Sarah Handzel, BSN, RN

You’ve gotten a negative review, and you want to respond online — after all, your reputation as a dentist is at stake, and you fear losing business if you don’t stick up for yourself. It’s natural to want to share your side of the story, but be careful. Even if you’re careful, it’s still possible to violate the Health Insurance Portability and Accountability Act simply by responding to a social media post.

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Dentists often defend themselves against negative reviews on popular social media and crowd-sourced rating websites. But as a healthcare provider, you’re required to protect and keep confidential any personal health information related to any of your patients. Any interaction you have online could potentially expose your patient’s sensitive information, even if it initially doesn’t appear to do so.

So how do you address negative practice or personal reviews on such websites? There are several ways to handle this type of situation while meeting your HIPAA obligations.

Think about the way in which you address unhappy patients in your office. Are you immediately defensive or critical of them, or do you try to respond with understanding and empathy? That old expression, “You catch more flies with honey than you do with vinegar,” definitely applies to these types of patient interactions.

It’s best to avoid a public back-and-forth between you and your patient. Instead, see if you can send your patient a private message, or, if possible, make a phone call to discuss their concerns. You might find that if you take the time to personally reach out and resolve the situation, your patient might remove or edit the negative review.

You can ask other patients to review your practice if they’ve had a good experience and are happy with your care. One of the best ways to counter a negative review is to fill your profile with positive reviews left by other people. A greater amount of positive comments will help outweigh anything negative left by a patient.

Looking for tips on obtaining more positive reviews? It helps to have a process in place. 

Here’s a primer on practice review systems

You should report reviews if they are blatantly false, slanderous or profane. Most review sites are more likely to remove reviews that are offensive, or that were meant for other providers or practices … as long as you can show that the details of the review don’t apply to you. Once you flag the review and include your reasoning for flagging it, you’ll probably receive a reply letting you know it was removed.

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Articles

Your practice just received a patient review on the internet that you know is inaccurate or unfair. What do you do? How you respond can have major legal and professional consequences, if you take the wrong approach. Here are some tips on proper courses of action.

How a Negative Dental Practice Review Can Lead to a HIPAA Violation

Medicaid requires states to provide dental benefits to children enrolled in the program.

With the fate of the Affordable Care Act uncertain, 

a recent poll from the Kaiser Family Foundation

 shows eight out of 10 Americans want lawmakers to keep federal funding for Medicaid expansion programs. This funding has already helped to expand Medicaid coverage to almost 11 million people.

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The results of the survey indicated strong support for keeping the Medicaid expansion funding, regardless of interviewee’s political party affiliation. Overall, 84 percent of Americans polled felt it was important for any ACA replacement legislation to continue to fund Medicaid expansion.

 requires states to provide dental benefits to children enrolled in the program, but states are free to decide whether adults will also receive benefits. Children are covered under a set of benefits called the Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit.

For pediatric patients, dental services provided through the Medicaid program must include:

Further, all states must develop a specific dental periodicity schedule after consulting with recognized dental organizations already involved in pediatric health care. Also, dental services provided to enrollees cannot be limited to emergency services.

Currently, each state’s Medicaid costs are matched by the federal government, up to a certain percentage. There is no current upper limit on funding a state can receive. Under the ACA, Medicaid was expanded to include individuals and families making up to 138 percent of the federal poverty level, but the expanded coverage was made optional for states under a 2012 ruling by the Supreme Court.

So far, 31 states and the District of Columbia have opted to expand Medicaid coverage for their citizens. It’s forecast that the federal government will pay up to $67 billion to match coverage in the states that have expanded their programs. In response, lawmakers are proposing limits to future federal funding while allowing each state much more leeway in how their programs are run.

In the poll, more than half of Americans indicated they had a personal connection to the Medicaid program, either through help they’ve received themselves, or through a family member or close friend. More than 70 million individuals are covered by Medicaid nationwide.

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Research by the Kaiser Family Foundation indicates that eight in 10 Americans want to maintain the federal funding for Medicaid expansion programs. Currently, 11 million people are covered by this Medicaid funding. Support for this program crossed political party lines, the research shows.


Americans Want Medicaid Expansion Funding Preserved, Poll Shows

The leading source of data breaches in the healthcare industry is hacking, this report says.

 paints a bleak picture about just how safe your dental patients’ data may be. The 

TRC’s latest look at patient data security

 shows that since 2015, the number of reported breaches has increased by 40 percent. That figure represents an all-time high.

