Over the past six months I have had the pleasure to meet many of you in person, including at district meetings and the Annual Meeting, as well as over the telephone and through various other communication vehicles. Going forward, and in addition to the report I plan to present at the House of Delegates, I will provide you, our GDA members, with a semi-annual report on the state of your Association. Other short briefing communications will continue during the year on a selective basis to avoid creating information overload. This is a first effort to provide such a semi-annual report.

The First 180 Days
Your GDA leadership and I began in March with the development of a 120-day plan of action to review in a “deep dive” the entire Association and its subsidiaries. That deep dive found a nice foundation to build upon as well as challenges to overcome and a significant amount of opportunity. Through the concerted efforts of your leadership the GDA has already become more cost effective and efficient and we will continue to look at more ways to improve, add products and services, and analyze any new offerings continuously. At the July 2014 House of Delegates I reported my findings, what we would do going forward as well as recommendations. Much of my report to the House of Delegates is covered in this communication.

Philosophy of Servant / Service Leadership: The GDA is Member Driven
Our approach is one in which YOU, the member, is at the top of the inverted pyramid. Everything we do at the GDA is for the best interests of oral health, dentistry and you, now and into the future. That philosophy informs everyone that the executive office staff and I serve you and therefore we will always strive to be member driven. From my experience, I can help you recognize and lead you to a “shared vision” and subsequently implement that vision for the membership. However, that vision must belong to the members and be your vision.

Expanding the Vision of GDA Advocacy to Emphasize Public and Media Relations
Our deep dive revealed that as an organization we are primarily single focused. We were and are the premier dental legislative advocate under the “Gold Dome” in Atlanta. That means that the majority of our resources and focus are targeted at legislative efforts. However, we have to some extent neglected the broader definition of “advocacy” for our members. Going forward, your GDA will add Public and Media Relations to our advocacy charge and elevate these two additional pillars to the same level as the legislative advocacy pillar! Why? Because each pillar is required for a firm advocacy foundation.

The legislature is only one audience that must be influenced to protect oral health best practices, patient safety, and the educational standards and effectiveness of the profession. The fact is, we have outstanding good news to convey to both the public and the media. When you cannot get the legislature to hear you, by informing the public and / or the media, they will in my experience put the needed pressure upon the legislature. The public and media become our advocates. Further, our Association must combat bad or incorrect information in the media that misinforms the public.

Reorganization of Your Association Office and Staff
In order to achieve the continuation of our legislative advocacy, and elevation of our public and media relations efforts, we also needed to refocus our talent, as well as replace talent. As you may know, we were without a Director of Government Relations when I arrived. What I did not know when I was hired was that Associate Executive Director Nelda Greene would retire at the end of August and Director of Membership Services Courtney Layfield would be moving to Alabama the same month! However, through two planning sessions as well as a needs assessment associated with the 120-day deep dive we have as of this writing reorganized and are fully staffed.

As a result of placing all pillars of advocacy at the top of our member services offerings your GDA Public Relations Committee and Patient Protection Task Force recently held individual planning sessions. Both resulted in plans of action. To implement these plans we have hired Carol Galbreath as our Senior Director of Marketing and Public Relations. We have also hired Stephanie Lotti to replace Courtney as our point person on Medicaid and PeachCare issues as well as a host of other member services. However, we are pleased that Courtney will continue to concentrate on the Georgia Mission of Mercy clinic scheduled for June 2015 from her location in Alabama. Finally, we welcome Fatimot Ladipo as our Director of Governmental Affairs just in time for the full round of district legislative receptions and preparations for the 2015 legislative session.

Your Governmental Affairs Committee and GDA leadership have identified several key initiatives that the GDA will pursue during the session. These include, but are not limited to:

• Seeking an appropriation to create dental student loan repayment program.
• Seeking tax credits for dentists who practice in rural areas.
• Monitoring state funding in the Department of Community Health as it relates to Medicaid and the Board of Dentistry.
• Continuing to advocate for access to care for adults in Medicaid and promoting basic preventive and restorative care coverage for adults in dental Medicaid.

