I started the Talking with the Toothcop podcast in December 2017. Andrea has been with me since early 2019. We love doing this podcast together. Sadly, it’s time for us to hit the pause button. We will be back—I promise! But we have a lot on our plates right now and it makes sense to pull back temporarily. If this podcast has been rewarding and educational for you professionally, take some time and go back to listen to our episode archive!  Outline of This Episode [0:22] What’s happening in our lives! [4:18] Check out ProEdge Dental [7:01] Sharing some bittersweet news [9:07] Learn more about protectIt dental  Past podcast episodes to check out! Check out some of our most popular and episodes packed with need-to-know information:  Dental Unit Waterlines: the Good, the Bad, and the UGLY (with Mike Rust + Kellie Thimmes The 7 Elements of Dental Compliance Programs How a Compliance Program can Save Your Bacon Sedation Inspections + EPCS + Continuing Education The Importance of Sterilization Processes - Stephen Kovach We’re always here to answer questions, so don’t be afraid to reach out. Until we return, subscribe to our email list!  Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Talking with the Toothcop

An Important Announcement from the Toothcop

I work with dental offices and do a lot of dental inspections/consults. I help people identify what they need to do differently. We talk through OSHA, HIPAA, infection control, radiology, medications, state board compliance, etc. But I get really excited about infection control and sterilization. That’s my stage—my moment to shine. In this episode of Talking with the Toothcop, we’re going to talk about instrument processing and cleaning procedures. Find out what you could be doing wrong and what to do instead! Outline of This Episode [0:49] Time to redo the 75 Hard Challenge! [6:00] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [7:16] What a sterilization room should look like [10:46] Don’t neglect monitoring your ultrasonic [14:37] Follow manufacturers instructions for use [16:45] Other things to note when using your ultrasonic [20:20] Learn more about protectIt dental at https://dentalcompliance.com/drugkit  [21:46] Check out the 2021 Dental Compliance Bootcamp!  What a sterilization room should look like I’ve seen thousands of sterilizations rooms. Some are great, some are poorly designed, and some just don’t shock me anymore. What should it look like? It needs to be physically segregated into different areas for instrument receiving and cleaning, decontamination, preparation and packaging, sterilization, and storage. There needs to be a “cleaned” area and a dirty area. I can’t tell you how often I see cross-contamination issues. When you bring the instruments into sterilization, the rest of the processes need to move in one direction. If you move in the opposite direction, you’re contaminating what’s supposed to be sterile.  Don’t neglect monitoring your ultrasonic A sterilization area contains two major processes: instrument cleaning and sterilization. If you don’t do one part right, it impacts the entire process. There are monitors in place for the sterilizer, color-changing indicators on instrument peel-pouches, and indicator tape on instrument cassettes. They give us visual confirmation of whether or not the sterilization process worked.  People often monitor the sterilization indicators but neglect the cleaning side of the process. You can’t just assume the instrument washer or ultrasonic is working effectively. Just because it sounds like it’s working properly doesn’t mean it is. You need a qualitative test—like a foil test—to make sure that it’s working properly. It needs to be done frequently. When those machines fail, they don’t sound any different. It is not obvious. I don’t love the foil test. What do I prefer instead? An ultrasonic cleaning monitor. It can be ordered through your dental suppliers. Get and use that weekly. Record in your records that it passes inspection. It gives you information on several data points: cavitation, enzyme concentration, and more.  Follow manufacturers instructions for use (IFU) Are you using the correct concentration of enzymes in the ultrasonic? More than half of dental offices aren’t. Whatever product that you use for ultrasonic enzymes, make sure you follow the manufacturer’s instructions for use. People frequently use the wrong concentration, which is why I’m partial to tablets. It’s easier to calculate.  Secondly, people don’t understand the water capacity of the ultrasonic. The box says “one tablet per gallon” so they drop one tablet in, not realizing they have a three-gallon unit. One tablet won’t cut it—you’re off by a lot. I was in an office last week that had a three-gallon ultrasonic and they were putting in one tablet. According to the IFU, they were supposed to be using two tablets per gallon. They should have been using six tablets total!  What’s an easy way to track this? Buy a label maker and print the name of the product and the number of tablets/ounces required each time you fill an ultrasonic.  Other things to note when using your ultrasonic What else do you need to focus on? Run the ultrasonic with the cover on. When the cover is not in place, you’re spewing aerosols of biohazards into the air. If you don’t have a cover, get a replacement. Anything that has moveable parts or hinges must be in the open position before it goes in the ultrasonic. If you’re not doing this, bioburden accumulates in the jaw or hinge. Those parts must be exposed to be adequately cleaned and sterilized.  Cleaning time is important and it varies per dental instrument. Review the IFUs for each individual piece you have as well as peel-pouches and instrument cassettes.  If you run the instruments and find when you’re rinsing them that they’re still dirty, what do you do? Run the cycle again. Fight the urge to manually scrub instruments. You will never do as good of a job as the instrument washer/ultrasonic.  Tune in next week for part II—the sterilization process! Resources & People Mentioned Check out the 75 Hard Program Ultrasonic Cleaning Monitor Check out the 2021 Dental Compliance Bootcamp!  Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Instrument Processing Part I: The Proper Cleaning Process

