The More Things Change

The More Things Change

Edward J. Vigna, D.D.S.*:

Greetings from Singapore, Saturday, September 5, 4:30 p.m. I have been here as part of the ADA delegation to the Federation Dentaire International World Dental Congress. I am about to leave on a long, and I do mean long, flight back to the U.S., and thought this be good time to start my next article for Northwest Dentistry. I will share just a few remarks about this experience.

Being part of the ADA delegation has been a real honor and has been very interesting. Many of the dental concerns encountered by U.S. dentists, including universal access to care, and rampant dental caries, especially among children, are concerns worldwide. The only difference is the magnitude of the problem. For instance, I was speaking with a dentist from the country of Benin, where they have about seven million people and 60 dentists; yes, 60. How is that for an access problem?! Continued support for the use of amalgam and the importance of keeping the dentist clearly the head of the dental team were consistent themes across delegations. Sound familiar?

The General Assembly of FDI is comparable to our House of Delegates and the Council akin to our Board of Trustees. Dr. Kathy Kell from Iowa is the only United States member of the FDI Council. As you might expect, we are well represented by one of our own from the Tenth District!

After flying for about 16 hours and sleeping on and off, it is still Saturday afternoon. I just found that day I lost on the way over to Singapore last week!

Back home at the ADA, we are busily preparing for the 150th Annual Session in Honolulu, Hawaii. Most of the activity of the August Board of Trustees meeting was devoted to the numerous resolutions and reports that will be addressed by the House of Delegates. The Board reviewed reports and resolutions that will come before the 2009 ADA House of Delegates in Honolulu in early October and is transmitting them to the House with Board comments and recommendations. In addition to Board-generated reports, the materials to be transmitted include resolutions submitted by others, including dental societies and councils. Even though the balanced budget report reflects no increase in dues in 2010, I still expect it to generate much discussion.

Some resolutions of interest passed by the Board are as follow:
• Approving continuation of the Smile Healthy Program, and calling on the Smile Healthy Advisory Panel to identify an organization or individual to administer the standard-setting process for additional product categories and to submit a supplemental funding request for that activity at a future Board meeting;
• Urging the state and regional testing agencies and the state boards of dentistry to collaboratively develop a plan for a single, national dental clinical licensure examination;
• Approving the elements of a draft agreement template for licensing oral preventive assistant curriculum modules for non-exclusive use by ADA constituent dental societies and accredited dental assisting programs, and calling on the Council on Dental Education and Licensure to notify the state dental societies and educational institutions offering accredited dental assisting programs of the availability of licenses for the oral preventive assistant curriculum module

At the August meeting, the Board heard a presentation on Large Group Practices. Informed by a new “Large Group Practice Survey” unveiled by the ADA HPRC/Survey Center, this discussion addressed the demographics of large group practices, the impact they have on the profession, and practice characteristics and models. Eight percent of dentists practice in large group practices of five or more dentists. Three percent of dentists practice in the very large group practices of 20 or more.

The Board heard from Dr. Rick Workman, founder and CEO of Heartland Dental Care, owner of 247 dental practices in 14 states. Dr. Workman stated that one of the prime competitive advantages a large practice like Heartland has is the ability to secure more favorable contract terms with carriers.

The ADA survey found that while ADA membership is lower among Large Group Practice (LGP) dentists, those who are members tend to have a very favorable opinion of the Association, very similar to that of all ADA members. Dr. Workman asserted, however, that many of his employees don’t feel warmly embraced in local dental society meetings. The survey also found that roughly 40% of LGP dentists would prefer to have a solo practice or partnership with other dentists, indicating that employment in LGP corporations may be a holding pattern for younger dentists before establishing their own practices.

Health care reform, or insurance reform as it is now called, remains atop of the list of member concerns. By the time you read my comments, they will likely be yesterday’s news or radically changed, but as of this writing ... ADA staff and consultants updated the Board on the status of health care reform legislation in Washington. Three House committees and one Senate committee have marked up bills so far - with the Senate Finance Committee still to come in September.

All bills currently center around four major policy concepts: regulating the private health insurance industry, creating a federal or policy-holder cooperative insurance company to compete with private insurers, helping people pay for and buy insurance and determining a way to pay the bill, which is estimated to cost one trillion dollars over 10 years.

During the August Congressional recess, staff sent an e-gram to the full ADA membership with talking points, encouraging ADA members to talk to their Representatives and Senators on oral health issues that may become part of the bill. There are several measures in the various bills that are especially of interest:
• There is nothing in the bill to increase Medicaid reimbursement rates for dentists;
• ADA lobbyists continue to try to attach a repeal of McCarran-Ferguson into the bill;
• Some of the bills have language supporting funding for mid-level provider efforts, subject to state laws;
• Oral health coverage for children is expected to be part of the standard package of coverage available in the “exchange”, which basically sets the terms for what insurance companies must provide to individuals. One of the committees has added stand-alone dental insurance programs into the “exchange,” but others apply this insurance reform only to medical insurance plans, which could lead to dental insurance migrating to big insurance providers.

In recent months, ADA Intelligent Dental Marketing (ADAidm) has encountered significant production and operational difficulties. Unfortunately, some of our members have experienced this directly. On behalf of the ADA leadership, I want to express our regret that this occurred. After careful consideration, ADA Business Enterprises Inc. (ADABEI) has determined that the best solution for ADA members and our Association is for ADAidm to resolve outstanding contractual obligations and for ADABEI’s business relationship with ADAidm to be dissolved. If any of you are clients of ADAidm and need any resolution to any issues of unfulfilled obligations, please contact me at

The BOT considered the importance of using the Strategic Plan to better focus Association resources, deal with emerging issues, align with the budget cycle, and communicate to the membership at large. We will continue to make significant changes to how Strategic Planning will be conducted within the association.

At the July meeting of the Commission on Dental Accreditation (CODA), the issue of “dental hygiene diagnosis” was revisited, and a recommendation to remove that term and its definition from the standard were passed.

I am now back in Nebraska trying to reestablish what day and time of day it really is. I hope to have seen many of you in Hawaii. As always, please get in touch with me if you have comments or concerns. Have a nice fall, and, as we say in Nebraska, Go Big Red!

Please contact me at or (402) 770-7070.

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