President's Message || MCDS Board of Trustees / Committee Reports
Treasurer's Report Detail || NJDA State Board of Trustees Report
Membership News || Articles || Announcements
OSHA Course - Thursday, June 22, 2000
PerioChip - Thursday, May 25, 2000
Atridox - Thursday, June 1, 2000
Annual All Day Course - Paul Belvedere - Wednesday, November 8, 2000
What is a biofilm? Is it an environmental documentary entered in the Cannes Film Festival? The answer is, not exactly. Biofilms are formed by microorganisms, including bacteria, fungi, and protozoans that colonize and replicate on the interior surfaces of dental unit water lines (DUWLs), forming a protective slime layer known as a glycocalyx. Dental plaque is the most well known biofilm. Once formed, these biofilms serve as a reservoir increasing the numbers of free floating microorganisms in the water exiting the waterlines.
Where do these microorganisms come from? According to the CDC, the source is the public water supply. The standard established by the Federal Safe Water Drinking Act for potable water is around 500 Colony Forming Units/ ml ( CFUs/ml ) of non-coliform bacteria; this amount can become amplified when water sits in your dental unit tubing overnight. This issue was first reported on over 30 years ago, so why rehash this topic now? Because our patients may have questions regarding the health safety of DUWLs due to a recent television news program which dealt with this topic in a heavy-handed, sensationalized manner. The 20/20 TV show I am referring to, employed a university microbiologist to analyze water samples from dental units, and compared the results unfavorably to water taken on camera from the mens toilet. In a blatant attempt to scare the public, or more likely to garner Nielsen ratings for the program, the show used an unsubstantiated, anecdotal account of an immune compromised patient who suffered a brain abcess shortly after her dental appointment to imply cause and effect. What is fact and what is fiction here? The facts are: microbial biofilm does form along the walls of the long, narrow tubing presently used in dental unit water lines, and the source of these microbes is the public water supply. The ADA has established a goal for the quality of dental unit water; no more than 200 CFUs/ ml, and is currently working with dental manufacturers to develop dental units that will achieve this goal.
Why has the ADA set this goal for DUWL quality? Is there a health risk to our dental patients from the biofilm that exists in our dental unit tubing? According to the CDC, organisms found in DUWLs are non-pathogenic for immunocompetent patients. To date, CDC is unaware of any serious health effects documented among patients or workers that can be directly related to contact with dental unit water. In addition, I spoke with Dr. Shearer, the director of the ADAs Information and Policy department and a Ph.D. microbiologist, who related the fact that there are no substantiated health problems that have been reported stemming from the dental treatment of immune compromised patients.
The CDC and the ADA are both in agreement that the presence of biofilm in DUWLs does not in any way pose a health risk to our dental patients. The ADAs motivation for establishing a goal for DUWL quality seems to stem from a desire to do the right thing as the governing body of the dental health profession, and to place a positive spin on public opinion regarding dentistry as appearing to be proactive. This is evident in the following statement in the CDC report, Yet, despite the absence of documented health effects, contact of the patient with water of poor microbiologic quality is inconsistent with infection control principles. If your patients ask you questions regarding this issue, you can confidently answer that the 20/20 newsprograms inference that having treatment at a dental office can make them sick is blatantly false and untrue. As dentists we know there is a huge difference between the quantity of microorganisms and the virulence of individual species. This is not a health issue, it is a public relations issue prompted by TV journalistic hype.
Mark Schambra DDS
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-March 14, 2000-
Attendance: Bloom, Brunsden, Chustckie, Fahsbender, Glickman, Huberman, Kahn, Leizer, Prabhu, Rosen, Rosenheck, Schambra, Silverstein, Villa, Weiner
Acceptance of Minutes 2/8/00-vote unanimous.
Presidents Report-M. Schambra
A 20/20 news program was aired February 18th which featured a piece about the level of bacteria present in dental water lines. The ADA recommendations are: 1) Follow the CDC infection control guidelines for handpieces, air water syringes, etc. 2) Flush all water lines before and after each patient. 3) Install anti-retraction devices where appropriate.
The recipient for the Sy Symanski Lifetime Achievement Award has already been selected and the award will be presented at the Mid-Atlantic Dental Expo this May in Atlantic City. The nomination from MCDS will be passed along for consideration for next years award.
The NJDA Night at the Races fundraiser will be at the Pegasus Restaurant on Wednesday, May 3rd for the benefit of NJDPAC.
Next week is the Sy Symanski Memorial Lecture. Drs. Schambra and Weiner will present the plaque to the speaker, Dr. Harold Baumgarten.
The plans for Staff Night are proceeding well. Comedians have been hired to do a comedy game show along the lines of Make Me Laugh, where contestants from the audience will play for prizes.
