Talking with the Toothcop

Sep 10 2020 38 mins 5

Dentists face numerous regulatory and liability issues. Keep up with the issues can be daunting and best, career ending at worst. Host Duane Tinker (AKA the Toothcop) discusses the issues and helps make them easy to understand and apply in your dental practice.

Dental Unit Waterlines: The Good, Bad, and the Ugly - Mike Rust + Kellie Thimmes
Sep 10 2020 60 mins  
Water is the lifeline of your dental practice. If your dental unit waterlines are covered in biofilm, you’re in trouble. How do you test your water lines properly? How do you treat your systems? What do you do if you don’t have a closed system? With the heightened awareness of spreading germs due to the Coronavirus crisis, it’s more important than ever to be mindful of prevention in your practice. In this episode of Talking with the Toothcop, Dwight and I chat with Mike Rust and Kellie Thimmes from ProEdge Dental about what dentists can—and should be doing—to prevent infections. Outline of This Episode [0:21] Mike Rust + Kellie Thimmes on the Toothcop [1:19] What people don’t know about Kellie + Mike [4:27] How to test your water lines properly [11:40] The CDC will revise dental infection control guidelines [20:40] Indicators that a dental office does or doesn’t care [28:28] Where does the problem originate? [31:58] Pro Edge’s new Flow-Cytometry technology [38:15] The Anaheim case that changed everything [42:01] What could happen when the CDC reviews their guidelines? [43:33] What do you do about open systems [55:17] UV disinfection technology [58:25] How to connect with Mike + Kellie Why biofilms originate in water lines Biofilms usually form in waterlines because they’re small, plastic, and the water sits stagnant. The bacteria sits there and thrives. It can also be found in anything with a filtration system—which can remove solids (like minerals and chlorine) but not small bacteria. So everything just sits there in their little pod and it’s the perfect breeding ground for bacteria. That’s why it’s so important to purge anything connected to your waterline unit. The extra flow of water in between patients helps move the germicide through the system and helps keep it clean—and prevents biofilms. The Texas dental board recently relaxed its Cavitron regulations to allow dentists to start using them again. Most dentists haven’t been using them since mid-march of 2020. Why? Kellie points out that firstly, they create aerosols. Secondly, water lines tend to hold a lot of bacteria. Dentists don’t want to worry about COVID and other bacteria. It’s also because Cavitrons are harder to shock. The failure rate is over 50% and they have higher counts of CFU’s than any other water line. How to properly test your dental unit waterlines You have to collect the water for the test from the right place. 9/10 times dentists that say they’re testing pull a sample from an air-water syringe. But dentists should be testing from the dirtiest thing(s) in the dental practice: a water sample from the Cavitron or Ultrasonic. If you’re passing your water test with samples from those you know you’re doing well. Kellie recommends taking a collective sample from each room in your dental practice If there’s a failure, then you shock everything. Both Kellie and Mike advise using an aseptic technique when you’re taking a sample. Take the handpiece off and use a new air water syringe tip. It’s not as messy and easier to collect the sample. Test your water as if you were doing it for a new patient. Are the current infection control guidelines enough? It was recently announced that the CDC will be revising dental infection control guidelines—which has been overdue for a while. It makes you question: Are the current guidelines as effective as we think they are? The CDC recommends periodic testing but doesn’t define the timeline. They say to defer to the manufacturer's instructions. You have to monitor your water regularly—at least quarterly if not monthly. Kellie and Mike agree that you must use an EPA approved shock product. If you’re not aware, the EPA regulates drinking water standards and anything that could impact groundwater. The FDA regulates medical devices (they review and approve). Everything you use in the dental office is a medical device. For you to use it, the manufacturer had to get approval from the FDA. Whenever you deviate or use a device other than its intended use, it’s considered off-label use. There are a lot of treatments for removing biofilm, so you have to find what works for your practice. Follow the IFUs for the products you’ve chosen and ask for help if you need it. Kellie states “I wish there was a magic bullet, but there’s just not. It’s called waterline maintenance for a reason—because it takes work.” If you’re committed to monitoring, you’ll get better results. What are indicators that a dental office is doing what they’re supposed to for infection prevention? Listen to hear their take! Sometimes you have to humanize the problem The case that happened in Anaheim, CA impacted 71 families. 70 of the kids had major surgeries and some lost parts of their jaw from preventable infections. All because ONE dentist office didn’t properly test or treat their water lines. Some dentists don’t want to test because if they find out there’s a problem then they have to do something about it. But it is your responsibility to know. You have to humanize the problem. It’s not about devices—it’s about those child’s faces. No dentist goes to work and says “I want to hurt someone today.” But do they go to work today and say “I want to make sure that we don’t hurt anybody, ever.” It’s a huge difference. That’s why it’s so important that the CDC reviews its guidelines. What to do if you have an open water system Many older dental offices still use city water and can’t introduce a germicide or antimicrobial into the system. You can treat your water, but you can’t efficiently shock the water. What do they do? You should retrofit your open systems so you can shock the water. Add a closed bottle system for $200 a chair + labor. In 10 minutes you can shock them with bleach and sleep at night. You just have to take the time to do it. Recently, In Corpus Christi Texas, they had water-boil advisories. Municipal water was contaminated. If you don’t have a closed system, that effectively shuts down your practice. It’ll cost you way more than converting your dental unit to closed bottles. Plus, you have to keep tabs on your city's boiled water advisories. Keep listening to hear our conversation about tap water versus distilled water and what Kellie and Mike recommend using. Pro Edge’s new Flow-Cytometry water testing technology Proedge has launched a Flo™ Dental Unit Waterline Testing Service Kit that allows you to get same or next-day test results. It takes one hour for them to process the results. They’re counting the bacterial cells in the water with laser technology and fluorescent dye. Why does it matter so much? Other tests can take days or even weeks to get results. Some practices have to remain closed when their water lines are being tested—only to find out they failed. That means they have to shock their systems, restest, and wait all over again. No longer. The price of this test is only a couple percent more. It’s a premium service without the premium price. Check out the resources for a link to an amazing deal on this new product. I want people to do the testing, work with good people, and save money while doing it. Resources & People Mentioned Special Dental Compliance ProEdge Offer Flo™ Dental Unit Waterline Testing Service Kit Dental Infection Control Washington state Mike Rust on LinkedIn Kellie Thimmes on LinkedIn ProEdge on Facebook Call ProEdge at 888-843-3343 Environmental Protection Agency (EPA) U.S. Food and Drug Administration Boil-Water Advisory Dental Unit Waterline Contamination in Anaheim Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

HIPAA Security Compliance: WHY it’s So Important
Aug 25 2020 20 mins  
HIPAA security compliance isn’t talked about often in the dental community. But the Office for Civil Rights (OCR) can and are investigating dental offices. If you’re not properly or adequately protecting your patient’s protected health information (PHI) you’re at risk of a hefty fine. In this episode of Talking With The Toothcop, I talk about the HIPAA security rule, business associate agreements, and how a data breach can impact your practice. Outline of This Episode [1:20] HIPAA Security Compliance [4:43] The HIPAA Security Rule [9:00] Consistently work toward compliance [10:13] The Business Associate agreement [14:57] Have adequate cyber insurance in place [17:38] Will OCR hit practices harder because of COVID? HIPAA Security Compliance: What a breach looks like I received an email from OCR (AKA the HIPAA Police) titled: “Small healthcare provider fails to implement multiple HIPAA security rule requirements.” So I opened it. Essentially, Metropolitan Community Health Services has to pay a $25,000 fine to OCR and has to adopt a corrective action plan to settle violations. Why? Because on June 9th, 2011—9 years ago—Metro filed a breach report that affected 1,263 patients. The OCR investigation revealed long-standing non-compliance. Metro failed to conduct risk-analysis and failed to implement any security rule policies, procedures, or training until 2016. Providers are supposed to safeguard their patient’s information. The moral of the story? We need to implement measures so we don’t have to report a breach affecting 500+ people. This is a classic example of where prevention could’ve made a world of difference. The HIPAA Security Rule The HIPAA privacy rule states that you must have agreements with vendors who have access to information, train your staff properly, and establish notice of privacy practices (how we can use and disclose patient information). The HIPAA Security rule is what people seem to have trouble with. It deals exclusively with the security of protected health information. One of the key components of the rule is to have someone appointed as the security officer. They establish access control for authorized users and set up firewalls, firmware, antivirus programs, updates, etc. They are tasked with risk analysis and mitigation: #1 Identify the potential threats and risks to PHI #2 Address the higher-risk or potential risks areas This is where dental practices have significant gaps and fall short. OCR started conducting audits of covered entities and found that more than ¾ of providers had not addressed security issues or implemented security measures to address the rule. What should security training include? What issues do I see in dental offices? Listen to find out! The Business Associate Agreement You need to understand who your business associates are: Who are the vendors you work with who have access to your patient information? IT people? Coaches or consultants? Software providers? Identify those business relationships and make sure you have a signed Business Associate Agreement (BAA) with them. It’s required before they gain access to your patient information. Let’s drive the point home: A data backup service was audited by OCR and they were connected back to a medical practice. The medical practice couldn’t produce a BAA—and got slapped with a $30,000 fine. It’s a big deal. There was another case in Florida: A former employee of a business had access to patient PHI. A BAA wasn’t in place and they were fined $150,000. I don’t want to scare you—I want to motivate you. I want you to understand the importance of addressing these issues. How many tooth fillings, root canals, and crowns would you have to do to cover a $30,000 or $150,000 fine? The preventative measures are worth every minute of your time. How does cyber insurance play a role? Will they cover fines? Keep listening... OCR takes their job seriously Very few dentists are in compliance. If they were audited by the OCR it would be a blood-bath. While perfection cannot be expected, there’s room for improvement for the industry. You must show consistent and periodic effort. OCR just loves to kick people’s butts, pandemic or not. They are proactive on the educational side and actively involved from a preventative standpoint. But they will take heavy-handed action when there is a breach of compliance. It is so important to protect your patient’s information. Hear all about it in this episode! Resources & People Mentioned Office for Civil Rights (OCR) HIPAA Security Rule Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

