Ga Dental - CDDS - Issue

Hey Lindsay,
One of my classmates emailed me a response from the Georgia Academy of General Dentistry for their stance against the CDHC. You may want to link this argument for use with some of the delegates that are leaning toward supporting the CDHC.

John

---------- Forwarded message ----------
From: Dr. Neal Morgan <nmorgan0135@yahoo.com>
Date: Oct 5, 2008 10:10 AM
Subject: Fw: Re: I oppose ADA Resolution #39
To: John Kuo <jckuodmd@gmail.com>, Michelle Konwick <mpkonwick@yahoo.com>

Here is some more info from GAGD.

--- On Sat, 10/4/08, Carol Wooden <cawooden@mindspring.com> wrote:

From: Carol Wooden <cawooden@mindspring.com>
Subject: Re: I oppose ADA Resolution #39
To: "Michelle Crider" <michelle@gagd.org>, nmorgan0135@yahoo.com
Cc: "Carol Wooden,DDS" <cawooden@mindspring.com>, "Robert McGee,DMD" <drbobandconnie@gmail.com>, lasaj@gagd.org
Date: Saturday, October 4, 2008, 1:16 PM

I apologize if this comes through twice. It looks like it did not send.
The delegates own verbiage is a good argument. If the CDHC (or other midlevel provider) "cannot be taught how to diagnose, tx plan and think their way through complications that may arise without the education that a dentist possesses", then how can they be taught to do restorative procedures and "uncomplicated" extractions which are stated in the training program? If the CDHC are being trained to go into areas where dentists do not exist, and that is the reason for the program, then to what dentist are they going to refer them?

I cannot diagnose a problem for a patient over the phone to tell them they need a "simple" restorative procedure, or an "uncomplicated" extraction. I cannot tell you that I never run into more than I thought I would with a patient's care that requires me to be more trained to handle the situation as it turns out, not how it started. How is a dentist expected to diagnose over the radio for the CDHC? When is the "simple" procedure aborted and referred? How is this done?

This has been labeled as a "midlevel provider" from the beginning and still is. That is regardless of how the ADA wants to spin it at this point. If we were, indeed, talking about a training program that referred the patient to a dental team, it would potentially be a good thing, but we are not. If we were, indeed, talking about a paper-pusher and oral hygiene trainer, it would be a different thing, but we are talking about more than that. We are talking about a midlevel provider that could change our landscape forever. There are many actions in the AGD white paper on access that could be accomplished without risking the patient's care, without developing a tiered system of care where poor or remote patients get different care than other patients. Has the delegate read these options?

There is also a resolution coming from the fifth district, basically for more study. At the very least, this should be done before we spend another 5 to 8 million dollars of our dues dollars on something that may not work, and worse, could backfire. I am a long-time member of the ADA, and plan on staying that way, but I do not want the ADA to spend 8 million dollars of our money on a program that potentially could hurt my patients, or me. The original 2 million that was spent was, in part, meant to show other groups that we put our money where our mouth was in trying to solve an access problem in Alaska. Perhaps the fact that we don't see other groups jumping on to help fund should give us a hint on the viability or risk of this.

These are 3 talking points from the steering committee to refer to:
ADA argument: "The CDHC is not a mid-level provider."

Rebuttal: In the 2007 Call for Letters by the ADA, the CDHC was directly called as; "the new mid-level allied dental personnel." Also, in Congress, the ADA supported legislation; H.R. 2472, the "Essential Oral Health Care Act of 2007," the CDHC is called; "a new mid-level allied dental professional who will work in underserved communities where residents have no, or limited, access to oral health care." This is proof that the ADA has not been consistent in its communication to the leadership and membership as to the specific designation of the CDHC. The definition changes to suit the need of those supporting the plan.

ADA argument: "The CDHC would be under the supervision of a dentist."

Rebuttal: If the problem is that there are not enough dentists in underserved areas, how is it possible that the proposed entity (CDHC) that will be going into the underserved area, and performing irreversible dental procedures, will have the supervision (general or remote, if existent at all) of a dentist?

ADA argument: "The ADA Workforce Task Force has already carefully evaluated the proposal and has found it acceptable."

Rebuttal: The 2006 Workforce Report never defined what constitutes a "midlevel provider" in dentistry. It did not consider differences between dental and medical delivery systems as related to utilization of midlevel providers. And, it was developed without an acknowledged definition of "access to care"……... the very problem that the 2006 Workforce document was supposed to be solving!

