If It’s a Scary World Out There, What You Must Know?
I’m generally not an alarmist and choose to look on the bright side of almost every situation. However, there are times when this view of the world, through rose-colored glasses, could lead to disaster. As I speak to groups of dentists and to dental students at many of the dental schools across the country I have noted a disconnect. There are many speakers, writers and consultants who say, “I don’t want to scare you.”Just so you know, I’m not that guy. Not only should you be scared, you should be terrified. But only if you choose to ignore the dangers and fail to implement the systems necessary to address the concerns.

Ultimately, there must be an overarching focus on compliance in every practice to insure the right thing happens consistently and that there are programs in placed that identify errors and thereby lead to improvements that elevate treatment results and overall outcomes. It’s very important for any new graduate to both understand the pitfalls that exist but also be equipped to recognize and avoid them.
So, what must you know?

Doctor, you are ultimately responsible for everything that happens in the office, even if you are not directly involved in the process or even aware of the action(s) taken by staff on your behalf. That means that OSHA compliance, HIPAA Compliance, Human Relations (HR: hiring and firing), claims submission, coding, documentation, accounting as well as treatment outcomes, conforming to contractual agreements … and this list is not exhaustive I know that’s daunting for a new dentist and new business owner, but it’s the reality and you should have a healthy appreciation for what can happen if these requirements are ignored.

Doctor, you are being monitored on multiple levels and by multiple entities. This is a given in the world we now reside. There are regulators that keep an eye on every single aspect of the dental practice to insure compliance. In my world and area of focus, insurance carriers use sophisticated software that can compare the submission histories for every doctor in the U.S., whether you are in or out of network. Boards are concerned with documentation to the extent that it must meet a specific standard and include some basic information to meet the standards established. Malpractice actions are at an all-time high.

Doctor, there are consequences should you choose to ignore the dangers and conduct your practice in a way that does not meet the requirements established and are non-compliant. The consequences could begin with a “slap on the wrist” and move all the way up to the loss of your license or even incarceration. I know what I’m talking about here!

Doctor, ignorance is excuse. The doctor, in today’s practice, no matter how long they have practiced and regardless of the training received during dental school or in the years since graduation must understand the risks, know how to run the business and how to maintain compliance if they expect to steer clear of the dangers that exist and to be able to practice without fear.
So, what must you do?

Learn: Knowledge is power and can also be the first step in implementing systems that protect and defend the practice against any complaint or regulatory action against the practice. Before one can prepare for battle, one must first know the enemy. As the doctor, this information can be gained by paying attention to the chatter. Most state and national associations have newsletters and/or journals that can help to alert the memberships and the professions of potential pitfalls and alert you to the changes before they become a concern.

There are chat rooms and message boards that openly discuss what’s going on in the “Real World.” It will be important to ignore the little voice inside that says, “That’s never going to happen to me.” I understand, as a student, you have many other concerns that take precedence over these issues. However, once you graduate, this issue must become a primary concern, so it would be to your benefit to begin the learning process before reality hits. Actually, today would not be too early to begin this leaning process and by reading this article, you have.

Lead: Be proactive, not reactive. Doctors, you must take the lead in the compliance process whether owner, associate, or some other professional arrangement. The leadership process begins by sharing the concerns with the team and by stressing “what’s in it for them” before the regulators come knocking at the door. It would be very important to share with the staff the benefits to the patient, to the practice and for them when systems are implemented to address any potential issue. Most quality assessment/quality improvement programs tie directly to patient care and to improving outcomes for the patients. Many aspects of a sound compliance program are designed to protect the privacy and safety of the patient as well as protect the staff. It is important to share with the team that many of the regulations and laws that govern the practice of dentistry also pertain to the staff. In many instances, the staff member can be held equally accountable if there is an action against the doctor.

Establish the expectations: Before any plan can be implemented, the first step is to establish the expectations (requited results). OSHA and HIPAA regulations very specifically establish the expectations and requirements to maintain compliance. Those standard have already been established. Adhere to them. Although many standards have been established by a government/regulatory entity, many other areas of the practice, the expectations can vary.

For example, the clinical documentation required to meet the standard of care in a particular area may vary and the regulations established by the dental practice act by the state may vary from another state’s. It’s important that the doctor understand and set the standards in a way that meet or exceed any regulatory requirement associated with the area of the practice and/or standard of care. If the standard has not been set by the regulating entity, the doctor must then establish the expectations of the result(s).

Education and Training: Once the standards and expectations have been established, there must be an investment made to educate and train the entire team to meet or exceed the standard established. Any chain, as you probably already know, is only as strong as the weakest link in the chain. Every member of the team must be aware of the expectations of them and they must fully understand the system and the part they play in insuring the expectations are met. It would be unreasonable to expect an acceptable result from an individual who is inadequately trained and who does not understand the expectations, or what they must do in the process to achieve the expected result. Doctor, if you are willing and able to learn enough to provide this education, go for it. If not, outside help may be necessary to provide education and training to the doctor and staff to become and maintain established standards.

Monitor: Once the system has been implemented, the outcomes must be continually monitored to insure that expectations are being met. What is monitored improves, period. If you expect a system to lead to improvement and/or to compliance to the practice’s established expectations, the outcomes must be monitored, reviewed and compared to previous results and to the ultimate expectation.

Improve: By monitoring the systems, results can then be compared system by system. Celebrate when improvement is noted. Doctor, it’s always important to catch the team member doing something right and acknowledge it. When positive feedback is given for a particular behavior, studies show, then that behavior is repeated. Is the expectations are not being met and/or the needed improvement is not recognized, review the system and identify where the wheels came off and rework/revamp the system.

Repeat: Once an improvement program of this type is implemented to address one particular area of concern the same principals can be used to address other areas of concerns in the practice. The improvement process is truly never ending.
This entire process is often referred to as quality improvement/quality assessment (QA/QI) and has been a successful system used in medicine for a number of years to address concerns and to lead to more positive outcomes. The bad news is that dangers do exist. The good news is that you can be prepared for any of the potential pitfalls and rest easily at night by being proactive and implementing the appropriate compliance programs into the practice.

You do not have to live in fear if you choose to address the concerns proactively. I am not being alarmist, but I am a realist. You are soon to be living in the professional world of dentistry and can choose to begin your practice life on the right foot. The right choice will help you have a long and uneventful career in dentistry. Should you choose to ignore the dangers and be unwilling to implement systems in your practice to identify correct potential problems, there could be significant repercussions.

Dr. Shelburne graduated from the University of Virginia with a double major in Biology and Religious Studies in 1977. He went on to graduate with honors from Virginia Commonwealth University’s Dental School and opened a private general practice in Pennington Gap, Virginia, in 1981. He and his family have served as short-term volunteer missionaries with the Baptist Medical Dental Missions International and on various Mission of Mercy projects in Virginia. In March 2008, he surrendered his dental license after being convicted of healthcare fraud and spent 19 months in Federal Prison and 2 months in a halfway house. Dr. Shelburne is a nationally known speaker/writer/consultant and an American Dental Association Subject Matter Expert who openly shares his mistakes, what he learned as a result, and how to avoid those career ending errors. “It is a wise man who learns from his mistakes, but a wiser man still that learns from another’s.