Don’t Tread on Me – Obama

Posted on November 12, 2009 by Dr. David Edward Marcinko MBA MEd CMP™

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Bite Me – CMS

[By D. Kellus Pruitt; DDS]pruitt

Shy but proud Texas Dental Association leaders still direct employees to encourage members to volunteer for permanent, mandated National Provider Identifier numbers. Why? “Just ‘cause.”

As part of an agreement the TDA made with the state to help politicians out of a lawsuit they brought upon themselves for not providing adequate dental care for the poor in the state, TDA leaders followed someone’s bad advice to encourage Texas dentists to accept CHIP (Medicaid) – which requires dentists to have arbitrary 10 digit NPI numbers to participate.

Don’t get me wrong. I have the highest respect for dentists who treat the poor for pay that doesn’t even cover overhead. That is compassion to a fault – even before CMS investigators arrive with subpoenas based on vague, nuisance complaints from disappointed patients, disgruntled employees and hungry competitors. Getting even with rich, greedy, or otherwise mouthy dentists has never been easier because I’ve heard that CMS intends to investigate all complaints.

Yes, low pay is only part of the nasty package that TDA officials are officially discouraged from discussing with membership – even as they beg for us to sign up for CHIP and “do our part to return our debt to society by helping those who cannot care for themselves.” So who would dare question the reason for the faux sentiment expressed by a long string of TDA Presidents? That would be me.

There are simply so many other charitable ways of publicly and privately returning help to the community that don’t add to the risk of donating one’s skill. Even if one does not help local free clinics, how hard can it be to quietly give away care, Doc, in these hard times? It’s just between you and God anyway, isn’t it? One simply enters N/C in the fee column. Confidentially I sometimes get hugs that so far can be neither controlled nor taxed.

It appears to me that CMS is arguably more influential with TDA leaders than common TDA members like me. If I am correct, this means that dentistry is at risk of being overrun by authoritarian bureaucrats hired by ambitious politicians who often promise more than they can deliver before ducking accountability for earthly bad decisions. The business model even reminds me of the TDA’s.

So now that the TDA played its hand with regard to its fondness for BCBSTX and the NPI number, what does it mean for Texas dentists if Obama’s imminent “Public Plan Option” turns into “Medicaid for All” – as some naively hope and others justifiably fear? This week, the AMA gave its support to the Public Option. Will the ADA be next? 

Dentistry unhurried is value-added service. One cannot get rich at it, but it’s an honorable living.

Regardless of whether you approve of my tactless vitriol or not, I have to say that when it comes down to feeding my family, even this special bastard could be silenced if there is no longer a market on the east side of Fort Worth for dentistry unhurried. Especially if it meant a monthly visit by CMS inspectors like Dr. Annie Bukacek is going through right now. Like me, she also gives her patients the time they deserve. But unlike me, she doesn’t have time to pick fights with shy bullies who hide behind employees.

I’ll get to the physician’s story in a moment. But first, just how important are secrets to the leaders of the nation’s preeminent non-profit dental organization? It’s important enough that many in the ADA House of Delegates want the power to mete out punishment to fellow officers who cannot keep their mouths shut. Some of those we elected even want to make the sanctions retroactive to deal with colleagues who have already broken the traditional unwritten good ol’ boy code of stoic conduct. At the same time, the TDA is begging dentists in the state to run for ADA office – starting on the local level. Why do you think dentists in Texas don’t want to get involved? Nobody accepts delivery from the cluetrain in Austin. It probably stops there at least a couple of times each week day.

I copied below three of the ADA Delegates’ referred resolutions from Judy Jakush’s November 2 ADANews article, “Delegates vote on Association business matters,”

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3821

1] Res. 70 states that if any member of the ADA, including delegation member, council, committee or task force member, or Board of Trustees member has been acknowledged as breaking the attorney-client privilege or executive session, that member is, at a minimum, barred from ever again participating in an attorney-client or executive session within the ADA. This shall include such acts which have been acknowledged as occurring prior to the enactment of this resolution.

2] Res. 67 would specify that candidates for elective or appointive officers may not have had any sanctions bestowed upon them by the Association. Also referred was Res. 67RC, which would direct that anyone found by the Committee on Credentials, Rules and Order to have violated his or her duties to the Association would be disqualified from holding elective or appointive office.