Data breaches happen when an individual’s name, Social Security number, driver’s license number, or medical or financial record is put at risk because of exposure, either in electronic or paper format. Not all data breaches are alike, but what they all have in common is that they typically contain personal identifying information that is not encrypted.

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The ITRC’s report focused on five industries, including business, education, medical/healthcare, government/military, and banking/credit/financial. In total, the medical/healthcare industry, which includes dental practices, organizations, and schools, represented 34.5 percent of the overall number of breaches.

The number of data breaches has grown steadily since 2005, when only 16 breaches were reported for the year. In looking at this year’s data, the ITRC notes that it is hard to tell whether there are more breaches that are occurring each year, or whether there are simply more reported data breaches. 

For the healthcare industry, hacking was identified as the most common source of data breaches. The second most common source of breaches was determined to be insider theft and employee error or negligence. In fact, insider theft has been a bigger problem for the healthcare industry than for the other industries studied.

Spear phishing was also shown to be a common method of obtaining personal information. This scheme uses email that appears to be sent from company executives or other high-ranking personnel. In March 2016, the Internal Revenue Service reported a 400 percent increase in phishing and malware incidents. Using this method, thieves trick employees into giving over private personal information, like W2s or Social Security numbers.

Karen Barney, director of research and publications at ITRC, says, “In general, privacy laws typically seem to not necessarily keep pace (with the security demands of newer technologies). There's a great need for corporate protocols and best practices to be in place.”

The Identity Theft Resource Center has published a report that says reported data breaches are up 40 percent since 2015. For context, there were 16 reported in 2005. Researchers identified hacking as the main source of data theft in the healthcare industry. But not far behind were employee theft and negligence.

It pays to specialize. Oral surgeons, according to the American Dental Association, are the best-paid dental specialists.

 from the American Dental Association’s Health Policy Institute shows that oral surgeons consistently earn more than their colleagues in other dental specialties. The brief focused on the average annual net income for five dental specialties: oral surgeons, endodontists, orthodontists, periodontists, and pediatric dentists.

The brief included data on earnings and busyness levels from 2000 to 2015. Oral surgeons enjoyed the highest earnings in 2008 at $568,968, but that income level dropped to $399,171 in 2010 after the start of the Great Recession. The data also suggested that the other dental specialties had their highest earning years before the Recession, while income levels fell to their lowest recorded earnings levels in the last four years.

The brief also looked at data on dentists’ perceived busyness levels. For each year included, orthodontists reported not being busy enough compared to the other dental specialties. The percentage of both oral surgeons and orthodontists who report not being busy enough also increased from 2014.

After several years of decline, average net income and busyness levels seem to have stabilized, especially from 2010 — 2013. Data from 2014 and 2015 indicate that income levels among the five dental specialties have begun to rebound from their lowest points during the Great Recession, but the gains are still modest.

It appears income level is influenced by a variety of factors, including average appointment wait time, busyness level, patient volume, and the number of dental specialists in a geographical area. A shift from small practices to larger, more consolidated practices could also be a factor in the increase in dental income levels.

Data was collected for the brief using the 

, which is conducted each year and obtains information from a random sample of 4,000 to 17,000 dentists in private practice. This survey oversampled dental specialists to ensure enough data was collected for statistical analysis.

A research brief published by the American Dental Association's Health Policy institute shows which dental specialists earn the most. The report looked at the average annual income for oral surgeons, endodontists, orthodontists, periodontists and pediatric dentists. The study also looked at how busy the specialists consider themselves to be.

The Dental Specialty that Earns the Most

There are several types of 401(k) fees you need to know about: administration fees, investment fees and service fees.

Many dentists save for retirement through a 401(k) program, but most don’t understand the fees associated with this type of retirement vehicle, or why they must pay them. High fees can severely limit your ability to reach your investment goals, so 

it’s important to understand the different types of fees you may be exposed to.

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Your 401(k) plan will require that you keep certain records, keep your accounting practices in order, and make sure you comply with all legal requirements. It’s also possible for your plan to offer additional services, like telephone voice-response systems, educational seminars, retirement planning software, and online transactions.

Sometimes, administration services will be covered by your investment fees. Most of these services can also be provided by a third-party. Either way, the more services you have in your 401(k) plan, the higher your administrative fees typically are.