It’s September! And it’s officially Dental Infection Control Awareness Month! We get you’re probably sick and tired of hearing about COVID and infection control. So guess what? Andrea and I will cover infection control without mentioning COVID, other than right now...We’ll cover getting a point-person in place and written policies and procedures. Check it out!  Outline of This Episode [0:20] Dental Infection Control Awareness Month! [1:20] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [3:02] Every office needs a point-person [6:17] Make sure you have written infection-control protocols [10:31] Learn more about protectIt dental at https://dentalcompliance.com/drugkit  Every office needs a point-person This is an opportunity to use the time we have in Slowtember to review infection control protocols. Every office needs to have an infection prevention coordinator—or OSHA safety coordinator—to oversee all things related to employee safety and infection control. If more than one person is in charge, no one is in charge. Andrea points out that you don’t want to run into a situation where you’re saying, “Oh, I thought you were taking care of that.”  Secondly, you want to make sure if that person leaves their role is reassigned to someone else. If you don’t know who it is, you probably don’t have someone in place. I promise you, there will be someone in your practice who wants to do the role. But if no one steps up, so be it. Someone has to lead the pack and you get to choose who that someone is. But make sure you give them the paid time to get it done. Make sure you have written infection-control protocols You need to have written policies and procedures that establish how you do things. According to the CDC, you need written procedures specific to the dental setting. This includes things like: Procedures for containing respiratory secretions Rules for sick employees Infection control education Policies for immunizations and vaccinations (Hepatitis B, Chicken Pox, MMR, Tetanus, Diphtheria/Pertussis) Safe injection practices for sharps/needles Rules for cleaning and sterilizing contaminated dental instruments Having instructions for use for medical devices and instruments (handpiece, sterilizers, x-ray machines, etc.) Cleaning and disinfection protocols for surfaces Cleanups of chemical spills or bodily fluids Testing dental unit waterlines + water treatment Protocols for the correct use of sterile water  Rules for how to manage boil water advisories A tuberculosis exposure control plan (review the statistics for your country and state) Many dental offices that have a written set of protocols have never read them. That means practices are simply assuming their staff has been trained on these things. Not good. The dentist is expected to have the most knowledge and experience with infection control. Sadly, they’re often the least knowledgeable and experienced. Don’t let that be you! You also want to have a detailed conversation with your staff about these protocols. Does your staff know them? You’re only as strong as your weakest link.  Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It’s available to non-clients (even better, It’s FREE for current clients). Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Dental Infection Control Awareness Month

Did you know that September is National Preparedness Month? So in this episode of Talking with the Toothcop, we share some quick tips your practice can follow to be prepared—for whatever may come. We also share a few ways you can take advantage of “Slowtember” and prep for the year to come.  Outline of This Episode [0:22] Quick tips for emergency preparedness [6:00] Take advantage of Slowtember [11:57] Check out Compliance Bootcamp [12:45] Shoutout to some podcast listeners! Quick tips for emergency preparedness What are some easy things you can do to prepare your practice for emergencies?  Check that emergency lighting (exit signs) are working properly if there’s a power outage. Check your fire extinguishers and make sure they aren’t overdue for inspection. The fire department can do—and will sometimes just walk in—fire extinguisher checks for you. Check your smoke detectors and change the batteries regularly.  Make sure that you perform an annual emergency drill. Have your staff put their John Hancock on a sign-in sheet and keep documentation proving you completed training. If it ain’t written, it didn’t happen. Get out your medical emergency plan and review it with your staff. Make sure that you walk through every part of the process (except calling 911).  Take advantage of Slowtember September is a slow month for many dental practices, so make sure—if you haven’t already—to get your compliance training knocked out. Cover bloodborne pathogens, HIPAA, cybersecurity, etc. If you participate with Medicaid/Medicare, you’ll also need to do your Fraud, Waste, and Abuse training.  Take a few minutes to review everyone’s credentials and make sure they’re up-to-date. You should check CPR certifications, DEA registrations, sedation permits, even your driver's license and vehicle registration. Check anything that has an expiration date on it—both personally and professionally.  What else can you do? Mark your calendar for Dental Compliance Bootcamp 2021! Bootcamp is all things compliance and risk-management related. It’s available to non-clients (even better, It’s FREE for current clients). Resources & People Mentioned Check out ProEdge Dental at https://proedgedental.com/toothcop!  Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Toothcop’s Quick Tips for Emergency Preparedness

In this episode of Talking with the Toothcop, you get a glimpse into the “behind the scenes” of what recording an episode really looks like. From food pranks to our favorite Starbucks orders—every tangent that we usually edit out is on full display. Don’t miss a fun and quirky episode that also includes some important news about our Dental Compliance Bootcamp! Listening may even get you some FREE coffee! Outline of This Episode [0:21] Food pranks: Starbucks + Subway [6:10] Check out ProEdge Dental at https://proedgedental.com/toothcop!  [12:12] Dental Compliance Bootcamp 2021 [20:00] Record-keeping + Compliance Programs + Cybersecurity [27:48] Learn more about protectIt dental at https://dentalcompliance.com/drugkit Learn about Dental Compliance Bootcamp 2021 Bootcamp is coming up, November 19th-20th in Hurst, TX (in the DFW area) at the Hurst conference center. The Hilton Garden Inn is attached to the conference center. We are going to have some hands-on medical emergency training. After attending, dentists will be able to facilitate training for their staff. Secondly, bring your team and run through some scenarios together. Justin Bonner, DDS Board Certified in Oral and Maxillofacial Surgery & Garrett Starling, MD Board Certified Anesthesiologist will be there! (the course instructors for our pain management course)  You’ll get some courses on insurance with Tonya Burns (Pediatric Consultant).  Laura Diamond—a healthcare attorney—will be returning this year. She’ll be presenting in our risk-management and record-keeping course.  The goal is to provide you hands-on clinical training that you can immediately put into practice. This years theme: Record-keeping + Compliance Programs Most of our presentations will center around: We will go in-depth on the nuts and bolts of a corporate compliance program for people who participate in Medicare/Medicaid. We will also complete a mock compliance committee meeting. You’ll learn what you need to talk about and cover in these meetings. Record auditing is a major element of compliance. We’ll cover what you need to audit/monitor, what it looks like, what records to create, and how to solve problems when you run into them. If you have any compliance responsibilities, come and immerse yourself in the experience. It’s not your typical conference. It is hands-on and immersive and you will get to experience everything with us. This is an opportunity to learn great things to apply to your organization. It’s also a chance for you to interact with our clients to decide if we’re a great fit for you. What’s your favorite drink from Starbucks? Let me know at toothcop(at)dentalcompliance.com and I’ll put you in a raffle for a gift card! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Mark your calendar for Dental Compliance Bootcamp 2021 Hurst Conference Center Hilton Garden Inn Hurst Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Lowdown on the 2021 Dental Compliance Bootcamp

