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In Defense of the eDR Industry

One Dentist Consultant’s Opinion

By Paul L. Child Jr, DMD, CDT
CR Foundation
3707 North Canyon Road, Building 7
Provo, UT 84604

Three days ago, I shared the email I sent to Dr. Paul Child and Kathleen Noll concerning their claims that electronic dental records offer dentists a return on investment (ROI). Dr. Child responded yesterday.

Darrell K. Pruitt DDS

———————————————

Dear Dr. Pruitt,

Thank you for your recent communication and questions regarding my recent article in Dental Economics, specifically your question: Does the ROI for Practice Management systems include the cost of HIPPA compliancy?

In regards to your communications with QSI, I cannot comment as I do not represent them. Unfortunately, I too am not able to give you the “proof” you are seeking, as I do not have a specific chart nor do I plan on fabricating one to “prove” the efficacy of computers in the dental office (although a controlled study would be interesting, I’m not sure it would be an effective use of funds to prove something that is already proven in every other industry).

However, I will provide you with information from thousands of our readers at CR as well as many more in our lectures worldwide.

The section of the article to which you are referring is under the title of: Practice and patient records management and patient education. Specifically, the paragraph states:

“Implementation of computers into each operatory and throughout the practice is the first and most frequent adoption of digital dentistry. In North America and most developed countries, this has reached the “early majority” stage as all of the criteria for being an advantage have been met. Dentists who have not yet adopted this prerequisite for digital dentistry should do so now! Daily advances and improved software adapted from other industries allow this technology to be affordable, attain the fastest adop¬tion rate, and offer a high return on investment. Current and highly effective systems include Eaglesoft (Patterson), Dentrix (Schein), PracticeWorks (Carestream Dental), and Web-based software such as Curve Dental” (underlines added for emphasis).

Please note that the sentence in which “high return on investment” is mentioned is referring to “advances and improved software adapted from other industries”. As such, other industries (too many to count) have proved without a doubt, the massive improvement in return on investment in the following areas: improved efficiency (eg. Legible records vs. scribbles, or worse off, incomplete records), improved accuracy of records, use of computers for rapid recollection of stored data, rapid recording of data, time savings, standardization, and many more. A brief look at the medical industry and literature (our closest industry – of which we are a part of) can demonstrate the above. In addition, the observations I made are directed to the use of computers in a practice.

Finally, proper implementation of practice and patient management systems can easily improve ROI, via better record taking, accurate financial statements that can be easily generated daily for better practice management, treatment planning with all options, benefits, and risks recorded – then printed for the patient, and most of all – time savings. What is a dentists time worth? My time is priceless (as is most dentists I know). Yes, there are clearly unknown aspects of this digital transformation from paper to digital. Government and controlling organizations may make new rules and regulations that can positively or negatively affect this process.

But, from our observations of thousands of other dentists that have made this transition, very few – if any, would even think about reverting back to paper.

To your question regarding HIPPA compliance, YES, the overall ROI would include even this. HIPPA compliance is still relatively new to many dentists, even though it has existed for years. This compliance in important for all the reasons you already know. As dentistry evolves and new technologies are introduced (and ruling bodies continue to make new rules and regulations), this digital evolution will continue to prove itself an EXCELLENT ROI for today’s and tomorrow’s dentists.

Best regards,

Paul L. Child Jr., DMD, CDT

Conclusion

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Dental Compensation Different than Docs

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A 2003 Survey of Dental Practices reported net income from dentistry-related sources.

Dentists Differ from Doctors

Dentists differ from physicians in that 90% are in private practice. In 2002, the average practitioner’s net income was $174,350. The average dental specialist’s net was $291,250. These figures represent a 0.7% and a 5.8% increase over 2001, respectively.

Assessment

Net income rose steadily since 1986, when general dentists made an average of $69,920 and specialists an average of $97,920. But, by 2010, according to PayScale.com, the average general dentist earned $98,276 – $157,437; a decreasing trend allocated as follows.

Compensation Chart 

Salary  $92,689 – $147,682
Bonus  $1,996 – $19,727
Profit Sharing  $1,038 – $27,514
Commissions  $480.74 – $32,500

Conclusion

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Dental Consultants

We’re a highly skilled team of dental consultants with over 45 years of combined dental, medical and management experience.

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Through a combination of personal on-site visits and modern video conferencing we consult with any practice across the nation to help them increase their profits and create a more successful working environment. We evaluate our clients’ exceptional professional services and add to them to improve patient loyalty and harmony among the staff. We will provide your practice with the tools to have complete control over exponentially increasing accomplishments and professionalism.

