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Dr. Jeffrey Dorfman's Blog
Posts Tagged ‘Healthcare’
Our New York City dental practice has considered the whole body relationship of dental disease for 24 years. We obtain periodontal cultures of patients with advanced gum disease, based upon the early work of Dr. Max Listgarten. The recent discovery of diabetes in a patient based initially on periodontal (gum) diagnosis is a case in point. The Center for Special Dentistry (www.NYCdentist.com) is proud to work with Dr. Keith Berkowitz at the Center for Balanced Health (www.CenterForBalancedHealth.com) in mid-town NYC. The fasting glucose tolerance test they performed to diagnose the patient’s diabetes will contribute to the overall health of this 42 year young woman. This should be considered the standard of care in dentistry particularly with the present Administration’s push to expand healthcare for all. It will improve health, save lives and is cost-effective. For microbiology results from Temple University’s Oral Microbiologic Testing Lab visit:
Please re-read my comments: I said our dental practice screened the patient for diabetes but worked with Dr. Keith Berkowitz (M.D.) at The Center for Balanced Health for diagnosis and treatment. Dentists should not diagnose and treat diabetes but they can be invaluable in screening patients.
Separately, most physicians do not have any understanding of dentistry nor how it relates to systemic health. It should be part of medical school. Just 15 minutes ago we had to reschedule a patient who underwent AV Nodal Reentrant Tachycardia (AVNRT) in March at a prominent Long Island heart hospital but was not given instructions to premedicate for dental procedures for the first six months post-op.
The Center for Special Dentistry in NYC has created a health care model for academic and clinical dentistry that has been successful for over a decade. It is affiliated with both Columbia and NYU dental schools. The Obama administration may learn about it at www.NYCdentist.com/faculty. We’d be thrilled to help expand it nationally and include medicine.
The Center for Special Dentistry in NYC has created a successful unique model for healthcare delivery and education in mid-town Manhattan that is affiliated with both Columbia and NYU dental schools. It provides dental care for those who cannot afford it and trains students for the real world. The program has existed for over ten years and is financially viable. This model could be rolled out to a much larger population for both medicine and dentistry.
The Dental Faculty Practice at The Center for Special Dentistry serves two purposes: 1) To provide dental care for those who cannot afford it, and, 2) To train dental students in a real-world, premium private practice setting.
Top students from Columbia University and NYU dental schools are selected to treat patients of lesser economic means in our mid-town dental practice. Our practice is composed of twelve dentists and specialists who focus on super premium cosmetic reconstruction. It is the only private dental practice in New York State wherein dental students may treat patients for reduced fees with the patient’s informed consent. This dental work is supervised by our Faculty Dentists. Patients do have the option of being treated solely by Faculty Dentists at our regular premium fees. Sometimes more complex cases may be completed by both Faculty and students.
Patients treated by students may typically expect fee reductions starting at 40% off premium fees depending upon the procedure. The procedures available to be performed by students are limited at the discretion of the Faculty Dentists.
This program exists as a public service. It is not associated with any managed care program. This program offers the uninsured an attractive alternative in a quasi-academic environment. A financial dental plan, with prearranged monthly payments, may be available for pre-qualified patients. The number of patients and the type of cases accepted into this program are limited. Patients who do not qualify may be referred to a local New York dental school for treatment.
Our program could serve as a model to address fundamental flaws in American health care education and delivery. It is believed that health care education should be offered to interested students in high school and college and that these students should be on a health professions fast track towards their graduate degree. These students should be offered jobs during high school, college and medical/dental school in which they will be given increasing responsibilities in health care delivery to alleviate labor shortages and to help underserved populations. These students will impress upon their family, friends and neighbors the benefits of preventive health care. This work-study approach would also greatly reduce the debt many students face upon graduation from medical and dental school.
Interested readers may visit NYCdentist.com/faculty for more information.
America cannot rely on companies like Aetna to lead it out of a deepening healthcare crisis. They are part of Wall Street not Main Street.
Our country needs to incubate American entrepreneurial ingenuity in healthcare, from the bottom up, similar to current efforts in the auto (X Prize) and green energy industries. It is the doctors, dentists, nurses, pharmacists, PAs, therapists and others working with their patients each day that might have the next GREAT idea. $100 million in stock options to healthcare CEOs does not rally the troops. Listening to them might help.
Why not create a “suggestion box” directly between American healthcare workers and the Surgeon General? Let Americans do what they do best. Innovate.
Where Are The Doctors?
by Dr. Jeffrey Dorfman
(Published in Dentist Quarterly – The official publication of the New York County Dental Society – March 2000)
I attended the Bear Stearns 12th Annual Health Care Conference that was scheduled to run from September 15-17, 1999 at the Waldorf-Astoria Hotel in New York City. There were over 1200 registered attendees and over 150 speakers representing all kinds of healthcare companies. I was one of very few doctors who was invited to attend. I was asked to leave.
I was asked to leave because I asked two questions. Will insurance companies like Aetna and Wellpoint respect the request of the American Dental Association and stop using ‘usual, customary and reasonable (ucr)’ terminology in dealing with patients and instead use ‘maximum plan allowance.’ The reason for this request is that there is no such thing as a usual, customary and reasonable fee; there is tremendous variation of reimbursements for a given procedure even within the same insurance company based upon the specific policy purchased and premiums paid. To use such terminology raises distrust in the mind of the patient regarding their doctors fees.
I also asked the management of several publicly traded dental management service organizations if their growth strategies could avoid taking equity positions in dental practices through the legal subterfuge of ‘hard asset buyouts.’ This is because the American Dental Association believes that the welfare of patients is best considered when the ownership and control of dental practices remain with dentists, not investors.
These are legitimate questions that must be answered if doctors are to become involved in the evolution of healthcare delivery in our country. Investment bankers and their investors should not consider doctors merely a variable cost in healthcare and in need of paternalistic employment. We should be considered equal partners and invited to attend these conferences. Healthcare is much more than the pathetic representation of revenues and income growth as shown at this conference.
Addendum: In December 1999 the CEO of Aetna was forced out of the company. A Wall Street Journal article at that time pointed to investor discontent that began in September 1999 that lead to his ouster.
*The author was a member of the Council on Dental Practice of the Dental Society of the State of New York at the time of initial publication.
William J. McDonough recently testified before a congressional subcommittee. He said: 1) In 1980, the average Fortune 500 CEO made 40 times more than the average employee. 2) In 2003, the average Fortune 500 CEO made 530 times more than the average employee.
In another story, Anthem, Inc. wants to acquire Wellpoint Health Networks for $16 billion. John Garamendi, the state Department of Insurance commissioner, wants to block part of the deal saying the combination would only benefit companies’ executives, not California consumers.
I think U.S. healthcare is in pretty good shape. I find brilliant and genuine doctors and auxillary personnel, and I find completely average doctors and sloggish bureaucrats.
And I find healthcare CEO’s taking excessive compensation at the expense of the good doctors, auxillaries and bureaucrats who could all use to make a little more money, and at the expense of patients.
Please email me your thoughts.
[Read the Wall Street Journal to find a writer, Joseph Hallinan, for more info on the first subject. It was a great article. The latter info was found in the August 4, 2004 WSJ in the Health Section].