Did you know there are specific rules from the Office of the Inspector General (OIG) regarding giving things of value (i.e. gifts) to solicit potential customers? In this episode of Talking with the Toothcop, Andrea and I talk about some of the specific rules on gifts and kickbacks. This is stuff that you need to be aware of so you don’t get hit with penalties and fines for breaking the law.  Outline of This Episode [3:34] The OIG Backpack Rule [11:26] Texas Administrative Code Rule 108.58 [15:25] The anti-kickback statute (42 U.S.C. 1320a-7b) [20:34] Section 259.008 Dental Practice Act [23:03] “But everyone is doing it” [28:08] Dental Compliance Bootcamp 2021 The OIG “Backpack” Rule The OIG released a special bulletin entitled “Offering Gifts and Other Inducements to Beneficiaries.” This advisory from the OIG clarifies how the state interprets and applies the rules and statutes to giving things of value to Medicaid benefit recipients.  While they understand the competitive market and desire of dental practices to differentiate themselves in the mind of potential patients, they must uphold the integrity and fairness of the Texas Medicaid program. Giving gifts may raise concerns among the community and other providers.  The OIG reinforces Texas Administrative Code §371.1669, which prohibits a person “From transferring or offering any remuneration which the person knows or should know is likely to influence the beneficiary’s selection of a provider, practitioner or supplier of Medicaid payable items or services.” The state of Texas has announced that they will enforce more stringent rules than the HHS OIG, including: Providers are prohibited from offering items or services to influence health care decisions. The OIG presumes that any items that do not exceed $10 per patient were not provided to influence their decisions. Likewise, anything offered to a patient must be directly related to dentistry (i.e. a toothbrush, toothpaste, floss, etc.). You are NOT allowed to give patients backpacks and school supplies, even if your intentions are good. We get that it’s back-to-school time and people like to give out back-to-school supplies. Dental providers cannot do that.  You may never offer patients cash or gift cards.  Is it different for non-Medicaid providers? Non-Medicaid providers still have to adhere to the Texas Occupations Code Section 102: Solicitation of Patients, which includes rules about not giving gifts to patients (though it doesn’t explicitly call out backpacks). Can non-Medicaid providers give gifts or do giveaways for current patients? Listen to learn more about Texas Administrative Code Rule 108.58 The anti-kickback rule (42 U.S.C. 1320a-7b) The Anti-Kickback Statute is a criminal law that prohibits the knowing and willful payment to reward patient referrals or the generation of business involving any item or service payable by the Federal healthcare programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients). This includes things like rent, hotel stays, meals, excessive compensation, paying referrals, etc. Physicians or dentists who accept or pay kickbacks will be penalized up to $50,000 per kickback plus three times the amount of the remuneration. Dentists make attractive targets for kickback schemes because you are a source of referrals.  Kickbacks in healthcare can lead to overutilization, increased program costs, corruption of medical decision-making, patient steering, and unfair competition. I hear of offices that offer free or discounted dental care for parents if they bring their children on Medicaid to the practice—which is clearly a violation of Federal law. Taking a kickback can never be justified, even if the service rendered was medically necessary. More of this is coerced in Texas Occupations Code Sec. 259.008 Unprofessional Conduct.  When people say “But everyone is doing it” Some dentists have pointed out to me that there is an unfair advantage because dentists in their community do these things. The temptation to get involved in a scheme like this is high because “everyone is already doing it.” Firstly, don’t do something that everyone else is doing. That’s not how you grow your business (especially with something illegal).  Instead, find out what’s legal in your state (and federally) and then run tests to see what works. It can be as simple as focusing on giving your patients the greatest experience possible. You can make it a memorable and pleasurable experience. How can you take customer experience up a notch? Lastly, if people in your community are doing illegal things, perhaps they aren’t aware. If you have the gumption, you can talk to them about it.  We cover a lot in this episode. Listen to the whole thing for all the nitty-gritty details! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental at https://proedgedental.com/toothcop!  Offering Gifts and other Inducements to Beneficiaries Texas Occupations Code Section 102: Solicitation of Patients Texas Administrative Code Rule 108.58 42 U.S.C. 1320a-7b - Criminal penalties for acts involving Federal health care programs Texas Occupations Code Sec. 259.008 Unprofessional Conduct Mark your calendar for Dental Compliance Bootcamp 2021 Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Backpack Rule: Giving Gifts in Dentistry

