Talking with the Toothcop

HIPAA security compliance isn't talked about often in the dental community. But the Office for Civil Rights (OCR) can and are investigating dental offices. If you're not properly or adequately protecting your patient's protected health information (PHI) you're at risk of a hefty fine. In this episode of Talking With The Toothcop, I talk about the HIPAA security rule, business associate agreements, and how a data breach can impact your practice.

Outline of This Episode

• [1:20] HIPAA Security Compliance
• [4:43] The HIPAA Security Rule
• [9:00] Consistently work toward compliance
• [10:13] The Business Associate agreement
• [14:57] Have adequate cyber insurance in place
• [17:38] Will OCR hit practices harder because of COVID?

HIPAA Security Compliance: What a breach looks like

I received an email from OCR (AKA the HIPAA Police) titled: "Small healthcare provider fails to implement multiple HIPAA security rule requirements." So I opened it. Essentially, Metropolitan Community Health Services has to pay a $25,000 fine to OCR and has to adopt a corrective action plan to settle violations. Why?

Because on June 9th, 2011—9 years ago—Metro filed a breach report that affected 1,263 patients. The OCR investigation revealed long-standing non-compliance. Metro failed to conduct risk-analysis and failed to implement any security rule policies, procedures, or training until 2016. Providers are supposed to safeguard their patient's information.

The moral of the story? We need to implement measures so we don't have to report a breach affecting 500+ people. This is a classic example of where prevention could've made a world of difference.

The HIPAA Security Rule

The HIPAA privacy rule states that you must have agreements with vendors who have access to information, train your staff properly, and establish notice of privacy practices (how we can use and disclose patient information). The HIPAA Security rule is what people seem to have trouble with. It deals exclusively with the security of protected health information.

One of the key components of the rule is to have someone appointed as the security officer. They establish access control for authorized users and set up firewalls, firmware, antivirus programs, updates, etc. They are tasked with risk analysis and mitigation:

• #1 Identify the potential threats and risks to PHI
• #2 Address the higher-risk or potential risks areas

This is where dental practices have significant gaps and fall short. OCR started conducting audits of covered entities and found that more than ¾ of providers had not addressed security issues or implemented security measures to address the rule. What should security training include? What issues do I see in dental offices? Listen to find out!

The Business Associate Agreement

You need to understand who your business associates are: Who are the vendors you work with who have access to your patient information? IT people? Coaches or consultants? Software providers? Identify those business relationships and make sure you have a signed Business Associate Agreement (BAA) with them. It's required before they gain access to your patient information.

Let's drive the point home: A data backup service was audited by OCR and they were connected back to a medical practice. The medical practice couldn't produce a BAA—and got slapped with a $30,000 fine. It's a big deal. There was another case in Florida: A former employee of a business had access to patient PHI. A BAA wasn't in place and they were fined $150,000.

I don't want to scare you—I want to motivate you. I want you to understand the importance of addressing these issues. How many tooth fillings, root canals, and crowns would you have to do to cover a $30,000 or $150,000 fine? The preventative measures are worth every minute of your time.

How does cyber insurance play a role? Will they cover fines? Keep listening...

OCR takes their job seriously

Very few dentists are in compliance. If they were audited by the OCR it would be a blood-bath. While perfection cannot be expected, there's room for improvement for the industry. You must show consistent and periodic effort. OCR just loves to kick people's butts, pandemic or not. They are proactive on the educational side and actively involved from a preventative standpoint. But they will take heavy-handed action when there is a breach of compliance. It is so important to protect your patient's information. Hear all about it in this episode!

Resources & People Mentioned

• Office for Civil Rights (OCR)
• HIPAA Security Rule

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

In this episode of Talking with the Toothcop, Dwight Shreve joins Andrea and I to cover some of the most-asked questions that have accumulated during the Coronavirus pandemic. We talk about face masks and respirators and how to use them properly. We also talk about addressing issues in your practice and the proper procedure if a staff member is diagnosed with COVID-19. If you have unanswered questions swirling around in your head, don't miss this episode!

Dwight Shreve worked at Crosstex for a couple of years as a Sales Manager and Infection Prevention Advisor. Now Dwight is an Independent Consultant with us at Dental Compliance Specialists. He has a passion for supporting patients and helping to make sure their needs are being met.