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ipsdentist@yahoo.com

Conclusion

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Some Dental Consultants Say the Most Incredible Things

Are Dentists like … Rodney Dangerfield? 

By Darrell Kellus Pruitt; DDS

“Let’s face it — in our world dentists do not get the respect they deserve. They are not perceived to be ‘real’ doctors … Perhaps the lack of sex appeal in dentistry is part of why dental coverage for everyone is an afterthought in the national health care conversation.”

Gary Kadi DDS, DentistryiQ

http://www.dentaleconomics.com/index/display/article-display/4196579430/articles/dental-economics/volume-100/issue-5/features/the-cavity_in_the.html

Even if Dr. Kadi is correct, and the barrier between a 12 year old and his toothbrush is a world-wide lack of respect of dentistry, that hardly means that electronic dental records (eDR) are going to make the kid brush any better. Experience tells me that if mom’s nagging won’t motivate the stinker, the computer won’t either.

eDR Rationalization?

For those who read the article, did you notice how Dr. Kadi, a dental practice consultant, attempts to subtly insert a fat rationalization for adopting eDRs into the middle of a comment lamenting dentistry’s lack of respect? Tricks like Kadi’s make stakeholders look silly at times, and it bothers me that hardly anyone notices and appreciates the humor that these pros bring to marketplace conversation. That’s why I like to point out mistakes like Kadi’s when I come across them. It’s getting harder to find these kinds of articles about eDRs. My pleasure!

Working Both Sides of the Consulting Fence

As far as I can tell, all but a few dental consultants work both sides of the fence in order to please vendors who give them good deals, as well as dentists who pay for unbiased help. Sponsorship by vendors is the bottom level of a consultant career if one chooses to make a living at selling advice. In this way, the dental consultant business is a lot like the financial advice business. Some advisors push their favorite investments that serve them well no matter what happens to their clients’ money. If a client wants advice, but prefers not to pay full price, interested vendors can be counted on to quietly chip in on an advisor’s bill. And that is why the customer must always be cynical. What’s more, it is arguably one’s community obligation to publicly challenge such artists by luring them out into the open to explain further what they meant to say to naïve people. Dr. Kadi begins:

“The national health-care debate cannot be complete unless we include dental care as part of the discourse.”

He then presents oft-repeated, convincing findings which support the widely held conclusion that one’s overall health is dependent on one’s oral health. Even though this chunk of common sense has recently been supported with well-respected research, the news isn’t a revelation. Other stakeholders have proclaimed the findings as an example of ultra-modern “Evidence-Based Dentistry,” and proof of the need for thousands of their dental products. However, let’s not kid ourselves. A healthy mouth has less to do with computerization than the proper application of a low-tech toothbrush. 10,000 years ago, even buzzards recognized that bad breath from advanced gum disease smells like imminent death from a long way off if the wind is right. The results Dr. Kadi leans his reasons against only confirm traditional Evidence-Based Superstition.

eDR Lobbying 

By half-way through the article Dr. Kadi turned “The cavity in the health-care debate” into a PR piece for eDRs. He’s in so deep that he cannot recognize that his misplaced concerns about image have nothing to do with dental patients’ oral health. Image is only cosmetic.

“A validation [of bringing “sex appeal” to the profession] is the inclusion of dentistry in the recently mandated National Healthcare Information Infrastructure (NHII). The purpose of the NHII is to create an information network to facilitate the creation of an electric health record [eHR] for all aspects of health care. The primary impetus is to achieve interoperability of health information technologies used in the mainstream delivery of health care.”

Note: Dr. Kadi admits that the goal is HIT, and sharing health information is the tool – not the other way around. As anyone can see, that kind of nonsense will never work out well in the US. Why that would be as foolish as stuffing a certifying commission for eHRs with industry, government and academic leaders rather than providers – and then tossing billions of dollars that could otherwise be used for treating disease out in the street for the biggest and fastest stakeholders who grab the most. That would be simply ridiculous.

Dr. Kadi bravely continues: “This will enable an individual’s health care information to be shared by all the necessary health care parties in a secure manner, including dentistry. It will improve patient care and reduce the number of patients, currently 100,000 plus, who die each year due to a lack of accurate, complete, or timely information. The federal government estimates a cost savings of $85 billion to $100 billion per year with electronic health records [eHR].”

Is HIT – Or any IT – Really Secure? 