The GDA anticipates possibly working with the Medical Association of Georgia and other health care provider groups to:

• Advocate for legislation that would alleviate the uncertainty providers have regarding insurers’ ability to change reimbursement rates at any time and for any reason.
• Address “all-products” clauses that appear in insurance plans and require a provider, as a condition of participating in any of the health plan’s products, to participate in all of the health plan’s products.
 
Your GDA legislative advocacy team will continue to watch for movement on issues such as disclosure by dentists of the material content of dental appliances, corporate dentistry, the creation of a universal definition of surgery, and changes to dental team supervision and scope of practice regulations.

Creating a Healthy GDA Medical Plan and Additional Association Member Services
During the deep dive your GDA leadership has taken, we found both challenges and opportunities in the services arena. We have some fine insurance products offered through Georgia Dental Insurance Services (GDIS), but they have not been fully utilized or leveraged to your benefit. For a more in depth look at all member services I would encourage everyone to go to and browse your GDA web page: www.gadental.org or just call us if you need help finding a service. We offer members discounts and special deals on credit card and check processing, personal credit cards, shipping via UPS, office staff clothing, patient account collections, office and personal appliances, Mercedes-Benz automobiles, dental record systems, patient financing, web site design and online reputation monitoring, legal services, retirement planning, and more.

YES, going forward, your GDA will continue to provide a Health Insurance Program for the membership. We will have some new wonderful health insurance plans for you to select from during the upcoming renewal. Our deep dive assessment revealed the health insurance program as previously constituted had exceeded its life cycle. However, we have revamped the program to give YOU more choices based upon your lifestyle and pocketbook. In addition, the plans will be more flexible, because GDIS and your GDA will be able to include you in a group program or individually write a plan that is custom tailored to YOUR needs. We are also adding additional staff to assist and walk you through what works best for YOU! We believe that these changes will not only be beneficial to those currently on the program, but will entice other member dentists to participate to grow this valuable member service. Just make certain that you call your GDA FIRST when you are looking for personal medical coverage or coverage for employees in your practice. Call (800) 432-4357 or email lemaire@gadental.org.

Over the next six months your Georgia Dental Insurance Services will beef up incentives for you with medical malpractice as well as the retirement benefit program. You will have no reason not to utilize your association services going forward. Visit www.gadental.org and contact the GDA office at (404) 636-7553 for additional information.

Your GDA is exploring adding new services to our stable of member benefits. These include health care supplemental plans, practice payroll processing, group purchasing co-operative programs, district back office management services, marketing services, and more!
And while our continuing education programs are well received our offerings are limited because CE is not a primary GDA focus. Instead the need for dentist and staff CE is filled by other more focused providers, such as the Hinman Dental Society. While the GDA will continue to offer CE as we move forward, we will invest in a “new niche” in business-oriented courses. Our topics will address business margins, budgeting, buy-sell, balance sheets, investment planning and wealth management, and personal and practice retirement planning among other issues. Your GDA believes this niche will assist all members in improving their bottom line and margins.

Current Issues Occurring in the Department of Community Health and Medicaid
The Department of Community Health (DCH) Board meets monthly to discuss issues pertaining to Medicaid and PeachCare, the State Health Benefit Plan (SHBP), facility regulations, and other health care related items. Over the last few months, rural hospitals, ABD (Aged, Blind, and Disabled) Medicaid Care Coordination, and the Georgia Families 360 (foster care transition to managed care Medicaid) have been the primary topics of discussion, along with the budget. The GDA thanks member dentist Dr. Donna Thomas Moses for her active service on the DCH board.

Proposed Regulations from  the Board of Dentistry
Being aware of the rules and regulations that affect the profession is imperative for any dentist. To assist our members in keeping abreast of issues being addressed by the Georgia Board of Dentistry (Board), the GDA has a presence at each of the Board’s monthly meetings. Most recently the Board has been handling issues involving non-dentists performing teeth whitening procedures, mobile and corporate dentistry, advertising, fee-splitting, conscious sedation permits, and even whether pets can be allowed in the dental office.