Hope this helps!
Carol

-----Original Message-----
From: Michelle Crider
Sent: Oct 3, 2008 1:44 PM
To: nmorgan0135@yahoo.com
Cc: "Carol Wooden, DDS" , "Robert McGee, DMD" , lasaj@gagd.org
Subject: Re: I oppose ADA Resolution #39

Dr. Morgan,

Thank you very much for forwarding Dr. Versman's response. I have cc'd GAGD President, Robert McGee, DMD, FAGD, and AGD Region 19 Director, Carol Wooden, DDS, MAGD, in this email. Perhaps they can give you additional talking points.

We appreciate all of your efforts. Keep us posted if you receive additional information from Dr. Versman, your colleagues or other ADA Delegates. We will continue to send updates as information comes our way.

Best regards,

Michelle

Michelle Crider
Associate Executive Director
Georgia Academy of General Dentistry
2711 Irvin Way, Suite 111
Decatur, GA 30030
404.299.7987 Phone
404.299.7029 Fax
www.gagd.org

On Oct 3, 2008, at 1:23 PM, Dr. Neal Morgan wrote:

GA AGD,

I am fowarding a response from a delegate from Vermont who supports CDHC. I have been debating with him with no luck.

Regards,
Weldon Neal Morgan, DMD

--- On Fri, 10/3/08, VERSMAN@aol.com <VERSMAN@aol.com> wrote:

From: VERSMAN@aol.com <VERSMAN@aol.com>
Subject: Re: I oppose ADA Resolution #39
To: nmorgan0135@yahoo.com
Date: Friday, October 3, 2008, 12:50 PM

Weldon,
How do you feel about hygienists who do gingival curettage, treat subgingival areas with a laser, etch teeth and place a sealant, give local anesthetic, administrate and/or monitor nitrous oxide and dental assistants who place and carve amalgam and remove subgingival cement?

I am just trying to get to understand your thoughts. The CDHC will not be doing any of these treatments. They will be under the supervision of a dentist and well trained. Don't you believe that with appropriate training individuals with good hand-eye coordination can be taught simple procedures. What they cannot be taught is how to diagnose, tx plan and think their way through complications that may arise without the education that a dentist possesses. I admire your passion but I am not sure you have heard the unbiased story of the CDHC. I until I heard it (very recently) I was not so sure I supported the CDHC concept but I am now on board. There is truly nothing to fear for well trained individuals going out into areas where there are NO dentists and helping people understand their dental needs and directing them to the care of a dentist.

We may agree to disagree, or just disagree but I do thank you for your concerns.

Wishing you the best,
Ken Versman

	Dear Colleagues, Please contact your ADA leaders (emails) across the US (before the ADA Annual Meeting in San Antonio) and ask them to support Resolution#35 "The Academy of General Dentistry (AGD) White Paper on Increasing Access to and Utilization of Oral Health Care Services" instead of the (Resolution #39) ADA program to establish a new mid-level "dentist" called a CDHC. Read explanation below in Ty Ivey's letter to you all. Thank-you, - Lindsay
	from Ty Ivey 9-19-08 To the members of the Central District Dental Society, As per the request from last night's meeting, I am writing you about the concerns that face the ADA delegation and what you can do to help if you agree with my assessment of the facts. I will represent the following to you as my opinions. This is for legal reasons. However, please remember that my opinions have been formulated on this issue by serving as your Delegate to the ADA for 15 years, as a member of the ADA Council of Government Affairs for four years and on the Alaska Task Force for three years. There are those who think that I am crazy. You will have to form your own opinion of that as well. One of the main concerns here is that across the country, very few districts are as well informed as you are and you are aware that you don't have all of the pieces to the puzzle. What is going on in dentistry today has been growing for approximately 10 years and the Executive Director for the ADA for the last 8 years has in my opinion aided these efforts (and he was recently dismissed). First there was the Alaska Dental Health Therapist. Short form of the story: After 18 months training in New Zealand, 18 people have been trained to work in the bush of Alaska... performing supposedly under the supervision of a dentist ( via teleconference ). These high school graduates can perform operative procedures including Stainless Steel Crowns. They can extract teeth and perform the duties of a dental hygienist on (supposedly, just) children and on adults in emergency situations. The ADA copped out on the lawsuit to stop this illegal practice of dentistry promoted by the US Public Health Service by settling the case and paying over 1/2 million dollars for a seat of the controlling board of this entity. This seat has still not been filled after over a year. This is because the Alaskans seem to have changed their minds about allowing the ADA any input. After this, the ADA decided that we needed to counter with "our own" mid level provider. It is a long story how we got to this place in time and you have to buy the wine to hear the whole story. However, we (ADA) are working on the establishment of a mid level provider called a CDHC - Community Dental Health Coordinator (so stated by the Pres of the ADA, Dr. Kathleen Roth, in her testimony to Congress.) After spending over $2 Million, the ADA is asking the HOD for approval of $5 Million more to finish creating this program and to train 18 people. The success of this new level of dental provider (Think of Medicine's confusing multi-levels of care ) is gravely in doubt. You must understand that the mood of the country is to do something, and I have reluctantly caved in to agree that we should work with the EFDA (Expanded Duty Dental Assistant) model that is already in use in several states. I want to make it clear that I believe that we should train more dentists and let the dentists do dentistry. But that is another bottle of wine and you are buying. For those who want more details, the AGD White Paper is posted on-line here: http://www.pagd.org/AccesstoCareWhitePaper_PassedHOD2008_FINALwCover-7-31-08.pdf It supports the position of EFDA's instead of the Community Dental Health Coordinators. This White Paper written by the AGD has given us one LAST chance to try to get the ADA headed in the right direction now that the aforementioned Executive Director has been fired. HERE IS WHAT I HOPE THAT YOU WILL DO: 1 - Write your ADA delegation - all of them. They are in your source book. The GDA can help you with e-mail addresses ( GDA toll free 800-432-4357 ). Ask them to oppose the CDHC model and in stead support EFDA's and also ask them to reject the $5 Mil funding for the CDHC. The Resolutions that involve these are #35 ( the CDHC Model ) and #39 for the funding. 2 - Then call your friends across the country. (Here are some emails for many ADA Delegates) They will probably not know anything about this. However, you may run into one of those people who think that I am crazy. Don't argue with them. Just get off of the phone. If your friend is upset and agrees with you, ask him/her to start their own chain of calls. NOTE THAT I AM ASKING YOU TO CALL NOT E-MAIL THESE PEOPLE. E-MAILS GET INTO THE WRONG HANDS AND GET MISINTERPRETED. So please call out of state. If you have any questions, send me an e-mail <tyivey@juno.com> or call my house at 478-474-5911 and leave a message if I am not at home. 3 - This is critically important. Because if the wrong resolutions pass on this subject, there will be no going back and we will have jumped off of the cliff to imitate the medical model. There will be no return after San Antonio. Thanks for you help. It is your association. Only you can save it, because the Delegation will fail without a ground swell from the grassroots. Ty tyivey@juno.com