NJDA Council Reports:
Annual Session-N. Villa
A resolution was presented to allow a one day only pass to the exhibit hall for nonmembers. The may be a means to recruit potential new members. The resolution will be brought before the Board.
Dues invoices were mailed to members and nonmembers (nonmembers with a cover letter). The cost of the mailing to nonmembers was $1200. Forty nonmembers joined and paid their dues for revenue of $18,000. Twenty-seven of these people were former members that re-joined and thirteen were never members
NJDA staff will take care of and pay for one mailing a year for its components who are sponsoring a CE course. The letters can be made customized (with the name and address of the recipient inserted). The component would have to provide the content and the letterhead. This would be in exchange for having a NJDA representative present at the event to discuss membership for recruitment purposes.
Peer Review-J. Fahsbender
Three cases were brought up for review and all were handled through mediation.
MCDS Committee Reports:
Mentor- E. Glickman
The Perio-Chip course will be offered on 5/25/00 and the Atridox course will be on 6-1-00. Both courses will offer new information on periodontal treatments.
The OSHA Blood-Borne Pathogens Annual Certification course will be 6-22-00.
All courses will have 2 CEUs and will be held at St. Peters hospital. Registration is at 6pm and the course is 7-9pm. Information and registration forms will be in the newsletter.
Drs. Greg Livanos and Raj Lall have joined the Mentor Committee and will actively be working on new programs for Fall 2000. Future newsletters will have information and details.
Bruce A. Huberman, DMD
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Detailed Treasurers Report
April 1, 2000
Nancy Villa, DMD
Previous Balance (3/1/00)
Current Balance (4/1/00)
PROFIT & LOSS STATEMENT
3/1/00 through 4/1/00
Monthly Meetings 750.00 Interest 55.44
TOTAL INCOME 1,345.44
Audiovisual (3/22 lecture) 551.20
Executive Committee Dinners 208.93
Dinner Meeting (Feb) 2,181.15
Lecture Fees 700.00
Office Expense (P.O. Box) 64.00
Staff Night (deposit) 500.00
TOTAL EXPENSES 5,371.18
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Components societies are not allowed to separately post minutes of the State Board of Trustees Report. You can now find the reports at http://www.njda.org/member/board_minutes/index.html.
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NJDA NOTEWORTHY NEWS
from Dental Benefits and Governmental Affairs Councils
Insurance Company Complaints: The council was provided with cumulative statistics for the period January 1 through December 31, 1999, indicating a total of 140 complaints for the year. Of these, 80 of the complaints have been successfully resolved, 10 were not resolvable due to contractual limitations, 23 were for data purposes, and 27 are still pending. Once again, Aetna was the subject of the most complaints (with 23), followed by Blue Cross Blue Shield (19) and Delta Dental (14).
Coordination of Benefits: Letter to Delta Dental: The council reviewed the letter Arthur Meisel wrote to Delta Dental at the request of NJDAs Board of Trustees. The letter requested a response as to whether Delta Dental would be complying with the Coordination of Benefits (COB) regulations (as clarified in Department Bulletin 96-17) as they relate to secondary plans. Deltas response indicated it would continue to reduce its secondary payment responsibility up to the Delta allowable amount until the Department of Banking and Insurance (DoBI) adopts specific regulations on COB with managed care plans.
Coordination of Benefits: Meeting With DoBI: Staff reported to the council on the meeting she and Arthur Meisel had with the Chief of DoBIs Managed Care Bureau (Ed Unger) regarding the continuing payment problems being experienced by dentists when a traditional plan is primary and a PPO or service plan is secondary coverage. Mr. Unger reiterated the Departments position; that is that when a traditional plan is primary, the patients liability is the dentists usual fee, and the balance remaining after the primary plans payment must be paid by the secondary plan (even if it is a PPO), as long as the amount is less than what the secondary plan would have paid if primary.
Delta Dental Position on Targis/Vectris Bridge: The council discussed Deltas decision to deny benefits for the Targis/Vectris bridge procedure due to the short duration of clinical trials. Since Delta considers this procedure investigational, no alternate benefit will be applied and the entire cost must be borne by the patient.
Medicaid: The Division of Medical Assistance has informed Mr. Clark that the reimbursement schedule for dental procedures will be increased for certain codes. The codes to be increased include general dentistry, anesthesia, and children's dental health including orthodontics. The proposed increases are between 50 -400%. The Division is providing NJDA with an opportunity for input on the specific codes to be increased. They have been requested to provide NJDA with a written letter requesting assistance. Upon receipt of the letter, the Medicaid Sub-Committee will be convened.
MCDS reduced our dues portion $13 to make up for the $13 dues increase this year by the ADA, therefore giving their members no net dues increase for 2000. A combination of non-dues income (corporate sponsorship/advertising), savings from printing the newsletter in-house, and continued fiscal restraint by the MCDS Board has enabled us to provide our members with this benefit.
