Cliff's Notes

The Business of Dentistry

“Infection Control, What You Use Does Matter” “Medicare/Medicade EHR Insentive Program” & “A Review on SonicFill”

Cliff’s Notes for June 12, 2011

….. E-Blast…..


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

 “The greater danger for most of us lies not in setting our aim too high and falling short; but in setting our aim too low, and achieving our mark.”                                      Michelangelo


In This Week’s Issue

  • Let’s Talk About Infection Control Part #3 – What You Use Does Matter!!
  • Medicare and Medicaid EHR Incentive Programs!
  • Product Review –SonicFill by Kerr

Seminar Notice:………………………………………………………………………………….

Infection Control Up-Date

Wednesday, June 22, 2011

Teaneck Marriott at Glenpointe

Infection Prevention & Control in the Dental Office

8:30 AM – 11:00 AM, Continental Breakfast Served – 2 CE’s (subject code #130)

Drs. $35.00 – Staff $15.00 Fees can be billed to your Henry Schein Account

The topics to be discussed in this 2 hour intense overview:

  1. Understanding CDC Guide Lines
  2. Disinfection
  3. Risk assessment
  4. Instrument processing
  5. Personal protection
  6. Sterilization procedures
  7. Sterilization monitoring

To register, call:

Carol @ 973-227-3533

Cliff @ 201-321-7494

Let’s Talk About Infection Control – Part III………………………………………

Let’s look at the real picture. You spend a long day chairside caring for 15+ patients and performing some really “fun” procedures. The day ended late so the you and the staff rush to get home to the family. You walk in and the first one to great you is the dog. Then your little boy/girl comes running over to hug you. You flop down on the couch to catch your breath and as Jackie Gleason said “how sweet it is”. But, are you wearing the same cloths you had on in the office?

In 1984, wow I’m getting old, I started my education on infection control. The one big thing the CDC was stressing at that time was that all viruses & all bacteria are now part of the “Jet-Set”. We get on a plane in London after breakfast and have lunch in New York. New strains of mutant germs are invading our local environment on a daily basis. As much as you stress room cleanliness and proper instrument care, you can’t sterilize a dental operatory you can only disinfect.

Disinfectants are not all the same. They all claim to have specific kill spectrums and they can’t make the claims unless they could prove it to the FDA. The main difference is “kill time”. Surface disinfectants are designed to remain wet on a hard surface for a specific amount of time. Often the directions will say “allow drying” and that means about 10 minutes between patients. However, we never wait for things to dry, we wipe them down. It is not practical for a modern dental office to spend more than 5 minutes cleaning/disinfecting an operatory between patients. If you book 10+ patients a day, an organized approach to instrument management will allow you to see 11. If your chair earns $300.00/hour (average), based on 200 days you can add $60k to your bottom line revenue. The investment can be 25 cents/patient or $2.50. However, the more expensive systems provide more features and benefits. Work flow evaluations are available at any time, please call me at 201-321-7494. 

What about the Environment?

Air borne “bugs” love the dental office environment. They float freely from the reception room to the lab, and then they get sucked up by the AC or heating systems and get a chance to fatten up in moist, dark and friendly “dirty” air filter and have babies.

How about the “bugs” that get sucked up in the evacuation system during a procedure, where do they go? You may be surprised that they don’t all go down the drain. Your vacuum pump needs to be vented for it to work. If it does not have a sealed vent to the outside of the facility, it will be venting in the utility room. What other equipment is in the utility room, maybe the compressor? Where does the compressor draw its air from? The chance is that your compressor does not draw fresh air from outside the facility. It utilize ambient air from the immediate environment. If the contaminated vapor being released by the pump is sucked up by the compressor, it will exit through the handpiece, air syringe, Prophy-Jet, and any other place that compressed air is required.

Did you ever think about what the inside of the compressor may look like? Sherwood Forest comes to mind. That’s why we need filters and that’s why dental compressors are so expensive. Those filters need to be serviced every 6 months.

The “re-distribution” of contaminated vapor is enhanced by splatter. Below is an ADA link to a report on the dangers of splatter.

Aerosols and splatter in dentistry


Every office uses barrier protection, but very few use it correctly. The main reason for ineffective barrier protection is usually because of cost. Ask yourself these questions:

  1. Do I dispose of my gloves and mask before I leave an operatory?
  2. How long do I use a mask or gown before discarding it?
  3. Do I handle charts with gloves still on?

Next week we will discuss the quality differences in gloves and masks. This week I want you to think about all things that you are exposed to in your office environment and what goes home with you and your staff. And, we’re not talking about bed bugs. 

If you have any questions or concerns or would like an office evaluation of your work flow procedures, please contact me at any time.

VELscope is Featured on the Dr. Oz Show……………………………………………

“The Dr. Oz Show” will feature a major segment on VELscope technology and oral cancer detection on Wednesday, June 8th. 

As before, the segment will feature regular show contributor and long-time VELscope user Dr. Jonathan Levine.

According to Dr. Levine, who taped the segment this week, “This show, I predict, will start a movement for patients to DEMAMD an oral cancer examination from their dentist and hygienist.  This will be the most powerful segment I have done with Mehmet Oz.”