Outline of This Episode

• [0:21] Andrea and I are joined by Dwight Shreve
• [1:58] Lockdown in Texas has been lifted
• [3:20] What is a face mask anyway?
• [7:02] Guidelines to follow in dentistry
• [12:17] Respirator Medical Evaluation Questionnaire
• [15:35] Complete a respirator fit test
• [18:56] The pandemic uncovered a rift
• [30:00] CDC return to work Criteria for staff
• [32:52] Do I have to pay my staff PTO?
• [34:28] Just because you don't HAVE to do something…
• [35:45] Texas Dentists: get consent for every procedure you do
• [45:42] Surround yourself with a good team

The difference between face "coverings" surgical masks, and respirators

A face covering—which is being mandated almost everywhere right now—can be a bandana, a neck gaiter, or a homemade mask made of whatever fabric you have on hand. There are surgical masks (level 1, 2, or 3) and then there are different types of respirator masks such as N95 and KN95 masks. They are regulated by the FDA and the use is mandated in certain environments.

One of the biggest questions I get is, "Do I have to do it, or is it recommended?" Currently, this is federal law and stuff you HAVE to do. OSHA has standards (which are effectively law) and they have guidelines that are recommended (you should do it). If you don't do it? The bottom line is that you can get in serious trouble.

Everyone working in a healthcare environment—even the dental office—should be wearing a surgical-grade face mask—NOT a face covering. You must focus on prevention to minimize the impact on the practice if someone is diagnosed with COVID. Why is it important? Listen to hear our discussion on the topic!

Dentists: You HAVE to use a respirator correctly!

Did you know that before you even put a respirator on, you're supposed to have a medical evaluation and a fit test? If you haven't done that yet—go back and get it done. OSHA provides a medical questionnaire for the medical evaluation that should be completed for each staff required to use a respirator mask.

The evaluation needs to be completed by a licensed healthcare provider. I suggest you send your staff with the eval to get cleared by a physician (to control your liability). Why is it important? If you are not medically fit to be wearing a respirator then you shouldn't be wearing one. In some instances, that means you cannot carry out the duties of your job. Only once a staff member is medically cleared do they get fitted for a respirator. What does that look like? Listen to find out!

Address issues that can negatively impact your practice

You have to look at issues that crop up for the potential that they have to dramatically and negatively impact your practice. You need to be proactive and look at things in advance while anticipating and weighing the risk versus benefit of applying a protocol—or disregarding the protocol and just continuing as is. Sometimes you have to put your personal feelings aside about things and do what's in the best interest of your practice.

You have to implement these steps so you can defend yourself if someone does get sick and it's linked back to you. it's always easier to prevent problems than it is to deal with them in the aftermath. Andrea emphasizes that there are laws and regulations in place you have to follow regardless of how you feel about the situation. Dwight points out that "Your practice is only as safe as your patients perceive it—and perception is reality right now. So if your patients don't perceive it's a safe environment to be in, they're not coming back."

What can you do to encourage open communication? Listen to find out.

Current guidelines on a team member who contracted COVID

Another question that we've been asked frequently is: We have a staff member that's sick, what do we do? How long until they can come back? Do we require them to get tested?

As of July 17th, 2020 changes were made to the guidelines to conserve tests. So the CDC is moving away from requiring tests to return to work and simply monitoring symptoms. There are three requirements a staff must meet to return to work:

• There needs to have been at least 10 days since symptoms have first appeared AND
• At least 24 hours must have passed since the patient has had a fever AND
• Symptoms such as cough and shortness of breath must be improved

The guidelines will likely change again, but you need to be familiar with them. Who pays for the tests—the employer or the team member? Listen to hear our answer.

A Note for Texans Participating in Medicaid: Get Consent

While this applies most specifically to my Texan listeners, I believe every dental practice should embrace these procedures.

Make sure you have consent forms for every single procedure you carry out, for every patient, every time. This includes preventative procedures and things you don't normally need to get consent for (fluoride treatment, x-rays, etc.). You must also make sure your clinical notes and all chart documentation reflect the service you're providing. If it's not written, it didn't happen, and it will be presumed fraud.

Ignorance is bliss—until you get caught. Get auditing and monitoring processes in place to make sure your clinical charting is being done properly. Dwight implores you to get your house in order and keep up-to-date on compliance issues. Dentists may not have known what they signed up for when it came to all the business aspects of dentistry but they're all inherently important to the small business that you operate and must be learned.

Resources & People Mentioned

• Families First Coronavirus Response Act
• FFCRA Employee Rights Poster
• CDC Return to Work Criteria
• CDC Potential Exposure at Work
• OSHA Respirator Medical Evaluation Questionnaire
• Connect with Dwight Shreve on LinkedIn
• BOOK: Rich Dad, Poor Dad

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

The impact of the Coronavirus is leading to heightened emotions and increased tension. I've been fielding a lot of phone calls from dentists who've had patients test positive for COVID-19—after they'd been seen in office. Some dentists have had staff who have been exposed or are testing positive for the virus. Dental practices are immersed in chaos and navigating through conflict has been difficult. Some dental offices function like one big dysfunctional family. So in this episode of Talking with the Toothcop, Andrea and I will cover some conflict resolution strategies to keep your practice running as smoothly as possible.