In a secure manner – really? There are so many other misleading statements in this paragraph as well. First of all, how can an eDR improve a dentist’s chance of successfully extracting a molar in one piece? It can’t. Secondly, how many of the alleged 100,000 victims died because of lack of electronic DENTAL records? Third, how many patients will die because of faulty information in interoperable records that would not have occurred if the records were paper? Fourth, to insinuate that patient information can only be shared over the Internet is plain silly. Telephone, fax and the US mail have been sufficient for dentistry for decades, and none involve HIPAA. Finally, the $85 to $100 billion in savings Dr. Kadi casually throws out is based on a five year old Rand study that’s been widely trashed for being biased in favor of the stakeholders who funded the research. That happens. It just amazes me that anyone in the healthcare industry who knows anything about HIT is foolish enough to still shop discarded garbage. And once again, regardless of the success of electronic medical records, how will eDRs save even $10 in dentistry? It’s impossible without re-defining “savings.”

Cost Savings

“Dentists and hygienists will play a vital role in this cost savings because people who go for regular cleanings will have their medical history updated in the shared system during each visit. In some cases, dental cleanings may be the only medical attention a person receives yearly.”

“Cost savings”? Where have I heard that term? And why didn’t Dr. Kadi simply say “savings”?

Now I remember. It was Dr. Robert Ahlstrom, the ADA’s eDR expert, who coined the handy buzzword in his testimony describing the benefits of paperless dental practices for the US Department of Health and Human Services in July of 2007. “Cost savings to providers and plans will translate in less costly health care for consumers. Premiums and charges will be lowered.” That would be the seventh of his 11 reasons that are each one so lame that other than Dr. Kadi, stakeholders never borrow them. Although it is undeniable that electronic records benefit insurers and the government more than the patient, if Ahlstrom hadn’t been coy, and had clearly stated that eDRs will save money in dentistry, his testimony would have been false. By calling it a “cost savings,” Ahlstrom technically concedes that using eDRs will indeed require an increase in cost of overhead – which dental patients will ultimately have to pay to obtain dental care. The saving part comes from “what could have been.” Whatever that could possibly mean, HHS Secretary Michael Leavitt bought it.

The PennWell Article

Because of a situation beyond my control, I am unable to provide a link, but to find more of my opinion of Ahlstrom’s testimony that is still used by lawmakers to establish national policy, simply google “Dr. Robert Ahlstrom.” My PennWell article from a year ago or so, “Dr. Robert H. Ahlstrom’s controversial HIPAA testimony,” is probably still his first hit. It could be on his first page the rest of his life.

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Assessment

If necessary, I’ll make a few more examples of insensitive HIT stakeholders who know better than to offer such crap to the nation’s lawmakers as well as providers who are too busy to pay attention to the welfare of their profession. The ADA should reassure the nation that there are cheap, effective low-tech ways dental patients can stay healthy that don’t risk their identities and won’t bankrupt a dental practice because of a stolen computer. But; they won’t do it.

Conclusion

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The DDS / Doctor [Salesman] will See [Up-Sell] you Now

Blurring the Line between Medical Professionalism … and Mercantilism

By Dr. David Edward Marcinko; MBA, CMP™

[Publisher-in-Chief]

Concerns and complaints about pushy dentists are apparently becoming more numerous among consumers, as elective cosmetic treatments and marginally effective tests and modalities are increasingly available from the same providers that patients formerly turned to for unbiased dental advice and oral healthcare. All for a price!

http://www.msnbc.msn.com/id/37198272/ns/health-oral_health

So, enter the cosmetic [rank-and-file] dentists and the elective renaissance of the profession – at least economically. An entire industry has even sprung up teaching dentists how to sell various products, and up-sell related services and procedures.

[picapp align=”none” wrap=”false” link=”term=dentists&iid=166771″ src=”0163/1731b859-b744-4a0e-b055-a9e985ad8673.jpg?adImageId=12959860&imageId=166771″ width=”372″ height=”459″ /]

Root-Cause [pun intended]  

Why is this happening? Economics of course! Dental profession success in eradicating cavities, caries and other common mouth disorders – which used to comprise 80% of dental procedures and income – is now a two-edge sword working against their financial self interests … damn!

In fact, I recall about three decades ago when the situation first became acute, as more than a few of our nation’s dental schools closed for lack of interest in matriculation. Right here in Atlanta, the prestigious Emory University School of Dentistry closed its doors while I myself was a patient there; and employed as a surgical resident at a nearby acute care hospital. Contemporaneous cocktail party talk and medical gossip centered on the “death of dentistry” as I exhaled a sigh of relief at my career choice.

Going forward, years later, far too many managed care contracts reimbursed so poorly that they became a loss-leader [access portal to a patient population] for dental practitioners. In other worlds, lose money or break-even on the covered services contract, but profit handsomely by offering [pushing] non-covered services to cohort contract members … and their sphere of influence.

