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Dentists, HIPAA, IT and Reform

Healthcare Reform and Presidential Candidates 

[Surprising Obama and McCain]

By Darrell K. Pruitt; DDS


Some readers of the Medical Executive-Post may wonder why a dentist’s opinions on healthcare reform should be given space on a website that is about the personal business, management, finance and economics of healthcare. 

Like Lab Animals

Even though dentistry is only around 5% of the healthcare market; when it comes to government/insurance regulation using the one-size-fits-all micromanagement model of MBAs and politicians – dentists are your lab animals. So, hear me squeal! 


Our nation’s leaders could learn sobering lessons about how their rules affect healthcare by observing how they affect dentists.  As businesses, dental practices are naturally much less complicated than medical practices. 

For one thing, dentists maintain only a few thousand active patient charts, whereas family physicians may have three to ten-thousand.  This is because physicians see forty or more patients a day.  Dentists, whose work involves intricate, but routine hands-on procedures in unpredictable mouths, may see ten patients in a busy day – eighteen if one counts checking hygiene patients. 

Sans Bottlenecks 

In dentistry, patient bottlenecks have never occurred in the clinical setting, even when burdened by modern, strategically complicated insurance hoops.  It takes just as long today to pull a tooth as it did in 1960. 

Actually, considering the OSHA mandate of the late ‘80s, defensive medicine and non-productive paperwork such as the meaningless HIPAA privacy release that patients have signed without reading since 2003, dentistry takes a lot more time than it used to. 

Thank goodness patients never take the time to read what they sign or dentistry would take even longer.

Pulling teeth will never be faster than it was a hundred years ago when x-rays, as well as surgical-grade alloys became available. Back then dentists were never delayed by the wait for onset of anesthesia. For a closely related reason, experienced patients didn’t want dentists piddling around indecisively using cold steel. 

Of Peg-Boards and Ledgers 

For decades, the busiest of medical and dental practices ran efficiently using only pegboards, ledger cards and lots of carbon paper, yet the staff still seemed to have time to ask patients about their families. The business of dentistry is so simple that even today some dentists choose to run their practices without the aid of a computer at all – thereby eliminating the unproductive expense of being a covered entity. 

Always remember this: there is nothing holding down the cost of being HIPAA compliant, and doctors with small, three-and-a-half employee businesses will be held to the same standards as hospitals with large staffs and a fondness for busywork – busywork that demands department budgets that include overtime pay.  HIPAA fits a sole-proprietor dental practice like socks on a rooster. 

The Economics of Choice 

Here is another important difference.  For a considerable amount of dental care, one might delay the purchase of a home entertainment center to chew comfortably.  For serious medical care, one might forgo a home to stay alive.  Almost all acute, health-threatening dental emergencies can be quickly solved in an outpatient manner with a simple extraction that costs less than $200, and available in almost any neighborhood.


From a dentist’s perspective, the Health Insurance Portability and Accountability Act [HIPAA] was never about portability.  Oh, I could tell you stories; couldn’t we all.  And, considering how many electronic health records have been fumbled under HIPAA, accountability is a cruel joke as well.  That leaves the original 1996 HIPAA Rule stripped down to HIA – the Health Insurance Act; transparency at last.

The Four Cornerstones

A year ago, President George Bush signed an Executive Order that centered on four “cornerstone” goals to help bring about a systematic approach for measuring quality and value in health care, and for making that information publicly available. They are:

  • Connecting the system through the adoption of interoperable health information technology;
  • Measuring and making available results and outcomes on the quality of health care delivery;
  • Measuring-Transparency and making available information on the price of health care items and services; and,
  • Aligning incentives so payers, providers and patients benefit when all are focused on achieving the best care-value at the lowest unit-cost

The last three cornerstones, Measuring, Measuring-Transparency and Aligning are dependent on providers volunteering for the first – Connecting.  Even though dentists were intended to be included in Bush’s plans for healthcare reform, connecting with dentists never happened – especially for dentists who did not volunteer for an NPI number – which gives stakeholders a legal right to Measure, Measure-Transparency and Align. 

Or, as my dad, a furniture maker, used to say, “Measure twice, cut once (and for your own sake do not get personally involved in the machinery).”


As a dentist who has observed physicians methodically lose control of doctor-patient relationships to stakeholders who hold payments for ransom, I say that if this is interoperability, I hope it never connects to my sheet metal file cabinets full of paper.  HIPAA has nothing to offer but expense and liability.

Mark my words. History will show that HIPAA was exposed as a national failure in dentistry first, and that the presidential candidates still don’t know. 

Won’t presidential candidates Barack H. Obama and John S. McCain be surprised! 


Politicians never consider dentistry. Though it is unfortunate and very expensive, it is nothing new. Stick around. I have other issues, as well, and am not bashful. Of course, your thoughts, opinions and comments are appreciated.

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5 Responses

  1. Being a “covered-entity” just became even more expensive

    An article was recently posted in ComputerWorld.com, ominously titled, “Feds finally put teeth into HIPAA enforcement.”

    Author Jaikumar Vijayan describes the harsh ruling that followed the HIPAA inspection suffered by Seattle-based Providence Health & Services.

