A House in Order

A House in Order

Kathryn kell, D.D.S.:

The ADA House of Delegates meets October 17 through the 21st in San Antonio, Texas. The number of reports and resolutions this year is large, and many issues will be debated in caucuses and on the House floor. Resolutions deal with licensure, education, universal coverage, mid-level providers, accreditation standards, association reserve funds, the budget, dues, membership, ethics, oral health, and public health concerns. In preparation for this, the Board has met several times this summer and fall to review and make recommendations on these and other issues. The Tenth District was well represented with reports from both Ed Vigna, the Trustee-Elect for the Tenth District, and Bob Brandjord, ADA past president and past Tenth District Trustee.

The Future of Dental Education
The Board participated in an extensive discussion about how the dental community and stakeholders can best prepare future dentists to address the challenges and opportunities of 21st century dentistry. Panelists included Dr. Charles N. Bertolami, dean, NYU College of Dentistry and president of the American Dental Education Association; Dr. Edward Vigna, Nebraska, chair of the workgroup to study the educational experience; and Dr. Steve Geiermann, ADA senior manager, Council on Access, Prevention and Interprofessional Relations. The discussion highlighted some interesting trends in dental education. Preliminary results on an opinion survey on extending or expanding the dental education model were presented. Potential challenges and opportunities of alternative models were examined.

The Board heard a presentation by Dr. Robert Brandjord, ADA past-president and chair of the ADA Community Dental Healthcare Coordinator (CDHC) Task Force, on the program at its August 2008 meeting. The Board found the presentation very helpful in explaining the CDHC concept, and has directed that the presentation be made available to all members of the House of Delegates. The Board strongly supports the CDHC program, and adopted resolutions approving next steps for program implementation and evaluation. The Board reviewed current funding status as well as anticipated additional financial implications for the ongoing operations and evaluation of the pilot sites and has made a recommendation that the ADA commit to long-term financial support of the program.
Dr. Brandjord also updated the Board on the progress in developing the Oral Preventive Assistant (OPA) curriculum. The Board reviewed the information on the completed OPA curriculum and affirmed its support for the OPA concept. The Board believes that the OPA materials are ready for dissemination, and approved the following resolution: Resolved, that appropriate staff develop the operational mechanisms for making the OPA curriculum materials available to state dental associations and educational institutions and provide a report to the Board in September 2009 on the dissemination and utilization of the OPA curriculum.

The Future Structure of Health Care
ADA staff updated the Board on remarks made at a recent Pay-for-Performance Conference concerning the future structure of our health care system according to some insurance companies and health plans. It is believed that this "grand plan" for our system will reassign responsibility for the various levels of care such that individuals will be responsible for their own wellness maintenance, "mid-level providers" will be responsible for primary care, physicians will handle second and tertiary care, and hospitals will provide intensive care. The dilemma for dentistry is that it does not easily fit into this model, since most dentistry is provided by a single dentist and at a single site. Many of our states will deal with the concept of a "Dental Home" and what this will mean for dentistry and the future of oral health care.

Nuts and Bolts
The Committee to Study the Introduction of Business in the House of Delegates has proposed several resolutions, using both electronic and paper means to distribute House materials beginning in the 2010 meeting and changing the timetable for Board meetings to facilitate the ready availability of documents. The Board of Trustees appreciates the work of the Committee in developing a proposal for managing the timely distribution of materials to delegates.

This substitute resolution, approved by the Board and recommended for House approval, calls for distribution of House of Delegates materials in an electronic format no later than 2012, with the Board responsible for developing a timeline for the transition, identifying all appropriate details and issues.

Ethics and Dental Education
In recent ADA Annual Sessions, there has been great concern expressed about the erosion of ethics in the dental education community. In July 2007, the Board of Trustees adopted a resolution calling on the Council on Dental Education and Licensure and the Council on Ethics, Bylaws and Judicial Affairs to develop an action plan. The two groups formed a subcommittee and dove into a very ambitious action plan that included 17 goals. A number of these recommendations revolve around engaging other groups - ADEA, ASDA, dental schools, and the American College of Dentists - to partner or develop complementary projects within their own organizations. There is also an expanded commitment to CE courses on ethics and a strengthening of ethical codes across the board. A profound concern was expressed over the reported decline in the public's esteem of and trust in the dental profession. They believe it is important that the same expectations of professionalism and ethical behavior be required in dental practices and organizations as it is in dental schools among students and faculty.

Commission on Dental Accreditation
Following lengthy discussion at our April 2007 meeting, the Board of Trustees adopted a resolution creating a task force to examine the structure, governance, policies, operating procedures, and functionality of the Commission on Dental Accreditation. The task force was charged to provide a comprehensive report of its findings and recommendations to the 2008 House of Delegates. Following extensive discussion, the Board voted to accept the report of the task force. The task force made 34 detailed recommendations in seven broad categories. You may find the full task force report, complete with its nine attachments, on ADA.org. The Board understands that by urging CODA to accept and implement these recommendations, it is asking the Commission to commit to a tremendous volume of work. In an attempt to underscore its strong belief in both the intent and recommendations of the task force report, the Board wishes to demonstrate to CODA the resolve of the ADA to assist in the extensive undertaking.

Resolution 59 Update
At the 2007 ADA House of Delegates, Resolution 59 was referred to the Board of Trustees for study and report to the 2008 House of Delegates. This resolution urged the Board to maintain the ADA's liquid reserves at a targeted level of 50% of the Association's annual budgeted operating expenses, and to consider any excess in developing the following year's annual operating budget consistent with a long-term strategy of dues stabilization, taking into consideration any known contingent use of reserves. The current ADA reserves policy specifies liquid reserves be maintained at a targeted level of 40% of the Association's annual budgeted operating expenses. Liquid reserves are defined as the total uncommitted balance of the Reserve Division Investment Account. Both a recently completed benchmarking study and published ASAE information seem to support raising the target to 50%. The Board recommends that the House of Delegates formally adopt the long-term financial strategy of dues stabilization and the target of 50% reserves.

Annual Session, Full Year Commitment
These are just a few of the issues before the House of Delegates. Please contact your delegates at any time during the year if you have concerns, and please thank them for their efforts in representing all of us. All of you should attend the ADA Annual Session if possible. Every year it is a great event offering educational experiences, the latest equipment and techniques, and a great way to meet your colleagues.

Thank You, Dr. Kell
This is my last year as your ADA Trustee. I have enjoyed representing you on the ADA Board and wish my successor, Ed Vigna, all the best in his upcoming years. It has been an honor to serve you and our profession


*Dr. Kathryn Kell is the Trustee to the Tenth District of the American Dental Association, representing Iowa, Minnesota, Nebraska, North Dakota, and South Dakota.