One Word from Mrs. Robinson – Plastics

Plastic surgeons, of course, are still the doctors most commonly associated with non-covered and purely cosmetic and elective treatments such as Botox injections, facelifts and tummy tucks. But, similar elective procedures — which generally aren’t covered by insurance — are being offered by a wide variety of medical specialists.

For example, many dermatologists, who treat patients for skin cancer and other diseases, also promote treatments to smooth wrinkles, lighten age spots and remove hair. Otolarnygologists, who care for patients with conditions of the ear, nose and throat, commonly perform nose jobs, brow lifts and eyelid surgery. And, podiatrists, who are often experts at foot reconstructive, diabetic and ankle surgery, sell shoes, shoe-inserts, laser beam treatments for fungus toenails and various cosmetic and prosthetic devices for deformed toenails and crooked digits.

Medicare Limits – Privates Don’t

At least Medicare requires an ABN [advanced beneficiary notice] for non-covered medical services, and limits non-participating doctors to 115% of the Medicare fee schedule for all providers. Increasingly, some private health plans are doing and proposing, same.  

Practice Management Guru

Now, I have no issue with efficient medical practice management operations, for any specialty. In this era of managed care and health 2.0, governmental intervention is onerous, competition is fierce and patient empowerment is reversing the aging command-control medical establishment. Nor, do I have a problem with offering the entire range of therapeutic and/or elective options to any patient. This is a “good – better – best” elective marketing concept.

In fact, the third edition of our best-selling book, the Business of Medical Practice [Transformational Health 2.0 Skills for Doctors] will soon be released this autumn www.BusinessofMedicalPractice.com. In it, we seek to educate doctors about modern business, management and economics practices; as well as the emerging participatory health 2.0 philosophy and information technology skills. Our goal is enhancing the survival potential of the independent practicing medical professional.

But, the ever expanding menu of treatment options – promoted by a trusted medical professional – should include procedural risks and complications, period of recovery and alternatives, including benign neglect [watchful waiting], marginal benefit and marginal utility, as well as price transparency.

Call this new-wave litany, a type of “informed patient business consent”.

[picapp align=”none” wrap=”false” link=”term=doctor+money&iid=182012″ src=”0178/66353b45-9776-48b9-9bdd-2993a48f32bf.jpg?adImageId=12959922&imageId=182012″ width=”372″ height=”459″ /]

Aphorisms of the Past

Over the years, we have heard phrases like the following from all sorts of independent specialists. I know I have, and so have you. Many are the butt of “insider” jokes:

MD: I’m sure that appendix is hot – I have a car payment to make

DPM: Even the normal foot can be surgically improved

DO: Now, I can bill like a real MD

DDS: We can straighten out – the straightest teeth

DC: I’ll crack your back in only forty sessions … and I finance

But, these are aphorisms of the last-generation. Today we are responsible adults. Let’s grow up and become medical professionals and “DOCTORS” again … not healthcare merchants, sales sharks or equipment shills that offer strategic competitive advantages; but not real patient benefits.  

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Assessment

The old practice management business adage of yesteryear – to work longer hours, see more patients quicker, up-sell marginally effective procedures, or do more treatments in order to realize more income – will not necessarily hold true in the modern era.

http://www.washingtonpost.com/wp-dyn/content/article/2010/05/17/AR2010051703034.html

According to colleague, financial advisor and ME-P thought leader Brian J. Knabe MD – a primary care physician and current www.CertifiedMedicalPlanner.com matriculant – and textbook chapter 27 co-author on physician compensation and salary:

In the environment of Healthcare 2.0, those doctors who embrace efficiency, innovation and appropriate business models will be better positioned to optimize their incomes. 

http://businessofmedicalpractice.com/chapter-27-salary-compensation-2/

Conclusion

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I Want Obama Transparency for the ADA

No More Hiding Places

By D. Kellus Pruitt; DDS

Today, Ed O’Keefe of the Washington Post posted “New Obama Orders on Transparency, FOIA Requests.”

http://voices.washingtonpost.com/federal-eye/2009/01/_in_a_move_that.html

O’Keefe writes:

“In a move that pleased good government groups and some journalists, President Obama issued new orders today designed to improve the federal government’s openness and transparency. The first memo instructs all agencies and departments to ‘adopt a presumption in favor’ of Freedom of Information Act requests, while the second memo orders the director of the Office of Management and Budget to issue recommendations on making the federal government more transparent.”