Are PMP inquiries required for sedation meds that are dispensed in the office? A listener read through the rules in January 2020 and spoke with a sedation officer and was advised that they did not need to do the PMP check if they were dispensing in the office. But the way the rule is worded makes it seem as though you do need to. So in this episode of Talking with the Toothcop, Andrea and I will cover Chapter 111 and spell out the PMP rule in detail. Hopefully, this will clear up any confusion you may have!  Outline of This Episode [3:43] Rule 111.1: Additional Continuing Education Required [6:24] Rule 111.2: Self-query of Prescription Monitoring Program [7:43] Rule 111:3: Prescription Monitoring by the Dentist [10:51] Breaking down the PMP inquiry rule [12:54] Rule 111.4: Prescription Monitoring by the Board [14:12] Rule 111:5: Electronic Prescribing Waivers [16:51] Subscribe to our email list to stay up-to-date! Rule 111.1 Subsection B: Additional Continuing Education Required According to Rule 111.1 Subsection B, effective September 1st, 2020 every dentist that prescribes controlled substances must complete two hours of continuing education “...related to approved procedures of prescribing and monitoring controlled substances.” This can be taken annually to count toward continuing education. Dentists have found this confusing because many have already taken the course. However, the requirement reset September 1st, 2020. So anyone who completed the two hours of continuing education on controlled substances before that date must retake it before September 1st, 2021. I know several thousand dentists have not yet taken this course. We offer this course on our site—that you can complete at your own pace—so check it out.  Rule 111.2: Self-query of Prescription Monitoring Program Rule 111.2 became effective Dec. 25th of 2016:  “Each dentist who is permitted by the Drug Enforcement Agency to prescribe controlled substances shall annually conduct a minimum of one self-query regarding the issuance of controlled substances through the Prescription Monitoring Program of the Texas State Board of Pharmacy.” Many dentists don’t even have a login for the PMP. You need to do this. The state board of pharmacies can report you and you’ll have to answer for your failure to comply. You will face disciplinary action, which starts with paying a fine and lead to jurisprudence assessment. Rule 111:3: Prescription Monitoring by the Dentist Rule 111:3 became effective March 1st, 2020, and says: “(a) Prior to prescribing or dispensing opioids, benzodiazepines, barbiturates, or carisoprodol, a dentist shall access the patient's prescription drug history report through the Texas State Board of Pharmacy's Prescription Monitoring Program (PMP) Clearinghouse. Failure to do so is grounds for disciplinary action.” The rule goes on to say that an employee of the dentist can do the PMP check when directed by said dentist. The only exceptions? The PMP inquiry does not have to be completed if the patient is diagnosed with cancer or receiving hospice care and it’s noted in their record.  If the dentist cannot do the inquiry due to circumstances outside their control—but has attempted—is not considered to have violated the rule. What circumstances might be outside of the dentist’s control? This would include something like the PMP website being down, your internet is down, etc.  You need to get a process in place, look at the drugs you prescribe, and make sure that you check the patient’s drug history through the PMP before you prescribe opioids, benzodiazepines, barbiturates, or carisoprodol. Administering versus prescribing or dispensing: What Gives? The PMPinquiry rule doesn’t apply to administering these drugs but prescribing or dispensing. Dispensing is giving it to the patient to take it later. Prescribing usually entails the patient picking up the medication from the pharmacy. In both cases, the patient has possession of the controlled substances with the opportunity to take them. A PMP check is not required prior to administering to a patient in your chair immediately. Why? Because you are controlling how it’s administered and how much is administered. So if you're doing in-office sedation and giving it to the patient immediately from your office supply, you don’t need to do the PMP Check. If you prescribe the drug for the patient to pick up and you to administer, then you do need to complete the inquiry before doing so.  We cover a few other pertinent rules in this episode so be sure to listen all the way through! Let us know if you have any questions at toothcop(at)dentalcompliance.com. Resources & People Mentioned Rule 111.1 Subsection B PRESCRIBING & MONITORING PRACTICES Texas Prescription Monitoring Program E-Prescribing Waiver Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental at https://proedgedental.com/toothcop!  Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

PMP Inquiries: Clearing up the Confusion

In this episode of Talking with the Toothcop, I share some sobering news that recently happened in Kansas. I’ll also share some important updates that dentists need to be aware of that were highlighted in the Texas State Board of Dental Examiners Newsletter. Stay up-to-date on the latest dentistry compliance issues—don’t miss it.  Outline of This Episode [0:21] 3-year-old boy dies during dental procedure [3:13] Get your dental unit waterlines tested through ProEdge! [4:30] Electronic Prescribing Waiver [6:03] Texas administrative code Rule 108.7 sub-section 16 [7:44] Tele-dentistry rule (HB2056) passed [12:50] Questions about Rule 108.7 sub-section 16 [14:33] Do dentists prescribe anxiety medication frequently?  [15:26] Learn more about protectIt dental’s emergency medical kit [16:43] The Professional Recovery Network 3-year-old Boy Dies During Dental Procedure A 3-year-old boy in Wichita, Kansas went in for a simple procedure. He was sedated to have some teeth removed after a gum infection. Unfortunately, something went awry during the procedure and the boy passed away after being transported to a nearby hospital. The incident is currently under investigation though it appears there was no wrongdoing.  However, incidents like these are a sobering reminder to have your dental office prepared in case of emergencies. You need a written protocol in place, your team needs to be aware of their role, and it needs to be referenced as often as possible.  Electronic Prescribing Waiver As of January 1, 2021, the Texas Health and Safety Code 481.0755 dictates that “Prescriptions for controlled substances be issued electronically, except in limited circumstances, or unless a waiver has been granted by the appropriate agency.”  The waiver applies to dentists that issue prescriptions for controlled substances—but don’t prescribe many at all. They can apply for a waiver to avoid setting up electronic prescribing. If granted, the waiver allows dentists to write up to 25 prescriptions for controlled substances per year. You can re-apply for your waiver up to 30 days before it expires (it lasts a year from when it’s issued).  Please Note: Many drugs that you may not consider are classified as controlled substances. Do your research and don’t let yourself get caught off guard by this.  Texas administrative code Rule 108.7 sub-section 16 Rule 108.7 sub-section 16 was the COVID rule. It’s now been replaced with what was sub-section 17: You must “Hold a Level 1 permit (Minimal Sedation permit) issued by the Board before prescribing and/or administering Halcion (triazolam), and should administer Halcion (triazolam) in an in-office setting.” Basically, if you want to treat patients with these meds, you must hold a Level 1 permit.  In the newsletter, the featured a question a reader asked, “Can I prescribe or dispense a drug for sedation without a sedation permit?” The answer is no. You have to have a minimal sedation permit to prescribe sedation medications to patients (dosage recommendations in board rules 110.1 and 110.4). Texas Legislative House Bill 2056 Passes The bill passed on June 16th, 2021. But on August 11th at 1 pm, the Texas State Board of Dental Examiners will host a stakeholder meeting to address the specific rules for teledentistry. This is your opportunity to make your voice heard and shape these rules on the front end. What can you do? Look at other state’s regulations and see what they’re doing and what their recommendations are. Too often dentists don’t get involved when they have the opportunity. If you’re not involved, you can’t complain about it! I think we will see rules formed by March.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Get your dental unit waterlines tested through ProEdge! 3-year-old Boy Dies During Dental Procedure The Texas State Board of Dental Examiners Newsletter TWT Episode: Electronic Prescribing of Controlled Substances Texas administrative code Rule 108.7 sub-section 16 https://tsbde.texas.gov/ The Professional Recovery Network Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Texas State Board of Dental Examiners Newsletter [Important Updates] 

