History Belongs to Those Who Show Up

History Belongs to Those Who Show Up

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

The “historic” midterm elections, as they are now being referenced, are over. For all the dentists in this country, they truly were historic. On November 2, a good friend of mine, Dr. Paul Gosar, was elected to the U.S. House of Representatives from Arizona. In previous articles I have mentioned Dr. Gosar, and the opportunity we had to elect an active practicing dentist to Congress. Paul will join Dr. Mike Simpson from Idaho as the only dentists serving in the Congress in Washington.

I can assure you Dr. Gosar will be a strong and solid supporter for all practicing dentists. A few short days ago he was getting up each day, going to the office, and experiencing all the frustrations caused by the action or the lack of action by the federal government. As a recent vice-chair of the ADA Council of Government Affairs and a long time member of the ADA House of Delegates, Paul is fully aware of the issues facing dentistry, and will hit the ground running. He may be a freshman, but we will hear his voice loudly and clearly on our behalf. This is Paul’s first venture into elected public service, and I wish him well.

In a broader sense, what does this election mean for your practice and the dental profession, now that the Republicans control the House and the Democrats the Senate? Although the Democrats have the numbers in the Senate, 60 seats are necessary to dictate action, and that is not the case. The narrow majority will empower the dealmakers in the middle (moderate Democrats and Republicans), and hopefully they will be able to get things accomplished. Of great importance to dentistry is that the GOP-controlled House will have oversight jurisdiction. This means that House committees can call hearings and ask federal agencies to explain their actions on federal regulations or guidance (e.g., EPA regulations, health care reform regulations, and so on).

Broadly speaking, GOP control of the House will mean that the agenda, particularly the funding agenda, will be 180 degrees different from that of former Speaker Nancy Pelosi. Republican House Minority Leader John Boehner recently said that a GOP-controlled House will begin with a vote to repeal President Obama’s health care reform law, and if that stalls, they will take it apart and vote to repeal it provision by provision. One of the first votes in the “repeal-by-provision” will be on the IRS 1099 issue (assuming the issue is not dispensed with in the post-election, or lame-duck, session later this year).

For now, the ADA Washington office is focused on the lame-duck session, and that agenda is difficult to forecast. The Washington office is implementing strategies to pass three bills of specific interest to the dental profession - all of which have passed the House and now require action in the Senate: HR 4626, the McCarran-Ferguson legislation; HR 2345, the Red Flags bill; and HR 903, our Dental Emergency Responder proposal. With any luck, the Congress will be in session long enough to allow us to pass our three bills.

Annual Session 2010
The 151st Annual Session was again a success and provided a vast array of continuing education, exhibits, and social events. Issues such as budget, licensure, financial Affairs, and workforce issues were of most importance, with workforce occupying a majority of our time. Below I have highlighted some of the major points.

Dr. Ray Gist is our new ADA president, Dr. Bill Calnon is president-elect, and Dr. Patricia Blanton second vice-president.

Budget and Dues
The House of Delegates approved the budget, which will require a seven dollar dues increase and a 23 dollar one-time assessment. The past several years we have had no increase and have been taking operating money from reserves. In my mind, that is not a good practice. We made many difficult cuts, but the increase was necessary to continue the valuable programming and services the ADA provides for members. The assessment will bring our information technology infrastructure up to date with focus on member communications, financing, and budgeting.

ADA policy on Diagnosis or Performance of Irreversible Procedures by Non-dentists:
The ADA, by all appropriate means, will strive to maintain the highest quality of oral health care by maintaining that the dentist be the health care provider who performs examination/evaluation, diagnosis, and treatment planning. The dentist shall be the health care provider who performs surgical/irreversible procedures; with surgical procedures being defined as the cutting or removal of hard or soft tissue.

ADA Opposition to Pilot Program which allow Nondentists to Diagnose or Perform Irreversible Procedures:
The ADA is opposed to non-dentists or non-licensed dentists (except dentists who are faculty members) making diagnoses, developing treatment plans, or performing surgical/irreversible procedures. The ADA may support pilot programs that
• do not jeopardize the patient’s oral health,
• are based on a valid assessment demonstrating that the program is necessary to fulfill an unmet need, and
• the program does not allow non-dentists to diagnose, treatment plan, or perform irreversible procedures.
The ADA critically reviews and seeks opportunities for input into any pilot program or study that has potential for significant impact on the dental profession.
The policy of the ADA shall be to actively participate in discussions/dialogue with government, oral health care organizations, or other agencies involved in dental workforce issues or oral health care issues.
The policy of the ADA shall be to seek funding for Association studies on dental workforce models or oral health care delivery issues or their evaluation.
If a pilot program involves a new member of the dental team, the new team member must be supervised by a dentist.
The development of any new member of the dental team shall be based upon determination of need, a CODA accredited dental school or advanced dental education program, and a scope of practice that ensures the protection of the public’s oral health.

Comprehensive Policy Statement on Allied Dental Personnel:
This is a very thorough and complete statement that is too lengthy for this article. I strongly encourage going to ada.org and reading this statement. It was House Resolution 132.

Non-Covered Services
Maximum Fees for Non-covered services:
The ADA continues to oppose any third-party contract provisions that establish fee limits for non-covered services. A “covered service” is defined as any service for which reimbursement is actually provided on a given claim. A “non-covered service” is any service for which the third party provides no reimbursement.

The ADA will pursue passage of federal legislation to prohibit federally regulated plans from applying fee limits for non-covered services. The ADA encourages constituent dental societies to work for passage of state legislation to prohibit plans from applying such provisions as well.

Definitions of Importance:
Definitions of Primary Dental Care Provider and Dental Home:
Primary Dental Care Provider: A licensed dentist who accepts the professional responsibility for delivering primary dental care.

Dental Home: The ongoing relationship between the dentist who is the Primary Dental Care Provider and the patient, which includes comprehensive oral health care, beginning no later than age one and continuing throughout the patient’s lifetime.

With Thanks
As the holiday season approaches, I wish everyone all the joys of this time of year. As we give thanks for all of our many blessings, I want to thank all of you for your service to and participation in the ADA. I wish you joy as we approach another new year!


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