    He writes that Lisa Gallagher, director of privacy and security at the Healthcare Information and Management Systems Society (HIMSS) in Chicago considers this as a serious corrective action plan. “Gallagher added that the deal with Providence sends a clear message to other health care providers that HHS is finally cracking down on HIPAA violators, after having been accused of lax enforcement in the past.”

    And what is it like dealing with HHS?

    Peter MacKoul, president of HIPAA Solutions LC, a consulting firm in Sugar Land, Texas responded: “If you look at what they’re being forced to do, it’s scary. They have lost their ability to contest anything; there’s no way of getting out of this agreement. And this is the best deal they could get.”

    Just how important are computers in dental offices anyway?
    -Darrell Pruitt DDS


  2. What difference does it make?

    I posted this on PennWell today.



    Will electronic health records save money in dental care? And does that even matter? I have assembled for you the official word from the leaders of the American Dental Association:

    – On the Advocacy section of the ADA website, it states that health information technology will be the organization’s primary tool for reducing the cost of dental care in the future.


    – Dr. Robert Ahlstrom, a healthcare IT hobbyist and part-time stakeholder who represents the interests of the ADA as well as all dentists in the nation, praised the HIPAA Rule in testimony to a the National Committee on Vital and Health Statistics (NCVHS), a government advisory panel that reports to HHS. Ahlstrom boasted that because of HIPAA, “Provider and plan cost savings will translate to less costly health care.” HHS liked his other nine rationalizations as well.


    – When past president of the ADA, Dr. Mark Feldman, was asked if EHRs will save money in dentistry, he refused to answer the question.


    I found Dr. Feldman’s reticence particularly confounding because less than a week ago, in his address to the ADA House of Delegates, he praised Dr. Dr. Bob Brandjord, a well-respected past ADA President, and one of my personal favorites. Here is one of Dr. Brandjord’s quotes that I am particularly fond of: “When we see something change that doesn’t make sense, we have to identify it and let the ADA know about it. Don’t roll over and take it if something doesn’t seem right. Your interpretation might not be accurate every time, but nobody who administrates or interprets the laws will be aware there are any issues to resolve if they’re never brought up.”
    From ADA News, 12/20/06

    Yet Dr. Feldman chooses silence.
    But then, what difference would it make anyway?

    – Dr. John Findley, the brand new ADA president says that regardless of whether dentists want them or not (and regardless of how much harm slippery patient records cause patients, I assume), it is a done deal: “The electronic health record may not be the result of changes of our choice. They are going to be mandated. No one is going to ask, ‘Do you want to do this?’ No, it’s going to be, ‘You have to do this.'”


    Regardless of the ADA’s committee-approved spin, the historic surrender of the Hippocratic Oath, and Dr. Feldman’s suspicious silence, being a covered entity will become even more expensive for dentists on November 1. That is when the Federal Trade Commission’s (FTC) “Red Flag Rules” go into effect. Unless you are a cash-only dentist, the FTC can now also reach out and touch you if you have a data breach.

    The way it looks from here, if one reports a loss of patient identifiers, such as from a stolen hard drive backup that many dentists carelessly transport to and from the office every day, inspectors from numerous sectors of government will line up at your door. However, if you don’t report a fumble, an FBI agent could be the first in line.

    Here’s the problem: Hackers and dishonest employees leave no trail. So if the FBI agent unexpectedly surprises a dentist with a search warrant in regards to a rash of identity thefts, the dentist will be the first to be suspected of selling patients’ identities. I wonder if Dr. Findley will have the courage to warn the members about that horrible possibility.

    Anyway, what difference would it make?
    Darrell K. Pruitt DDS


  3. News Update

    HHS’ inspector general’s office has issued a report criticizing the CMS for its failure to protect patient information by lax enforcement of the Health Insurance Portability and Accountability Act’s security rule, saying in an accompanying letter that the inspector general’s own audits of hospital security systems show “numerous, significant vulnerabilities” that put patient data “at high risk.”

    So, perhaps our friend Dr. Pruitt is more correct, than not!


  4. HIPAA CEs Need to Update Policies on Use of Cell Phones and Cameras

    Covered entities (CEs) should review and update their policies on cell phones and cameras and make the rules clear and highly visible to employees, patients and visitors, privacy experts tell RPP.

    When photos are needed for treatment, the CE should give employees access to a digital camera and discourage the use of cell phone cameras. “That helps mitigate much of the potential for further unauthorized disclosure,” Frank Ruelas, privacy and compliance trainer for CEs, explains. “With a cell phone, you can e-mail the photo to someone. There’s no way you can do that with just a camera. It can’t happen by accident.”

    Abner Weintraub, president of The HIPAA Group, a consulting firm says that CEs should make patients aware of their photography policy, and have them sign the policy to show that they’ve read it. “When a patient has to sign that he or she will not use their phone’s camera, audio or video, the signature carries a lot of weight,” he says.

    Source: Report on Patient Privacy [10/12/09]


  5. Nothing’s as easy as it used to be.
    Dr. Pruitt


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