Medicare and Medicaid EHR Incentive Programs:………………………………

What Do They Mean to You?

In July of 2010, the Centers for Medicare and Medicaid Services (CMS) enacted the Medicare and Medicaid Electronic Health Record Incentive Programs, which were authorized as part of the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.
This initiative provides financial incentives to eligible hospitals and clinicians (including dental practices) that use electronic health records (EHRs). Dentists are eligible for the Medicaid EHR Incentive Program, while only oral surgeons are eligible for the Medicare EHR Incentive Program. 

Determining Your Eligibility:

What percentage of your patient volume is covered by Medicaid? To qualify for a Medicaid EHR incentive payment, 30% of your patient encounters in any continuous 90-day period from the prior calendar year must have been covered by Medicaid.

If more than half of your encounters during six months of the prior calendar year took place at a federally qualified health center or rural health center, you can include other “needy individuals”—even if they don’t have Medicaid—in your calculations. Needy individuals are defined as those who receive:

  1. Medical assistance from Medicaid.
  2. Medical assistance from the Children’s Health Insurance Program.
  3. Uncompensated care by the healthcare provider.
  4. Services at either no cost or reduced cost based on a sliding scale determined by the individual’s ability to pay.

Group practices:

If you work in a group practice, you can use the practice’s total patient volume to make your calculations. In other words, if the total practice across all staff has a patient volume of at least 30%, then each individual dentist can qualify as having 30% for purposes of the Medicaid EHR Incentive Program.

 Do you use certified EHR technology?

To qualify for the program, you must own or have access to certified EHR technology that has been certified by the Office of the National Coordinator for Health Information Technology (ONC). You must also be able to demonstrate “meaningful use” of that technology (see below for more information). Reporting requirements vary, depending on how many years you’ve participated in the program:

 First year: In your first year of the Medicaid EHR Incentive Program, simply having adopted or upgraded to certified EHR technology will suffice for you to receive an incentive payment. No additional reporting is necessary.

Second year: You must demonstrate meaningful use of your certified EHR technology for a period of 90 days.

Third and subsequent years: You must demonstrate meaningful use of your certified EHR technology for the entire 12 months. For example, if you register for the program any time in 2011, you would use the following reporting schedule:

 2011 – Show proof of having adopted or upgraded to certified EHR technology.

2012 – Demonstrate meaningful use of the technology for a period of 90 days.

2013 and beyond – Demonstrate meaningful use of the technology for 12 months.

Meaningful use criteria:

“Meaningful use” simply means that you must prove that your EHR technology is being used in measurable ways: 

  1. The use of a certified EHR technology in a meaningful manner, such as e-prescribing
  2. The use of certified EHR technology for electronic exchange of health information to improve quality of healthcare.

 The use of certified EHR technology to submit clinical quality and other measures:

There are 25 defined meaningful use objectives. If you are eligible for the program, you’ll be required to meet 15 core objectives and at least five other measures from a list of 10. You can find the complete list and explanations on the CMS website.

 Working to Make the Program Fit Your Needs:

Right now, many of the core meaningful use objectives don’t apply to oral healthcare providers and this makes it very difficult for the average dentist to participate in the program.

For instance, if you have a patient with diabetes, the program requires you to be able to electronically track this condition as well as the patient’s diabetes medications. You could state “unknown” in fields related to such medical conditions and probably still meet the meaningful use criteria—but your dental practice management system will still have to be able to record a patient’s full medical history (not just oral health history) in order to be certified.

Dentrix dental practice management software can receive modular certification. This, however, does not fully solve the problem and you may have to invest in other systems that together meet all 15 core objectives and measures.

Henry Schein Practice Solutions is working with several groups, including the ADA, CMS, Health Resources and Services Administration (HRSA), National Network for Oral Health Access (NNOHA) and the American Association of Oral and Maxillofacial Surgeons (AAOMS), to highlight the need for a certification standard specifically for electronic dental records (EDRs) that will make the program more accessible to oral health professionals. We are developing a list of oral health measures to submit to CMS and requesting they be included in the definitions of meaningful use.

We are also participating in the ADA workgroup for EDR standards with the goal of creating a certification for EDRs that can apply more easily to the CMS meaningful use criteria.

For more information about eligibility requirements, the program timeline and how to register, please visit the CMS website.

 Product Review – SonicFill by Kerr…………………………………………………….

Kerr has announced that the first U.S. Shipments of SonicFill will begin this month. This product will allow you to place a finished posterior restoration in 2-5 minutes.

 SonicFill™ Revolutionizes Posterior Composite Placement:

The first sonically activated single step bulk-fill dental composite system for posterior restorations. Fill up to a 5mm cavity in 5 seconds. Proprietary sonic activation enables a rapid flow of composite into the cavity for effortless placement and superior adaptation. It’s that fast, easy and effective – greatly reducing procedure time.

 The following presentation features Dr. Ron Jackson. It is 28 minute long and shows the entire procedure. The short version is 2 minutes long. That’s how long the restoration takes after the tooth is prepped. For an in-office demonstration, please contact me at any time @ 201-321-7494 or

SonicFill System

Ron Jackson is introducing a new composite resin specially designed for posterior use.

For more information, Log onto:<>

June 12, 2011 - Posted by | Uncategorized

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