Outline of This Episode

• [0:21] Conflict resolution strategies for dentists
• [2:29] Find someone in your corner
• [6:03] Communication is the key to overcome conflict
• [17:04] Consider each point of view as valid
• [20:36] How COVID-19 has impacted the dental industry
• [20:36] Limit your exposure to minimize your impact
• [23:47] Reference the links below for NEED to know info

Find someone in your corner

The first conflict resolution method I sort of stumbled upon when a dentist called me to walk through a situation. I was able to be a sounding board that wasn't passing judgment and could help them reason through the situation—even though they did the majority of the problem-solving themselves.

Working through a difficult situation can be easier if you have someone in your corner who can help you muddle through the possible solutions. Andrea points out that having someone to talk to can give you peace of mind, even if they aren't part of the solution.

Conflict resolution strategies must include communication

Of all of the conflict resolution strategies you could utilize, communication should be at the top of the list. I work with a dentist who was wrapped up in a situation where a staff member came to work sick—with a cough—and was later diagnosed with COVID-19. The staff hasn't been diligent with wearing their face mask, so the doctor was stuck trying to figure out who had been exposed. She ended up furloughing part of her staff for two weeks while they quarantined at home.

One of the exposed staff members that were sent home was extremely upset and hurled some colorful hurtful words towards the dentist. The dentist knew they were upset and responding emotionally—but it was still hurtful. This staff member completely ghosted her and refused to return phone calls. The dentist finally had to call her and let her know that if she didn't return her call she wouldn't be receiving a paycheck. The staff member returned her call, completely embarrassed by her actions and profusely apologetic.

The situation started with a completely emotional blow-up, but the dentist and her staff members got their butts back to the bargaining table, cleared the air, apologized, and found a way to move forward. You MUST be willing to sit and do the work and figure out a workable solution. If you're not willing to do that, it's an easy decision—leave.

Step back from your emotions and exhibit empathy

Are you being driven by fear? Are you anxious about keeping your job so you can provide for your family? Have you been personally impacted by the coronavirus? Everyone has a different frame of reference that dictates how they handle crises. To resolve conflict—or prevent it from reaching the point of conflict resolution—you need to step back from your knee-jerk emotions and exhibit some grace and empathy. It doesn't mean anyone is right or wrong—but just have differing opinions.

Andrea points out that you can combat emotional outbursts with even more vile opinions and feelings, or you can empathize and put yourself in those persons' shoes. You only have power over how you respond to the situation—so respond with grace. Give them the opportunity to apologize or leave. Be raw, real, transparent, and bridge the gap—in an appropriate way. Communicate on a different level to overcome conflict and misunderstandings.

Conflict resolution begins with a willingness to listen to your staff and understand their viewpoint and try and find some common ground. Consider their point of view before you dismiss their contribution—because they likely are trying to help you. Likewise, dental staff must work to gain understanding if you don't understand what you're being asked to do. Don't allow your confusion or frustration to fester. Be willing and open to be educated and change your viewpoint if necessary.

Limit your personal exposure so you can minimize your professional impact

COVID-19 has made a significant negative impact on the dental industry. We can hope and pray this doesn't happen again. But in the meantime, we can work together to minimize the personal and professional impact it has on our lives. Be cognizant of the choices you make in your private life. If you take unnecessary risks and expose yourself to the virus it doesn't just impact you. It impacts the practice you work in and it WILL have a cascade effect—so keep that in mind. Protect yourself, minimize exposure, and don't expose your coworkers.

But what do you do if your office—patients and staff—are exposed to the Coronavirus? Do you need to close your office or furlough staff? We don't have all of the answers, but we've linked to some of the best resources below to help you decipher what your next step should be. Always feel free to reach out with any questions. At the very least, I can be your sounding board.

Resources & People Mentioned

• Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic
• Families First Coronavirus Response Act: Employee Paid Leave Rights
• FFCRA Poster
• ADA Steps to Take if a Patient Reports COVID-19 Exposure After Treatment
• What to Do if Someone on Your Staff Tests Positive for COVID-19

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Are you looking for a tax consultant for your dental practice? Do you understand the necessity of tax planning and preparation for your business? Even better—are you aware of the tax savings you're missing out on? Tax Consultant Craig Cody joins us to talk about financial planning & taxes.

