Part 2:
Regulatory Compliance
Badges? We ain’t got no badges. We don’t need no badges. I don’t have to show you any stinking badges.
Gold Hat, The Treasure of the Sierra Madre
There are several regulatory needs that practitioners must take care of in their practice. These issues are not exciting, but they are important. They involve complying with government regulations.
With all these regulatory and compliance issues, in the end it does not matter whether the practitioner likes them or not, whether they believe they are an intrusion into their life, or whether they believe they are effective. They need to comply. The business owner is responsible for seeing that everyone in the office complies with the general intent and details of the regulations. Several steps will help to ensure that the practitioner does comply.
- The practitioner needs to learn the laws
As the leader and manager of the practice, the practice owner must be familiar with the regulations that affect the practice. They should take continuing education courses that show how to comply with these laws. (The practice owner should also require staff to take these courses.) They should purchase material from the ADA or other sources that guide them in developing office compliance policies. They can often delegate compliance to a trusted employee and must encourage the employee to take their role seriously and remain involved. Many consultants will help a dentist set up compliance policies and develop documentation.
- The practice owner should train new and current employees on how to follow the law
Each regulation describes the training that practice owners must conduct with employees. Most require extensive training for new employees, retraining, and certification for ongoing employees.
- The practice owner needs to document office compliance
If the practitioner does the training and other compliance requirements, they must be able to prove it if a regulator requests. They must therefore document all the training and other activities that the practice does to support compliance. Often, the documentation (not the training itself) avoids a problem. Much like patient records, if the practitioner does not document it in the records, it does not happen.
- The practice owner must do annual updates
Practitioners often believe that they have complied with the regulations when they have done something once. Most regulations require that practice owners update all staff members annually. People forget information if they do not use it regularly. Their perspectives change, and the laws and regulations change over time. Annual refresher courses help everyone understand what to do and why they need to do it.
These regulations are not onerous. They are well‐intentioned rules to be sure that dentists protect themselves, their workers, patients, private information, and the public. Each office needs to develop a culture of compliance. This culture says that the office does not grudgingly do the minimum of what it must, but looks for ways to ensure that all the affected people are protected.
LICENSES AND REGISTRATIONS
STATE DENTAL LICENSE
Completing a state or regional clinical board exam does not get a dentist a license to practice dentistry. They still must apply for a license in every state in which they will practice. As a rule, they must also pass an exam that covers the state’s dental laws before the state will grant the dentist a license. By far the biggest problem is the clinical exam. The rest is pretty much paperwork, although the dentist must know the state dental laws in detail.
A dentist must have a current state dental license certificate (the piece of paper) in hand before seeing the first patient. They must not see a patient without it because they would be practicing dentistry without a license. This is a bad way to start a dental career. The dentist may have received notice at school, by phone, or in any of several other ways that they have “passed.” But unless the state makes a specific exception, a graduate cannot see patients until they have the license in hand.
Some new dentists schedule patients based on the assumption that they will pass the licensing exams. Others assume the license will arrive by a specific date. These bad gambles can have serious adverse results if the gambles do not pay off. Other new graduates hurry to have their names placed in the phone book so that it will be there for the remainder of the year. This is another bad bet that can cause trouble for the graduate if someone complains to the board of dentistry that they are purporting to be a dentist before graduating or gaining licensure. These are also bad ways to start a dental career.
Many states require a dentist to register their license at the county courthouse where they will be practicing. This may seem like a silly contrivance to pad the wallet of the court clerk. Maybe it is. Nevertheless, if the state Dental Practice Act says that a dentist needs to register, they must register. It is the law, despite how silly someone might think a particular requirement is. They need to follow the law.
All states require either annual or biennial license renewal. If a practitioner fails to renew or pay the renewal fee, they will forfeit the license. If there is a date for renewal (e.g. December 15 of the previous year), then the practitioner needs to have the application in on time. Most states require that practitioners complete a certain number of hours of continuing education courses. Some states require specific types of certifications (e.g. cardiopulmonary resuscitation [CPR], HIV education, narcotics regulations) before renewal. The dentist needs to read the state laws carefully and follow them to the letter. A dentist’s ability to practice is too important. If someone wants to make a statement about the intrusion of government into their life, they need to write a letter to the newspaper editor and not use their dental license renewal as a forum to speak.
Many people hold dental licenses from several states, although they practice only in one state. Many states may accept regional board examinations for dental licensure. However, most states only accept those clinical exams for the first five years after completion. (Some states offer licensing by credentials or reciprocity. Others do not.) Consequently, many dentists will gain licensure in many states, using that as insurance in case they may want to move to that state in the future. The annual license renewal fees are cheap compared to the problem and expense of taking a new clinical exam at some time in the future. Besides, the cost of those licenses is a tax‐deductible expense of doing business. This further decreases the out‐of‐pocket (after‐tax) expense of maintaining those licenses. The practitioner should check with the states in which they hold licenses. Some states put time limits on how long they will license someone if that person does not practice in their state.