Soon, other ADA members are going to bluntly ask Pres Dr. Ron Tankersley:

“If the President of the United States has the courage to face those whom his actions affect, why oh why doesn’t the President of the American Dental Association support transparency in the non-profit organization that belongs to dues-paying members?” After all, ADA members pay more than $1000 per year for ADA services.”

“If you are an ADA leader, pay close attention. This is the future I warned you about that far too many of you avoided out of convenience. As you can read below in his memos, Obama promises, “The Government should not keep information confidential merely because public officials might be embarrassed by disclosure, because errors and failures might be revealed, or because of speculative or abstract fears.”

Who will be held accountable for the ADA/IDM blunder… among other bone-head ideas?

Obama promises that his administration:

“Will work together to ensure the public trust and establish a system of transparency, public participation, and collaboration. Openness will strengthen our democracy and promote efficiency and effectiveness in Government.”

I think openness will do the same in healthcare if we can move a handful of entrenched ADA leaders on down the road. They are weighing us down with their selfish special interests.

Assessment 

Did you hear that, Dr. Ron Tankersley, President of the American Dental Association? There are simply no more hiding places for the anonymous ADA hobbyists who elected you. I’m sure the long run of irrelevant ADA Presidents was fun before electricity and social networks, though.

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Top Ten Signs the ADA is Hunkering Down

About the American Dental Association

By Darrell K. Pruitt; DDS

Today, I especially cherish my right as a dues-paying member of the ADA – and as an American – to share my blunt, un-requested opinion as if you were a colleague, a patient or disinterested lawmaker.

For by early 2011, such liberty could warrant official sanction by the yet to be revealed national enforcer of the 2010 ADA Code of Conduct … if by then they find someone in the ADA capable of publicly announcing my crimes with a straight face, just before I receive a good talking-to about professionalism. If the future Ethics Enforcer would like me to help burnish his or her brand new gunslinger reputation quickly and deeply, I will gladly link any ADA official’s name to mine, and we’ll be companions for as long as I feel our union helps bring even more transparency to my profession. I’ve been an SEO assist for several ADA leaders for a couple of years already. Just ask ADA President Dr. Ron Tankersley – or – just Google his name.

Getting Spanked? 

I’m not too worried about getting spanked. What can the ADA possibly do to me? Besides, officially, nobody will utter as much as a peep because of the transparency thing. Unofficially, ADA officials will privately send more attaboys because they trust me. They know by now that I never betray friends. I’m selectively transparent – which is my right but not yours, non-profit ADA. I think we both know, Dr. Tankersley, that I’m not the only one who thinks a minority of ADA leaders are playing naïve, childish and costly games.

Then again, it could just be my persistent, egocentric stage of emotional development that causes me to imagine that Resolution 82 is pointed directly at the nose of D. Kellus Pruitt; DDS.

“Patient rights, ethics considered” was posted on Nov 16 on the ADA News Online, and was written by Jennifer Garvin 

http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?articleid=3843

Garvin writes, “Res. 82 asks that the following principles be considered for an ADA member Code of Conduct:”

1. Members will maintain high standards of integrity and conduct their dealings as members of the Association in a professional manner.

2. Members will treat other members and Association officers, trustees and staff with courtesy and respect, and shall refrain from conduct that is unreasonably disruptive or is harassing.

3. Members will respect the decisions and polices of the Association and will not engage in conduct that is disruptive to Association staff or causes the Association to expend an unreasonable amount of time or effort to address.

4. Members are encouraged to use proper Association channels of communication to address differences.

5. Members will comply with all applicable laws and regulations, including but not limited to antitrust laws and regulations.

6. Members will respect and protect the intellectual property rights of the Association, including any trademarks, logos and copyrights.

7. Members will not use Association membership lists for personal solicitation purposes.

8. Members will not use all or part of Association lists, including membership directory, online member listings, conference attendees and education course participants for selling, prospecting or creating a directory or database.

9. Members will treat all information furnished by the Association as confidential and will not reproduce materials without the Association’s written approval.

10. Members will avoid conflicts of interest.

Assessment

Garvin concludes: “The resolution also states that a proposed member code of conduct, together with proposed sanction and enforcement procedures, be presented for consideration by the 2010 House of Delegates.”  It is probably earthly unprofessional to make light of authoritarian bluster, but this really reminds me of the John Landis film “Animal House” when Dean Wormer put John Belushi and other ΔΤΧ Fraternity misfits on double secret probation. ADA Trustees shouldn’t take themselves so seriously. It looks silly to those watching. Or then again, keep it up. After all, it looks silly to those watching.

Toga Party! Dentures 2 for 1! Just ask for Dr. Ron.

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Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. But, feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, be sure to subscribe to the ME-P. It is fast, free and secure.

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Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com 

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