	ADA Delegates emails
	Here is a comprehensive list of emails to forward your opposition for the mid level provider bill at the ADA meeting in San Antonio. The states with only one email will forward your message to their delegates. Click-Here
	A Big Thanks! to Dr John C Kuo <jckuodmd@gmail.com> for helping to assemble this information.

	WHITE PAPER ON INCREASING ACCESS TO AND UTILIZATION OF ORAL HEALTH CARE SERVICES
	from the Academy of General Dentistry
	click above for the White Paper

	More Discussions and/with some Disagreements
	Hey Lindsay, One of my classmates emailed me a response from the Georgia Academy of General Dentistry for their stance against the CDHC. You may want to link this argument for use with some of the delegates that are leaning toward supporting the CDHC. John ---------- Forwarded message ---------- From: Dr. Neal Morgan <nmorgan0135@yahoo.com> Date: Oct 5, 2008 10:10 AM Subject: Fw: Re: I oppose ADA Resolution #39 To: John Kuo <jckuodmd@gmail.com>, Michelle Konwick <mpkonwick@yahoo.com> Here is some more info from GAGD. --- On Sat, 10/4/08, Carol Wooden <cawooden@mindspring.com> wrote: From: Carol Wooden <cawooden@mindspring.com> Subject: Re: I oppose ADA Resolution #39 To: "Michelle Crider" <michelle@gagd.org>, nmorgan0135@yahoo.com Cc: "Carol Wooden,DDS" <cawooden@mindspring.com>, "Robert McGee,DMD" <drbobandconnie@gmail.com>, lasaj@gagd.org Date: Saturday, October 4, 2008, 1:16 PM I apologize if this comes through twice. It looks like it did not send. The delegates own verbiage is a good argument. If the CDHC (or other midlevel provider) "cannot be taught how to diagnose, tx plan and think their way through complications that may arise without the education that a dentist possesses", then how can they be taught to do restorative procedures and "uncomplicated" extractions which are stated in the training program? If the CDHC are being trained to go into areas where dentists do not exist, and that is the reason for the program, then to what dentist are they going to refer them? I cannot diagnose a problem for a patient over the phone to tell them they need a "simple" restorative procedure, or an "uncomplicated" extraction. I cannot tell you that I never run into more than I thought I would with a patient's care that requires me to be more trained to handle the situation as it turns out, not how it started. How is a dentist expected to diagnose over the radio for the CDHC? When is the "simple" procedure aborted and referred? How is this done? This has been labeled as a "midlevel provider" from the beginning and still is. That is regardless of how the ADA wants to spin it at this point. If we were, indeed, talking about a training program that referred the patient to a dental team, it would potentially be a good thing, but we are not. If we were, indeed, talking about a paper-pusher and oral hygiene trainer, it would be a different thing, but we are talking about more than that. We are talking about a midlevel provider that could change our landscape forever. There are many actions in the AGD white paper on access that could be accomplished without risking the patient's care, without developing a tiered system of care where poor or remote patients get different care than other patients. Has the delegate read these options? There is also a resolution coming from the fifth district, basically for more study. At the very least, this should be done before we spend another 5 to 8 million dollars of our dues dollars on something that may not work, and worse, could backfire. I am a long-time member of the ADA, and plan on staying that way, but I do not want the ADA to spend 8 million dollars of our money on a program that potentially could hurt my patients, or me. The original 2 million that was spent was, in part, meant to show other groups that we put our money where our mouth was in trying to solve an access problem in Alaska. Perhaps the fact that we don't see other groups jumping on to help fund should give us a hint on the viability or risk of this. These are 3 talking points from the steering committee to refer