LOCAL OCCUPATIONAL LICENSES
Many municipalities have local occupational licenses. They are generally inexpensive but are another requirement for a practitioner to meet. These licenses are often used for ad valorem or property taxes, levied by the local municipality. Other areas may have local income taxes (occupational taxes) that they levy on people who work in their jurisdiction. They may use occupational licenses to track compliance with these taxes as well. The dentist needs to check with the local dental society, an established practitioner, or an accountant about these because they will know if the municipality has such a tax and where to sign up for it.
DRUG ENFORCEMENT ADMINISTRATION REGISTRATION
Before a dentist can dispense or write prescriptions for “scheduled” or narcotic drugs, they must register with the US Department of Justice Drug Enforcement Administration (DEA). Many people call this a “license” although, in fact, it is a registration. Dentists do not need to pass a test, they only provide information concerning their dental licenses and prescription writing needs, and then send a fee. The registration is currently for three years and must then be renewed. (Note that a dentist needs a valid dental license number before registering with the DEA, but they can request an application form before they gain licensure. This may save them several weeks in the initial practice start‐up time.) Each registration number is for a particular office. If someone has more than one office location, they must have more than one DEA number (and pay more than one registration fee). The DEA has a website (http://www.deadiversion.usdoj.gov/drugreg) that allows practitioners to apply for registration.
When the Department of Justice issues a certificate, it contains a number that must appear on all narcotic prescriptions. Many practitioners have their DEA number printed on their prescription forms. (A practitioner also needs this number to phone in a prescription to the pharmacy for a scheduled drug for a patient.) Some states require the dentist to use prescription pads with special characters embedded in the paper that make them difficult (or impossible) to photocopy. This is an attempt to keep patients from misusing prescriptions for narcotic drugs. Again, the dentist should check with the local dental society or practitioners to find the laws for the area.
Most dentists occasionally prescribe narcotics, especially analgesics, in their practices. Therefore, they will need a narcotics registration. In most states, a dentist can still practice without this registration; they just cannot dispense or prescribe scheduled drugs. If a practitioner does not have this registration, they can still write prescriptions for non‐scheduled drugs (such as antibiotics). All prescriptions must relate to dental treatment and must be for a patient of the practice. Many dentists have got into trouble with their dental board or other law enforcement agencies for improper prescriptions. This is usually for writing non‐dental‐related prescriptions or for writing prescriptions for people who are not patients (often self or family).
STAFF CERTIFICATION
Individual staff members in addition to the dentist may have license compliance issues. It is usually the practitioner’s responsibility to ensure that they do not hire someone the state has not properly licensed or certified. This includes checking the hygienist’s license, expanded function assistant’s certification, or radiographic safety certification. The practitioner needs to keep current copies of these certifications. Some states require that they post the certificates in a public area of the office.
OCCUPATIONAL SAFETY AND HEALTH ADMINISTRATION AND THE DENTAL OFFICE
The OSHA is a federally mandated program that is intended to increase worker safety while on the job. Traditionally, unions were the source of worker safety rules. The federal government began to develop these rules as the workforce became less unionized. President Richard Nixon developed OSHA in 1973. Initially, it only covered high‐risk workplaces, such as construction sites and heavy manufacturing. It has gradually increased its sphere of influence to cover almost every possible workplace in the United States. Many federal laws that govern business only control the larger corporations. OSHA pertains to all businesses that hire employees, even if they hire only one employee.
Many dentists want to rant and rail against OSHA as an unnecessary intrusion into their practices. However, these rules provide guidance on good workplace techniques and conditions. OSHA compliance is not a big problem if someone takes a positive attitude and sees that it is done. The ADA has material that is useful for complying with OSHA regulations in the office. One of the big issues is to be sure that the dentist has documented all the training and other compliance measures.
PURPOSE
OSHA’s goal is to protect the worker. OSHA does not concern itself with the customer, client, or patient safety. (For example, OSHA would not cite a dentist if a patient does not wear safety glasses, but it could cite them if employees do not.) OSHA develops rules and regulations for each workplace environment. It often depends on other federal agencies to make recommendations concerning the rules and standards to follow. For example, OSHA follows the Centers for Disease Control and Prevention (CDC) guidelines concerning the transmission of bloodborne pathogens when developing OSHA guidelines for the workplace.
OSHA has an open definition of an employee. Anyone who receives pay is an employee. They may be full‐time, part‐time, or probationary. Professional employees, such as dental associates, also fall under OSHA rules. An owner–dentist may or may not fall personally under these rules. If the dentist practices as a sole proprietor, or as a partner in a partnership, then they are technically an owner, not an employee. OSHA is not concerned with owners unless the owner is also an employee. This happens when the dentist practices as a corporation. Here, they are both an owner and an employee of the corporation. OSHA rules then pertain to them. However, most state dental boards will apply OSHA‐type standards to any practitioner, regardless of their business form. The reason is that this is the standard of care all dentists need to follow.
REQUIREMENTS FOR DENTAL PRACTICES
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