Voluntary contributions from NJDA Members are strongly encouraged to support NJDAs sponsorship of the Special Olympics. This is a worthwhile cause that is also providing member dentists with a targeted PR marketing campaign.
MBNA has a credit card endorsed by NJDA that provides royalties (non-dues income) to NJDA based on usage.
DENTAL BENEFIT TIDBITS
I See The Bandwagon, Should I Jump On?
In my Tidbit Spin Control I talked about different payment modalities. Since then I have had conversations and requests for advice on which plans to join, and which to avoid. The official policy of organized dentistry at all levels is that any plan is acceptable, as long as it fulfills both your and your patients needs, and you enter into any agreement with full knowledge. I cannot advocate any plan and similarly advocate the exclusion of others. Federal anti-trust legislation prevents me from saying that one plan is bad and you should not join. This type of advice is known as concerted effort to limit trade, which is illegal. (You really dont want to visit me in jail, I look just awful in stripes!) Two doctors can discuss things like fees, participation or non-participation in plans or reimbursement levels. Under the umbrella of a dental association meeting, three or more doctors discussing these things can be defined as a conspiracy in restraint of trade. When the dental association goes to bat for you to force the State Insurance Commissioner to raise PIP fees to the statutory limit required by law, we cannot poll our members to find out what the average fees are. This can be construed as a violation of anti-trust regulations. We purchase a list of fees from the same fee service the insurance industry uses. The insurance industry is exempt from anti-trust laws, and we all know that being the honorable people they are, they never engage in a concerted effort or a conspiracy in restraint of trade.
There is a new type of plan out there. It is called Fee for Service. In this plan, the doctor performs the treatment agreed and the patient pays him (unique, isnt it!). Traditional Indemnity Plans are where a third party pays for the dental service after it is performed. This payment is in the form of a table of allowances, a UCR table or schedule of allowances. The reimbursement levels are usually capped at an average of one thousand dollars per annum. This cap hasnt changed much in over twenty years. A deductible is the amount that the patient must pay before any of their benefits come into effect; in some plans the deductible is waived by the benefit plan for preventive care. A co-charge is the amount that the patient must pay to make up the difference between your submitted fee and what the benefit pays. Forgiving the deductible or co-charge to decrease the patients out of pocket expense is considered fraud. Capitation Plans are where the participating doctors are given a list of subscribed patients and are paid a specified amount up front, usually at the beginning of each month, per head (thus capitation). For this fee, the doctor is required to provide certain specified dental services at no or reduced cost to the patient. The doctors monthly capitation reimbursement is unrelated to whether the patient comes in or not. A profit can be made if some of the listed patients dont come in. Human nature being what it is, some offices place obstacles to patients to prevent them from coming in, while still collecting the capitation amount. With capitation, the liability and risk is totally the doctors responsibility. Once the benefit plan has paid the monthly capitation amount, their contractural obligations have been met and their hands are clean. If there are
one thousand patients on the list, and they all come in, this is no longer capitation...it is decapitation. I personally consider a payment model such as capitation ethically troubling. I have a problem when the incentive is to not treat patients, and the more patients you dont treat, the greater is your profit margin.
There are other dental benefit modalities which will be discussed in future Tidbits. Should you jump onto any bandwagons? It depends on your circumstances, philosophy of dentistry, concepts of patient care, your ethical standards, and
desire for risk. One thing I can be definite about however, is that you should thoroughly investigate any plan before joining. Use the services of an accountant and/or attorney. In addition the New Jersey Dental Association has a member service where they review plans that are submitted and make you aware of the pitfalls. Remember that the final decision is always yours.
All of the opinions expressed are my own; however I try to base them on current facts and information. My primary source of information is CDT-3/2000, American Dental Association, 1999.
Daniel B. Krantz, DDS
Middlesex Representative to Council on Dental Benefits
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Mid-Atlantic Dental Expo
Atlantic City Convention Center
FREE FREE FREE Child Care
You asked for it and the Council on Annual Session responded by giving FREE CHILD CARE (no hourly charge as published earlier).
Bring your entire family with you. While you and your spouse are attending courses and activities, your children (ages 2 and over) can be entertained with games, crafts and activities. The hours of this service, which will be located in the Atlantic City Convention Center, will be Friday, May 19 from 8:00 a.m. until 4:30 p.m.; Saturday, May 20 from 8:00 a.m. until 2:30 p.m., after which the Magic Show will begin at 3:00 p.m. in the Exhibit Hall. Check the box on the registration form to receive more information.
Artists and PhotographersLend us your talent
Our talented NJDA dentists will be showcased at MADE at the Atlantic City Convention Center during the Welcoming Wine and Cheese Reception on Friday, May 19. This will be an opportunity to display the work of which you are so proud and share it with all of those in attendance. Dr. Michael Unger is the coordinator of this event. For further information, contact Lynn M. Foley at 1-800-831-NJDA (6532) and your message will be forwarded to Dr. Unger.