We Tackle Coronavirus Dental Compliance Questions - Dwight Shreve
Aug 07 2020 50 mins  
In this episode of Talking with the Toothcop, Dwight Shreve joins Andrea and I to cover some of the most-asked questions that have accumulated during the Coronavirus pandemic. We talk about face masks and respirators and how to use them properly. We also talk about addressing issues in your practice and the proper procedure if a staff member is diagnosed with COVID-19. If you have unanswered questions swirling around in your head, don’t miss this episode! Dwight Shreve worked at Crosstex for a couple of years as a Sales Manager and Infection Prevention Advisor. Now Dwight is an Independent Consultant with us at Dental Compliance Specialists. He has a passion for supporting patients and helping to make sure their needs are being met. Outline of This Episode [0:21] Andrea and I are joined by Dwight Shreve [1:58] Lockdown in Texas has been lifted [3:20] What is a face mask anyway? [7:02] Guidelines to follow in dentistry [12:17] Respirator Medical Evaluation Questionnaire [15:35] Complete a respirator fit test [18:56] The pandemic uncovered a rift [30:00] CDC return to work Criteria for staff [32:52] Do I have to pay my staff PTO? [34:28] Just because you don’t HAVE to do something… [35:45] Texas Dentists: get consent for every procedure you do [45:42] Surround yourself with a good team The difference between face “coverings” surgical masks, and respirators A face covering—which is being mandated almost everywhere right now—can be a bandana, a neck gaiter, or a homemade mask made of whatever fabric you have on hand. There are surgical masks (level 1, 2, or 3) and then there are different types of respirator masks such as N95 and KN95 masks. They are regulated by the FDA and the use is mandated in certain environments. One of the biggest questions I get is, “Do I have to do it, or is it recommended?” Currently, this is federal law and stuff you HAVE to do. OSHA has standards (which are effectively law) and they have guidelines that are recommended (you should do it). If you don’t do it? The bottom line is that you can get in serious trouble. Everyone working in a healthcare environment—even the dental office—should be wearing a surgical-grade face mask—NOT a face covering. You must focus on prevention to minimize the impact on the practice if someone is diagnosed with COVID. Why is it important? Listen to hear our discussion on the topic! Dentists: You HAVE to use a respirator correctly! Did you know that before you even put a respirator on, you’re supposed to have a medical evaluation and a fit test? If you haven’t done that yet—go back and get it done. OSHA provides a medical questionnaire for the medical evaluation that should be completed for each staff required to use a respirator mask. The evaluation needs to be completed by a licensed healthcare provider. I suggest you send your staff with the eval to get cleared by a physician (to control your liability). Why is it important? If you are not medically fit to be wearing a respirator then you shouldn’t be wearing one. In some instances, that means you cannot carry out the duties of your job. Only once a staff member is medically cleared do they get fitted for a respirator. What does that look like? Listen to find out! Address issues that can negatively impact your practice You have to look at issues that crop up for the potential that they have to dramatically and negatively impact your practice. You need to be proactive and look at things in advance while anticipating and weighing the risk versus benefit of applying a protocol—or disregarding the protocol and just continuing as is. Sometimes you have to put your personal feelings aside about things and do what's in the best interest of your practice. You have to implement these steps so you can defend yourself if someone does get sick and it’s linked back to you. it's always easier to prevent problems than it is to deal with them in the aftermath. Andrea emphasizes that there are laws and regulations in place you have to follow regardless of how you feel about the situation. Dwight points out that “Your practice is only as safe as your patients perceive it—and perception is reality right now. So if your patients don't perceive it's a safe environment to be in, they're not coming back.” What can you do to encourage open communication? Listen to find out. Current guidelines on a team member who contracted COVID Another question that we’ve been asked frequently is: We have a staff member that’s sick, what do we do? How long until they can come back? Do we require them to get tested? As of July 17th, 2020 changes were made to the guidelines to conserve tests. So the CDC is moving away from requiring tests to return to work and simply monitoring symptoms. There are three requirements a staff must meet to return to work: There needs to have been at least 10 days since symptoms have first appeared AND At least 24 hours must have passed since the patient has had a fever AND Symptoms such as cough and shortness of breath must be improved The guidelines will likely change again, but you need to be familiar with them. Who pays for the tests—the employer or the team member? Listen to hear our answer. A Note for Texans Participating in Medicaid: Get Consent While this applies most specifically to my Texan listeners, I believe every dental practice should embrace these procedures. Make sure you have consent forms for every single procedure you carry out, for every patient, every time. This includes preventative procedures and things you don’t normally need to get consent for (fluoride treatment, x-rays, etc.). You must also make sure your clinical notes and all chart documentation reflect the service you’re providing. If it’s not written, it didn’t happen, and it will be presumed fraud. Ignorance is bliss—until you get caught. Get auditing and monitoring processes in place to make sure your clinical charting is being done properly. Dwight implores you to get your house in order and keep up-to-date on compliance issues. Dentists may not have known what they signed up for when it came to all the business aspects of dentistry but they’re all inherently important to the small business that you operate and must be learned. Resources & People Mentioned Families First Coronavirus Response Act FFCRA Employee Rights Poster CDC Return to Work Criteria CDC Potential Exposure at Work OSHA Respirator Medical Evaluation Questionnaire Connect with Dwight Shreve on LinkedIn BOOK: Rich Dad, Poor Dad Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Conflict Resolution Strategies for Dentists
Jun 30 2020 29 mins  
The impact of the Coronavirus is leading to heightened emotions and increased tension. I’ve been fielding a lot of phone calls from dentists who’ve had patients test positive for COVID-19—after they’d been seen in office. Some dentists have had staff who have been exposed or are testing positive for the virus. Dental practices are immersed in chaos and navigating through conflict has been difficult. Some dental offices function like one big dysfunctional family. So in this episode of Talking with the Toothcop, Andrea and I will cover some conflict resolution strategies to keep your practice running as smoothly as possible. Outline of This Episode [0:21] Conflict resolution strategies for dentists [2:29] Find someone in your corner [6:03] Communication is the key to overcome conflict [17:04] Consider each point of view as valid [20:36] How COVID-19 has impacted the dental industry [20:36] Limit your exposure to minimize your impact [23:47] Reference the links below for NEED to know info Find someone in your corner The first conflict resolution method I sort of stumbled upon when a dentist called me to walk through a situation. I was able to be a sounding board that wasn’t passing judgment and could help them reason through the situation—even though they did the majority of the problem-solving themselves. Working through a difficult situation can be easier if you have someone in your corner who can help you muddle through the possible solutions. Andrea points out that having someone to talk to can give you peace of mind, even if they aren't part of the solution. Conflict resolution strategies must include communication Of all of the conflict resolution strategies you could utilize, communication should be at the top of the list. I work with a dentist who was wrapped up in a situation where a staff member came to work sick—with a cough—and was later diagnosed with COVID-19. The staff hasn’t been diligent with wearing their face mask, so the doctor was stuck trying to figure out who had been exposed. She ended up furloughing part of her staff for two weeks while they quarantined at home. One of the exposed staff members that were sent home was extremely upset and hurled some colorful hurtful words towards the dentist. The dentist knew they were upset and responding emotionally—but it was still hurtful. This staff member completely ghosted her and refused to return phone calls. The dentist finally had to call her and let her know that if she didn’t return her call she wouldn’t be receiving a paycheck. The staff member returned her call, completely embarrassed by her actions and profusely apologetic. The situation started with a completely emotional blow-up, but the dentist and her staff members got their butts back to the bargaining table, cleared the air, apologized, and found a way to move forward. You MUST be willing to sit and do the work and figure out a workable solution. If you’re not willing to do that, it’s an easy decision—leave. Step back from your emotions and exhibit empathy Are you being driven by fear? Are you anxious about keeping your job so you can provide for your family? Have you been personally impacted by the coronavirus? Everyone has a different frame of reference that dictates how they handle crises. To resolve conflict—or prevent it from reaching the point of conflict resolution—you need to step back from your knee-jerk emotions and exhibit some grace and empathy. It doesn’t mean anyone is right or wrong—but just have differing opinions. Andrea points out that you can combat emotional outbursts with even more vile opinions and feelings, or you can empathize and put yourself in those persons’ shoes. You only have power over how you respond to the situation—so respond with grace. Give them the opportunity to apologize or leave. Be raw, real, transparent, and bridge the gap—in an appropriate way. Communicate on a different level to overcome conflict and misunderstandings. Conflict resolution begins with a willingness to listen to your staff and understand their viewpoint and try and find some common ground. Consider their point of view before you dismiss their contribution—because they likely are trying to help you. Likewise, dental staff must work to gain understanding if you don’t understand what you’re being asked to do. Don’t allow your confusion or frustration to fester. Be willing and open to be educated and change your viewpoint if necessary. Limit your personal exposure so you can minimize your professional impact COVID-19 has made a significant negative impact on the dental industry. We can hope and pray this doesn’t happen again. But in the meantime, we can work together to minimize the personal and professional impact it has on our lives. Be cognizant of the choices you make in your private life. If you take unnecessary risks and expose yourself to the virus it doesn’t just impact you. It impacts the practice you work in and it WILL have a cascade effect—so keep that in mind. Protect yourself, minimize exposure, and don’t expose your coworkers. But what do you do if your office—patients and staff—are exposed to the Coronavirus? Do you need to close your office or furlough staff? We don’t have all of the answers, but we’ve linked to some of the best resources below to help you decipher what your next step should be. Always feel free to reach out with any questions. At the very least, I can be your sounding board. Resources & People Mentioned Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic Families First Coronavirus Response Act: Employee Paid Leave Rights FFCRA Poster ADA Steps to Take if a Patient Reports COVID-19 Exposure After Treatment What to Do if Someone on Your Staff Tests Positive for COVID-19 Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

From Cop to Tax Consultant: How Craig Cody Serves the Dental Niche
May 14 2020 23 mins  
Are you looking for a tax consultant for your dental practice? Do you understand the necessity of tax planning and preparation for your business? Even better—are you aware of the tax savings you’re missing out on? Tax Consultant Craig Cody joins us to talk about financial planning & taxes. Craig Cody is a Certified Public Accountant (CPA) and the President & Founder of Craig Cody & Company. He was formerly a cop with the NYPD and ended his career as a Lieutenant after 17 years on the force. Listen to this episode for some expert advice—and maybe a few cop stories. Outline of This Episode [2:33] From law enforcement to tax consultant [5:03] Strategies to manage tax savings [12:02] What can a CPA do for you? [14:20] Dentists should NOT double as bookkeepers [16:05] Craig and I share a cop story or two [22:30] Connect with Craig Cody & Company From law enforcement to tax consultant Craig was an Economics major in college, but after 3 years he left to join his dad at the NYPD. After 17 years on the force, he decided it was time to move into something else. He wasn’t unhappy, he loved his time with the NYPD, but it was the right move. Now, his son is with the NYPD, already at the rank of sergeant. Many cops transition to lawyers when they retire from the force. But Craig Cody decided to go into financial planning. He thought getting his CPA would be the ideal way to stand out. But in the process, he fell in love with taxes and tax planning. Now he runs a firm that specializes in helping YOUR business keep more of what you make. Sometimes, $20,000, $30,000, or $40,000 a year. What is the biggest tax mistake you can make? Craig points out that when we shop for a vehicle we do a lot of research. When we plan a vacation we research where we want to go. But what research went into the entity you chose for your business? Do you communicate with your CPA? Do you HAVE a CPA? Your CPA isn’t an expense. With the right tax consultant, they can be an income item. Instead of worrying about what you have to pay, they can help you think about what you can save. Maximize the legal deductions you’re allowed to take Before even forming a practice you should consult with your attorney and a CPA to decide which entity to operate under (LLC, S Corp, partnership, etc.). Choosing the wrong one could mean you lose out on the Qualified Business Income (QBI) deduction—a 20% deduction. What about deductions for a home office? Or a home gym (if you have a pool, gym equipment, etc.)? Do you have a medical expense reimbursement plan? Craig helps his clients maximize the legal deductions they’re allowed to take and keep more money in the business. Once you hit the Married Filing Jointly income limit of $315,000 of taxable income, that 20% deduction starts to phase out. But if you plan properly, you can keep more of that deduction. Keep listening to hear more of Craig’s tips. Why Dentists NEED a tax consultant I learned early on that I should’ve talked with a consultant before even opening a bank account. Once I hired a CPA, my bank of choice wouldn’t give them access. Craig agrees—it’s important to start conversing with a CPA early. Not only can they help you avoid costly tax errors, but they can help you build a tax plan, go through your P&L and balance sheet, and even help with monthly bookkeeping. Craig admits when he sees the books of a dentist who’s handled it themselves, he prays they’re a better dentist than they are bookkeepers. Even if they think they’re correct, they’re typically not even close. Craig states: “There is a reason they went to dental school—and it wasn’t to do accounting.” Dentists often breathe a huge sigh of relief when Craig & Company step in and help take over their books and tax preparation. The value they offer is insurmountable. Listen to the whole episode to learn more about WHY you need a tax consultant. Craig and I also throw in some hilarious cop stories you don’t want to miss! Connect With Craig Cody Get Craig’s FREE Book Craig Cody & Company Craig’s LinkedIn Profile The Progressive Dentist Podcast Craig(at) Call at 516-869-4051 Resources & People Mentioned Voices of Dentistry Conference Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