Craig Cody is a Certified Public Accountant (CPA) and the President & Founder of Craig Cody & Company. He was formerly a cop with the NYPD and ended his career as a Lieutenant after 17 years on the force. Listen to this episode for some expert advice—and maybe a few cop stories.

Outline of This Episode

• [2:33] From law enforcement to tax consultant
• [5:03] Strategies to manage tax savings
• [12:02] What can a CPA do for you?
• [14:20] Dentists should NOT double as bookkeepers
• [16:05] Craig and I share a cop story or two
• [22:30] Connect with Craig Cody & Company

From law enforcement to tax consultant

Craig was an Economics major in college, but after 3 years he left to join his dad at the NYPD. After 17 years on the force, he decided it was time to move into something else. He wasn't unhappy, he loved his time with the NYPD, but it was the right move. Now, his son is with the NYPD, already at the rank of sergeant.

Many cops transition to lawyers when they retire from the force. But Craig Cody decided to go into financial planning. He thought getting his CPA would be the ideal way to stand out. But in the process, he fell in love with taxes and tax planning. Now he runs a firm that specializes in helping YOUR business keep more of what you make. Sometimes, $20,000, $30,000, or $40,000 a year.

What is the biggest tax mistake you can make?

Craig points out that when we shop for a vehicle we do a lot of research. When we plan a vacation we research where we want to go. But what research went into the entity you chose for your business? Do you communicate with your CPA? Do you HAVE a CPA? Your CPA isn't an expense. With the right tax consultant, they can be an income item. Instead of worrying about what you have to pay, they can help you think about what you can save.

Maximize the legal deductions you're allowed to take

Before even forming a practice you should consult with your attorney and a CPA to decide which entity to operate under (LLC, S Corp, partnership, etc.). Choosing the wrong one could mean you lose out on the Qualified Business Income (QBI) deduction—a 20% deduction.

What about deductions for a home office? Or a home gym (if you have a pool, gym equipment, etc.)? Do you have a medical expense reimbursement plan? Craig helps his clients maximize the legal deductions they're allowed to take and keep more money in the business.

Once you hit the Married Filing Jointly income limit of $315,000 of taxable income, that 20% deduction starts to phase out. But if you plan properly, you can keep more of that deduction. Keep listening to hear more of Craig's tips.

Why Dentists NEED a tax consultant

I learned early on that I should've talked with a consultant before even opening a bank account. Once I hired a CPA, my bank of choice wouldn't give them access. Craig agrees—it's important to start conversing with a CPA early. Not only can they help you avoid costly tax errors, but they can help you build a tax plan, go through your P&L and balance sheet, and even help with monthly bookkeeping.

Craig admits when he sees the books of a dentist who's handled it themselves, he prays they're a better dentist than they are bookkeepers. Even if they think they're correct, they're typically not even close. Craig states: "There is a reason they went to dental school—and it wasn't to do accounting."

Dentists often breathe a huge sigh of relief when Craig & Company step in and help take over their books and tax preparation. The value they offer is insurmountable. Listen to the whole episode to learn more about WHY you need a tax consultant. Craig and I also throw in some hilarious cop stories you don't want to miss!

Connect With Craig Cody

• Get Craig's FREE Book
• Craig Cody & Company
• Craig's LinkedIn Profile
• The Progressive Dentist Podcast
• Craig(at)CCodyCPA.com
• Call at 516-869-4051

Resources & People Mentioned

• Voices of Dentistry Conference

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Many dental practices have been sitting closed, deemed non-essential businesses during the coronavirus crisis. Or they've only seen patients on an emergency basis. States will soon slowly start reopening businesses. But that begs the question—how will this crisis change dental practices? Will there be new standards put in place? Will infection control finally get the attention it deserves? Mike Rust with ProEdge Dental and India Chance with Learn2Prevent join me to talk through the implications for dentistry in this episode of Talking with the Toothcop.

Outline of This Episode

• [0:22] OSHA regulations: respiratory protection program
• [4:02] Pent up demand for dental services coming?
• [6:13] Interim guidelines for dentists
• [8:57] Upcoming concerns dental practices face
• [12:22] When will dental offices start opening?
• [18:50] Aerosols have ALWAYS been a problem
• [28:27] Why is their resistance to change?
• [32:45] Who is closing their practices?
• [38:43] Preparing to reopen your dental practice
• [41:40] Ways to make the transition positive
• [48:33] Dental Line Water Unit Safety

Have a plan in place for your dental practice

India shares an example of a client who saw a patient and found out after the fact that the patient was asymptomatic, but tested positive for the Coronavirus. He had rushed to reopen his practice and was immediately exposed to the virus. Now he's suddenly faced with notifying everyone he's come in contact with and closing his practice for another two weeks.

