The Dentist's Network #65


	Dentist Suing Dentist Denture Patient Software Manages Software

Bruce Bryen, CPA.
Managing Partner
The Snyder Group, LLC
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Litigation And Its Consequences: When Dentists Sue Each Other

Dentistry has been one of the few professions to have avoided litigation from its patients. There have been some court cases but, fortunately, they have occurred infrequently. The areas of litigation that have taken place on a regular basis concerning dentists have been within lawsuits brought by dentists against other dentists.

What Are Some Points of Contention?
One of the most frequent areas of litigation concerning lawsuits with dentists involves disputes about non-competition and non-solicitation issues within the employment, shareholder or operating agreements. These involve money and the rights of the practice owner, and also the patients’ rights. Who owns the patient charts and mailing lists? Is the geographic area narrow enough to not deprive the departing dentist of his livelihood? Is the time frame for the covenant short enough? Has there been consideration for the covenants previously agreed upon? Is there a buyout clause for the covenant?

Another area of disagreement is that of practice valuation when the dental practice is splitting up for reasons such as divorce, death, disability, retirement or the general lack of the ability to get along. With a fully executed, witnessed agreement, one wonders how litigation can commence. What is the purpose of the agreement if it doesn’t stop the litigation before money is spent on attorneys and experts for support of the documents? Many valuations stop at the date on the valuation. These appraisals are used to support buyout values, retirement formulas and other items stated in the dental practice ownership agreements. Unfortunately, many of the ownership contracts are not revised from year to year when values have changed, sometimes dramatically.

What Happens When a Resolution Does Not Occur and Court Is the Only Option?
This should be the last resort under all circumstances. The dentist should do everything possible to avoid going to court. There is no winner in litigation. The fees for attorneys, experts and support litigation staff are astronomical. The amount of time required at depositions, the effort expended gathering information for proofs of the case and the loss of time practicing dentistry because of the hours needed to prepare are overwhelming.

If there is no alternative to litigation, it is important for the dentist to organize the necessary data to support the position taken. Since there are few lawsuits involving dentists, there are also few experts who have experience in litigation with dentists. Lawyers who are good litigators may not understand dentistry or the agreements signed by the dentists. The contracts themselves may be weak because of a lack of experience by those who prepared the original agreements, if there even are agreements. If they are not constantly updated, or if they lack formulas for the computation of value on a current basis, the executed contract may be meaningless in support of the position taken by the dentist. It is critical for purposes of credibility to retain experts who have experience in litigation that concerns dentistry and not expertise in some other field like manufacturing, etc.

How to Prepare for Trial
Find an attorney who has experience with dentistry. The real estate attorney or general attorney who has represented you for years is probably not the correct person to assist you. That attorney usually does not have experience with dental practices. That attorney probably does not know who to retain as an expert for support because of the lack of experience in representing dentists. Your accountant, if experienced in litigation matters, can be extremely helpful. Do not correspond with your adversary, if possible, while the litigation is taking place. Keep good notes of your conversations with your own experts. Write down what they are requesting and gather what is needed promptly for them. The more prepared and accurate you are, the less expensive your costs will be. Try not to call your experts unless there is something that is important to review. Every time a phone call is made, a charge is incurred.

Contact this author for additional information about litigation and its effect on your practice. As an expert in providing testimony and support litigation services for dentists, with over thirty five years of experience in this field, your comfort level will be enhanced with the phone call.

Bruce Bryen, CPA has successfully assisted dentists with their personal and financial matters for more than thirty years. As a partner in The Snyder Group, he delivers creative and prudent financial strategies to help dentists build and protect wealth at every stage of their careers. His extensive expertise includes financing, debt restructuring, retirement planning and tax advising to help dentists keep more of what they earn. Bruce is also experienced in providing litigation support services and has testified on numerous occasions as an expert witness.

If you would like additional help or are interested in having Bruce Bryen speak to your dental society or study club, he can be reached at bruce@thedentistsnetwork.net or at 1-800-988-5674.

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Louis Malcmacher
DDS MAGD
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Learn To Love The Denture Patient Again

Dentistry is rapidly changing. Clinically, there are many changes that have happened over the last ten years that have really been significant to our thought processes, our materials and how we apply techniques to patients.

The single biggest example of this is in the implant market. Let me first give you some background on the implant market in the United States and in the rest of the world. In the U. S., approximately 8% to 10% of general dentists surgically place implants. In many countries around the world, 80% to 90% of general dentists are placing simple implants. For example, I know a number of general dentists in Europe and the Middle East who place implants the way that you and I place composite resins. They place them every day they practice, and it is a routine procedure in their offices.

There are some challenges in the implant market. First of all, the implant market is very confusing because numerous companies offer different kinds of implants and many dentists don’t bother to wade through the vast array of products. Second, many dentists live in the past and think that most implants still require two-stage surgeries, that implants cannot be immediately loaded, that six to eight millimeters of bone is needed in a buccal-lingual dimension and that the surgeries are difficult to accomplish. Third, dentists have heard from specialists that complicated diagnostics are needed for any implant case, and that is out of the realm of most general dentists. In addition, the cost of an implant is high, thereby placing the patient cost for a single tooth implant in the range of $3,000 to $4,000.

General dentists do need to get into the implant market immediately. Note to oral surgeons and periodontists—the more your general dentists place implants, the more they will recognize bigger cases and refer more to you. We’ve seen this in every other single dental specialty; endodontics and orthodontics are perfect examples of this.