A number of amendments and new regulations have been proposed by the Board including the requirement for dentists with sedation permits to begin utilizing a capnography machine to monitor end tidal CO2. It was noted that the cost of such a machine is approximately $4,500. Both the American Association of Oral and Maxillofacial Surgeons and the American Society of Anesthesiologists have updated their sedation standards to require the use of a capnography machine. The American Dental Association’s Council on Dental Education and Licensure will begin a comprehensive review of the ADA Anesthesia Guidelines in early 2015, which will include consideration of a capnography machine.

Other proposed Board rule changes address the use of chlorohydrate in pediatric patients, advertising, and continuing education credits.
In addition, former State Senator and former Vice President of the GDA Dr. Greg Goggans was appointed this summer to fill a seat on the Board of Dentistry.

Appeals Court Overturns Georgia’s Prompt Pay Law
After considering the parties’ briefs and hearing oral argument regarding America’s Health Insurance Plans v. Hudgens a judge in the Northern District Court for the Northern District of Georgia found that the new portions of Georgia’s prompt pay law are preempted by ERISA. That decision was appealed to 11th Circuit Court of Appeals. A three-judge panel heard oral argument from counsel for America’s Health Insurance Plans and state Insurance Commissioner Ralph Hudgens on November 21, 2013. A decision from this panel was issued on February 14, 2014, affirming the District Court’s decision to strike down Georgia’s “prompt pay” law on ERISA preemption grounds. The Georgia Attorney General’s Office has opted not to appeal this decision.

North Carolina Dental Board Arguing FTC Ruling Before Supreme Court
The North Carolina Board of Dental Examiners is challenging a lower court ruling over North Carolina Board of Dental Examiners v. Federal Trade Commission and an order by the Federal Trade Commission (FTC) which said that the North Carolina board engaged in unfair competition in the market for teeth-whitening services by excluding individuals not licensed to practice dentistry from providing teeth-whitening procedures. On March 3, 2014, the U.S. Supreme Court agreed to hear this case. Essentially the Supreme Court will be determining the scope of the state-action doctrine, which exempts state actors (such as licensing boards), from federal antitrust scrutiny. The case will be heard during the Supreme Court’s next term this month, October 2014.

Georgia Board of Dentistry Facing Tooth Whitening Lawsuit
A federal lawsuit, Trisha Eck v. Tanja D. Battle, et. al., was filed in the U.S. District Court for the Northern District of Georgia on April 1, 2014, that challenges the Georgia Board of Dentistry’s position that teeth whitening is the practice of dentistry and should only be performed by a licensed dentist. The lawsuit was filed by Trisha Eck, an individual who owned a tooth whitening business in Warner Robins, Georgia, and the Institute for Justice, a national law firm.

Trends Involving Mid-Level Providers
In 2014, 13 states had legislation or significant policy discussions surrounding the “mid-level” dental model. In Kansas, New Mexico, Ohio, Vermont, and Washington, the Kellogg Foundation played an instrumental role in driving the discussion regarding mid-level providers. The Foundation budgeted $16 million for a three-year program to push this effort in those five states. The other primary foundation working in this arena is the Pew Center for the States.  As a result of their efforts, legislation has been introduced in Maine, New Hampshire, and North Dakota and they may be seeking champions of the mid-level provider model in Colorado and Michigan. Other states that have had legislation or legislative discussions regarding alternative dental workforce models include Connecticut, Massachusetts, and South Dakota.

Of these endeavors the only measure that was enacted into law was LD 1230 in Maine. LD 1230 creates the position of “dental hygiene-therapist.” However, as a prerequisite for licensure, a candidate must already be licensed as a dental hygienist in Maine.
Two trends were observed nationally in the states considering alternative workforce legislation during 2014:
1) Bills were modified to incorporate dental hygiene into the proposal to garner legislative support from that sector; and
2) Efforts were renewed to establish “mid-level” programs on tribal lands in the lower 48 United States.

In Conclusion: I Look Forward to Talking with and Meeting You
Please call me at (404) 636-7553 or write me at capaldo@gadental.org if you have any questions about this report. I hope you enjoy this information. Let me know if you have any recommendations and please keep inviting me to attend your district meetings and other events. I will attend every GDA officer visit and legislative meeting in every district this fall, so please come out and say hello.