Do you have a plan in place to protect your practice? I've been telling clients to have a go-bag ready. If they're exposed and can't risk returning to their families, they need somewhere to quarantine for the next 14 days. Vaccines won't be released anytime soon and dentists must implement everything possible to protect themselves, their staff, and their patients.

Respiratory protection programs and proper PPE

Dental offices often see patients who are ill, and exposure to aerosols and bodily fluids are unfortunately par for the course. But little has been done to rectify the problem. It's sad that it's taken a pandemic for people to open their eyes—but I'm amazed by the innovation and creativity that's ensued. Solutions are being created and proposed and that needs to continue.

Patients need to be assured we are doing everything possible to protect them—So do your staff.

We've heard talk that many hygienists aren't planning to return to their jobs because the risks they face are too great to overcome. Their PPE isn't sufficient to protect them from the aerosols they're exposed to. That's why it's imperative you do your research and make sure you and your staff are equipped with the proper PPE. Communicate to them that your practice is doing everything possible to maintain their health and safety.

How should you prepare for reopening?

I instructed most of my clients to drain their dental unit water lines before the shut-down ensued. If you weren't able to, I highly recommend doing shock treatments at least 1 week before reopening. That gives you time to test the water lines and make sure they aren't overgrown with biofilm. Mike shares some updates on ProEdge and the innovations they're making to deliver faster results.

You also need to prep your autoclave and do any necessary maintenance, cleaning, and disinfecting. The CDC is making posters available that describe symptoms of the virus to post in your waiting rooms. They created another infographic for staff members that shows the symptoms staff must keep watch for. To hear more ideas and changes being recommended, keep listening!

Will the dental industry bounce back?

Many practices are considering closing their doors instead of reopening. In Maryland, dentists usually finish school with over $250,000 in debt. Opening a practice costs anywhere from $500,000 to 1.2 million. New dental practices can't sustain long-term closures. Some practices who had just opened faced months with no income and are going to be filing bankruptcy.

Dentists who've been in the industry for years are considering moving into DSO positions with no patient contact. Others who are close to retirement are simply retiring early. But on the flip side, there is likely some pent-up demand for dentistry. Most people haven't been able to receive routine care and cleanings. Perhaps dentists will see an intense influx of patients that will help offset some of the time spent closed.

Whether dentists like it or not, necessary change is coming. The Coronavirus pandemic is affecting the infection control standards that are in place—and hopefully improving them. Many dentists are hesitant to make changes. Change is uncomfortable, scary, and even expensive—but imperative. Listen to the whole episode for our full discussion on the future of dentistry.

Resources & People Mentioned

• The CA Workplace Guide to Aerosol Transmissible Diseases
• COVID-19 Health Care Worker Protection Act of 2020
• OSHA Respiratory Protection Guidelines
• The Shield Group
• Learn2Prevent
• ProEdge Dental Waterline Labs
• India Chance on LinkedIn

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Critical Incident Stress Management. Unless you're in the military or a first responder, you're likely not familiar with this terminology. It is a protocol developed specifically for dealing with traumatic events. I've shared many times that I was a cop before becoming the Toothcop. But what many don't know is that I was also a chaplain. I was trained to help fellow first-responders through physical and psychological trauma.

In this episode of Talking with the Toothcop, Andrea and I talk about grief and the grieving process. We talk about critical incidents and how to recognize the signs and symptoms that you're dealing with psychological trauma. We also share some stress-management strategies and resources for yourself and your team to work through critical incident stress.

Outline of This Episode

• [0:22] Critical Incident Stress Management
• [9:06] Grief: experiencing psychological trauma
• [13:35] We must move through the 5 stages of grief
• [16:41] The pandemic: A series of incidents
• [21:42] Critical incident stress management system
• [25:08] Signs and symptoms of psychological trauma
• [33:49] Reduce the effects of trauma for yourself and your teams
• [38:48] What does this have to do with OSHA?

The psychological trauma we're all facing

We're all grieving right now. Some of us have physically lost someone to COVID-19. Many have lost their jobs, their businesses, and their independence. We are mourning our loss of connectedness and dealing with severe loneliness. Whether you recognize it or not, we're dealing with unprecedented levels of stress. Even though we can't SEE the damage, the damage is just as pervasive, certain, and severe as physical trauma.

Andrea points out that losing a job is a normal occurrence in society—but we can't cope with the repercussions the way we normally would. It isn't as simple as going out and getting another job. Everyone is being affected emotionally. In most instances I've witnessed, it's harder to come out of emotional trauma than physical trauma. I want to emphasize that it's okay to feel how you're feeling—but you need to recognize that you're grieving to move through the 5 stages of grief (denial, anger, bargaining, depression, and acceptance).