The Impact of COVID-19 on the Future of Dental Practices - Mike Rust & India Chance
Apr 28 2020 65 mins  
Many dental practices have been sitting closed, deemed non-essential businesses during the coronavirus crisis. Or they’ve only seen patients on an emergency basis. States will soon slowly start reopening businesses. But that begs the question—how will this crisis change dental practices? Will there be new standards put in place? Will infection control finally get the attention it deserves? Mike Rust with ProEdge Dental and India Chance with Learn2Prevent join me to talk through the implications for dentistry in this episode of Talking with the Toothcop. Outline of This Episode [0:22] OSHA regulations: respiratory protection program [4:02] Pent up demand for dental services coming? [6:13] Interim guidelines for dentists [8:57] Upcoming concerns dental practices face [12:22] When will dental offices start opening? [18:50] Aerosols have ALWAYS been a problem [28:27] Why is their resistance to change? [32:45] Who is closing their practices? [38:43] Preparing to reopen your dental practice [41:40] Ways to make the transition positive [48:33] Dental Line Water Unit Safety Have a plan in place for your dental practice India shares an example of a client who saw a patient and found out after the fact that the patient was asymptomatic, but tested positive for the Coronavirus. He had rushed to reopen his practice and was immediately exposed to the virus. Now he’s suddenly faced with notifying everyone he’s come in contact with and closing his practice for another two weeks. Do you have a plan in place to protect your practice? I’ve been telling clients to have a go-bag ready. If they’re exposed and can’t risk returning to their families, they need somewhere to quarantine for the next 14 days. Vaccines won’t be released anytime soon and dentists must implement everything possible to protect themselves, their staff, and their patients. Respiratory protection programs and proper PPE Dental offices often see patients who are ill, and exposure to aerosols and bodily fluids are unfortunately par for the course. But little has been done to rectify the problem. It’s sad that it’s taken a pandemic for people to open their eyes—but I’m amazed by the innovation and creativity that’s ensued. Solutions are being created and proposed and that needs to continue. Patients need to be assured we are doing everything possible to protect them—So do your staff. We’ve heard talk that many hygienists aren’t planning to return to their jobs because the risks they face are too great to overcome. Their PPE isn’t sufficient to protect them from the aerosols they’re exposed to. That’s why it’s imperative you do your research and make sure you and your staff are equipped with the proper PPE. Communicate to them that your practice is doing everything possible to maintain their health and safety. How should you prepare for reopening? I instructed most of my clients to drain their dental unit water lines before the shut-down ensued. If you weren’t able to, I highly recommend doing shock treatments at least 1 week before reopening. That gives you time to test the water lines and make sure they aren’t overgrown with biofilm. Mike shares some updates on ProEdge and the innovations they’re making to deliver faster results. You also need to prep your autoclave and do any necessary maintenance, cleaning, and disinfecting. The CDC is making posters available that describe symptoms of the virus to post in your waiting rooms. They created another infographic for staff members that shows the symptoms staff must keep watch for. To hear more ideas and changes being recommended, keep listening! Will the dental industry bounce back? Many practices are considering closing their doors instead of reopening. In Maryland, dentists usually finish school with over $250,000 in debt. Opening a practice costs anywhere from $500,000 to 1.2 million. New dental practices can’t sustain long-term closures. Some practices who had just opened faced months with no income and are going to be filing bankruptcy. Dentists who’ve been in the industry for years are considering moving into DSO positions with no patient contact. Others who are close to retirement are simply retiring early. But on the flip side, there is likely some pent-up demand for dentistry. Most people haven’t been able to receive routine care and cleanings. Perhaps dentists will see an intense influx of patients that will help offset some of the time spent closed. Whether dentists like it or not, necessary change is coming. The Coronavirus pandemic is affecting the infection control standards that are in place—and hopefully improving them. Many dentists are hesitant to make changes. Change is uncomfortable, scary, and even expensive—but imperative. Listen to the whole episode for our full discussion on the future of dentistry. Resources & People Mentioned The CA Workplace Guide to Aerosol Transmissible Diseases COVID-19 Health Care Worker Protection Act of 2020 OSHA Respiratory Protection Guidelines The Shield Group Learn2Prevent ProEdge Dental Waterline Labs India Chance on LinkedIn Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Critical Incident Stress Management: What You NEED to Know
Apr 24 2020 43 mins  
Critical Incident Stress Management. Unless you’re in the military or a first responder, you’re likely not familiar with this terminology. It is a protocol developed specifically for dealing with traumatic events. I’ve shared many times that I was a cop before becoming the Toothcop. But what many don’t know is that I was also a chaplain. I was trained to help fellow first-responders through physical and psychological trauma. In this episode of Talking with the Toothcop, Andrea and I talk about grief and the grieving process. We talk about critical incidents and how to recognize the signs and symptoms that you’re dealing with psychological trauma. We also share some stress-management strategies and resources for yourself and your team to work through critical incident stress. Outline of This Episode [0:22] Critical Incident Stress Management [9:06] Grief: experiencing psychological trauma [13:35] We must move through the 5 stages of grief [16:41] The pandemic: A series of incidents [21:42] Critical incident stress management system [25:08] Signs and symptoms of psychological trauma [33:49] Reduce the effects of trauma for yourself and your teams [38:48] What does this have to do with OSHA? The psychological trauma we’re all facing We’re all grieving right now. Some of us have physically lost someone to COVID-19. Many have lost their jobs, their businesses, and their independence. We are mourning our loss of connectedness and dealing with severe loneliness. Whether you recognize it or not, we’re dealing with unprecedented levels of stress. Even though we can’t SEE the damage, the damage is just as pervasive, certain, and severe as physical trauma. Andrea points out that losing a job is a normal occurrence in society—but we can’t cope with the repercussions the way we normally would. It isn’t as simple as going out and getting another job. Everyone is being affected emotionally. In most instances I’ve witnessed, it’s harder to come out of emotional trauma than physical trauma. I want to emphasize that it’s okay to feel how you’re feeling—but you need to recognize that you’re grieving to move through the 5 stages of grief (denial, anger, bargaining, depression, and acceptance). The critical incident stress management system Critical incident stress management (CISM) is “an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem”. The way people respond to emergencies and disasters strains their ability to function. Their future depends on learning how to manage the psychological stress and impact of those incidents. The system is geared towards: Normalizing your instinctive reactions Lessening the impact of the incident Encourages the natural recovery process Restores adaptive functioning skills And helps determine the need for further support No one signed up for the trauma we’re all facing. We are grieving our old way of life—because when things return to “normal” they’ll never be the same. We may not all be dealing with death, but we are still dealing with loss. We must seek to understand it to lessen the impact. Signs and symptoms of psychological trauma Stress is a mental phenomenon that can be manifested physically. Some of the symptoms include: Exhaustion, nausea, vomiting, weakness, chest pain, rapid heart rate, headache, excessive thirst, fainting, elevated blood pressure, exacerbate allergies, symptoms of shock, and more. Our bodies are trying to tell us there’s something wrong. We can also experience cognitive, emotional, and behavioral reactions. Cognitive reactions: blaming others, confusion, reduced attention span, poor concentration, troubled thoughts, nightmares, and so forth. Emotional reactions: frustration, anxiety, guilt, sense of loss, anger, denial, fear of loss of control, feelings of isolation, and more. Behavioral reactions: Emotional Outbursts, changes in activity level, disturbed sleep, increase in smoking or drug use, easily startled, anti-social, withdrawn, change in eating habits, fidgety and restless, change in sex-drive. The odds are everyone is dealing with some of these symptoms in one form or another. You have to recognize that this is normal right now, but YOU have the power to change how you react and move forward. How to reduce the effects of trauma—for yourself and your team There are a few simple recommendations for dealing with the effects on an individual level: Limit exposure to noise and odors Take 15-minute rest breaks Drink non-caffeinated fluids (water) Don’t eat excessive sugar or fat Don’t rush back to work Talk through your feelings Whenever we eventually return to our offices, owners and managers need to keep these things in mind. Many people may be hesitant to return to work and it’s your job to help them feel safe. You must also convey to patients that your office is safe. One way you can help your team transition back to work is to facilitate a structured critical incident debriefing with your team. It’s a 7-step phase that helps you work through the psychological trauma together—because none of us are in this alone. Listen to the whole episode for an in-depth discussion on each of these topics. For more resources, visit some of the links below for dealing with critical incident stress management or setting up a critical incident debriefingfor your team. Resources & People Mentioned International Critical Incident Stress Foundation OSHA’s Critical Incident Stress Guide Maslow’s Hierarchy of Needs Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

