Need a New Career in Dentistry – Become a Consultant

Or – Maybe Just a Hobby

By Darrell K. Pruitt; DDS

One might ask how much knowledge of dentistry is required before a person is qualified to call oneself a “dental practice management consultant” – beyond maybe being able to spell HIPAA with only one P, and Hippocrates with two.

Meet Jill Coon, Inc

An anonymous management consultant who works for Jill Coon, Inc of Florida posted this brave suggestion on the company Facebook today:

“Why not take 3 max anterior PA’s and 1 mandibular PA once a year with bitewings to check for caries in front teeth? We actually bill insurance for 3 PA’s not 4. Hygiene production just increased!”

My Translation 

Here is a translation of her question from dental-speak to English:

“Why don’t dentists take routine x-rays of front teeth like they do for back teeth, when doing so increases hygiene production and payments from the insurance companies?”

[Dental team members, please sit on your hands for this one].

Bonus Round 

Bonus question: Can anyone think of any reason why one might not want additional routine x-rays – even if insurance pays for it at 100% (of usual and customary fees)?

Hint: It can be trickier to avoid irradiating the thyroid when taking anterior x-rays than while taking routine bitewing x-rays.


I’ll be back soon with the tricky opinion I will have posted on Jill Coon, Inc Facebook. It will be her first if nobody beats me to it.!/pages/West-Palm-Beach-FL/Jill-Coon-Inc/125510596754?v=wall&ref=mf


Is there anyone out there with almost no knowledge of dental care who wants to match wits with a sales rep for a consulting company that “specializes in dental insurance billing and treatment planning for dental practices”?

Industry Indignation Index: 47

How about it – HHS Secretary Kathleen Sebelius, JD?

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5 Responses

  1. Unbelievable — advocating unnecessary irradiation in the name of billing more. In a way, it’s good that they are not teaching dental students the business side of things. Maybe if dentists ran their own businesses instead of hiring out consultants for everything, patients would get a higher standard of care.

    [Bayside Family Dental]


  2. A sudden follow-up about insurance radiation

    I haven’t yet started a stand-alone follow-up article about routine x-rays since my original piece, “Need a New Career in Dentistry – Become a Consultant” appeared on the Medical Executive-Post on Friday.

    I’m still not sure if and when I’ll reveal more about unnecessary dental x-rays on a public venue outside of this Facebook conversation. If I’m not careful, I could receive special delivery of a subpoena, a brick, or a burning bag of something on my porch … just kidding; sort of.

    To be honest, I’ve never been threatened, and I’ll tear the arms off of that unfortunate bozo if and when I’m forced to. I am simply enjoying this sport far too much among a handful of my “friends” to yet break away to describe it for my other friends on Pruitt’s Platform or ME-P. Besides, the blow-by-blow would simply be too much stuff. Let’s see what happens. Then I might send out a less tedious summary of some kind.

    Nevertheless, I’ll probably send a heads-up note to ME-P, even if I don’t write a summary article. They have been very fair with me and I owe them a lot. Even though ME-P is still almost entirely a physician-oriented Website, more and more dentists are starting to take notice of their courage. Publisher David Marcinko MD ain’t afraid of nothin’, and those guys love gonzo investigative stuff about my obscure but important dentistry niche. The Medical Executive-Post now has 189,630 readers. Pruitt’s Platform probably has 12 not counting my relatives.

    To me, this Facebook-based adventure is like a chess match in which I easily recognized my opponent’s fatal, bone-head bad moves very early, and by the time Jill Coon Inc realized her rookie mistakes, all of my pieces were already in position to sweep her King’s row. Now it’s far too late for JCI to recover … although today she tried valiantly to change history with a lame attempt to re-define what she clearly stated days ago. It doesn’t help that her words are still available within a couple of clicks. Insensitive business models like Jill Coon Inc’s don’t yet appreciate that incredible sales pitches are no longer brilliant flashes that vanish before accountability arrives. Bad news will beat you home from school these days.

    Unless JCI and a Florida dentist who agrees with her, change the whole game by pulling out credible research instead of empiricism that suggests yearly periapical x-rays of upper and lower centrals along with bitewings makes sense from both economic and health perspectives, this match will soon be over. I’m simply waiting now for a convenient time to turn “check” into “checkmate.” There is still an opportunity for JCI to gracefully concede the game. I’m pretty sure she knows what she has to do.

    Like so many other vendors with Facebooks, JCI is so wrapped up in her own presence that she is oblivious to social media transparency.

