA also found 13% of the dentists reported that they suffered from depression, while it’s estimated that only 3.8% of the general population is affected.

The challenging, demanding work of a dentist’s office can affect the well-being not just of dentists but of office staff, as well. Dentistry can be an especially stressful profession because dentists and their staff often:

  • Work in isolation in confined, small, sometimes windowless spaces
  • Deal with time constraints, economic challenges and other business-related pressures, many of which have only worsened with the advent of COVID-19
  • Perform stressful procedures on a sensitive part of the body with no room for error
  • Deal with long working hours and a heavy workload
  • Face an unfavorable public perception of dentists and dentistry
  • Work with patients who may loathe or resent visiting the office
  • Provide care for others on a day-to-day basis and may not be as accustomed to caring for themselves
  • Are often high achievers who may view reaching out for help as a sign of weakness or failure

Know the signs

As a dentist, you’re trained to identify oral pathology by clinical evidence, diagnostic testing and a patient’s own account. But identifying mental health problems can be very different. Signs related to mental health issues are most often manifested as behavioral changes or they’re experienced internally by the affected individual in the way he or she thinks and feels.

Common signs and symptoms of someone dealing with depression, anxiety or other common mental health issues include:

  • Behavior that is uncharacteristically sad, irritable, critical, indecisive or disorganized
  • Reduced productivity or frequent absence from work
  • Loss of interest in hobbies and other pleasurable activities
  • Withdrawal from friends, family and other social activities
  • Expressions of negativity or feeling “helpless,” “burned out,” “lost” or “hopeless”
  • Frequent complaints of tiredness, headaches, stomach problems, back pain or other aches and pains
  • Changes in sleep, such as insomnia or oversleeping
  • Changes in weight or diet, such as eating more or less than usual
  • Abuse of alcohol or drugs, including prescription medications

These symptoms may increase in severity and frequency over time. In advanced cases, affected individuals may lose their ability to support the team and function in the office.

What you can do

Raise awareness and reduce the stigma

Make sure you and your staff can talk openly about problems and reach out for help without negative judgment. As an office leader, you can model this behavior by talking openly and honestly about stress and problems you may be experiencing. Remember that your colleagues and staff could be experiencing similar issues, so openly sharing can be comforting and encouraging. If you don’t suffer from mental health problems, work to be empathic and supportive of those who do.

Resources and assistance should be available and accessible, and using them should never threaten someone’s job or reputation. Consider adding an employee assistance program (EAP) to the offered benefits at your practice if you haven’t already.

Take care of your emotional health

Here are some tips for self-care during stressful times:

  • Take care of your body. Try to exercise regularly, eat well-balanced meals and get enough sleep. Limit your alcohol intake and avoid tobacco and other drugs.
  • Connect with others. Share your concerns about how you’re feeling with a friend or family member. It’s important to maintain a strong social support system and to build healthy relationships during difficult times.
  • Take breaks and vacations. Allow yourself time to unwind and engage in activities you enjoy.
  • Seek help. If stress is impacting your life and work, don’t be afraid to seek out help from others when you need it.

Know where to turn for help

The following free resources can help promote mental health in the dental office:

Other mental health resources include:

  • The National Suicide Prevention Lifeline (800-273-8255). Provides 24/7 free, confidential support for people in distress as well as best practices for professionals and resources to aid in prevention and crisis situations.
  • NAMI. The National Alliance on Mental Illness provides advocacy, education, support and public awareness to individuals and families affected by mental illness.  
  • SAMHSA. The Substance Abuse and Mental Health Services Administration is an agency within the U.S. Department of Health and Human Services that leads public health efforts to reduce the impact of substance abuse and mental illness on America’s communities. Their resources include a helpline at 800-985-5990.

The mind, just like the mouth, requires constant care. Optimal mental health is a crucial part of your practice success and your overall well-being. Don’t neglect mental well-being in your office or feel shame or stigma about needing to reach out for help.

Dentists and the COVID-19 vaccine: what to know

After a somewhat rocky start, the COVID-19 vaccine rollout seems to be progressing favorably for dental professionals. Most states now consider dentists to be essential health care workers eligible for priority vaccination, and many states now allow dentists to administer the vaccine to their patients. 

Most dentists can get the vaccine

Most states now include dentists as essential health care workers eligible for their first phase of vaccination, according to the most recent information complied by the American Dental Association (ADA).

  • Currently, more than half of states place dentists in the highest priority tier, 1a, for immunization.
  • Several states, including Florida, Minnesota, and Nevada, also include dentists in their first phase of immunizations, but give counties the discretion to prioritize them higher or lower within that phase.
  • Other states, including Colorado, Louisiana and North and South Dakota, include dentists in their first phase of immunizations but place them in a lower-priority tier than other essential health care workers.

Only a few states don’t consider dentists to be essential workers. Oklahoma classifies dentists as part of a group of “allied health fields and general outpatient health service priority groups” that will be eligible for the vaccine as part of the state’s second phase of immunizations. Texas, meanwhile, has not yet determined where dentists will fall within its immunization plan.

Some dental staff can also get the vaccine — and may be required to do so

Several states, including Arkansas, Georgia, Iowa, New York and Wisconsin, consider dental office staff such as dental hygienists to be essential health care workers eligible for priority vaccination.

Dental practice owners may also be able to require their staff to receive the vaccine. There are some important caveats to consider, though. For instance, if your practice has 15 or more employees, a vaccination requirement must accommodate disabilities, including pregnancy-related issues, under the Americans with Disabilities Act, and must respect staff members’ religious beliefs. You may also be required to pay for the vaccinations.