The Importance of Sterilization Processes - Steven Kovach
Apr 07 2020 57 mins  
Sterilization processes are always important in dental practices to protect your staff and your customers. During the Coronavirus pandemic, everyone is especially concerned about proper procedure. You have to follow Instructions for Use (IFUs) and properly sanitize and sterilize your instruments. In this episode of Talking with the Toothcop, Stephen Kovach—whom I am now referring to as the “Godfather of Infection Control”—joins Andrea and myself to chat about the importance of sterilization processes. Stephen Kovach is Educator Emeritus at Healthmark Industries and has been in the medical field since 1975—now celebrating his 45th year in Healthcare. He is a member of IAHCSMM orthopedic council for loaner instrumentation and a voting member on various AAMI committees. He’s published numerous articles varying in subject matter from perfusion to the importance of cleaning surgical instruments. Outline of This Episode [0:22] Stephen Kovach joins Andrea and I [2:14] Stephen’s tremendous wealth of experience [4:05] Instrument sterilization and cleaning [10:13] The importance of IFUs [19:03] Stephen’s thoughts on hinged instruments [26:55] The legal precedent for following IFUs [34:45] Get rid of rusty instruments [37:25] What to monitor with water quality [50:31] Why you need 2 full-sized sterilizers [52:20] Coronavirus and infection control The importance of proper sterilization and cleaning According to my research—which I will publish at some point here—9/10 offices aren’t doing a good enough job cleaning their instruments. When I recently heard Stephen speak, he pointed out that “When you sterilize dirty instruments the end result issterile dirt”. Every dental office NEEDS to have a quality management system in place—and most don’t. Stephen points out that dentists need to be referencing the AAMI ST79—The “Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities”. But most aren’t. Why? Stephen and I agree it’s because the high price ($400) is a barrier to entry. While their information is proprietary, it would be wise to have this information widely disseminated for the safety of our patients. What you may not know about Instructions for Use (IFUs) I’ve talked about IFUs before and have emphasized the importance of acquiring and referencing them for proper instrument sterilization. They outline the exact cleaning and sterilization process step-by-step to ensure proper cleaning of the tools. What you may not know is that device manufacturers have tested this repeatedly, and to get their products to market the FDA HAS to approve the IFUs they’ve submitted. They don’t just slap instructions together willy-nilly. It is a well-researched process that you need to follow. I’ve been surprised how many dental professionals have no idea what I’m talking about when I ask them if they’re using their IFUs. Turns out, IFUs can be hard to obtain. I’ve even asked a device rep for an IFU and was told point-blank it was only provided to clients. Some can be found online—but not all are readily available. Stephen and I agree you must seek out and obtain IFUs for any tool or instrument you use. Follow at the very least the minimum requirements for sterilization and go above and beyond when possible. Keep listening for our discussion on cleaning hinged instruments. Document your procedures to protect your practice Stephen has been a part of many depositions where professionals are asked how they documented their process and how they followed their IFUs. If they stray from the directions on the IFUs they must state why they think their cleaning procedure was superior to that of the manufacturer. If you stray from the proper sterilization procedures and a patient's illness or even death is traced back to you—you’re in serious trouble. You must be able to prove in a court of law that you followed the instructions properly and show documentation. Some professionals claim they were told something different by the manufacturer—but have no concrete proof. Stephen recommends that if you contact the device manufacturer and they verbally tell you a process that contradicts the IFU—get it in writing. Ask them to outline the company letterhead and mail it to you for records. But if all else fails, following the IFU is the ultimate protection. Why following instructions are SO important during the Coronavirus Pandemic Stephen was quick to point out that he sees some of the best pre-infection control in dental offices. His personal dentist washes his hands in front of him, uses hand-sanitizer, puts on a mask and safety shield, and protective eyewear. Continue to practice these basic means of infection control—but do it correctly. Stephen has noticed that most people don’t even know how to properly use Clorox wipes. The contact time of the solution on the surface is of the utmost importance. Most people quickly wipe down surfaces with a wipe and call it good. But if you read the instructions (which vary) it states that the surface must remain visibly wet for up to 4 minutes to properly sanitize. Read the instructions people! Contact time is also important for hand-washing. The longer you wash your hands (experts say you can sing the “Happy Birthday” song in your head) the more effective you are removing bacteria, viruses, etc. Proper sterilization techniques are more important than ever during the pandemic—not because it was less important before—but because it brings you and your patients peace of mind in a time of chaos. Listen to the whole episode for our discussion on critical water, proper training, and how many sterilizers are necessary. Resources & People Mentioned Stephen Kovach on Instagram Stephen on LinkedIn CPD Guy Website Dryshield Onesource AAMI ST79 Healthmark Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Thriving in Times of Trouble...Time to get to Work!
Mar 17 2020 41 mins  
We can all agree, things are going badly right now. Times are tough. This podcast is a group effort- an attempt to help you re-focus your efforts and turn this downturn into a profitable time for your business. Our think tank Duane Tinker- AKA: "The Tooth Cop" CEO of Dental Compliance Specialists, Andrea Baysinger, Chief Client Happiness Officer and co-host extraordinaire and Jacque Tinker, COO of Dental Compliance Officer put their heads together to bring you a message of hope and help in this difficult time. Here is a quick a dirty list of things you can do to put your practice in a good place come the end of this mess we are facing now. Check it out. This is a fun one guys! OUTLINE OF THE EPISODE: [7:05] Review and update OSHA safety plan and written infection control plans. Understand the difference between them [7:45] Update compliance Training- Take our 4-hour Infection Control CE. Bone up and take the time to update annual compliance training. Your staff can complete training online on their pjs on their phone. [9:45] Do your Medical Emergency Training and practice scenarios. [10:45] Audit your records. [11:50] Train. [13:00] Virtual Team Meetings. [14:15] Call your patients. [15:10] Update your lobby. [16:15] Support your staff during this time of insecurity. Support your team and give them something to work on in the off time. [19:00] Make videos for your patients. [19:30] Get on videos on social media. [21:50] Complete your compliance inspections, especially the infection control inspection and certification! [23:00] Get Infection Control Certified. [31:15] Update your marketing plan. Create an Avatar and re-focus your efforts. [34:15] Update your forms. [35:45] New W4 forms. [36:15] Clean your office with EPA disinfectants. [37:15] Update your systems, fix problems in the practice. [38:00] Check your posters and things that need to be posted in the practice. We love you and wish you and your business and family the most peace in the coming weeks. Let us know if there is anything we can do to help you. 817-755-0035

How to Cultivate Leadership in Dentistry - Steve Dove and Bryan Crawford
Mar 17 2020 23 mins  
Leadership in dentistry is severely lacking in this day and age. I’m not talking about governing bodies—but dentists who are true leaders in their field and practice. Steve Dove, DDS, and Bryan Crawford join me to have a raw and real discussion about cultivating leadership, our heart for dentistry, and our shared vision of growing leaders in the industry. Disclaimer: we recorded this at the Voices of Dentistry Conference. Outline of This Episode [0:21] Steve Dove, DDS and Bryan Crawford join the Toothcop! [4:42] Why an ounce of prevention is worth it [10:37] Budget for compliance and prevention [13:45] Steve points out that we live in a numb society [16:10] Dentists need to be passionate about people [18:18] Why Steve and Bryan are launching a leadership podcast [20:15] Cultivate a heart for people—empower and equip them [21:18] Where to follow the ‘Dental Leadership Academy’ podcast Where does leadership in dentistry begin? In our discussion, Steve and I agreed that a leader must acknowledge their shortcomings and know where their vulnerabilities are. The next step is actively improving on your weaknesses—or delegating them to someone. Steve struggles with organization tasks but his wife (also a dentist) excels at them. So she tends to take on organizational tasks while he focuses elsewhere. The key is knowing when to leverage your strengths. Steve points out that you don’t always want to focus on bringing your weaknesses up to average. Instead, focus on your strengths—and the strengths of those around you—and improve those. You can make your strengths incredible. People notice when you’re different—not when you’re average. An ounce of prevention Steve shares some kind words in this episode about the value that he sees in what I do as a compliance expert. I’m working to step in as an advocate to make sure dentists are compliant. The goal is to empower them to do better and be better. While you can’t always see an immediate ROI, I do help prevent problems from happening. Dentists aren’t always aware of things going on in their practices that could ruin them, but a focus on compliance and prevention can change that. Steve points out that dentists don’t often get thanked for the preventative services that they do. People turn down or ‘poo-poo’ getting a sealant put on their teeth. What they don’t realize is that it can prevent cavities down the road. It can prevent needing a root canal in 5 years. An ounce of prevention will save them from using hours of PTO over multiple appointments. If dentists are preaching to their patients that they must take preventative measures to protect their teeth, why aren’t more dentists taking preventative measures to protect their practice? To protect their livelihood? Or become better leaders? Dentists need to know the repercussions of the things they don’t do. Learn to be passionate about people Why do I care so much about dentists? Why am I invested in helping their practices thrive? Because most dentists have giant hearts. They are full of compassion. They do amazing things for people every single day. After all, a beautiful smile is worth more than words can describe. When you notice what’s different about a confident person, more often than not it’s rooted in caring about other people above themselves. Steve points out that we live in a society that has become numb to what’s going on around them. We snap at the person who hands us our Starbucks coffee. We treat others like crap simply because we can. We need to learn to take a step back and realize they are people. We need to see them for who they are and treat them with respect. We need to reignite a passion for caring for people—and our patients. Why Steve and Bryan launched their podcast A dentist can truly make an impact on someone’s life. You have to grow and learn to be a good person—expound on that strength and passion that you already have. At the time of this recording, Steve and Bryan were about to launch their podcast—the ‘Dental Leadership Academy’. They are passionate about helping dentists grow into leaders. They hope that their podcast can help cultivate a desire for growth in fellow dentists. It all starts by reaching just one person who can reach others. Steve, Bryan, and I all have a heart for dentistry. We want to empower and equip others to be better dentists and leaders. According to Steve, “A good leader is measured by how many leaders he or she creates”. If you’re ready to become a better leader and dentist, you have to go check out their podcast, the ‘Dental Leadership Academy’—linked below! Resources & People Mentioned Dental Leadership Academy on Apple Podcasts Dental Leadership Academy Website Dental Leadership Academy YouTube Dental Leadership Academy Facebook Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Why You Should Offer a Dental Membership in Your Practice - Jordon Comstock
Mar 03 2020 38 mins  
Have you considered adding a dental membership plan to your practice? Have you looked at the pros and cons but just haven’t pulled the trigger? My guest today, Jordon Comstock, has simplified the process by creating BoomCloud—Dental Membership Software. In this episode of Talking with the Toothcop we talk about why a dental membership plan is worth it, having systems in place, and the BoomCloud interface. Both Jordon’s parents were in the dental industry and he started as a lab tech. Most of his immediate and extended family are in dentistry. He grew up surrounded by the struggles of dental offices and sought to create a plan to help simplify their business—but amplify their results. The software he created helps dentists easily manage a membership plan. Listen to this episode for details! Outline of This Episode [1:10] Jordan’s history in the dental industry [6:18] The benefits of a membership program [10:25] Solving the access to care issue [12:09] Regulations regarding memberships [15:05] Dental practice success stories [21:27] What membership programs do for your practice [24:07] What to understand from a compliance perspective [27:13] The benefits of working with BoomCloud [33:41] Jordon’s automatic insurance verification app What are the benefits of a dental membership program? Dental providers—and patients—often vent about how miserable it is to work with dental insurance. They often deny payment on claims or reduce reimbursements and can make a dent in your revenue stream. Starting a membership program in your practice is a way to offset troublesome insurance issues—and provide care to patients without dental insurance. Jordon shares that an average membership a practice will offer is $30 a month or $350 a year, but that it varies from practice-to-practice. It would cover things such as exams, cleanings, and x-rays and offer a percentage off procedures. You can look at it as the Amazon Prime of dentistry. Jordon has noticed that patients enrolled in a membership spend 2-3x more than someone using insurance would. Above all, it provides you a consistent recurring revenue stream for your practice. It can also offset slow months when a practice is billing fewer procedures. 3 case studies that show the membership model works Jordon shares about 3 practices who adopted a membership program and how they made it work: The first practice had 500 patients sign up throughout one year. They looked up how many patients they treated consistently who were without dental insurance and offered them the membership at their next appointment. They combined this with an email blast to all of their patients. Now, they have $12,000 of recurring revenue month, whether or not any work is done. The second dental practice enrolled 1,000 patients in their program with $25,000 in recurring monthly revenue. On top of talking with their uninsured patient-base, they focused on Facebook ads. One particular year they grew by 370% percent. The 3rd practice had 2,000 people sign up with $40,000 in recurring revenue. They used direct mail marketing and targeted communities ages 55+ who would be looking at retirement and facing the loss of dental insurance. Every strategy works, you just need to pinpoint what’s best for your practice. And with approximately 180 million Americans without insurance, your program can offer dental care to those without access. Smart business owners don’t start from zero A traditional dental practice starts from scratch every month and must work their way up to the cash flow needed to support their business—and cash flow is a huge problem in the dental industry. A membership program removes the problem. Small business owners need to focus on reducing risk. A membership program removes your reliance on PPOs as a revenue-stream. It gives your practice stability. Many successful practices adopt a hybrid approach: they stop working with difficult dental insurance plans with while launching their program. They continue working with the policies that afford them a decent profit margin. It’s a win-win for your dental practice and your patients. Launching a program also reduces issues with insurance companies. You still need to keep records for patients and procedures—but your risk of recoupment from insurances due to “record-keeping problems” will be reduced. Keep listening to find out the simple thing you need to do to protect your practice from a compliance standpoint. Systems help you scale I asked Jordon to talk about BoomCloud and some of the benefits their platform offers. Here’s a snapshot of what you get: BoomCloud offers a dashboard that shows monthly and yearly revenue, active patients, cancellations, and more. They have tools/systems to remind patients of bills, if a credit card was declined, etc. ACH function—patients can connect their bank account and their monthly fee can be automatically withdrawn The ability to choose a proven membership template You can easily verify that a client’s membership is active and that they’re paying their fee They even offer a patient portal Anyone can start a membership program for their practice, but it is far easier to manage when you can rely on software—and not a team member trying to track the details on their own. The more members you add, the harder it will become to manage on your own, and that’s where BoomCloud simplifies the process. Listen to the whole episode for complete details on Dental Memberships, BoomCloud, and Jordon’s automatic insurance verification app for dentists—JetPack. Resources & People Mentioned The Insurance Extravaganza Conference Connect with Jordon Comstock on LinkedIn BoomCloud Dental Membership Software BoomCloud Free eBook BOOK: The Automatic Customer JetPack Dental Insurance Verification Jordon’s podcast: Say No To PPOs Jordon(at) Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

