Cliff's Notes

The Business of Dentistry

Only 4 Years Left & The Regualtors Are Coming!

Cliff’s Notes



for January 2, 2011



 ….. E-Blast…..


Cliff Marsh, Henry Schein ……Cell: 201-321-7494……Fax: 201-262-2210…..E-mail:



“We will open the book. The pages are blank. We are going to put words on them ourselves. The book is called Opportunity and its first chapter is New Year’s Day”

Edith Lovejoy Pierce




In This Week’s Issue

·         Only 4 Years Left, Your Running Out of Time!

·         The Regulators Are Coming! Don’t be Penny Wise & Dollar Foolish!

·         A Wish for the New Year From Cliff’s Notes and the Legendary Harry Harrison!



Only 4 Years Left, You’re Running Out of Time!………

As the New Year begins its time to start making all those changes we talked about in the past year. However, where do you start? There are so many things you want and need to create and implement to better your business and secure more “retained earnings”.


The most important thing to begin addressing is the NHII (National Health Information Infrastructure). The NHII goes live on January 1, 2015 and that gives you 4 years to prepare your practice and spread out your implementation and expenses.


The key word is DIGITAL! 15 years ago the federal government enacted the American Clean Water Act. The purpose was to keep contaminants away from “ground water” and was the pre-curser to amalgam separators, x-ray solution disposal, and a host of other regulations. I re-call warning everyone that the regulations were coming and most practices elected to wait until the last minute. No problem, make a few phone calls, write a few checks, and for a few hundred dollars worth of equipment and an annual waste disposal contract, you’re in business.


Well, the NHII may not be that easy. It will require software upgrades and a host of “digital solutions” such as radiology, digital impressions, digital diagnostics, and eventually a completely paperless environment.


The following excerpts are from an article written by Arlene Furlong and published in the ADA News on June 18, 2008. The entire article can be reviewed at


Please pay close attention to the last line of the excerpt and feel free to contact me at any time with any questions or concerns by calling 201-321-7494 or


By 2015—when the National Health Information Infrastructure will be operational—a patient’s dental record will no longer travel alone.

Dental records will be included within electronic health records that also include patients’ entire medical histories, pharmacy, vision, laboratory tests and all other clinical information. EHRs will travel from health care provider to health care provider on the NHII, a communications system often described as a network of information highways.

Although not widely discussed within the general membership to date, the development of the electronic health record will likely be the most challenging and ultimately defining initiative the ADA deals with in the next 5-10 years. Those working to ensure dentists are prepared say that with only six years left until this dramatic change, 2015 is just around the corner.


“We can expect a national strategy for managing and communicating patient information as the electronic health record initiative moves forward,” says ADA President Mark Feldman. Dr. Feldman also serves on the Electronic Health Record Workgroup. “The ADA will advocate to keep compliance scalable for a small business operation and keep our members informed of what they will need to do to comply.”

The federal government’s intent is to increase information technology to promote overall quality and cost reduction of the entire health care system. The HHS, under whose purview the NHII falls, defines it as “an initiative set forth to improve the effectiveness, efficiency and overall quality of health and health care in the U.S.”

The ADA is currently monitoring and providing input on 11 bills in Congress related to the electronic health record. Most recently, ADA regulatory and legislative staff June 5 attended a stakeholders meeting with the Energy and Commerce Committee to assist in further development of a health information technology bill. That bill would provide a roadmap for how to best integrate the federal government’s role in the promotion of HIT, set forth stronger privacy protections and make the Office of the National Coordinator of Health Information Technology within HHS permanent. (ONC was established by President George W. Bush’s 2004 executive order promoting the development and implementation of a nationwide health information technology infrastructure.)

The NHII communication system hinges on a comprehensive, longitudinal electronic health record for all patients, of which the ADA has long taken the lead. (The 1996 House of Delegates adopted a resolution to promote free exchange of health information across professional borders.)


“Ultimately, and beyond the development of interoperability standards, dentists will be encouraged to acquire the technology necessary to utilize the EHR to share patient information in a secure manner,” observes Dr. Robert Faiella, ADA 1st District trustee and a member of the EHR workgroup. “This will allow us to have accurate past medical and dental histories, drug profiles and interaction, laboratory results and improve patient safety.” Adds Dr. Faiella, “It will govern not only our access to vital information, but also change how we are reimbursed by third party carriers, and eventually, may impact the resale value of our practices upon retirement based on technological capability.”



The Regulators ARE Coming!…………………………………..

Over the last several months a number of my clients have been audited by insurance companies. Regulatory compliance has become a “hot button” issue for most. Insurance companies are requiring OSHA compliance and emergency medical protocols. Another issue that will be surfacing very shortly will be State Sales Tax Compliance.  Let me make a statement, Henry Schein does not charge any state sale tax! The Governor charges tax. Henry Schein collects it for the state and forwards it to the treasury department on your behalf. If it is not collected for you, you are responsible and you shouldn’t  play games with the tax man. As the states search for more revenue, tax audits will increase. The fines and penalties can be extensive and “ignorance of the law is no excuse”. If you have any questions or concerns, contact your tax advisor.


There is another factor, not everything you purchase is taxable in your state. In New Jersey, about 40% of the items you use are non-taxable, in New York, it’s more like 5%. The Sales Tax rate is determined by state laws at the point of possession.


Every action has a reaction. In today’s litigious society you need to recognize risk. Dentistry’s Gray Market: It’s Black and White, Don’t Purchase Imitations. Low prices appeal to all of us. We look for a great deal on everything, from our homes to our chewing gum. There’s nothing wrong with wanting to save money. However, amazingly low prices on dental products and materials may indicate imitations – gray market goods that aren’t approved and products obtained from non-authorized distributors don’t come with a warranty and leave you with little recourse in litigation.

How can you know which dental products are imitations? A suspiciously low price is your first indication. 3M ESPE offers a brochure featuring a photo of two products with the labels side by side. You can’t tell the real from the fake. So, in truth, the only way to avoid products that will put you and your patients at risk is to know your distributor.

What’s wrong with gray market dental supplies? Some products are expired and relabeled. They may look like and be labeled as a name brand product, but the company on the label (3M, for instance), does not warrantee the item. When your patients are at risk, your practice is at risk. Don’t take my word for it, ask your legal advisor or your malpractice insurance carrier. If a patient should have an allergic reaction to a product you use or if there is a clinical failure, the product manufacturer will support your legal defense unless the point of purchase was not an authorized distributor. In today’s litigious society this is a major concern, so if you’re going to play with fire, expect to get burned.

3M, Kerr, GC America, DMG America, Dentsply and most other dental material manufacturers are aggressively pursuing un-authorized distribution. This is a healthcare industry and it’s too easy to find authorized distributors, just call the manufacture or access their website.

Counterfeit products even extend to digital cameras used for medical photography! Check out these sites and announcements to learn more about gray market goods and how protect your practice and your patients from gray market goods.


Journal of the Canadian Dental Association, April 2002:

Per The Journal of the American Dental Association, offshore dental labs (the gray market) was a topic of interest in February, 2005 at The Dental Summit conference in Chicago:


A Wish For The New Year!…………………………………….

Harry Harrison hosted the most popular morning radio show in New York. I hope you enjoy one of radio’s most famous New Year’s wishes. From my family to yours, we you a safe and healthy 2011 and as Mr. Spock said “live long and prosper”.

January 2, 2011 - Posted by | Uncategorized

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