The best way for most general dentists to start on their implant journey is with narrow diameter implants. These implants are typically in the range of 2 to 2 ½ mm. You can use them in resorbed mandibular ridges; they are very simple to place, 4 mm of buccal lingual bone is adequate, they can be loaded immediately and rarely even require a flap. Like everything else we do in dentistry, case selection is important for success.

The most common use for a narrow diameter implant is to retain a lower denture. This is a huge untapped market that most dentists shun. There are approximately 50 million denture patients in the United States, 90% of who dislike their lower denture. Most general dentists dislike the lower denture because it doesn’t fit. In a simple, one-hour appointment, narrow diameter implants can be placed in the lower jaw and a denture can be made to snap into these implants. The total patient cost is approximately $3,000, which is a very reasonable compared to conventional implants. This is within the skill set of every general dentist with some training.

The system I use in my own practice is Atlas Narrow Diameter Implants by Dentatus. Take one of their excellent courses and, in a few hours, you will be well versed in placing these implants. Dentatus has developed an extremely easy system for general dentists which consist of only two surgical burs. The key to their system is their Tuf-Link silicon liner, which retains the denture incredibly well. This is much different than other mini-implant systems that rely on metal housings in which more of the denture needs to be removed. The Dentatus Atlas System gives the general dentist much more leeway and is significantly easier to use.

By the way, there is a reason that denture clinics have opened up across the U. S. To a large part, we as general dentists have not responded to this market of 50 million denture patients and corporations definitely see the market and have jumped in to fill the vacuum with good success. Especially in the current economic times, we need to do as many dental procedures as possible to keep our offices profitable and combining dentures and narrow diameter implants together is a wonderful treatment modality.

Learn to love the lower denture patient again. They represent a significant demographic of every dental practice and, when you take care of Grandma, she will send in her kids and grandkids. This is an excellent practice builder that has been overlooked for much too long. This will change the way you and your patients look at dentures forever.

Dr. Louis Malcmacher is a practicing general dentist in Bay Village, Ohio, an internationally known lecturer, dental consultant and author, and consultant to the Council on Dental Practice of the ADA. Interested in knowing more about how to truly enjoy dentistry? Click here.

Interested in having Dr. Malcmacher speak to your dental society or study club? Click here.

To reach Dr. Malcmacher, email him at DrMalcmacher@thedentistsnetwork.net or call 1.800.952.0521.

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Dr. Lorne Lavine
Dental Technology Consultants
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Managing In Tough Times

If you read the technology journals and blogs as often as I do, then you’ve probably heard of a new paradigm in network control and security called Managed Services. I’ve started to offer this to my clients but it’s important to understand what it is and why you need it. Much of this information is from a website from another company that does this called NetCanary, but they are all pretty much the same.

Your computers are the machinery that runs your business. Every bit of down time costs you money. Just as dental offices do preventative maintenance to keep their patients’ oral health at a high level, a computer network needs regular maintenance to keep it running smoothly.

If you are not in the business of IT support, then it makes no sense for you to self-manage your network. Using on-call consultants for basic maintenance has also become a costly proposition for most offices. Add to that the delay from the time you notice a problem to it actually getting fixed, and all this extra downtime is costing you money.

Managed Services provides electronic management technology that has changed the way companies can maintain and manage their IT systems. No longer do you have to wait for things to break before your network gets attention. With these systems watching over your network, many problems can be seen and corrected before they impact your staff. Modern automation technology alerts technicians whenever specified events occur on your network, which allows them to directly focus on areas that need attention. Without this automation, a technician would waste valuable time hunting around for possible problems. These systems show him or her exactly where to look.

Thanks to secure remote access capabilities, most problems can be fixed remotely via the Internet. For you this means problem resolution in minutes, not hours! Plus your network security is not compromised. This is an important factor for organizations in regulated industries such as dentistry that have HIPAA regulations.

Patches and updates are released regularly for your operating systems and key applications to fix problems with security and make them run better. Without these updates applied, your software is vulnerable to threats that can damage your systems or, worse, make them available to attackers.

Most Managed Services software contains a sophisticated asset inventory system that tracks every piece of software installed on your computers. The software can automatically identify which stations need updates. Every week your management node will download these updates once and then apply them to all the machines on your network that need the updates. This is far more efficient than you downloading and updating each workstation and server individually. (In most cases, it makes sense to schedule these updates to apply after hours so your staff is not interrupted by the installation process.)

The old way of providing network support relied upon you to call a technician when something broke. Then you waited for someone to come find your problem. There was no telling how long it would take to find and fix it. In this outdated "reactive" support model, you pay when things go wrong. Your IT consultant gets paid when things break down. There is no incentive to make your network as reliable and efficient as possible.

Cost of supporting computers is a common complaint among dental offices. Something goes wrong on your network and the support bills start piling up. How much will it cost this month? Many dentists we’ve worked with in the past commonly agree that the unknown support costs are one of their most aggravating management issues.

Most Managed Services are subscription-based. There is no hardware or software to buy. No staff to hire. You pay a monthly fee based upon your number of servers, workstations and network devices. All monitoring, notification and remote support is done for you. The only extra charges you might pay are for consulting, implementation of new equipment or software or services that are not part of maintaining your existing IT infrastructure.

Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provides dentists a full range of services relating to the implementation of technology.

Interested in having Dr. Lavine speak to your dental society or study club? Click here.
Dr. Lavine can be reached at drlavine@thedentistsnetwork.net.

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