Administrative fees can be charged against the assets of your plan, be allocated from among a portion of each account balance included within your plan, or charged as a flat-fee against each account included in your plan.

Managing your investments typically incurs the highest fees associated with your 401(k) plan. Today, most 401(k) plans offer a combination of actively and passively managed mutual funds. Investment fees can lower the overall performance of an individual fund.

Investment fees can include commissions related to the buying and selling of shares, investment advisory fees which are related to the ongoing management of assets of the 401(k), and other fees.

Your charge for investment management and other investment-related services is usually a set percentage of the assets you choose to invest. They are deducted directly from your investment returns, so it’s important to pay particular attention to them. The amount of money you can collect from your 401(k) will be determined after these fees have already been deducted.

Optional features of your 401(k) plan can be subjected to service fees in addition to your overall administrative fees. If you have more than one person in your 401(k) plan, these service fees are only charged to the individual accounts making use of a particular plan feature.

If you have questions about the fees associated with your 401(k) plan, take the time to review your plan’s summary plan description and the plan’s annual report, both of which contain information on what the plan provides, how it operates, and information on the plan’s assets, liabilities, income, expenses, and fees incurred. You can also contact your 401(k) plan administrator for assistance with questions about your fees and other expenses incurred to your plan.

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When was the last time you looked at all the fees associated with your 401(k)? How much are they costing you? And, what, exactly, are you paying for? This primer will help you understand where those 401(k) fees are going.

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The lush forests aren't the only thing that's green in in Oregon. The average income growth rate there has held steady at 2.1 percent since the fourth quarter of 2007.

Since the start of the Recession in late 2007, personal income levels have grown at a slower rate than usual — but the good news is, income levels have still been increasing. Nationwide, personal income is estimated to have grown by 1.7 percent annually since the fourth quarter of 2007. This compares to an average growth rate of 2.8 percent over the last 30 years.

Growth rates of personal income are used to track economic trends state by state. Information regarding the economic health of individual states is important not only to individuals and families, but to local and state governments who rely on tax revenue and consumer spending.

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State personal income is defined using three key components: earnings from working or owning a business, rent, interest, and dividends, and any transfers from a business or government. Contributions to pensions and insurance programs are included in personal income in addition to wages and salaries.

, the PEW Charitable Trusts collected data about personal income growth for all 50 states. The report examined compound annual growth rates (CAGRs) for each state since the fourth quarter 2007, in addition to income growth rates over the past year.

Click the link to see which states had the highest average personal income growth rates since 2007, starting with number one:

· North Dakota enjoyed the fastest rate of personal income growth compared to every other state. Personal incomes in the state grew at a rate of 4.7 percent since 2007.

· In the last year, incomes dropped by 1.8 percent, largely due to declining petroleum prices.

· Incomes in the Lone Star State grew at a rate of 3.1 percent since 2007.

· Over the past year along, state residents have enjoyed a 1.7 percent growth rate in incomes.

Click to the next page to see states three and four.

· The growth rate for incomes in Utah was 2.6 percent.

· Over the past year, incomes have risen more than the state average since the Recession, growing at 3.7 percent.

· For the past 8.75 years, state personal incomes in Colorado have grown by 2.4 percent.

Click to the next page to see states five and six.

· 2.2 percent has been the average state personal income growth rate for Californians since 2007.

· Personal incomes have grown by 2.9 percent over the past year alone.

· The average income growth rate for Oregon held steady at 2.1 percent.

· Over the past year, average incomes have increased at a rate of 3.3 percent.

Click to the next page to see states seven and eight.

· Citizens of Washington state have seen their personal incomes rise at a rate of 2.1 percent since 2007.

· A growth rate of 3.3 percent has occurred within the last year.

· Like several other states, South Carolina also had an average personal income growth rate of 2.1 percent.

· Incomes grew by 3.0 percent within the past year alone.

Click to the next page to see states nine and 10.

· The state personal income growth rate for Alaska was also 2.1 percent.

· Over the past year, growth rates for income in the state fell by 2.0 percent, due in part to declining wages in the mining and mineral extraction industries.

· Since 2007, state personal income growth has increased at a rate of 2.1 percent.

· Personal income growth rates have fallen within the last year by 1.2 percent. This is mostly a consequence of lost wages in the coal, natural gas, and oil industries. 