A Deep-Dive into Infection Prevention and Control: Because Safety Never Takes a Holiday
Feb 18 2020 66 mins  
While it’s a phrase straight from the mouth of Paul Blart: Mall Cop, it holds true. Safety never takes a holiday, and the safety of your staff and patients should be first and foremost in your mind. Dental professionals need to be educated on proper procedures for cleaning and sterilizing the tools that they’re using every day so they’re not exposing people to pathogens. Over the course of this next quarter, I’m dispatching to different dental offices that we work with to conduct a series of experiments. The goal is to find out if the most stringent infection control procedures that we utilize are doing enough. If they aren’t, then it’s time to make some changes to our checklists and procedures as well as in the dental industry as a whole. Outline of This Episode [1:30] Infection prevention and control and my upcoming project [11:09] The importance of sterilizing your equipment [17:59] Learn how to read and follow IFUs [26:36] Addressing lack of formal infection control training [32:22] Learn how to properly use your ultrasonic [41:01] Make sure you’re receiving the proper vaccinations [42:48] Wear proper protective gear: gloves [46:56] The alarming biofilm being found in dental waterlines [1:02:49] How does infection control apply to ortho? Texas—and all states—should require infection prevention and control training There is no infection control training in Texas and quite honestly, they’re behind the times. Admittedly, they aren’t as forward-thinking as other states. I believe that very few schools—and not just in Texas—are teaching current standards in their curriculum. It begs the question, are our dental assistants getting the proper training? What about dentists? I’ve found that some schools of dentistry have their dental students go through a rotation where they learn how to process and sterilize their instruments. But most instrument processing is done by a paid staff and dentists are never educated on the proper procedure for cleaning their tools. This has got to change. There is a gross lack of knowledge and a whole lot of misunderstanding in the industry. Many dentists and their assistants are learning techniques and procedures from sales reps who don’t know what they’re talking about. They’re often the only outside contact that dentists have which is a problem in and of itself. Very few dental offices properly use their ultrasonic Dental staff often overlook one simple thing that will give them the answers to proper sterilization procedures—Instructions For Use (IFUs). It’s a user manual for your instruments that lays out the exact procedure to properly use, clean, and sterilize your tools. It’s pretty idiot-proof. There’s an amazing product called SonoCheck—it’s a tablet that you drop into your ultrasonic to test if it’s working properly. You drop it in green and it should come out yellow. If there are major problems with your Ultrasonic cleaner, it won’t change colors at all. I’ve seen time and time again that offices just crank the dial on the ultrasonic to whatever time it lands on and expect it to clean their instruments. Most are only doing half the time required in their instruments IFUs. Dental offices NEED to start using them for the correct amount of time. They also should use critical water, the right amount of water at the right temperature, and enough of the right kinds of enzymes. The bottom line is if the instruments aren’t processed long enough and in the proper manner, they won’t be clean. You’ll be using dirty instruments on your patients. The often overlooked tactic to protect your staff It’s simple and highly effective: wear the right kind of protective gloves. Most dentists, hygienists, assistants, etc. are required to get a Hepatitis B vaccine. Most do it before they finish school but some don’t finish the series. They don’t get tested to make sure they have the antibodies if they’re exposed. It’s currently the only required vaccination. But if you’re not wearing protective gloves and get stuck by an instrument used on a patient, you’re exposing yourself to other pathogens as well. It could be hepatitis B, Syphilis, Malaria—anything bloodborne. You must assume that everyone is sick and that every instrument is trying to kill you until proven otherwise. Gloves are inconvenient, sure. But you CAN learn how to process instruments with gloves. Train until you get comfortable with them, but for heaven’s sake wear the dang gloves! Treat your water lines regularly and monitor them for biofilm We’ve talked about this before, but biofilm is a buildup of bacteria (both good and bad) that can adhere to water lines. They’re terribly difficult to kill and the longer they go unnoticed the more difficult it becomes. I believe states will start mandating water line testing. My advice? Don’t wait until it’s mandated. In 2016, a dental unit water line in Anaheim, CA was contaminated with a mycobacterium. It was discovered when dozens of children showed up complaining of facial swelling and pain. Their faces and jawbones were infected with this bacteria. One child had the bacteria progress so severely that she had to have part of her jaw bone removed—all because of an untested waterline in a dental office. The hassle it may cost you is not worth the PR nightmare. It’s not worth losing your license, your practice, and perhaps your freedom. Test your water lines, treat them with shock treatments, and replace them if necessary. You must know how to monitor and maintain control of your water quality. Jacque and I discuss in-depth testing and cleaning of water lines, proper use of ultrasonic equipment, how these strategies apply to ortho, and much more. Be sure to listen to the whole episode to learn how to better protect your practice! Resources & People Mentioned OSAP OSHA AAMI ST79:2017 Sonocheck Brandmax Triple Enzyme Cleaner ProEdge Dental Water Labs Aquasept Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Dental Compliance Q&A: The Toothcop Tackles YOUR Questions
Feb 04 2020 76 mins  
In this special Q&A episode of Talking with the Toothcop, Jacque and I will tackle questions we’ve been receiving from listeners. We want to preface this episode by saying that we never intend to promote our business with this podcast. First and foremost, we want to focus on educating the dental community about compliance. However, we’ve received so many questions about what we do that we thought we’d address them all in this episode! Listen to hear how I became The Toothcop, what exactly it is that we do, and some specific things to watch out for in your office. Outline of This Episode [0:21] Answering Listener questions [1:45] How Duane got started in Dental Compliance [5:05] Starting a business that didn’t exist [8:30] The chief nerd at Dental Compliance Specialists [10:00] The business at the beginning [12:58] Building relationships with dental offices [19:11] Do everything we tell you to do [28:54] How to get your staff on board [35:59] We help monitor and train [40:45] What exactly is it that we do? [47:20] Chart and record audits [51:40] What happens when you don’t heed our advice [1:01:07] What you need to know about exclusion checks [1:08:50] Corporate Integrity Agreements (CIA) [1:10:55] Above all—don’t panic! My journey from street cop to toothcop People are often curious how I got into dental compliance. It doesn’t seem like a natural segue from being a deputy sheriff to a dental compliance specialist. However, it truly was a natural progression. After being a street cop, I had the opportunity to work for the state dental board investigating cases for them. I really was a toothcop—I still wore a gun and carried handcuffs when I walked into a dental office. As I investigated dental fraud and other concerns that arose, I began to realize that I could do something to help prevent these issues from happening. These dental offices weren’t necessarily intending to commit fraud or allow patients to be harmed—they just didn’t know what they didn’t know. So I quit being a cop. Then I started reaching out to offices that I had investigated, offering to help them learn how to prevent what was wrong. We started a business in a space that didn’t really exist. Even now, there is only a small group of people that do what we do. We were simply armed with an idea and blind faith that we could make it happen. We believe what we do matters and truly makes a difference in people’s lives—even if we can’t quantify it. What exactly do we do at Dental Compliance Specialists? When I dove headfirst into dental compliance I did a lot of traveling. I was in dental offices with my checklist in hand covering state board requirements, observing staff, and answering questions. We were continually adding in more checklists that covered OSHA, HIPAA compliance, infection control, and more. I would find issues, take notes, and train as I went along. I was going into offices every quarter and running into the same issues—no one was retaining what I taught them. Talk about frustrating! I was on the verge of complete burnout and told Jacque I didn’t think I could do this anymore. If they don’t remember the training or implement changes, what was the point? Jacque said “give me a year” and we got to work, brainstorming how we could streamline the process. Now, we have a system in place for everything. We broke our compliance training down into 12 modules. Each month a dental office is given a virtual module to cover. We leverage technology and do inspections in small pieces (i.e. one visit is just for radiology training). Doing this gave them manageable chunks to learn and retain, and we were interacting and answering questions monthly vs. quarterly. It’s about building relationships based on confidentiality Our entire business is based on confidentiality. We want to work with dental offices to improve their compliance, not penalize them for existing issues. We don’t disclose who we work with or what the compliance issues are. Even if clients permit us to share that we’ve worked with them, we won’t share anything we’ve done. We want to build trust to facilitate dialogue—to make you feel comfortable and not judged. No one is perfect and no office is perfect. In all of the years we’ve been doing this, maybe 2-3 offices have come close to passing my initial compliance inspection. I’ve seen some pretty horrendous things in offices full of pretty great people. I remind them things are fixable and help them figure out how to implement changes and often see significant changes for the better in “before & afters”. We can’t tell you how many patients or staff members didn’t get sick. We can’t tell you how many fines or recoupments we helped you avoid. But we can help give you peace of mind. We can train your staff to reach the highest level of compliance standards. You can rest easy knowing that you’ve done everything you can to protect your business and your patients. Most common question: What is required vs. recommended? This one just makes us shake our heads. We understand that some people are comfortable in gray areas and others prefer black and white. But we would never recommend something if it was just optional. Everything we put in our checklists and training modules help you obtain the highest level of compliance. It protects you, your staff, and your patients. It’s not just about “best practices” anymore. You can get fined. You can go to jail. Even if you don’t have malicious intent, you will be held responsible for mistakes made. So we don’t skip steps. Our system for nailing down compliance failures and integrating guidelines to implement change is tested, tried, and true. So you need to ask yourself the question, “is it legal, ethical, and does it reflect my values? If the answer is no, it’s time to make some changes. Jacque and I dive deep into specific questions covering chart and record audits, exclusion checks, corporate integrity agreements, and so much more—be sure to listen to this important and educational episode. We don’t want you to feel overwhelmed, but equipped. Above all, don’t panic. If some of these topics leave you with a sinking feeling in the pit of your stomach reach out to us! We’d love to help. Resources & People Mentioned Blog: 7 Key Elements of a Compliance Plan Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