New Companion Tickets: A dentist purchasing a full price ticket (no discounted registration qualifies) for a course will be given a free companion ticket to be used that same day for the following courses: Belva Plain (Tea with an Author), Jack Medina (Fact & Fantasy of Nutrition, Fitness & Your Personal Wellbeing), and the CPR course. Dentists may receive only one companion ticket per day and staff, spouses or guests may use the ticket.
New Dentist Discount: All New Dentists (in practice less than 10 years) will be eligible for a discounted registration fee for scientific courses. This discount is made possible through the generous contributions of Delta Dental Plan of New Jersey. As always, students who are members of ASDA may attend scientific courses free of charge (space available basis). Residents may receive a 50% discount on all scientific courses if a letter from the Chief of Services accompanies the registration form.
As a member benefit, there is a total of 10 free CEUs available through essays and table clinics at MADE. Make sure you check the MADE brochure for the listing of times and locations.
All registrants are encouraged to visit the exhibit hall throughout the weekend so they may experience the array of innovative dental products, equipment, and new programs available on the market. Guests of registrants are encouraged to visit and should request a name badge in order to gain free admittance to the exhibit hall. NOTE: Many NJDA members hold off expected purchases from suppliers and place orders with exhibitors at the meeting to show their support of MADE.
And More to Do for Non-Dentist Attendees too
Middlesex County Associateship leading to full or partial purchase. High quality, fee for service, no insurance participation. 1999 gross--$795,000. Two to three generation patient base requiring continued skilled care. $525,000. Mail Curriculum Vitae and objectives to: NJDA, Box 2000, New Jersey Dental Association, 1 Dental Plaza, PO Box 6020, North Brunswick, NJ 08902-6020
ASSOCIATE POSITION WANTED
General dentist with GPR and working experience seeking full time position in a busy practice.
Please leave message at 609-716-9640
or fax 609-716-8925.
Dr. Alla Fishbeyn
1997 NYU CD, 1999 JFK GP residency, looking for P/T fee for service high
Enthusiastic team player. Enjoy working in creative and productive environment.
For contact call
Childrens Dental Health Month
HEALTHY SMILES ARE
OUT OF THIS WORLD
Dental Health Fair and Awards
Ceremony - April 13, 2000
If you wish to participate in the Childrens Dental Health Program,
CAVAN BRUNSDEN, DMD at 732-679-2323
NJDA Night at the Races
Wed., May 3
To register or for additional information
contact Tim Clark at 422-2705
MCDS members may attend general meetings of all component societies in the state and receive continuing education credit for the program (course) portion of the evening. Component Societies are providing this feature as a benefit of membership. Individuals wishing to purchase dinner must reserve prior to the meeting by calling the contact person indicated. A complete listing of programs can be found in the members only CE section of the NJDA website (www.njda.org). Be advised that programs involving NJDA officers and staff may not be eligible for credit. Licensees may utilize 7 credits per licensing cycle in practice management courses.
Save the Date...
The NJDA Council on New Dentists will be sponsoring a reduced fee course at the annual session in Atlantic City, Saturday, May 22nd. Featuring Dr. Karl Leinfelder: "Clinical Evaluation of Restorative Systems"
All members 10 years out of dental school or less can attend the full day course for only $90.
More details to come in future issues.
MCDS Web Site Our web site has all of the latest MCDS news, as well as archives of past newsletters and useful links. You can reach the site through NJDAs component section (http://www.njda.org/member/02_components/middlesex). Contact Diane Davis at NJDA at 821-9400 or firstname.lastname@example.org for a user name and password.
MCDS Video Library at St. Peters Hospital. All you need is a valid ADA membership card to access the extensive video collection.
Lawline Remember LAWLINE if you have a legal question related to your dental practice. As a continuing member benefit, NJDAs General Counsel, Arthur Meisel, Esq. is always available to confer, at no cost, with members.
If you have a question or need assistance, call Mr. Meisel at his direct-dial number (732) 422-2730 or send him a fax at (732) 821-1082.
Discounted hotel rates are available to ADA members at selected hotels in Chicago, New York, and Washington, D.C. For specific hotels and rates, call ADA at 312-440-2500 extension 2853.
Members who join Walt Disney's Magic Kingdom Club receive discounts at Disney hotels, resorts, and stores and on Disney cruises. Membership in the Magic Kingdom Club is free to ADA members. For more information, call ADA at 312-440-2500 extension 2582.
Hertz offers ADA members money-saving rates on car rentals in the United States and Canada, as well as bonus coupons throughout the year. For more information, call ADA extension 2923.