The critical incident stress management system

Critical incident stress management (CISM) is "an adaptive, short-term psychological helping-process that focuses solely on an immediate and identifiable problem". The way people respond to emergencies and disasters strains their ability to function. Their future depends on learning how to manage the psychological stress and impact of those incidents. The system is geared towards:

• Normalizing your instinctive reactions
• Lessening the impact of the incident
• Encourages the natural recovery process
• Restores adaptive functioning skills
• And helps determine the need for further support

No one signed up for the trauma we're all facing. We are grieving our old way of life—because when things return to "normal" they'll never be the same. We may not all be dealing with death, but we are still dealing with loss. We must seek to understand it to lessen the impact.

Signs and symptoms of psychological trauma

Stress is a mental phenomenon that can be manifested physically. Some of the symptoms include: Exhaustion, nausea, vomiting, weakness, chest pain, rapid heart rate, headache, excessive thirst, fainting, elevated blood pressure, exacerbate allergies, symptoms of shock, and more.

Our bodies are trying to tell us there's something wrong. We can also experience cognitive, emotional, and behavioral reactions.

• Cognitive reactions: blaming others, confusion, reduced attention span, poor concentration, troubled thoughts, nightmares, and so forth.
• Emotional reactions: frustration, anxiety, guilt, sense of loss, anger, denial, fear of loss of control, feelings of isolation, and more.
• Behavioral reactions: Emotional Outbursts, changes in activity level, disturbed sleep, increase in smoking or drug use, easily startled, anti-social, withdrawn, change in eating habits, fidgety and restless, change in sex-drive.

The odds are everyone is dealing with some of these symptoms in one form or another. You have to recognize that this is normal right now, but YOU have the power to change how you react and move forward.

How to reduce the effects of trauma—for yourself and your team

There are a few simple recommendations for dealing with the effects on an individual level:

• Limit exposure to noise and odors
• Take 15-minute rest breaks
• Drink non-caffeinated fluids (water)
• Don't eat excessive sugar or fat
• Don't rush back to work
• Talk through your feelings

Whenever we eventually return to our offices, owners and managers need to keep these things in mind. Many people may be hesitant to return to work and it's your job to help them feel safe. You must also convey to patients that your office is safe.

One way you can help your team transition back to work is to facilitate a structured critical incident debriefing with your team. It's a 7-step phase that helps you work through the psychological trauma together—because none of us are in this alone.

Listen to the whole episode for an in-depth discussion on each of these topics. For more resources, visit some of the links below for dealing with critical incident stress management or setting up a critical incident debriefingfor your team.

Resources & People Mentioned

• International Critical Incident Stress Foundation
• OSHA's Critical Incident Stress Guide
• Maslow's Hierarchy of Needs

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Sterilization processes are always important in dental practices to protect your staff and your customers. During the Coronavirus pandemic, everyone is especially concerned about proper procedure. You have to follow Instructions for Use (IFUs) and properly sanitize and sterilize your instruments. In this episode of Talking with the Toothcop, Stephen Kovach—whom I am now referring to as the "Godfather of Infection Control"—joins Andrea and myself to chat about the importance of sterilization processes.

Stephen Kovach is Educator Emeritus at Healthmark Industries and has been in the medical field since 1975—now celebrating his 45th year in Healthcare. He is a member of IAHCSMM orthopedic council for loaner instrumentation and a voting member on various AAMI committees. He's published numerous articles varying in subject matter from perfusion to the importance of cleaning surgical instruments.

Outline of This Episode

• [0:22] Stephen Kovach joins Andrea and I
• [2:14] Stephen's tremendous wealth of experience
• [4:05] Instrument sterilization and cleaning
• [10:13] The importance of IFUs
• [19:03] Stephen's thoughts on hinged instruments
• [26:55] The legal precedent for following IFUs
• [34:45] Get rid of rusty instruments
• [37:25] What to monitor with water quality
• [50:31] Why you need 2 full-sized sterilizers
• [52:20] Coronavirus and infection control

The importance of proper sterilization and cleaning

According to my research—which I will publish at some point here—9/10 offices aren't doing a good enough job cleaning their instruments. When I recently heard Stephen speak, he pointed out that "When you sterilize dirty instruments the end result issterile dirt". Every dental office NEEDS to have a quality management system in place—and most don't.

Stephen points out that dentists need to be referencing the AAMI ST79—The "Comprehensive Guide to Steam Sterilization and Sterility Assurance in Health Care Facilities". But most aren't. Why? Stephen and I agree it's because the high price ($400) is a barrier to entry. While their information is proprietary, it would be wise to have this information widely disseminated for the safety of our patients.

