A Year to Contend With

A Year to Contend With

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

The 150th anniversary year of the American Dental Association is drawing to a close, and it has been quite a year, to say the least!

Annual Session
Our ADA Annual Session in October was a success. Going into this meeting, we were concerned about attendance. The Hawaii meeting, which is preset for every 10 years, is always more lightly attended, and that fact, coupled with the slow economy, caused concern about the outcome. With that said, we ended up with a total attendance of more than 24,000, including 3,000 first-time attendees! This was a remarkable outcome, and a tribute to the hard work of the Annual Sessions Council. A special thanks to Dr. David Remes from Minnesota, our Tenth District member of that Council. Make your plans now for the 2010 meeting in Orlando next October 9-12.

The House of Delegates was eventful, starting with about four hours of an attorney/client session addressing some very troubling happenings within the ADA. Early in 2009, the Board of Trustees became aware of some irregularities within the ADA and an increase in customer concerns with ADAidm. (Early in 2007, ADA Business Enterprises Inc. (ADABEI) had become a 50% owner in ADAidm.) In order to fulfill the ADA Board’s fiduciary responsibilities and Duty of Care, the ADA hired outside counsel to look into these matters. Final reports (the attorney/client privileged reports mentioned above) were presented to the Board of Trustees in June 2009. Upon hearing the reports and their recommendations to address the problems and shortcomings that were uncovered, the ADA Board took immediate and decisive actions to correct the problems. These reports were offered to the House of Delegates, so that the House was well informed on these matters of significance.

These reports were discussed in depth during the 2009 House of Delegates. The resolution of all this will be costly to the ADA. At this time, it appears to be in the neighborhood of five million dollars. Some of the costs of the investigation are being charged to the ADA, and the costs directly attributable to ADABEI are being charged to ADABEI.

In 2009, the ADA also learned of significant problems relating to the financial operations and controls within ADA. These problems are in the process of being addressed, and a new Chief Financial Officer has been hired who has a great deal of experience building best practice financial and accounting systems. The ADA Audit Committee is in the process of selecting new external and internal auditors to assist ADA in establishing the necessary financial controls and financial system best practice.

Our new Executive Director, Dr. Kathy O’Loughlin, gave her first address to the HOD, and everyone left saying, “Wow! If her actions are as good as her words, we are definitely in good hands.” Dr. O’Loughlin is taking swift action to address many of the internal problems addressed earlier, from the staff perspective. I feel confident Dr. O’Loughlin will serve us very well.

Good fortune was with the ADA this year to have had Dr. John Findley serve as our president, as well as Executive Director for six months. No one could have served us better during these trying and difficult times. We all owe him a great deal of gratitude for the many, many hours he put in on our behalf. Thank you, John. You will go down in my book as one of the best ever!

We now start a new year under the capable leadership of Dr. Ron Tankersley. Ron will build on the accomplishments of this past year and continue to move us forward. In my mind, the Board of Trustees has our work cut out for us. The ADA HOD has put us on notice that they are watching our behavior, and we must perform. That is not to say the BOT as a whole was directly responsible for any of the failures of the past, but it is our responsibility as the managing body of the Association to make sure our actions are above reproach.

Workforce Models
Although the first BOT meeting of the ADA year isn’t until December, it has been a busy month for organized dentistry. Activity surrounding what I believe is one of the most pressing issues facing us, workforce models, has caught fire. We learned last week that the Kellogg Foundation would be giving grants, in the amount of $150,000 to $200,000 yearly for three years, to the states of Kansas, New Mexico, Ohio, Vermont, and Washington to create a DHAT program. The Pew Foundation is conducting the same activity in many of these states and California as well. You all in Minnesota are thinking, “been there, done that”. However, this creates many, many concerns for all of us. Very quickly, the landscape is becoming cluttered with many different models all trying to accomplish the same goal. At the same time, we have many stakeholders accusing the ADA of being protectionist and only interested our model, the CDHC. While this is one solution, we also support the use of Expanded Function Dental Assistants (EFDA) and the Oral Preventive Assistant (OPA), all described in workforce reports as far back as 2005. Where we struggle is with policy that is restrictive and dated in some cases. We must continue to establish policy that supports the core beliefs of the Association and the wishes of the HOD, while at the same time allows the flexibility for us, the ADA, to be able to engage in the dialogue with those who want to exclude us from the debate.

All indications are that there is a waning desire to engage organized dentistry in the discussions. Money talks. It seems the foundations (with support of various state agencies and interest groups) are able and willing to develop and accept models that they think will solve the access problem, with no evidence showing their safety or effectiveness. I am frightened by statements that just because a DHAT has been used in another country (which may have a very different standard of care) for a number of years, it is all right for us, and no pilot studies or scientific proof are necessary. We have watched as mistakes have been made over the years in the name of treating our underserved population. Numerous members of the medical delivery model are alive and well, but so are our underserved, underinsured and uninsured, and indigent populations, and medical care is more expensive! Will a DHAT help the underserved population? I certainly doubt it, but we should discuss its merits so that all will understand our apprehensions, and what we feel are the most efficient, productive methods to get care to all of our population. Proper funding seems to be an overused term, but it works. Fund the existing models to demonstrate that point.

My concern remains the possibility of the ADA becoming irrelevant in the statutory and regulatory scheme, particularly in the discussion at the state level. The ADA will have a difficult time writing policy answering the individual needs of 50 states. Our members must ultimately follow the actions taken by the states, and if we are increasingly excluded from that process, the changes could not be in the best interests of the profession and the public we serve. Each and every state must evaluate its own situation and, as you in Minnesota can attest to, Be Prepared.
As you can see, workforce will be a major topic for our December board meeting, and I will have much more to report on this topic in the coming year.

And Counting
As we approach Thanksgiving, we must be thankful for the opportunity to engage in this debate and concern, and that we are members of the most caring profession. I wish you all a very happy holiday season, and all the best in the new year.

Always Available
Much more to come next year, so stay tuned. As always, please contact me with your concerns and comments: vignae@ada.org 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.