3] Res. 68 was referred to the Council on Ethics, Bylaws and Judicial Affairs for report to the 2010 House with recommendations for Bylaws changes. The proposal calls for CEBJA to review the Bylaws and craft language that would define the mechanism for sanctions up to and including removal from office of a delegation member or Board of Trustee member if there is found to be cause for removal as shall be defined. That cause, at a minimum, should include those causes as delineated currently for council members. Res. 68 also calls for a method for fair and impartial hearings to be recommended and the establishment of an authorized House committee that can be held on an ad interim basis between annual sessions of the House of Delegates with authority to determine and impose any such sanctions deemed appropriate. 

Remember, the ADA is a non-profit, professional organization whose only purpose for existence is to serve dental patients through dentist members who support it with dues. When one reads these and other resolutions in Jakush’s article, it looks like ADA President Dr. Ron Tankersley is running the Pentagon. We’re only dentists for crying out loud!

Dr. Annie Bukacek’s 6-month battle with CMS

This morning I read what has turned out to be a popular article titled “Investigators descend on doctor,” written by Candace Chase, writing for the Daily Inter Lake which serves northwest Montana.

http://www.dailyinterlake.com/news/local_montana/article_d8cde54e-cc2d-11de-9ddd-001cc4c03286.html

“Dr. Annie Bukacek of Hosanna Health Care in Kalispell was surprised when a 30- to 40-foot-long command-post vehicle pulled up unannounced last week, along with a posse of state and federal health-care fraud investigators.”

“Bukacek points out that anyone – a disgruntled ex-employee or patient or someone who doesn’t like a physician’s looks or politics – could trigger an investigation and cost a physician as well as the government thousands of dollars.” 

I wonder what would happen if a dentist openly taunts CMS leaders? As I previously mentioned, it is Dr. Bukacek who claims, “They said they have to followup every allegation made.” 

When all American dentists are required to volunteer for NPI numbers and can no longer be legally paid in cash at the time of service, we’ll all be hung by an ADA-approved mistake of historic proportions. I suggest that ADA members take time right now to jot down names so that when judgment day inevitably arrives, one will be prepared to hold accountable the ADA employees who recommended the numbers. After reading how ADA leaders are hunkering down, it looks like going through employees will probably be the only way to touch the bosses they bravely try to shield.

Oh yeah. I posted the 5th of almost 30 comments that so far follow Candace Chase’s provocative article:

“Dr. Annie Bukacek’s experience is why as a US citizen in the land of the free, I simply refuse to do business with the US government. Bite me, CMS. Did you hear me? I said bite me!”

Assessment

It’s not likely that I’ll regret those words because I am powerless to stop myself from typing them anyway.

Conclusion

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2 Responses

  1. Dr. Pruitt, on January 23, 2010 at 5:10 PM said:

    Kay Bailey Hutchison’s challenge: Patients’ Privacy

    Today, I blew the doors off of the thousands of Den-Pac dollars Texas Dental Association members pay lobbyists in Austin. And I did it at no cost, in my own free time and for my own entertainment.

    Today, I posted the following letter on Kay Bailey Hutchison’s Facebook Fans page – which I already control.

    Please tell me once again, TDA, why is it that our state organization doesn’t have a Facebook?

    Quit your pouting, TDA. Get into the game. We’re losing.

    —————————————————-

    Dear Senator Kay Bailey Hutchison:

    Dental practices across Texas are in danger of sudden bankruptcy – even if Texas dentists self-report data breaches. (Computers are often stolen in burglaries).

    “HHS sets March 10 deadline for HIPAA privacy, security breach notification”

    http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3898

    Author Jennifer Garvin writes: “The U.S. Department of Health and Human Services has announced a March 10 deadline for dentists who are covered under HIPAA to notify the department of any breaches of unsecured protected health information between Sept. 23, 2009—when the Breach Notification Rule went into effect—and Dec. 31, 2009.”

    This fall, the Ponemon Institute estimated that it costs over $200 per patient record to report a breach. ($50/record for notification and 150/record in lost business once patients are notified). So what happens if a dentist knows his or her computer was hacked last month, and it contains all 3000 of his or her patients’ records? What if the dentist or a staff member has simply misplaced a hard drive, but cannot find it within 60 days?

    I think anyone can see that when unfortunate dentists learn that it costs half a million dollars to report a data breach, there will likely be even less reporting of data breaches. The crooks win, and it harms every Texan.

    One more thing ADA reporter Jennifer Garvin didn’t mention: If a dentist loses 500 or more records, the data breach has to be reported to the local news media as a press release.