    Finally, I have to say that I find the dynamics of social media as a marketplace tool especially interesting because my intentions are easily transparent to my targets. The fact that Jill Coon is a Facebook “friend” who we both know is reading every word of our conversation makes my nipples hard, actually.

    Oh what the hell. I’ll submit this to ME-P. I’ll let the editor decide about the last paragraph or so.

    D. Kellus Pruitt; DDS


  3. What’s a degree in Healthcare Management?

    Today, the Chicago Dental Society featured this link to Teresa Duncan’s “The Dental Implant” blog and her article describing how healthcare reform will affect dentistry. I wanted to post a comment on the CDS Facebook, but the CDS Communications Director no longer permits me to do that.

    I was shocked to notice that Ms. Duncan, who has a degree in Healthcare Management, failed to mention digital health records in dentistry as an important part of the administration’s plans for hi-tech quality control. No kidding! How could a member of the Academy of Dental Management Consultants miss that?

    I wanted to immediately ask Teresa Duncan, who is also a member of the Speaking Consulting Network, about what appears to be her lapse in responsibility. However, a few months ago my last communications with the Chicago Dental Society Communications Director was a question too far about why the ADA Facebook continued to accept new fans, but had yet to provide any content for them. That was back when the ADA Facebook had 1200 fans. Today that number has tripled, yet still no ADA content is offered – only Google ads. If you wish to look into this mystery that ADA employees are ordered to keep carefully hidden from members who pay their salaries, be my guest. But whatever you do, don’t ask the Communications Director of the Chicago Dental Society too many questions. She’ll kick your butt smooth off of their happy Facebook … forever.

    Here is my question that I ultimately posted on Teresa Duncan’s happy blog: “Thanks for the informative article, Teresa Duncan. What do you expect in the way of electronic dental records, even if it isn’t mentioned in the new healthcare plans?”

    Do you think Teresa Duncan will respond? I hope she does. I’d like to take a measurement of what is behind a Master of Science degree in Healthcare Management from Marymount University.

    D. Kellus Pruitt; DDS


  4. Teresa Duncan and I agree … sort of

    Yesterday, I came across an article written by a dental practice management consultant named Teresa Duncan on her blog, The Dental Implant. The title of her article is “Health Care Reform and Dentistry.”

    Even though Duncan offered more information about the national plan for dentists than I had read anywhere, I thought it was odd that virtually nothing was mentioned about electronic dental records, since the Obama administration is counting on saving billions in healthcare using digital health records. I left this comment: “Thanks for the informative article, Teresa Duncan. What do you expect in the way of electronic dental records, even if it isn’t mentioned in the new healthcare plans?”

    Teresa Duncan replied last night:

    “Hi Dr. Pruitt -thanks for stopping in! I suspect that the push will begin soon for standardization of medical records. Not so much for safety as is the general given reason but for ease of collection and maintenance by the government and large insurers.

    As for dental records, we have too many different vendors and no standardization at all. The only thing we can agree on is SOAP – there is no standard for lab result collections, referral notes etc. I’m afraid I don’t have that crystal ball – not sure if we’ll see such a thing before the magic year of 2014.”

    Here is what I posted in response this morning:

    Thank you for this conversation, Teresa. There are very few dental practice management professionals who are willing to discuss eDRs with dentists on a public forum like your blog. I hope you will be able to help me and some friends who quite frankly, have our doubts about the benefits of digital health records in dentistry. We need straight answers before we are forced (?) to make what could be the worst mistakes in our careers – switching from paper records to digital. Our patients who trust us to watch out for their welfare have the most at stake in eDRs, not stakeholders and not dentists.

    Personally, I have concerns about not only the safety of digital dental records, but I don’t think eDRs offer any special service that cannot be adequately carried out using conventional communications tools like the telephone, fax machines and even the US Mail – none of which require one to be HIPAA-covered entity. By the way, I should point out that there is nothing holding down the cost of being HIPAA compliant. Do you think that cost will go up or down? I think once HHS starts investigating doctors’ offices, HIPAA costs will sky-rocket.

    I find it interesting that you say the push for adoption of eDRs will occur after the “standardization” of eMRs. Right away, that sounds bureaucratic-ominous, but I’m afraid you are correct. What do you want to bet that in 2014, one-size-fits-all won’t fit dentists? Dentistry isn’t yet even an afterthought.