Good news: Personal income is growing nationwide. A recent report from the Pew Charitable Trusts indicates that income has grown by 1.7 percent across the board since the fourth quarter of 2007. The not-so-good news: The average income growth rate over the last 30 years was about 2.8 percent. These are the 10 states where income levels have grown the most since the fourth quarter of 2007.

10 States with the Highest Personal Income Growth

The Centers for Disease Control and Prevention looked at data from the National Health and Nutrition Examination Survey to establish the level of sugary beverage consumption.

Despite efforts aimed at reducing the public’s consumption of sugar-sweetened beverages, adults and children are consuming unhealthy amounts of sugar through the consumption of these types of products.

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According to the Centers for Disease Control and Prevention, 

sugary drinks are some of the leading sources of added sugar in the typical American diet

. The CDC also notes that excessive consumption of these types of beverages is associated with tooth decay and dental caries, weight gain and obesity, type 2 diabetes, gout, and heart, kidney, and non-alcoholic liver disease.

The CDC defines sugar-sweetened beverages as any liquid that is sweetened with a form of added sugar. Examples of sugar-sweetened beverages include soda, fruit drinks, sports drinks, energy drinks, and sweetened coffee beverages.

The CDC also used data from the National Health and Nutrition Examination Survey to measure the consumption of SSBs in the United States. Data was collected from 2011 to 2014 and showed that about one-half of all U.S. adults, or 49.3 percent, consume at least one SSB every day. The highest intake of SSBs occurred in young adults. Men consumed, on average, more of their daily caloric intake from SSBs when compared to rates of consumption among women.

Researchers also measured the rate of SSB consumption among children over the same time. The report showed that almost two-thirds of children in the U.S. consumed an SSB in any given day, making up 62.9 percent of the population of children in the country. Boys consumed more of these types of beverages compared to girls, with SSBs making up about 7.3 percent of a typical boy’s caloric daily intake.

 recommend that added sugars make up no more than 10 percent of all calories ingested each day, and that people should choose beverages with no added sugars if possible. To curb sugar consumption, several states have also enacted soda taxes to raise the price of these unhealthy products, and organizations like the World Health Organization (WHO) have called for increased taxes on these types of products, since they are so closely linked to rising rates of a variety of public health problems.

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Despite soda taxes in some states, Americans are still consuming too many sugar-sweetened beverages. This is according to the latest report from the Centers for Disease Control and Prevention. Nearly half of all American adults consume at least one sugar-sweetened beverage daily, the CDC says. Almost two-thirds of children consumed a sugar-sweetened beverage over the same study period. Boys consumed more than girls.

Americans Consuming Too Many Sugary Beverages, CDC Says

According to this study, office devices that run on VxWorks, such as your X-ray machine, are particularly vulnerable.

The dental industry is amid a transformative shift toward the use of technology to provide patient care. But with increased reliance on computers for diagnostic and treatment purposes, there’s one thing dentists need to be aware of — cybersecurity threats.

Fortinet, a cybersecurity vendor, has recently completed a study using data collected from 450 healthcare providers that shows just how critical it is for dental practitioners and other healthcare entities to protect themselves online. Fortinet found that more than 700,000 hacking attempts were made against healthcare organizations in any given minute of the fourth quarter of 2016.

Derek Manky, head of the FortiGuard Labs global threat research team at Fortinet and global security strategist 

, "By far, the most interesting trend we have seen is Internet of Things-based attacks. These are attacks not going after traditional Windows-based PCs or Internet Explorer but rather the No. 1 attacks specifically in healthcare have been against an operating system called VxWorks. We saw about two million attempts to hack into this system in Q4 2016. This runs on medical devices and infusion pumps and personal monitors, these sorts of things, and that's really concerning."

The Internet of Things is a relatively new term used to describe the increasing ways in which machines communicate with each other. Beyond what we think of when we consider the traditional Internet, the Internet of Things involves cloud computing and expanded networks of data-gathering sensors or applications. The Internet of Things is an instantaneous mode of communication, and it’s both mobile and virtual. In short, it’s the future of our increasingly-connected world.

For dentists, the implications of this cyberattack study are clear. VxWorks is a real-time operating system that is used in several dental technologies, including dental X-ray machines. If hackers break into this operating system in a dental practice or facility, they might easily gain access to sensitive patient information.

"Too often the enemies of security are invisible, they are not seen and there is a false sense of security. Just because you do not see anything doesn't mean your network is fine. The mistake is traditionally people try to build up security against an invisible enemy. First you have to find out what is happening in your vertical and then build the proper security solutions against that,” says Manky.