    I’m afraid there is a lot of bad news that even Texas dentists don’t know about HIPAA and the NPI number. The ADA has never allowed open discussion of electronic health records because a few years ago, too many careers and campaign contributions were invested in inflated benefits of a bankrupt interoperable national health record system. Dentists’ patients never have a seat at the table. Not surprisingly, they always get hurt the most.

    If you become Governor, you have an old problem that nobody may have warned you about until today. Any ideas, Senator? I’ll try Governor Perry and others soon with the same question: What are you going to do?

    D. Kellus Pruitt; DDS

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  2. D. Kellus Pruitt DDS, on January 24, 2010 at 6:06 PM said:

    Texas dental negotiations – A conversation on Kay Bailey Hutchison’s Facebook

    Whether you want to believe my giddy hyperbole or not, it’s a damn good thing that I long ago took over the negotiations for the future of dentistry – even before forcing BCBSTX to close their Facebook.

    I’ve been fighting for my patients’ neglected interests while TDA lobbyists have been cashing Den-Pac checks and making excuses. You decide which is more cost-effective – lobbyists or hobbyists.

    Cara Burgess is a Texan friend I’ve gotten to know on Senator Kay Bailey Hutchison’s Facebook Fans page. Let me share with you our recent conversation about dental care in Texas. It might be worthwhile to TDA leaders to pay attention. I bring powerful truth that can no longer be avoided because of cosmetic concerns.

    Darrell Pruitt (to Cara Burgess): As a provider, I am against universal care.

    Cara Burgess: Darrell-what are your suggestions to help Americans have better access to health care they can afford?

    Darrell: Thanks for the interest, Cara.

    Texan dental patients will be affected by big problems concerning privacy breaches of dental offices. The news may surprise you. I’ll post it as a letter to Sen. Hutchison in a minute or two.

    (See: “Kay Bailey Hutchison’s challenge: Patients’ Privacy”)

    http://community.pennwelldentalgroup.com/forum/topics/kay-bailey-hutchisons

    For a quick answer to your question – we need less stakeholder interference between doctors and patients. Almost all doctors truly want the best for those they treat. We need time to provide personal care – not “personalized” care.

    Cara: So Darrell are you saying no insurance companies? All billing done directly between patient and Dr.? And only use insurance if you have a catastrophic illness or event?

    Darrell: Cara, you read a lot into my answer, and you’re actually pretty accurate. The nation needs to question the true value of dental benefits as part of non-taxable employment packages before continuing to unquestioningly subsidize the insurance industry. My view is counter to the ADA’s official position, by the way.

    It’s my Republican-friendly opinion that it makes sound long-term sense to truly encourage responsible Americans to accept first-hand accountability for their dental health – and in turn, take better care of their overall physical health. It is clear to me that this means eliminating tax subsidies for dental insurance companies which make more money if their clients don’t make dental appointments for preventive care.

    It is clear to me that employees should be given the option to take their benefits in cash rather than managed care dentistry – dentistry by the lowest bidder with no quality control. For one thing, if tax subsidies are eliminated for dental benefits, free market competition for employees’ dollars that has long been absent in the dental insurance industry will hit managed care CEOs like sudden gravity. They will either immediately increase accountability to their clients, or fail in business. Gravity can be a bitch for those unaccustomed to it.

    And if worse comes to worse, a health-threatening infected tooth can be extracted for less than $200. Even now, people without dental benefits occasionally lose a few teeth before they decide to take up better oral hygiene habits. Gravity.

    Thanks for being interested in my viewpoint, Cara.

    Cara: “Even now, people without dental benefits occasionally lose a few teeth before they decide to take up better oral hygiene habits.”

    In some cases though lack of oral hygiene isn’t the only reason some people lose those teeth. Even with insurance some people find they can’t afford the deductibles required for care.

    But what about the people who don’t have access to health care benefits through their employer?

    I personally hate dealing with the insurance companies and have attempted to find both health care and dental care without using insurance and so far find I still will not be able to afford the cost. Especially when you have chronic health issues to deal with.

    Darrell: Thanks, Cara.

    First of all, consider the differences in costs for dental care versus medical care. Dentistry is not even in the same class. People go bankrupt because of hospital bills, not dental bills.

    As I mentioned, almost all dental expenses are due to personal neglect. There are special circumstances when the state must intervene – such as when children’s health is neglected. But if saving lives is deemed more important than cosmetics and insurance industry profits, preventive care and extractions are cheap and effective real solutions. Besides, there is no such thing as “dental insurance.” There are only “dental benefits.”

    We have become a society which enables neglect.

    D. Kellus Pruitt; DDS

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