A lot of people get the Treatment, Payment, and Healthcare Operations (TPO) Exception wrong. So in this episode of Talking with the Toothcop, Andrea and I dissect what it is. We also talk about what to do if you need patient authorization and the importance of informed consent for treatment. Don’t miss it!  Outline of This Episode [0:21] Coffee + Rom-Coms [4:07] Learn more about ProEdge Dental! [5:24] The treatment exception [10:00] The payment exception  [11:01] The operations exception  [12:14] If you NEED authorization [13:25] Informed consent for treatment [17:49] Learn more about protectit dental! The treatment exception You can communicate with other healthcare providers (i.e. dentists/specialists) to care for a patient (consults, discussions, coordination of care, etc.). Under HIPPA you don’t need authorization from your patient to communicate with healthcare providers regarding treatment. Some state laws are more restrictive. For example, in Minnesota, this does not apply and you are required to get authorization. Federal HIPPA laws allow communication if your state does not have more restrictive requirements.  The payment exception  If Grandma stops by to pay a patient's bill, you may have to follow the minimum necessary principle (that a legal guardian is the only one allowed access to patient information). So you may not be able to close the date of service or the procedure but you sure can take payment. If it’s necessary to state a balance to get paid, it’s perfectly fine.  The operations exception  The operations exception allows dental offices to access and use/disclose their patient‘s information. You don’t need authorization from the patient or legal guardian. How does that look in practice? Duane is allowed to access a patient’s records without them being notified because it’s for compliance purposes.  If you NEED authorization  If you need authorization from a patient to disclose PHI to a third party, there is a form you need them to complete with specific elements that need to be on it. Most information release forms don’t have the necessary information. So what’s needed? It must clearly identify your entity and who you’re allowed to release information to What part of the patient’s record you’re authorized to use or disclose The explicit purpose for the disclosure A notice that informs the patient they have the right to revoke the authorization at any time (this is what most dental offices are missing) A signature on the form by the patient or legal guardian  NOTE: Get familiar with your state's recommendations to make sure they don’t have specific requirements for authorizations. If you’re from MN hit me up at toothcop(at)dentalcompliance.com for a template for the form you need! Informed consent for treatment This seems like an ongoing issue I encounter regularly. Different states have different requirements for informed consent. Common sense dictates—to protect yourself and your practice—you should obtain informed consent from your patients. They should know the potential risks of a procedure and alternative treatments that could be appropriate (including no treatment). They should also be informed of the potential consequences if they choose not to have a procedure done.  If you practice in multiple states, follow the most stringent standard in all of your locations. Then you’ll never run the risk of being out of compliance. In Texas, you need consent for everything that comes with a risk. In Texas, Medicare requires consent for every procedure on the date of service it’s being completed. If you don’t get consent, the insurance companies can recoup what they paid for the services.  Have any good coffee bean recommendations? Send me an email with your suggestions!  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Movie: New in Town HHS Guidance on TPO Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