    Then you say the delay is “Not so much for safety as is the general given reason but for ease of collection and maintenance by the government and large insurers.” Once again, you and I agree. Paperless practices benefit the insurers and CMS more than anyone else. The 2002 amendment to the 1996 HIPAA Rule was designed by and for stakeholders, not patients. What a waste of trust.

    Then you accurately point out that there are too many different vendors and no standardization at all. That is the same problem hospitals and physicians are confronting right now. There is no guarantee that the $40,000 eMR systems they purchase today will not be ruled unacceptable within a couple of years. Or the eMR company could go bankrupt – leaving the doctor without service. That has already happened. Why would a dentist want to risk that? – And for what? I think now is a horrible time to invest in a new digital records system, don’t you?

    It looks like you and I have both come to the same conclusions about the absurdity of electronic health records in dentistry. However, you lose me when you lament that “…there is no standard for lab result collections, referral notes etc.” What lab results are you talking about?

    Finally, in the “magic year” of 2014, how many dentists do you think will have paperless practices? I say 20% tops. I also predict that by 2014, half of the dentists will be using pegboards ledger cards and lots of carbon paper.

    D. Kellus Pruitt; DDS


  5. Sorry for missing your name, Dr. Lorne Lavine. I didn’t see it at the top of the page. (And I still don’t).

    You write: “Patients do need to have confidence in the process but based on the current HIPAA standards, it’s my belief that any system that falls within HIPAA guidelines should be more than adequate.”

    Come on, Lorne. Who do you think you are kidding? I’m a dentist for crying out loud! Don’t try out your cheap stuff on me, please.

    HIPAA has done nothing to slow the loss of patient IDs from dentists’ offices and you know it. HIPAA is an absurd joke – especially in dentistry. I’ll debate that historic ADA blunder any time you want. How’s this: I bet you aren’t 100% HIPAA compliant. If you are, you are probably the only dentist in the US who is. Here’s something: Do you have patients sign HIPAA forms in your office? Why? Don’t you know that those documents are meaningless? Have you read what you demand your new patients sign? If asked, could you state the purpose of the document? I’ll go a step further. I bet you’ve signed unread HIPAA forms in a doctor’s office yourself. Let’s get silly.

    Since I’m not a HIPAA-covered entity like you are, I don’t ask my patients to waste everyone’s time signing those meaningless forms. I wonder how much money your friend Dr. Larry Emmott would estimate HIPAA forms cost practices every year. What if you had to wait until your new patients actually read through what you ask them to agree to? How far behind schedule would you get if only one or two of them had sincere questions about your intentions with the document? What would you say to them?

    Don’t look now, but you are losing clients, Dr. Lavine. I forgot to warn you that one should never never never argue with a customer in the front of the store.

    Nevertheless, you continue to plunder on, arrogantly insensitive to customers’ concerns: “In any event, it’s a moot point…all records will be electronic, sooner than later, and you can either go along willingly or kicking and screaming…the end result will be the same.”

    It really, really aggravates me when a vendor in a nice suit talks down to me in an authoritarian voice. It reminds me of a BCBSTX dental insurance floor supervisor named Wilma who ate a peach while she talked down to me over the phone. And it especially attracts my attention when a vendor tells me that I have no choice but to buy a product I simply do not want to spend money on. Never mind that eDRs you push raise the cost of delivering dentistry without providing any special benefits, Dr. Lavine. And let’s just pretend the eDRs I’ll be forced to purchase don’t endanger the welfare of my practice and my patients. Now our argument is stripped down to a question of basic human rights – one man to another: So in all sincerity, I ask you who the hell do you think you are, Dr. Lorne Lavine, that you can show such blatant disrespect for the Hippocratic Oath, the US Constitution and me?

    All records will be electronic, sooner than later, and you can either go along willingly or kicking and screaming…the end result will be the same.all records will be electronic, sooner than later, and you can either go along willingly or kicking and screaming…the end result will be the same.When you consider how viciously Americans can fight to preserve their freedom, would you want to be the person who forces dentists to buy dangerous eDRs they don’t want from salesmen they don’t respect for patients whom the products will harm millions of times more often than paper records?

    How exactly would you accomplish that task, Dr. Lavine? Or do you assume someone in government will trample my rights so that you will have a cushy market to sell your dangerous wares?

    OK. I’ve been hard on you, Lorne. I can tell you that it doesn’t get much worse than the Internet spanking I just dealt you. Nevertheless, if you’ve had enough and would rather not respond, and pretend you’ve never run into me, I understand. You lasted longer than anyone else before losing. And you really do look good in a suit. Much better than I do.

    D. Kellus Pruitt; DDS


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