How to Simplify Dental Insurance Billing - Colleen Huff
Jan 21 2020 37 mins  
Dental insurance billing is something many dental offices struggle with because it can be so complex. When do you bill? What rates do you bill? What if the patient has two insurance coverages?How do you keep your office organized and implement a system? It’s a lot to remember. Colleen Huff joins me in this episode of Talking with the Toothcop to answer some of those questions—and help you simplify the process. Colleen Huff has been everything from a bookkeeper to a scheduling coordinator, with extensive experience managing practices. In her management role, she saw a severe lack of training—to the point dental offices were engaging in illegal billing practices and didn’t know it. So she started educating others on proper practice. Colleen has been a dental insurance coach for the last 17 years. Outline of This Episode [0:20] Colleen Huff’s background [5:05] Can you simplify the dental billing process? [15:45] The biggest mistake dental offices make [19:20] Anyone engaging in fraudulent billing is liable [22:10] Understanding insurance breakdowns [26:20] Dealing with multiple insurance coverages [28:05] Common issues offices struggle with [30:55] How do you systematize and organize? [34:20] Connect with Colleen How do you simplify the verification process? We’re at the beginning of the year right now, when many clients have switched to new insurance—which typically means a mad scramble to verify coverage. Coleen does everything she can to make sure insurance is verified weeks before a patient’s appointment so they can contact them about any problems that arise. If a client has a Medicaid policy—which can terminate at a moment's notice—you must be sure to verify it the day of the appointment. She also recommends doing this for commercial insurance plans because they no longer run on just a calendar year. Many are contract year, benefit year, or even a rolling year based on employee hire date. It is preferable to know ahead of time whether or not there will be a financial challenge for you and your patient. You can notify the client upfront, instead of billing them later and dealing with an angry client. With the real-time eligibility systems in place, the process has become much easier. Listen as Colleen and I chat about how she documents the process and communicates problems with patients. The biggest mistake dental offices make The #1 problem Colleen sees in dental offices is not submitting claims on the proper completion date. Many offices send claims before the work isn’t completed, citing that “everyone does it” or “no one ever gets caught”. Doing so is dangerous for your practice. You need to submit the claim for the proper date the procedure(s) was completed or face the consequences when you’re caught. It will be jail time. It’s not just the Dentists that can be prosecuted. A billing staff who knowingly submits fraudulent claims can be found at fault. Whining that “The Dentist told me to!” will not protect you. If you are part of the billing staff you must be reviewing claims before you send them. It comes down to integrity. The more you allow and the more “little” discrepancies that you let slide will make an impact. Make sure your morals and beliefs align with how you are operating your practice. We talk about an incident where a provider did end up in prison and the reason behind it—keep listening. Why insurance breakdowns are important Colleen and I agree: you must know how much a procedure will cost a patient. Run the verification, make whatever calls necessary, and print out a breakdown of what a client will owe. Then, collect whatever copay is necessary. Your billing will be more accurate. This also removes the chance of most—if not all—surprises and helps you avoid a patient getting an unexpected bill. Some offices struggle with moving into the 21st century and claim that “Patients should understand their insurance and what they charge”. Colleen is more familiar with insurance than most people, but even she doesn’t know everything—and you can’t expect your patients to either. Gathering information on the front end is important. Is it time-consuming? It can be. But most insurance companies have a way for you to check verification and coding online. Sometimes it may take a phone call. But it saves you future hassle and makes your patients feel relieved and secure in your ability. Referrals come from happy customers, and the more you simplify the process for them, the happier they’ll be. Your dental insurance billing questions answered Colleen took some time to answer common questions and issues that dental offices struggle with: If a client has two insurance policies, which is primary and which is secondary? There are a few simple rules. First, a Medicaid policy is always secondary (except for a few rare circumstances). Your plan is always primary to your spouses. For a minor child, unless court-ordered differently, the parent with the earliest birth date in the year is the primary insurance. Should you bill your full fee or the contracted rate? Always bill your full fee. The insurance company will pay the contracted rate and you adjust off the rest based on the contracted fee schedule. How do I negotiate fee schedules? Colleen notes that you must be billing your full rate. If you don’t, an insurance company will see that they’re already paying you what you’re asking, and you have no leverage for negotiation. It takes time, but if you go through the proper channels you can see a fee schedule increase. What is the difference between a write-off and an adjustment? A write-off is when you bill the insurance for something that’s not covered according to your contracted agreement or the patient’s policy. If the service was carried out, you may NOT bill the client for the cost and must write it off. An adjustment is an amount that is adjusted off the bill sent to the insurance company. They pay you the rate your contracted for and nothing more. Listen to the whole episode as Colleen shares her background in the industry, strategies for staying organized, things to keep an eye out for, and much more! Resources & People Mentioned Colleen Huff’s Facebook page NADP Conference Colleen’s Website Colleen’s email: DentalInsuranceCoach(at) Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

How to Utilize Instructions for Use in Infection Control
Jan 07 2020 32 mins  
How to Utilize Instructions for Use in Infection ControlInstructions for Use (IFUs) should be included with any and every medical device that you use in your practice. Learning how to properly use and follow IFUs will aid in proper infection control. As we are rolling into 2020, improvement in infection control in dentistry is at the forefront of my mind. So in this episode of Talking with the Toothcop we’re going to cover how to properly clean and disinfect medical devices (and how to reference the IFUs). Check it out! Outline of This Episode [0:20] Welcome to 2020! [4:55] Infection control and room for improvement [6:30] Policy to practice book from OSAP takeaways [7:45] Properly use IFU’s (Instruction for Use) [13:30] You need written policies and procedures for infection control [17:45] Enzyme solution and critical water [22:55] Proper care of hinged instruments [24:45] Spot-testing in dental offices [26:30] Infection control testing coming in 2020! [31:00] Move in one direction and never backward Why Instructions for Use are SO important Instructions for Use teach you how to properly use any and all medical devices that you use in your practices. Everything is regulated by the FDA—each product HAS to provide an IFU to remain compliant. They’ll tell you how to use it, care for it, clean and sterilize it, and how to store it. They are comprehensive guidelines for the proper care of your devices to increase longevity and protect your patients. The process of cleaning your medical devices I want to just walk through the general steps (and everything you need to consider) as you clean and sterilize your medical devices: Transporting the instrument(s): When you are transporting devices from the operatory to the sterilization room you must consult the IFU. For example, If it’s a sharps device, you must transport it in a closed container that cannot be permeated and label it as a biohazard. Rinsing the instrument(s): Does your devices IFU specify that it needs to be rinsed in a certain type of water? Many now require that they are rinsed in critical water. The Ultrasonic bath: Are you sterilizing hand instruments? Drills? Cavitron tips? For each item, you have to consult their specific IFU to properly clean and sterilize them. Enzyme solution: What type of enzyme solution to you need? Protease, amylase, or lipase? All three? How many squirts or tablets per amount of water being used? Guess what—your IFU will tell you everything you need to know. You also need to de-gas your ultrasonic by running it for 10 minutes before putting your instruments in. Second Rinse: You NEED to use critical water again! Most people are using tap water, and it’s probably not doing the job. Instruments are expensive. You want to properly care for them and the best way to do that is by following their instructions for use. Andrea and I talk about considerations for hinged instruments, so keep listening! Written policies and procedures Most offices don’t have written policies and procedures in place for infection control. Or, they’re so generic that they’re useless as a guideline. But you need one for your practice. I’ve found that the best infection control guidelines that you can find online come from dental schools. But you can’t just grab their manual and call it good. You need to take their baseline and edit it. Structure it for the proper verbiage for your practice. Make sure it addresses policies for stages of the instrument process, sterilization, transport, storage, to reuse or not reuse, surgical milk—the list goes on. This is its own training manual. You can’t tuck into an OSHA manual. You need to have systems in place to properly update it and make sure all staff are reviewing it consistently. Keep listening as Andrea and I chat about the specifics. Infection Control in 2020: Where are we headed? Good enough isn’t good enough. I’ve spent hours researching infection control and am investing in some tests that I will use this year. I’ll be able to see in-the-moment if a dentist’s office is properly cleaning and sterilizing their instruments. My goal is to track my testing and make the data consistent, measurable, and reliable. We don’t want to see what we think are water spots or rust on instruments and find out that they are biological. We need to set a higher standard for ourselves and our patients. That begins with proper infection control. The CDC doesn’t spend time studying dentistry, so we need to make sure that our standards go above and beyond what is in place. Listen to the whole episode as Andrea and I chat about our plan for 2020. Resources & People Mentioned Ole and Lena Jokes OSAP FDA format guidelines for IFUs Supercritical Water Oxidation Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