HIPAA: The Treatment, Payment, and Healthcare Operations (TPO) Exception

Recently, I’ve dealt with some level of confusion surrounding the Hepatitis B vaccinations (HBV) and post-vaccination testing requirements. So in this episode of Talking with the Toothcop, I’m going to cover what both OSHA and the CDC require for the HBV and post-vaccination testing.  Outline of This Episode [2:03] Hepatitis B vaccination requirements in dentistry [5:08] OSHA requirements for post-vaccination testing [10:22] Hepatitis B vaccination recap Hepatitis B Vaccination Requirements When a dental office hires a new person, they need to determine if that person will have exposure to bloodborne pathogens. Front office staff may have exposure in one dental office and others won’t, whereas a clinical staff will have ongoing exposure. It all depends on the activities of your staff and whether or not they’re cross-trained. But it’s not like a bloodborne pathogen follows the rules and won’t cross into an area they’re not supposed to. If a new staff member will likely face exposure throughout their employment, they need to be offered the Hepatitis B vaccination. The employer must: Get a copy of the employee’s vaccination record If the employee declines the vaccination, they must sign a declination form. (i.e. they may have already had the vaccination). Dentists, you must show you offered the vaccination within 10 days of hiring the new staff member. Document your attempt to get the vaccination records. Include all of this in your new hire paperwork.  The vaccination is a three-shot series given over six months. At the conclusion, your staff member’s blood needs to be tested to ensure they’ve developed antibodies for Hepatitis B.  OSHA requirements for post-vaccination testing In a 2000 OSHA response to Christopher S. Taylor, M.D. (a flight surgeon), OSHA stated that: “The employer shall make available the hepatitis B vaccine and vaccination series to all employees who have occupational exposure, and post-exposure follow-up to all employees who have had an exposure incident." (Enforcement Procedures for the Occupational Exposure to Bloodborne Pathogens, [CPL 2-2.69]) In short, according to OSHA, the employer must pay for post-vaccination evaluation and follow-up at no cost to the employee (2 months after the vaccination series is complete).  In 2015, Richard L. Raimondo, Jr. D.D.S, posed two questions to OSHA. Once my employees have completed the 3-dose hepatitis B vaccination series, is there a requirement to obtain a test for hepatitis B antibodies? OSHA responded that, yes, a test is necessary for antibodies (according to the CDC).  Dr. Raimondo also asked if anyone hired before this standard was in effect must be tested for antibodies and offered the vaccination series. OSHA responded that at the time, they didn’t recommend further vaccinations or titer testing for anyone vaccinated before December 26, 1997. However, for anyone vaccinated after December 26th, 1997, they did recommend anti-HBs [titer] testing. Hepatitis B vaccination requirement recap What does this mean for dentists? Determine who needs to be vaccinated. Offer them the vaccination and prove you’ve made the offer (i.e. declination form and vaccination record).  Document, document, document. If it isn’t written, it didn’t happen.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Check out ProEdge Dental for waterline testing! OSHA response to Richard L. Raimondo, Jr., D.D.S OSHA response to Christopher S. Taylor, M.D. Guidance for Evaluating Health-Care Personnel for Hepatitis B Virus Protection and for Administering Postexposure Management Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Lowdown on Hepatitis B Vaccinations + Post-Vaccination Testing

This episode of Talking with the Toothcop is a two-parter! In the first half, you’ll get a look behind the curtain and get to know me—Duane Tinker—and my co-host, Andrea Baysinger. In the second half of this episode, we share an important reminder about nitrous oxide compliance rules. Don’t miss it!  Outline of This Episode [3:01] How Andrea became my co-host [6:05] I’m an introvert—until I take the stage [8:09] Andrea is an introvert disguised as an extrovert [9:29] Country versus city living (who is who?) [12:22] Raising Australian Shepherds on a ranch [13:05] Dentists that administer nitrous oxide [14:31] How dentists get busted for lack of compliance I’m an introvert—until I take the stage I am an introvert. I’m like Sylvester Stallone (Hawk) in the Movie “Over the Top.” Hawk is a professional arm wrestler preparing for a national event in Las Vegas. At the end of the movie, Hawk is interviewed. He said that before he steps in the ring, he turns his hat backward and it’s like he turns his face and becomes a different person. That’s how I feel when I’m about to walk on a stage and speak. I’m a shy wallflower until I take the stage.  Andrea is very talkative and is a self-proclaimed social butterfly. But she believes it’s just a different version of her. She has a degree in English and loves writing and being introspective. So she’s at her best when she’s chosen to be alone. She feels at peace. She recharges, then gets back out with people.  Country living versus city living My wife and I have a ranch and sometimes I’ll go weeks without leaving it. We’ve got everything we need here (including fast internet). Andrea grew up in the country, too, in a small town of 1,500 people. She thought she was going to stay there for life but she followed her brother to Texas. She packed everything in her Maxima, got a part-time job within two weeks, and has been here for almost 8 years. She’d never in a million years thought she’d end up in a field close to healthcare and now she can’t imagine anything else (including living in the country again).  My wife and I have 6 Australian Shepherds, five of which are related. We have a lot of livestock (sheep, goats, ducks, and geese) because my wife does competition herding with her dogs. Supporting my wife in training the dogs is my extracurricular activity. Plus, there are always things to do around a ranch.  Dentists that administer nitrous Switching gears, I’ve been getting a lot of calls and emails from dentists who are shocked about rules that have been in place for three years now. Many dentists are way out of compliance and don’t know where to start.  How are dentists getting busted for lack of compliance? The state only does inspections for those with level 2, 3, and 4 sedation permits. Those who are administering nitrous will never be inspected for that. But let’s say a new patient comes to see you for a second opinion. You prepare a treatment plan, make your recommendations, and the patient decides to go with you for treatment.  Six months down the road, you get a letter from the state board. They want to copy the patient’s record and the dentist’s emergency plan, and the dentist has no idea what they’re talking about. Nine times out of ten, it’s a complaint against another dentist. That’s how dentists get busted for not having emergency plans. It’s how the conversation starts with me.  Dentists who administer nitrous: What you should be doing What do you need to do? You need to have a written emergency plan in place and train your staff on that plan. You need an AED, stethoscope, blood pressure cuff, backup suction unit, and emergency oxygen unit. Most of the dentists that are calling me had no clue. Luckily, it’s an easy fix.  The takeaway? Be in the know. Get the newsletter from your state licensing board. Visit their website frequently for important information and updates. Get on our email list. We’ll inform you of new rules and regulations. Something is always changing and impacting dental offices. Need help with compliance? Give me a shout! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Over the Top with Sylvester Stallone More information on sedation inspections Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Get to Know Duane Tinker + Andrea Baysinger