A recent study by Fortinet determined that in 2016, healthcare organizations faced on average more than 700,000 hacking attempts a minute. What's even more troubling is that hackers are increasingly targeting networked devices, such as the digital X-ray machine in your practice. Hacks such as these can easily yield sensitive patient data, leading to identity theft.

Is the equpiment in your dental office causing hearing loss? Apparently, there's an app for that. This new app will measure decibel levels using your smartphone's microphone.

Occupational noise-induced hearing loss can be a real threat for dentists and anyone else working in a dental practice. Now, there is a new tool dentists can use to measure sound levels in the office.

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The National Institute for Occupational Safety and Health (NIOSH) developed the 

. The mobile app was created with the goal of allowing workers in all types of industries to measure and display real-time noise exposure data to raise awareness about working conditions. Individuals using the app will be able to make informed decisions about potential hearing hazards, and scientists and occupational health experts will be able to build job exposure databases used to promote better hearing health and prevention efforts.

NIOSH estimates that up to 22 million workers are exposed to hazardous noise levels annually. Elevated noise levels can have a profoundly damaging effect on an individual’s quality of life, as well as cause substantial economic losses to society.

Noise exposure in dental offices is not usually a major problem, but some studies have shown dental professionals are at risk for hearing loss. Equipment like handpicks or ultrasonic scalers can generate noise that approaches established exposure limits.

The app is not meant to replace professional sound level meters or noise dosimeters. It also cannot be used for compliance purposes. But it does provide a readout of noise levels using a smartphone’s built-in microphone. Users can also connect an external microphone if they prefer. Sound levels are reported in decibels, and the app can be used to find information related to noise and hearing loss prevention.

Mobile app users can save and share measurement data, and if the GPS feature is enabled on the user’s smartphone, they can use it to provide the exact geospatial location of the noise measurement. Currently, the Sound Level Meter App is available for download through the Apple iTunes store.

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Noisy handpicks and ultrasonic scalers have been shown to approach decibel levels that can cause hearing loss. Are you at risk in your dental practice? A new app developed by the National Institute for Occupational Safety and Health will help you get a sense for just how loud the equipment in your practice is. It uses the microphone built into your smartphone.


New App Helps Dentists Save Their Hearing

The grant money will be used to expand the Wisdom Tooth Project, which helps educate older Americans and their caregivers about dental health.

Oral Health America (OHA), a national non-profit organization supporting the American Dental Association has been awarded a grant of $668,000 to provide better dental education and services to older Americans.

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The grant money will be used to expand the Wisdom Tooth Project, which was created to help educate older adults and their caregivers about dental care and connect them with dental professionals to obtain much needed dental services.

Part of the Wisdom Tooth Project also includes advocating for better oral health for older Americans and connecting at-risk communities with resources and support to increase access to dental care. Since 2009, the Wisdom Tooth Project has implemented 

 to help remove some of the barriers older Americans face when trying to receive needed oral care:

: This website connects older adults, caregivers, and health care providers to oral health resources. Older adults can look for local care, access educational resources, and act to help promote national oral health policies.

2. Demonstration projects: In 2015, OHA completed a project targeting pharmacists to help them be better prepared to answer any oral health questions older adults might have.

3. Advocacy: OHA has long been an advocate of a national adult dental benefit in publicly funded health insurance. The organization consistently takes steps to educate the public and legislators about barriers older adults face when attempting to access dental care.

4. Professional symposia: OHA hosts meetings at state and national levels to bring together diverse groups of healthcare professionals and community leaders. The goal of these meetings is to inspire and implement change to improve the oral health of older adults.

5. Health education and communications: OHA developed a health education curriculum, “Tooth Wisdom: Get Smart About Your Mouth,” to be delivered in community settings. Pilot programs have taken place across the country.

The grant was awarded to OHA by the DentaQuest Foundation, which has been a supporter of OHA’s mission since 2010. It is hoped that the grant money will allow OHA to strengthen their oral health and aging network, focusing attention on the relationship between oral health and total body health. The organization aims to target legislators, advocacy groups, and consumers with their message. 

The DentaQuest foundation has awarded Oral Health America with a $668,000 grant to better address the oral health needs of older Americans. OHA will use the money to bolster its Wisdom Tooth Project, which helps educate older adults and their caregivers about oral health. The group will also use the grant to connect older Americans with dental services.