What you may not know about Instructions for Use (IFUs)

I've talked about IFUs before and have emphasized the importance of acquiring and referencing them for proper instrument sterilization. They outline the exact cleaning and sterilization process step-by-step to ensure proper cleaning of the tools. What you may not know is that device manufacturers have tested this repeatedly, and to get their products to market the FDA HAS to approve the IFUs they've submitted. They don't just slap instructions together willy-nilly. It is a well-researched process that you need to follow.

I've been surprised how many dental professionals have no idea what I'm talking about when I ask them if they're using their IFUs. Turns out, IFUs can be hard to obtain. I've even asked a device rep for an IFU and was told point-blank it was only provided to clients. Some can be found online—but not all are readily available.

Stephen and I agree you must seek out and obtain IFUs for any tool or instrument you use. Follow at the very least the minimum requirements for sterilization and go above and beyond when possible. Keep listening for our discussion on cleaning hinged instruments.

Document your procedures to protect your practice

Stephen has been a part of many depositions where professionals are asked how they documented their process and how they followed their IFUs. If they stray from the directions on the IFUs they must state why they think their cleaning procedure was superior to that of the manufacturer.

If you stray from the proper sterilization procedures and a patient's illness or even death is traced back to you—you're in serious trouble. You must be able to prove in a court of law that you followed the instructions properly and show documentation.

Some professionals claim they were told something different by the manufacturer—but have no concrete proof. Stephen recommends that if you contact the device manufacturer and they verbally tell you a process that contradicts the IFU—get it in writing. Ask them to outline the company letterhead and mail it to you for records. But if all else fails, following the IFU is the ultimate protection.

Why following instructions are SO important during the Coronavirus Pandemic

Stephen was quick to point out that he sees some of the best pre-infection control in dental offices. His personal dentist washes his hands in front of him, uses hand-sanitizer, puts on a mask and safety shield, and protective eyewear. Continue to practice these basic means of infection control—but do it correctly.

Stephen has noticed that most people don't even know how to properly use Clorox wipes. The contact time of the solution on the surface is of the utmost importance. Most people quickly wipe down surfaces with a wipe and call it good. But if you read the instructions (which vary) it states that the surface must remain visibly wet for up to 4 minutes to properly sanitize. Read the instructions people!

Contact time is also important for hand-washing. The longer you wash your hands (experts say you can sing the "Happy Birthday" song in your head) the more effective you are removing bacteria, viruses, etc.

Proper sterilization techniques are more important than ever during the pandemic—not because it was less important before—but because it brings you and your patients peace of mind in a time of chaos. Listen to the whole episode for our discussion on critical water, proper training, and how many sterilizers are necessary.

Resources & People Mentioned

• Stephen Kovach on Instagram
• Stephen on LinkedIn
• CPD Guy Website
• Dryshield
• Onesource
• OSAP.org
• AAMI ST79
• Healthmark

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube

Today I talk with my good friend and compliance colleague India Chance.

This podcast is a way to update you on the rapidly changing situation in Dentistry as it relates to the Coronavirus.

We are updating you on the changes and how to access information to help your practice.

If you need help with compliance or have questions about infection control call us at 817-755-0035

www.dentalcompliance.com

We can all agree, things are going badly right now. Times are tough. This podcast is a group effort- an attempt to help you re-focus your efforts and turn this downturn into a profitable time for your business.

Our think tank Duane Tinker- AKA: "The Tooth Cop" CEO of Dental Compliance Specialists, Andrea Baysinger, Chief Client Happiness Officer and co-host extraordinaire and Jacque Tinker, COO of Dental Compliance Officer put their heads together to bring you a message of hope and help in this difficult time.

Here is a quick a dirty list of things you can do to put your practice in a good place come the end of this mess we are facing now. Check it out.

This is a fun one guys!

OUTLINE OF THE EPISODE:

• [7:05] Review and update OSHA safety plan and written infection control plans. Understand the difference between them
• [7:45] Update compliance Training- Take our 4-hour Infection Control CE. Bone up and take the time to update annual compliance training. Your staff can complete training online on their pjs on their phone.
• [9:45] Do your Medical Emergency Training and practice scenarios.
• [10:45] Audit your records.
• [11:50] Train.
• [13:00] Virtual Team Meetings.
• [14:15] Call your patients.
• [15:10] Update your lobby.
• [16:15] Support your staff during this time of insecurity. Support your team and give them something to work on in the off time.
• [19:00] Make videos for your patients.
• [19:30] Get on videos on social media.
• [21:50] Complete your compliance inspections, especially the infection control inspection and certification!
• [23:00] Get Infection Control Certified.
• [31:15] Update your marketing plan. Create an Avatar and re-focus your efforts.
• [34:15] Update your forms.
• [35:45] New W4 forms.
• [36:15] Clean your office with EPA disinfectants.
• [37:15] Update your systems, fix problems in the practice.
• [38:00] Check your posters and things that need to be posted in the practice.