It’s Time to Start Preventing Airborne Diseases in Dentistry - Michelle Strange
Dec 17 2019 39 mins  
Airborne diseases in dentistry are unfortunately prevalent but preventable. Protecting yourself, your staff, and your patients from aerosols should be a priority in your practice. We are all up-in-arms about bloodborne pathogens and do everything in our power to prevent them, but we neglect airborne diseases. That needs to change! Michelle Strange joins me in this episode of Talking with the Toothcop to start the conversation. Michelle has been in the dental industry since 2000, and a licensed hygienist since 2005. At one point, she was an OSHA Compliance Manager and Director of Clinical Education at O2 Nose Filters. She left private practice 5 years ago and is now an Educational Consultant for TePe Oral Hygiene Products. Michelle also co-hosts a podcast, “A Tale of Two Hygienists”. Outline of This Episode [0:20] I introduce my guest, Michelle Strange. [3:05] Research on dental aerosols [4:05] The conversation about airborne diseases [6:40] Personal Protective Equipment [10:25] Protect your patients and staff [16:00] The psychology of bias [19:30] Transparent conversations with your patients [24:15] The dangers of chemical aerosols [27:55] How different personalities deal with change [32:35] Wrap your head around the why The lowdown on airborne diseases There are many safety protocols in place to prevent the transmission of bloodborne pathogens. A standard has been set that professionals must follow to protect themselves. But when it comes to airborne diseases, most providers aren’t even using the correct protective mask. Chickenpox, Measles, Mumps, Tuberculosis, Herpes, and the common cold are all respiratory diseases transferred in aerosols. Bloodborne diseases can only be transferred if you are cut, and you are exposed to contaminated blood. Airborne diseases can be spread if someone simply breathes or coughs! The dental industry doesn’t address this as well as they should—that needs to change. The importance of Personal Protective Equipment (PPE) Because of the ease of transmission, it is imperative that you’re utilizing the proper PPE. Michelle has always had a proclivity for proper infection control. She made sure to use the Ultrasonic and air polishers for every single patient. But when she was working as a hygienist, she was always sick with a sinus infection or bronchitis. It got so bad that her patients would comment it was odd when she wasn’t sick! Michelle is convinced it’s because she never knew the proper level of mask she should be wearing. When you are working with high levels of aerosols, you need to be using a level three mask. Not only for your protection but your patients as well. Michelle and I cover the topic in detail—keep listening! The Dunning–Kruger effect: overcome cognitive bias in dentistry The Dunning-Kruger effect, simply paraphrased, implies that we as professionals believe we are more qualified than we actually are. Michelle contends that we need to consistently work to overcome our cognitive bias that we ‘know it all’. It’s important to remember that what you were taught in the ‘80s is going to be outdated. Science is constantly evolving in the world of dentistry. We are constantly learning about new ways to treat and prevent disease. Keep an open mind and allow yourself to be challenged and always question the status quo. Your mindset must always come back to the proper protection of staff and patients. Michelle and I believe there needs to be more transparent conversations with patients in the dental industry. It’s okay to admit that you’re not always the expert. Inform them that you’re staying on top of new research and new procedures and will always keep them in the loop on their treatment. It’s not just biological—be aware of chemical aerosols as well While airborne diseases are the aerosol that can be the most concerning, Michelle and I felt the need to caution you about chemical aerosols as well. When you’re working in the lab carving dentures or trimming models those particulates are quite fine. So are you wearing the proper mask? Are you breathing in those particles? Do office staff enter the work areas without proper PPE? People aren’t just getting sick, they’re getting really sick. You need to cultivate an awareness of these concerns and educate your staff and patients. Dentistry is the highest producer of aerosols, but dental masks are based on medical standards. Michelle and I discuss the need for dental standards as well as some other concerns that impact change in the dental office. Listen to the whole episode for more important information. Resources & People Mentioned O2 Nose Filters The Dunning-Kruger effect Connect with Michelle Strange Michelle on LinkedIn Michelle’s podcast TePe USA Educator Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Navigating the New Era of Dental Billing - Leslie Icenogle
Dec 04 2019 33 mins  
Dental billing is an ever-changing process. As a dental provider, how do you stay on top of changing regulations and coding? Do you outsource your billing? Leslie Icenogle joins me today to talk about medical billing for dentistry and where it overlaps with dental billing. We also chat about outsourcing your billing and continuing education for your staff. Leslie got her start in pediatric dentistry over 30 years ago and has worked in oral surgery for 32 years. She has extensive experience dealing with medical billing and started teaching dental practices how to integrate medical billing. After a couple of years of being asked to take on the work herself, Insurance Billing Outsourcing was born. Outline of This Episode [0:30] Leslie Icenogle’s background in dentistry [3:05] ICD-10 Diagnosis in Dentistry [8:00] SOAP notes: subjective, objective, assessment, and plan [10:45] How do you make the process easier? [13:50] Compliance and cash flow go hand-in-hand [16:15] Outsourcing is sharing liability [22:20] Cleaning up your billing practices [26:05] High turnover in billing positions [27:55] Connect with Leslie Understanding medical billing in dentistry Dental and medical billing is at a crossroads, where many things will now be required to be billed to medical insurance primary to dental insurance. Many states already require claims to be submitted with the proper ICD10 coding in place. You’ll begin to see (or continue to see) dental insurance denying claims because they were looking for denial or payment from the medical insurance first. A lot of treatment that dentists could be billing is not being billed—which is a win for the medical insurance and a loss for you. It will be a learning curve to understand how to begin coding these claims properly. This is where Leslie would step in and offer proper training to your staff. You must learn how to correctly file with the proper attachments, write letters of medical necessity, and learn how to properly read Explanation of Benefits (EOB’s). If this is something you’re not ready to implement completely, consider outsourcing to a company such as Leslie’s. SOAP Notes: The importance of documentation The ‘SOAP’ acronym stands for subjective, objective, assessment, and plan. It is a note-taking system that your practice will need to begin implementing. Medical insurance is all about documenting the details. If you’re doing anything other than a simple cleaning, they want to know why the patient is being seen. What is the chief complaint? How did it happen? What is the history of the illness/issue and was it properly treated? Document their HPI (History of Present Illness) extensively. Your notes must be clear and detailed. Leslie and I both recommend creating a template where you can input the proper patient information. It helps simplify the process and keeps you consistent. Clean up and simplify your dental billing As Leslie has worked in the field, she’s found that most dentists are receptive to her feedback or criticisms. After all, the entire goal of cleaning up your billing and learning new processes is to increase cash flow! There are a few ways you can clean up your process as you’re learning the new coding: Create a template that allows you to easily input a patient’s information and history. Verify benefits for the medical and dental insurance on the front end, and do so correctly. Assign someone—perhaps your office manager—to conduct an audit of patient files. They can assess if the notes are detailed enough, if the insurance was verified correctly, and that the claim was filed properly. Is the person handling the billing truly able to dedicate all of their time to it? Or are they being pulled in different directions? Another option you can consider to reduce the burden on your staff is to outsource billing. Invest in education for your billing team If your practice has designated billing staff—take good care of them. Leslie and I see high turnover rates in billing positions. Often, it’s due to improper training (or lack of training). You must invest in continued education for your billing staff and not let them fall to the wayside. We recommend implementing training annually. This allows your staff to stay up-to-date on the changing rules and regulations in medical and dental billing. It also properly equips them for their job. Ignorance is NOT bliss and your practice could be hemorrhaging money. Spend a little money on the front end on training to amplify the cash flow coming in from proper billing. Leslie and I talk about the benefits of utilizing ICD-10 coding and why you shouldn’t resist it. Don’t miss this engaging episode of Talking with the Toothcop! Connect With Leslie Leslie on LinkedIn Insurance Billing Outsourcing Website Call IBO at 317-565-4988 Leslie(at) Resources & People Mentioned ADA Lawsuit against Delta Dental ICD Coding in Dental Claims Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

The Toothcop’s Security Measures to Protect Your Practice
Nov 05 2019 33 mins  
What are some of the security measures you need to have in place to protect your practice? In today’s day and age, security breaches can come from many different directions. In this episode of Talking with the Toothcop, Andrea and I will lay out some ways you can protect your business. From security breaches to controlled substance regulations—we’ve got you covered. Outline of This Episode [0:20] Cyber Ransom Attacks [4:55] What does a breach mean for you? [8:30] Prepare for potential breaches. [13:20] HIPAA security and privacy officer [14:40] Bootcamp will cover liability and compliance [17:50] How to prepare for and handle “Never Events” [23:10] Controlled substance rules and regulations [27:15] Change in DEA regulations [28:10] Controlled substance storage [30:30] Stop over-prescribing antibiotics Cyber attacks are the real deal It’s a new era, and cyberattacks are becoming more prevalent. A hacker will infect your system with an encryption virus, and to regain access you have to pay a ransom. This isn’t just a thing happening on TV shows anymore. It’s something that has to be investigated by the FBI, reported to the Office for Civil Rights (OCR), and potentially even media outlets. Is there anything you can do to prepare? What do you are attacked? Invest in a great IT company that will answer any questions you may have. Obtain adequate cyber-insurance coverage. Have legal counsel in place that you can call if it’s ever necessary. Prepare as well as you can—make sure you have more than adequate website security. Don’t let your practice be compromised and watch your reputation take a nose-dive. Do everything you possibly can to protect your practice and your clients. We give you a few options in this episode! HIPAA breaches and how to prevent them If you do indeed experience a breach of protected health information, you must have systems in place to handle the situation. You need a designated privacy officer and security officer. If you’ve done your due diligence and have systems in place, it can be taken into consideration if there is an investigation. A forensic investigation is recommended (especially in the case of a cyber-attack) to determine the scope of the breach and what information was affected. Assess where your vulnerabilities may be and take preventative action. Was there a change in technology? Where are your gaps? Don’t simply rely on your IT company telling you that you’re safe—ask questions so that you understand and know you’ve done everything possible. How to prevent “Never Events” “Never Events”, usually referred to as “Sentinel Events” are unanticipated extraordinary events that incur serious injury, illness, or the death of a patient. Unfortunately, events like these can and do happen (we talk about prevention and preparedness in depth in this episode). Even if you do everything right and are a great clinician, the litigation and stress involved in the process can be debilitating. You can’t turn back time—but you can be proactive. Have checklists in place to make sure life-saving medical devices are checked regularly. Practice life-saving procedures with your staff. Be prepared for the unexpected. Controlled substance rules, regulations, and safety measures A state board rule was enacted in Texas eff. September 1st requiring providers to check a patient's substance history before prescribing controlled substances. There are also whispers that a law will be enacted in 2020 that will only allow prescriptions for controlled substances to be done electronically. Do your research now to find a compatible software to have in place by the time this is state law! It’s an added safety measure that will protect you from some liability as well as protect your patient’s life. In the meantime, if you prescribe or utilize controlled substances they must be securely locked up (behind TWO locks and TWO keys). You must have a log to track dispensing that is stored safely with the drugs. Andrea and I talk in detail about security measures, HIPAA breaches, drug regulations and much more so be sure to listen to the whole episode for details! Resources & People Mentioned Allscripts Office for Civil Rights (OCR) Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Be Prepared to Handle Medical Emergencies in the Dental Office
Oct 15 2019 53 mins  
Everyone lives by the mantra that medical emergencies in the dental office will “never happen to us”. Patients certainly don’t think about that when they schedule a dentist appointment. But it is your job as a provider to be prepared for the unthinkable. Failure to plan is a plan to fail. There is risk in what you do whether you think about it or not. We cover medical emergencies in detail in this episode of Talking with the Toothcop—be sure to listen! Outline of This Episode [1:30] Preparing for Medical Emergencies [6:00] Do scenario training until you don’t fail [7:55] Combating opiate abuse in the dental office [13:50] Use your intuition and don’t make stupid decisions [17:15] Sedation Rules: Pre Anesthesia Checklist [21:20] Opioid addiction resources for Texas [24:10] Tracking claim denials and implementing systems [26:00] Learn proper administration of emergency medications [35:50] Why do we do what we do? [39:00] DEA Registration and resources [40:10] ‘Trust but Monitor’ in practice [46:40] People can’t afford for us to get it wrong [48:30] Details about the annual Dental Compliance Bootcamp! Do scenario training to prepare for medical emergencies in the dental office Run through scenarios with your team. What do you do if a patient goes into cardiac arrest? What do you do if they have an allergic reaction or don’t handle sedation well? Strategize what you would do in these scenarios and talk about how emotions will play a factor in your ability to carry out what your plan. Run through your weaknesses extensively—because a patient can’t afford the luxury of you only playing to your strengths. The only way to truly prepare for an emergency is to make a plan and test your plan extensively. You cannot run a one-and-done test. You must practice until you don’t get it wrong. Practice doesn’t make perfect. Practice until you reach perfection. Remember that it could very well be someone’s life that is at stake and plan accordingly. Combating opioid addiction in the dental office Dentists and dental staff deal with the same problems everyone else does. Unfortunately, due to the nature of their professions, they have easy access to addictive substances. If you’re a dental provider struggling with a problem but claim to have it “managed”—it will catch up with you. Don’t risk your license, your practice, your family, or your life. Get help now. Check out the resources in our show notes. On the flip-side, you must carefully monitor the controlled substances that you are prescribing. You must check your patient’s consumption history and make sure they are not abusing the system. You have an obligation—both morally and ethically—to treat your patient’s pain, while not jeopardizing your license. Bottom line? Use your intuition and don’t make stupid choices. Listen as Andrea and I discuss in detail specific stories of opioid abuse and the consequences suffered by those involved. We also talk about DEA registration and why it’s needed for every location you practice at. Know how to properly use life-saving medications You must have an emergency drug kit on hand to deal with whatever medical emergency you feel could arise—and know how to properly administer them. You NEED to be proficient in Basic Life Support (BLS) and Pediatric Advanced Life Support (PALS). But don’t just stay up-to-date on your certifications, be sure you consistently practice the procedures. It does you and your patients no good if you have a certification, but when the time comes that you need it, you fall short. You must provide the highest standard of care and prepare for the worst-case scenario. If you offer sedation at your practice, you must have the medications on hand to reverse the sedation. Typically you’ll also need to know how to set up an IV and administer medications that way. So practice practice practice. Why do we do what we do? Our Mission: build authentic relationships we build our legacy of making dental practices safer for patients, dentists, and staff by holding quality-focused professionals accountable to their standards. Our Vision: is not merely to exist but to be better, do better, and live better so that no one is harmed by a dental practice. Our goal is to equip you to think for yourself and practice the “trust but monitor” mantra. Always be sure to locate the source of the information—even when it’s coming from me. Remember, our patients can’t afford for us to make mistakes! Resources & People Mentioned Professional Recovery Network Website PRN’s phone number: 800-727-5152 DEA’s Practitioner’s Manual Check out our Dental Compliance Bootcamp! Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