to: ADA argument: "The CDHC is not a mid-level provider." Rebuttal: In the 2007 Call for Letters by the ADA, the CDHC was directly called as; "the new mid-level allied dental personnel." Also, in Congress, the ADA supported legislation; H.R. 2472, the "Essential Oral Health Care Act of 2007," the CDHC is called; "a new mid-level allied dental professional who will work in underserved communities where residents have no, or limited, access to oral health care." This is proof that the ADA has not been consistent in its communication to the leadership and membership as to the specific designation of the CDHC. The definition changes to suit the need of those supporting the plan. ADA argument: "The CDHC would be under the supervision of a dentist." Rebuttal: If the problem is that there are not enough dentists in underserved areas, how is it possible that the proposed entity (CDHC) that will be going into the underserved area, and performing irreversible dental procedures, will have the supervision (general or remote, if existent at all) of a dentist? ADA argument: "The ADA Workforce Task Force has already carefully evaluated the proposal and has found it acceptable." Rebuttal: The 2006 Workforce Report never defined what constitutes a "midlevel provider" in dentistry. It did not consider differences between dental and medical delivery systems as related to utilization of midlevel providers. And, it was developed without an acknowledged definition of "access to care"……... the very problem that the 2006 Workforce document was supposed to be solving! Hope this helps! Carol -----Original Message----- From: Michelle Crider Sent: Oct 3, 2008 1:44 PM To: nmorgan0135@yahoo.com Cc: "Carol Wooden, DDS" , "Robert McGee, DMD" , lasaj@gagd.org Subject: Re: I oppose ADA Resolution #39 Dr. Morgan, Thank you very much for forwarding Dr. Versman's response. I have cc'd GAGD President, Robert McGee, DMD, FAGD, and AGD Region 19 Director, Carol Wooden, DDS, MAGD, in this email. Perhaps they can give you additional talking points. We appreciate all of your efforts. Keep us posted if you receive additional information from Dr. Versman, your colleagues or other ADA Delegates. We will continue to send updates as information comes our way. Best regards, Michelle Michelle Crider Associate Executive Director Georgia Academy of General Dentistry 2711 Irvin Way, Suite 111 Decatur, GA 30030 404.299.7987 Phone 404.299.7029 Fax www.gagd.org On Oct 3, 2008, at 1:23 PM, Dr. Neal Morgan wrote: GA AGD, I am fowarding a response from a delegate from Vermont who supports CDHC. I have been debating with him with no luck. Regards, Weldon Neal Morgan, DMD --- On Fri, 10/3/08, VERSMAN@aol.com <VERSMAN@aol.com> wrote: From: VERSMAN@aol.com <VERSMAN@aol.com> Subject: Re: I oppose ADA Resolution #39 To: nmorgan0135@yahoo.com Date: Friday, October 3, 2008, 12:50 PM Weldon, How do you feel about hygienists who do gingival curettage, treat subgingival areas with a laser, etch teeth and place a sealant, give local anesthetic, administrate and/or monitor nitrous oxide and dental assistants who place and carve amalgam and remove subgingival cement? I am just trying to get to understand your thoughts. The CDHC will not be doing any of these treatments. They will be under the supervision of a dentist and well trained. Don't you believe that with appropriate training individuals with good hand-eye coordination can be taught simple procedures. What they cannot be taught is how to diagnose, tx plan and think their way through complications that may arise without the education that a dentist possesses. I admire your passion but I am not sure you have heard the unbiased story of the CDHC. I until I heard it (very recently) I was not so sure I supported the CDHC concept but I am now on board. There is truly nothing to fear for well trained individuals going out into areas where there are NO dentists and helping people understand their dental needs and directing them to the care of a dentist. We may agree to disagree, or just disagree but I do thank you for your concerns. Wishing you the best, Ken Versman