We love you and wish you and your business and family the most peace in the coming weeks.

Let us know if there is anything we can do to help you.

817-755-0035

Leadership in dentistry is severely lacking in this day and age. I'm not talking about governing bodies—but dentists who are true leaders in their field and practice. Steve Dove, DDS, and Bryan Crawford join me to have a raw and real discussion about cultivating leadership, our heart for dentistry, and our shared vision of growing leaders in the industry.

Disclaimer: we recorded this at the Voices of Dentistry Conference.

Outline of This Episode

• [0:21] Steve Dove, DDS and Bryan Crawford join the Toothcop!
• [4:42] Why an ounce of prevention is worth it
• [10:37] Budget for compliance and prevention
• [13:45] Steve points out that we live in a numb society
• [16:10] Dentists need to be passionate about people
• [18:18] Why Steve and Bryan are launching a leadership podcast
• [20:15] Cultivate a heart for people—empower and equip them
• [21:18] Where to follow the 'Dental Leadership Academy' podcast

Where does leadership in dentistry begin?

In our discussion, Steve and I agreed that a leader must acknowledge their shortcomings and know where their vulnerabilities are. The next step is actively improving on your weaknesses—or delegating them to someone. Steve struggles with organization tasks but his wife (also a dentist) excels at them. So she tends to take on organizational tasks while he focuses elsewhere.

The key is knowing when to leverage your strengths. Steve points out that you don't always want to focus on bringing your weaknesses up to average. Instead, focus on your strengths—and the strengths of those around you—and improve those. You can make your strengths incredible. People notice when you're different—not when you're average.

An ounce of prevention

Steve shares some kind words in this episode about the value that he sees in what I do as a compliance expert. I'm working to step in as an advocate to make sure dentists are compliant. The goal is to empower them to do better and be better. While you can't always see an immediate ROI, I do help prevent problems from happening. Dentists aren't always aware of things going on in their practices that could ruin them, but a focus on compliance and prevention can change that.

Steve points out that dentists don't often get thanked for the preventative services that they do. People turn down or 'poo-poo' getting a sealant put on their teeth. What they don't realize is that it can prevent cavities down the road. It can prevent needing a root canal in 5 years. An ounce of prevention will save them from using hours of PTO over multiple appointments.

If dentists are preaching to their patients that they must take preventative measures to protect their teeth, why aren't more dentists taking preventative measures to protect their practice? To protect their livelihood? Or become better leaders? Dentists need to know the repercussions of the things they don't do.

Learn to be passionate about people

Why do I care so much about dentists? Why am I invested in helping their practices thrive? Because most dentists have giant hearts. They are full of compassion. They do amazing things for people every single day. After all, a beautiful smile is worth more than words can describe. When you notice what's different about a confident person, more often than not it's rooted in caring about other people above themselves.

Steve points out that we live in a society that has become numb to what's going on around them. We snap at the person who hands us our Starbucks coffee. We treat others like crap simply because we can. We need to learn to take a step back and realize they are people. We need to see them for who they are and treat them with respect. We need to reignite a passion for caring for people—and our patients.

Why Steve and Bryan launched their podcast

A dentist can truly make an impact on someone's life. You have to grow and learn to be a good person—expound on that strength and passion that you already have. At the time of this recording, Steve and Bryan were about to launch their podcast—the 'Dental Leadership Academy'.

They are passionate about helping dentists grow into leaders. They hope that their podcast can help cultivate a desire for growth in fellow dentists. It all starts by reaching just one person who can reach others. Steve, Bryan, and I all have a heart for dentistry. We want to empower and equip others to be better dentists and leaders.

According to Steve, "A good leader is measured by how many leaders he or she creates". If you're ready to become a better leader and dentist, you have to go check out their podcast, the 'Dental Leadership Academy'—linked below!

Resources & People Mentioned

• Dental Leadership Academy on Apple Podcasts
• Dental Leadership Academy Website
• Dental Leadership Academy YouTube
• Dental Leadership Academy Facebook

Connect With Duane

• https://www.dentalcompliance.com/
• toothcop(at)dentalcompliance.com
• On Facebook
• On Twitter
• On LinkedIn
• On Youtube