 In our last episode, we talked about how the Texas State Board allowed their COVID-19 rules to expire. We think it’s a good thing! But a lot of dentists are not happy about it. So in this episode of Talking with the Toothcop, Andrea and I dive a little deeper into the topic. We’ll share why we think it’s a good thing and what dentists can do moving forward.  Outline of This Episode [2:51] The feedback on the COVID-19 rule expiration [5:22] You can continue what you were doing [8:10] Dentists are encouraged to follow CDC guidelines [11:00] Let us know if you have any episode requests! The feedback on the COVID-19 rule expiration I’m not entirely surprised dentists aren’t happy with the expiration of the rule. Many dentists want to know what they have to do—they like structure. I thought it was a beautiful thing that the state board was allowing dentists to take the reins again.  But a large cross-section of dentists like the comfort of being told what to do. I don’t entirely understand. I get that you want to focus your energy elsewhere. But I like to be recognized for my ability to think, reason, and make my own decisions. Not everyone feels the same way as I do.  Oddly enough, there were a lot of gray areas when regulations were first announced last year. Dentists wanted clarity. Now they’ve taken clarity away again and it can be overwhelming. So what can you do? Continue what you were doing We want to be clear. Just because the Texas state board allowed their COVID-19 rules to expire does not mean you have to stop following them. If you—and your patients—were comfortable with the level of safety it afforded you, then by all means stick with it. Work within your comfort level.  However, I believe you need to get comfortable stepping outside of your comfort zone. It’s how you grow. You learn to trust your instincts and your ability to trust your own decisions. As a dentist, you’ve earned respect and you’re recognized as someone qualified to make tough decisions beyond the average person (when it comes to oral health). But everything that pertains to your patient’s health is your responsibility. Don’t be afraid to do your own research and make your own decisions. Dentists are encouraged to follow CDC guidelines The state board encouraged dentists to follow CDC guidelines but did not instruct them to. It sounds like this governing body understands it’s stressful, so if you want guidance, you can continue to follow the CDC recommendations. But they are giving you room to make your own interpretations. By the tone of the ruling, there is flexibility and forgiveness if you get something wrong.  Any recommendations for requests for our next topic? Let me know at toothcop(at)dentalcompliance.com! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 CDC Guidance for Dental Settings Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Diving Deeper into the COVID-19 Rule Expiration

The Texas dental board let the COVID-19 rule expire (rule 108.7 subsection 16). How does that impact dentists moving forward? What rules do some providers still need to follow? What procedures are still recommended by the CDC? We cover it all in this episode of Talking with the Toothcop!  Outline of This Episode [3:20] The impact of the expiration of the COVID-19 rule [4:41] The OSHA Emergency Temporary Standard [9:25] 1910.504: The Mini Respiratory Protection Program [16:35] Subscribe to the podcast and sign up for our newsletter! The impact of the expiration of the COVID-19 rule How does this impact you? Maybe very little. There is no longer a Texas State Board rule that says you have to follow these specific rules. You don’t have to wear N95 masks. You don’t have to do twice daily temperature checks. You don’t have to screen patients and check their temperature. But many of you have gotten used to the process and feel like it’s best to continue. You absolutely can! You get to decide how to care for and keep your patients and staff safe—whatever that looks like for your practice.  The OSHA Emergency Temporary Standard There is an OSHA standard—the “Emergency Temporary Standard”—that was released a few weeks ago and was effective immediately upon release. That means it is an enforceable federal law. Who is impacted by this law? Those who work with people who are suspected of having or confirmed to have/had had COVID-19. This can include employees at: Hospitals Nursing homes Assisted living facilities Emergency responders Home healthcare workers Employees in ambulatory care facilities It does not apply to non-hospital care centers where non-employees are screened before entry and those with COVID-19 are not allowed to enter. So if you screen everyone that walks in the door, this rule doesn't apply to you.  If it does apply, you must have a written safety plan, patient screening management, transmission-based precautions, PPE, physical distancing, and more. What qualifies as screening? Listen to find out! OSHA Standard 1910.504: The Mini Respiratory Protection Program When respirator use is required, the respiratory protection standard applies. This requires medical evaluations, fit testing, a written safety program, user seal checks, and training. What does the “mini” version require? User seal checks and proper training. 90% of dental offices are already here.  CDC COVID-19 guidelines are still recommended The state board still recommends finding the CDC guidelines: Postpone procedures if they aren't medically necessary Implement Teledentistry and Triage Protocols (doesn’t apply yet)  Screen and triage everyone entering for signs and symptoms of COVID-19 Monitor and Manage Dental Healthcare Professionals (if you’re sick, stay home) Create a process to respond to COVID-19 exposures among DHCP and others Implement universal source control measures Encourage physical distancing Consider COVID-19 testing for patients and staff who don’t exhibit symptoms (we recommend you don’t do that) Do things to minimize exposure Implement universal use of PPE Familiarize yourself with this stuff! Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! The expiration of the COVID-19 Rule Texas Dental Board Rule 108.7 Subsection 16 COVID-19 Healthcare ETS The Mini Respiratory Protection Program CDC Guidance for Dental Settings Save the date for bootcamp: Nov. 19th and 20th Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

The Expiration of the COVID-19 Rule: How Does it Impact Dentists?