The Importance of Dental Policies and Procedures
Oct 01 2019 61 mins  
Today’s episode of Talking with the Toothcop is all about the fascinating topic of staying up-to-date with your equipment evaluations and dental policies and procedures. Yes, I think compliance IS fascinating! Andrea and I cover everything from blood-borne pathogens to X-Ray equipment—don’t miss this important episode. Outline of This Episode [0:23] What Andrea and I are going to cover [3:20] X-Ray law updates in Texas [7:05] Written policies and procedures [15:50] HIPAA and monitoring PHI [35:25] Hepatitis B Prevention and vaccination [37:05] Minimizing exposure & safety protocols [41:20] 75 Hard update [45:00] PPE provided at no cost [50:00] You can’t always see your enemy [53:50] Provide proper post-exposure care [56:45] Sterilization of single-use items Dental policies, procedures, and prevention! The whole reason you have written policies and procedures is to protect yourself, your staff, and your patients. In theory—really though, in practice—you should have a written policy to address every risk area you may encounter in your dental office. These are a few of my favorite things: HIPAA manual Infection control handbook OSHA policy Proper billing procedures Clinical policies Medical emergency policies The list goes on! It can be in multiple manuals or one large handbook, but it’s important that you know what’s in it and that your staff knows where to find it. As a general rule of thumb, you need to review your policies and procedures annually and update them as needed. Make sure that your manual is legal, ethical, and reflects the values of your organization. I always feel like somebody’s watching me… ...and I got no privacy! Seriously though—you NEED to make sure you are monitoring your office’s server access logs. Is a login being used outside of business hours on a normal basis? Did you notice the login of a former employee is being accessed? It is important to monitor for irregularities and anomalies so you know when and if you’ve been hacked. It’s all about protecting your patient’s protected health information (PHI). This is why it is the law that everyone in your practice has different usernames and passwords for the systems in place that are not shared. This allows you to monitor access, as well as only allow access to certain roles that fit an employee’s role. You must keep audit logs of your servers for 6 years in case of an audit. Down to the nitty-gritty: Blood-born pathogens and prevention You must offer Hepatitis B vaccinations to your staff at no cost to them. You want your employees to get the vaccination within 10 days of being hired and have them sign a document stating: they’ve had the vaccination, they’ve previously been vaccinated, or they acknowledge it’s been offered and decline the vaccination. So what can you do to prevent the spread of a blood-born pathogen? You can minimize exposure by: Using High-Volume Evacuators Use needle-capping devices Use puncture-resistant sharps containers Provide hand washing/hand sanitizer stations Provide Personal Protective Equipment (PPE) at no cost Follow the policies and procedures you’ve set forth and you’re 99% of the way towards protecting your staff. Andrea and I cover a whole lot more—keep listening. What do you do when the unthinkable happens? Protecting your staff isn’t just about prevention. Sometimes, mistakes happen and you or a staff member may have been exposed to a blood-borne pathogen. What you do next matters. First, take care of your staff! Document the incident. Document the route of exposure. Make sure the staff is immediately tested for blood-borne pathogens. Secondly, get consent to test the patient’s blood as well. Unless, of course, you already know if they have Hepatitis B or HIV. Be sure that the proper channels are in place to take care of your employees. This includes medical evaluations and treatment, and counseling if they test positive. Listen to the whole episode for more valuable policies and procedures! Resources & People Mentioned Dental Cone-beam OSHA HIPAA Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

How to Inspect and Maintain Your Nitrous Oxide Equipment - Stephan Nugent
Sep 17 2019 26 mins  
Do you know how to properly care for your nitrous oxide equipment? Are you properly following instructions for use (IFU) documents when cleaning your Accutron? Knowing how to properly care for your equipment—and therefore your patients—is important for their longevity and functionality. Here to chat with me today is Steve Nugent from Professional Sales Associates. One of his specialties is Accutron nitrous oxide products. He reached out to me about a recent episode I did to give me some feedback and I’m so glad he did. He’s got some insightful tips on protecting your equipment. Be sure to listen to this important episode of Talking with the Toothcop! Outline of This Episode [0:22] I welcome my guest Stephan Nugent to the podcast [4:45] Centrally plumbed and portable nitrous oxide manifolds [7:20] Inspection of equipment—follow the instructions for use! [11:35] Disinfecting Flowmeters [16:00] Don’t let complacency seep into your office [19:30] Maintenance of nitrous oxide equipment [21:55] Single-use MEANS one and done! Pros and cons of a centrally plumbed or portable manifold According to Steve, both systems are fairly durable and robust. A centrally plumbed system is going to allow you more flexibility and can be available in every room needed. It’s going to be at a higher price point to install, but resupplying the gas is fairly affordable. On the flip side, a portable manifold system has a lower price point. But it does come with some limitations. It is moveable but cumbersome—and it can’t be in two places at once. So you’ll either need multiple manifolds or have to schedule patients accordingly. You’ll also be constantly refilling canisters, and it isn’t as affordable when you go that route. Either way, both options are suited for the task at hand. You just need to take into consideration your budget and intended use. Follow Instructions for Use (IFU)—they are the letter of the law Nearly every device used in a dental practice is regulated by the FDA with strict guidelines for use. Therefore, it is extremely important to follow the IFU’s that accompany the product. Not following the instructions could cost you—and is technically breaking federal law. IFU’s give you one less process that you need to develop yourself, so take advantage of that! Even something that seems simple, such as cleaning your devices, is clearly laid out for you. Steve recommends only utilizing the cleaning products outlined in the IFU. If you go rogue and use a stronger chemical, you risk damaging your equipment and impacting its longevity. For more details on how to properly clean your dental tools—keep listening! Don’t let your dental office become complacent I’m a firm believer that if you work in the dental industry, you need to become an expert on infection control. It is a complex thing to tackle, but there are resources available—I certainly provide some! Make sure you stay up to date on the latest FDA guidelines. Do not let your practice become complacent. If you do, you’re setting yourself up for lawsuits. Also, don’t go off-script. You may have the best of intentions when purchasing a heavy-duty well-reviewed cleaning product. But when put to use you could inadvertently destroy expensive equipment. You always need to consider the long term affects your actions have—even when it comes to something simple. Evaluating your nitrous oxide equipment You know me—I’m all about compliance. Evaluating and monitoring your equipment is high on the list of things you must do. Steve and I both recommend using a barrier to help alleviate disinfectant concerns, as well as spraying cleaning chemicals on a cloth. DO NOT spray chemicals directly on your equipment (unless, of course, your IFU states to do so…). Evaluate your rubber goods regularly. If there are holes in them you’re exposing yourself and the patient unnecessarily. If there’s a hole, duct tape is not your friend—it’s time to replace it. Likewise, single-use nasal hoods mean single-use. Throw them away when you’re done! For more discussion on proper product usage, properly cleaning your Accutron equipment, and MORE listen to the full episode of Talking with the Toothcop! Resources & People Mentioned Professional Sales Associates CaviCide Disinfectant Accutron Connect With Stephan On LinkedIn snugent(at) Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

Why HIPAA Compliance with Technology is important - Nancy Sabino
Sep 03 2019 28 mins  
HIPAA Compliance—protecting your client’s information—NEEDS to be an important practice in your dental office. This topic is just as pressing as protecting the health of your patients and staff. Managed Service Providers (MSP) are a great way to help you maintain HIPAA compliance. In this episode of Talking with the Toothcop, I talk with Nancy Sabino of SabinoCompTech about technology and protecting patient information. Nancy and her husband founded SabinoCompTech in 2008 out of a desire to help people. They primarily focus on Medical and Oral Healthcare—so she KNOWS the ins and outs of the dental industry. They focus on the “Awesome IT Way” and providing excellent care to their businesses. Listen for some great advice on keeping your dental practice HIPAA compliant. What is a Managed Service Provider (MSP)? I’m going to be honest—you should know what an MSP is, but if you don’t, it’s easily described as an “outsourced IT department”. They offer technical support, advice, cyber-security, cloud services and much more. Your MSP stays up to date on technology so that it’s one less thing that you as the provider have to worry about. This gives you the freedom to focus on what you NEED to do. The IT world is constantly changing, and unless you and your staff are completely savvy in all things technology, I recommend utilizing the services of an MSP. SabinoCompTech is based in Katy, TX but local service providers can be found everywhere. Remediation is ALWAYS more expensive than being proactive People often jump to “how much is this going to cost me?” but fail to consider the ramifications of the cost if something goes wrong. It’s all about prevention! Being proactive allows you to better control costs. An example Nancy gave is that in 2020 Windows 7 will no longer be supported by Microsoft. If you’re still using that operating system, it will no longer be issued important security updates. Would you necessarily know that? Probably not. But your MSP will. If you continue using non-supported operating systems, you open yourself up for security breaches. If you don’t plan now to replace those computers—it will cost you. This year the lowest HIPAA violation will cost you a whopping $25,000. That’s enough to put most small practices out of business! Keep listening as Nancy and I talk about protecting and securing patient information. What baseline technology and security measures should be in place? Nancy was kind enough to share some of the things that you need to have in place for your practice, here are just a few: You need to pay for antivirus software that is updated continually Encrypt any device that can be encrypted in case of theft Your staff needs to be educated on the most common scams Update Windows frequently and make sure the updates go through Have backups of your data set in place and check them DAILY The last point is extremely important—if your computer crashes and you lose all your patient data you need to have it saved elsewhere. This is something your MSP can help you manage and backup daily. They’ll also run tests to make sure the information is not corrupt and can be recovered. The two most common problems that are preventable The first issue is that most dental practices don’t have security risk assessments done. If you don’t know where your weaknesses lie it leaves you more open to security breaches. Nancy’s company offers an annual risk assessment and then work with you to make needed changes to become HIPAA compliant. Remember, prevention costs you far less than cleaning up a patient data breach! The second issue is that many businesses do not have proper policies and procedures in place. How can staff be properly trained on patient security when a comprehensive guideline isn’t in place? They can’t. An MSP can run a risk assessment and actively work with you to develop security guidelines for your practice. This episode is a must-listen if you’re looking for ways to secure patient information and make sure your practice is HIPAA compliant! Outline of This Episode [0:22] I introduce my special guest, Nancy Sabino. [1:40] About SabinoCompTech [6:18] Being proactive allows you to control costs [10:20] Protect and secure patient information [13:30] Baseline for technology and security measures [22:35] Two common issues that are preventable [26:30] Things you can to immediately Resources & People Mentioned SabinoCompTech The Office for Civil Rights Connect With Nancy Nancy Sabino on LinkedIn SabinoCompTech on LinkedIn SabinoCompTech on Twitter SabinoCompTech on Facebook Awesome(at) Call SabinoCompTech at 281-392-8802 Connect With Duane toothcop(at) On Facebook On Twitter On LinkedIn On Youtube

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