Attendance: Bloom, Brunsden, Chustckie, Fahsbender, Glickman, Huberman, Kahn, Leizer, Prabhu, Rosen, Rosenheck, Schambra, Silverstein, Villa, Weiner
Acceptance of Minutes –2/8/00-vote unanimous.
President’s 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 year’s award.
• The NJDA “Night at the Races” fundraiser will be at the Pegasus Restaurant on Wednesday, May 3rd for the benefit of NJDPAC.
Program-M. Weiner
• 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.
Membership-N. Villa
• 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 CEU’s and will be held at St. Peter’s 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.

Respectfully submitted,
Bruce A. Huberman, DMD
Secretary

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 NJDA’s 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. Delta’s 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 DoBI’s 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 Department’s position; that is that when a traditional plan is primary, the patient’s liability is the dentist’s usual fee, and the balance remaining after the primary plan’s 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 Delta’s 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 NJDA’s 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.

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 patient’s 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 don’t 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, isn’t 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 hasn’t 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 patient’s 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 doctor’s monthly capitation reimbursement is unrelated to whether the patient comes in or not. A profit can be made if some of the listed patients don’t 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 doctor’s 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 don’t 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