Are you doing proper sedation and anesthesia reviews? Are you making sure you don’t have drugs sitting in your office that expired pre-COVID? Are you checking with a patient’s primary care provider before administering anesthesia? Being busy and overwhelmed isn’t an excuse for not doing your due diligence. In this episode of Talking with the Toothcop, Andrea and I touch on the importance of doing a proper review.  Outline of This Episode [4:09] Sedation and anesthesia reviews [8:49] Upcoming anesthesia course Check for expired drugs and equipment I’ve done a lot of sedation and anesthesia reviews in the last few months, and I can tell that some offices have been quite distracted. Those that have been quite busy aren’t staying on top of the things they should, like an annual inspection of the sedation process and equipment reviews. As a result, I’m finding a lot of expired stuff. They’re lucky I found it—not the state board. You need to be routinely checking to make sure you’re not storing expired drugs.  Sedation and anesthesia reviews You also need to be diligent in your patient screening and selection for anesthesia. Don't overlook even the slightest detail. Get the proper medical consultations done versus just getting medical clearance. “Medical clearance” is not an absolution of viability for you. You can’t just exchange paperwork with their primary care physician. Take the time to document the conversation in your clinical notes (with great detail).  Take your pride out of the equation. Even if you’ve done something 1,000 times, there may be one time something goes wrong. If you can’t prove you’ve done your due diligence and properly screened your patient, you won’t have a leg to stand on. Err on the side of caution. If a conversation happened—but it’s not in your records—it didn’t happen.  Upcoming anesthesia course We have an anesthesia CE course coming up on June 5th from 8 am to 12 pm central, but open to anyone across the US. The course is “Principles and Practices of Dental Office Anesthesia,” taught by Dr. Justin Bonner and Dr. Garrett Starling. If you’ve done the same anesthesia course, change it up. Hearing the same thing from a different perspective might impact you in a more meaningful way. Learn more by clicking the link in the resources! Call to action: When you get to your office, check the expiration dates on your emergency drugs and all of your equipment. Make sure they aren’t expired.  Resources & People Mentioned Learn more about protectIt dental at https://dentalcompliance.com/drugkit or call them at 888-878-8916 and tell them that the Toothcop sent you! Principles and Practices of Dental Office Anesthesia: https://dentalcompliance.com/products/live-anesthesia-principles-and-practices-of-dental-office-anesthesia Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Don’t Neglect Your Sedation and Anesthesia Reviews

Last week, I read an article about an oral surgeon in North Carolina who got busted after a patient died. So in this episode of Talking with the Toothcop, we’re going to talk about what happened, why it happened, and how it could have been prevented. This isn’t to shame the dentist or staff involved, but to learn from the mistakes that were made. Tragedies in the dental office should never happen.  Outline of This Episode [0:22] Death in the dental office [8:50] Get professional help before it’s too late [13:45] The Professional Recovery Network  [18:21] Your patients may not trust you anymore [20:20] The current action being taken [24:15] Upcoming CE courses Death in the dental office According to the article Leland oral surgeon suspended by Dental Board, under investigation by SBI for drug misuse, Dr. Mark Austin had his license suspended following an investigation by the State Board of Dental Examiners. The patient in question came in for an appointment to receive a dental implant. The doctor administered sedatives before and during the procedure. Unfortunately, the patient’s oxygen saturation dropped significantly, and after attempting to place an endotracheal tube, 911 was called. The patient died a few days later in intensive care.  This prompted an immediate investigation by the dental board. The DEA and state board combed through this dentist’s practice. Even worse, in an earlier audit, the doctor couldn’t account for substances that were supposed to be maintained at his office, including Fentanyl. The investigation also alleges that he used illicit substances personally for two years while practicing.  The patient was at 60-70% oxygen for 20 minutes. Brain death happens when it’s deprived of oxygen for 4–6 minutes. When EMS arrived, the patient didn’t have a pulse. The Dr. had not administered CPR prior to their arrival. His brain was deprived of oxygen for far too long, and he suffered irreversible brain injury and died 4 days later.  Get help—or get busted If you or someone you know is struggling with a drug or alcohol problem, get help. It can be done anonymously before you impact your patient’s lives. Because when a dental board gets involved, they’ll issue an emergency suspension which creates a public spectacle. This situation is attached to Dr. Austin’s license for the rest of his life. Every insurance company he attempts credentialing with will know. Some won’t take the risk. If someone had recognized he had a problem it could all have been prevented. It’s hard to get help. But when you do, you go to a special rehab just for doctors. You’re there with other dentists or physicians in recovery. You avoid a public stigma while getting acceptance and support. This isn’t about shaming dentists, it’s about getting them help.  It’s sad that a world-renowned cardiologist—someone who devoted his life to helping people—lost his life in a preventable situation.  You have a moral obligation to protect your patients Someone had to have seen the signs in this doctor and did nothing. You can’t hide a drug addiction for over a year. If you work with someone who is struggling, you have an obligation and responsibility to report this behavior. You’re either part of the problem or part of the solution. The staff had a moral and ethical obligation to make a decision. They didn’t make the right one.  The proper training and preparation for something like this could have prevented someone’s death. This is why we’re talking about this. Dental offices need to be taught the right way to do things. A reasonable person should ask, “What could I have done to prevent that?” Sadly, these staff members will carry guilt with them for the rest of their lives.  The current action being taken The dental board received information that Dr. Austin had prescribed controlled substances for staff members—outside the scope of dentistry. The board also received evidence that he was unable to account for controlled substances and had been taking them for two years. In a nutshell, he agreed to a suspension of his license.  Resources & People Mentioned Leland oral surgeon suspended by Dental Board Professional Recovery Network (Texas) Consent Order Suspending License Dental Compliance CE Courses Connect With Duane https://www.dentalcompliance.com/ toothcop(at)dentalcompliance.com On Facebook On Twitter On LinkedIn On Youtube 

Death in the Dental Office: Avoid Tragedy with Proper Training

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.

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Talking with the Toothcop

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