Despite these challenges, it might be an option worth pursuing. A recent survey found that 64% of patients who were hesitant to return to their dental office would be willing to do so if the entire staff had received the COVID-19 vaccine.

Many dentists can administer the vaccine

Currently, dentists in at least 20 states can administer the COVID-19 vaccine. It’s worth noting, however, that not all these states will necessarily allow dentists to vaccinate patients in their dental offices.

For instance, the California Dental Association says it’s unlikely that dentists in the state will be able to administer vaccines from their dental offices because of storage requirements, billing issues and space requirements for patients who need to be monitored after they receive the vaccine. More likely, they say, is that dentists will be able administer the vaccine at hospitals or through government vaccination programs, such as mass vaccination sites.

In New York, dentists can administer the vaccine only at sites overseen or approved by the state or a local health department and supervised by physicians, physician assistants or nurse practitioners.

Members of your staff may also be able administer the vaccine. For instance, California and some other states will allow dental hygienists to do so.

To help you determine your state’s rules about administering the vaccine, the ADA has created an interactive map with the latest updates.

In eligible states, dentists and dental hygienists who wish to administer the vaccine may also have to complete training beforehand. The ADA has compiled a state-by-state guide that includes information about the vaccine, educational resources and training.

Finally, the ADA is also requesting that the federal government grant liability protection to dentists who administer the COVID-19 vaccine.

Amalgam fillings: A closer look at the recent FDA recommendations

The U.S. Food and Drug Administration recently advised against the use of dental amalgam in high-risk groups. What do these new recommendations mean for you and your practice? Here’s a closer look.

What is the case against dental amalgam?

Amalgam fillings contain a mixture of silver, tin, copper and mercury.

In its recommendations released Sept. 24, 2020, the FDA suggested that certain groups of people, including pregnant and nursing women, children under 6 and people with certain health conditions, may experience harmful effects of mercury exposure.

The FDA cited “uncertainties about the acceptable reference exposure levels for mercury vapor” and the potential for negative health outcomes. The FDA did not cite any new scientific evidence for this position.

What is Delta Dental’s position on dental amalgam?

Amalgam is a long-lasting, clinically effective tooth restorative material and has a proven track record of over 150 years. Based on the scientific evidence available, amalgam fillings do not pose a health risk to children or adults, except the small group of people who are allergic to the metal components of amalgam.

The mercury in fillings is safe in its bound form. When it breaks down, however, mercury can be released as vapor. Exposure to high levels of mercury vapor — higher than those in fillings — can cause damage to the kidneys and brain, according to industrial studies.

We recommend you discuss treatment options with your patients who fall into these risk groups or otherwise have concerns.

There are no changes to Delta Dental’s coverage of restorative treatments such as amalgam and composite fillings.

When should amalgam fillings be removed?

The FDA advises against removing or replacing existing amalgam fillings that are in good condition unless medically necessary. This aligns with Delta Dental’s recommendation.

Amalgam fillings that are in good condition, with no nearby decay present in the tooth, should not be removed. Removing them may result in loss of tooth structure and unnecessarily releases mercury vapor.

When removing amalgam fillings, please follow best management practices for amalgam waste handling and disposal. By law, you must use amalgam separators of at least a 95% removal efficiency, as required by the Environmental Protection Agency. This rule went into effect July 14, 2017, with compliance for dental offices since July 14, 2020.

For more information about Delta Dental policies around restorative treatments, please refer to your Dentist Handbook under Provider Tools.

Dentists seen as indicator of economy’s health

As dentists go, so goes the economy. This according to a recent New York Times article, which describes dentists as “the perfect barometer” for the economy’s health during the coronavirus pandemic.

And the good news is that there’s cause for optimism.

Why dentists? According to some economists, dental practices are an ideal business model: The practices tend to be long lived, their dentists earn consistently high salaries, and the services they provide can’t be found elsewhere. If you need dental care, you need a dentist.

This stability makes dental practices a good indicator of how well — or if — the nation is rebounding from the ongoing pandemic. And so far, the signs are positive.

Initially among the hardest hit industries within the healthcare sector, the dental industry is staging a strong recovery. Almost 90% of dental practices are paying their employees fully as of the week of July 13, according to data from an American Dental Association (ADA) Health Policy Institute survey. That’s up from only 11% during the first week of April.

This rebound equates to 250,000 jobs gained — which is 10% of the jobs added to the entire U.S. economy — according to Bureau of Labor Statistics data.

While this is encouraging, the recovery is not complete. Employment with the industry is still down 30%, with almost 300,000 fewer people employed than were before the pandemic.

Perhaps more telling is patient volume. The Times article reports that patient volumes are currently half of what they were before the pandemic. And, fewer than half of practices report having patient volumes greater than 75% of their typical volume, according to the ADA survey for the week of July 13. So while you and your staff might be ready to return to work, your patients might be a bit more reluctant.

Still, patients are returning. For instance, in mid-April more than 85% of practices reported that their practice volumes were less than 5% of what they usually were. The current figures then, while down from pre-pandemic numbers, are a significant improvement and more importantly, part of a consistent upward trend.

Collections, too, are trending up. While in mid-April more than three-quarters of practices reported their volume of collections at less than 5% of normal, the most recent survey data reveals that more than 80% of practices have at least half of their usual collection volume, and more than half of those practices have more than 75%.

So while there are still significant challenges to overcome, the overall news is good. This data suggests not only a positive outlook for the American economy, but a particularly strong comeback for the dental industry.

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