Blog Posts

Walking to Work (Remotely!)

Wed, 13 Nov 2024 18:08:55 +0000

By Gracie Hogue

For those of us who work at a desk, we've all grown familiar with the sensation of our backs (and let's be honest: our butts) not feeling the greatest at the end of the workday. Sitting in a chair and leaning toward our computer screens, our postures take the brunt of our hard day's work. How many times have I clocked out of work and felt like my body was just kind of... mad at me?

Personally, most of the things I do in life are centered around sitting. When I'm not at work, I'm drawing or painting at my desk, writing, sitting at my sewing machine, or sitting on the couch knitting or sketching while a favorite movie is on. But this autumn, I read a little quip about how "sitting is the new smoking," and that got my attention. The article also talked about how those who sit all day long-term are more likely to develop cardiovascular issues, more at risk for cancer, and even more at risk of developing Alzheimer's disease in their old age. On a "lighter" note, sitting all day makes someone more likely to have permanent back and shoulder issues, and can have repercussions on mental health. It can even affect where our body will tend to gain and hold weight (in the gut).

Then I looked into the benefits of walking at a desk, and there are so many! Basically, the benefits are the opposite of all the risk factors mentioned above:

Less at risk to develop cardiovascular disease
Less at risk to develop cancer
Less at risk to develop Alzheimer's disease
Better posture, less back and shoulder pain
Better mental health
Increase of gut health and better digestion
Increase in metabolism
Better blood circulation
Increase in hormonal balance
Decrease in stress

...and the list goes on. Now, I'm not a gym-culture or "sporty" person whatsoever. I'm nerdy and bookish-- as unathletic as they come. But I realized that I wanted sitting to be a reward, not a way of life. So I got a standup desk and an under-desk treadmill. Immediately, I am seeing the benefits.

For starters, my feet which have been notoriously cold 24/7 because of bad circulation and hormonal imbalance are no longer ice blocks. My digestion and gut health has improved. My mental focus has improved. My posture has improved. I no longer experience lower back pain at the end of the workday. When I clock out, instead of my body feeling mad at me, the sensation is "Whew! Good job!"

After our MPS team Zoom meeting in the morning, I turn on my treadmill and set it at 1.5 mph, and I "walk to work." Last week I walked 10 miles while working. This week, my goal is to get at least 4 miles a day in. Who knows, maybe more. And honestly, one of the best parts of it is that when I do my recreational hobbies at the end of the day that do involve sitting, it feels like a reward; I have the clarity of mind to enjoy it and I don't dread the task of "more sitting at a desk."

I understand that this is not a possibility for many people in their line of work. But if you do work remotely or have the capability to have a standup desk and under-desk treadmill, I cannot recommend this enough. You don't have to spend tons of money-- my treadmill was under $100 and it works great. If you're not a gym person either and don't enjoy workouts, this is a way-more-attainable 2025 resolution. I promise you won't regret it.

A Former OSHA Inspector's Top 3 Pet Peeves

Wed, 16 Oct 2024 14:21:38 +0000

By Caitlin Denison, BS, RDH

When I was a compliance officer and OSHA Inspector, I tried to keep my cool and not let the little things irk me. Despite my best efforts, however, each industry had its few hazards that I always found particularly frustrating. Today, I’m going to share with you my compliance pet peeves for the dental industry. I have issued citations and fines for each of these hazards and want your office to avoid them!

1. Lack of safety data sheets (SDS)- This was likely my most issued citation across all industries. Each chemical in the workplace needs an accompanying SDS on file. These documents may seem superfluous, but they are vital should an employee be exposed to the chemical, as they describe first-aid measures specific to the product, as well as clean-up instructions. SDS can easily be obtained online, or from your supplier. Keeping up with the SDS as you order products will help you avoid a backlog.

2. Eyewash station not working- In the event of a chemical or biological exposure to the eye, flushing the eye for 10-15 minutes with tepid water is typically recommended. OSHA requires that you have a plumbed eyewash for this purpose. Too many offices do not test their eyewash stations to ensure they are working properly. The time of an accident is not the time to find out if your eyewash is functional or not.

3. Improper eye protection- If you are performing a procedure that could potentially result in spatter of biological material or chemicals, eye protection must be worn. It is typical to see dental workers working in a patient’s mouth with either no eye protection, or only eyeglasses. It is the employer’s responsibility to provide appropriate eye protection and ensure it is worn.

Avoid OSHA citations and penalties with advanced planning. Caitlin is available to conduct a mock audit of your dental practice to help you get into compliance. Call today (931) 232-7738 or email caitlin@oliviawann.com.

A personal note from Caitlin:

Greetings! My name is Caitlin Denison, and I am thrilled to be the newest Compliance Trainer at Modern Practice Solutions. Immediately prior to joining the MPS team I was working clinically as an RDH. So, to all my RDHs and RDAs out there on the front lines-- I feel your pain! I always figured I would eventually find my way into dental compliance, as I worked as an inspector for Tennessee OSHA prior to getting my RDH degree.

In my role at TOSHA, I saw many of the compliance pitfalls faced by dental offices. As a hygienist I experienced these pitfalls firsthand. Trying to be compliant when you’re in the trenches treating patients and keeping a business running is a lot harder than it looks!

Sometimes --and I was guilty of this as a compliance officer-- the government can get too bogged down in their own regulations to see practical ways to implement laws and standards. Conversely, dental professionals can get stuck on minute details of how they prefer to do things and fail to meet compliance expectations. For these reasons, I think it is really valuable to have someone working for you who has experience on both sides of the issue. Achieving the right balance or rigorous compliance and practical implementation is key to long-term success.

I am excited to join a team of fellow dental professionals-turned compliance experts. With our combined decades of experience in the field we are ready to steer your office smoothly down the road to compliance!

What to Ask (and Not Ask) When a Service Animal Walks Into Your Practice

Tue, 24 Sep 2024 15:18:49 +0000

by Gracie Hogue

When a patient brings a service animal to the practice, the situation can be potentially baffling to staff. It's understandable if practice staff can feel apprehensive about what to do next, or wonder what the correct questions are to ask and what questions are to be avoided. As this situation seems to be increasingly more common in dental practices, it could be easy to say or ask the wrong thing.

Protocols for service animals need to be clear so our staff and the patients (and service animals!) are kept safe, and dental treatment can go smoothly. First of all, you may ask the patient if the animal is a service animal, as opposed to a pet or an emotional support animal. Do not ask for a certificate or paperwork that states that the animal is bonafide as a service animal. Do not ask the patient to make their service animal demonstrate what it is trained to do. Asking the patient about their disability should be strictly avoided so that the patient's privacy is respected. And as tempting as it may be, staff should not interact with or pet the service animal, as that is often a signal to the animal that they are now "off duty." The service animal should not be distracted from its important work. The service animal also should not have to wear a safety vest at all times, in the case that it could impede their freedom to do their work.

Asking what tasks it is trained to perform is perfectly appropriate, and it is also totally fine to ask if the animal is required because of a disability. Asking if the animal is housebroken is also a great and necessary question to ask.

At this point, considerations should be made as to where the service animal is comfortably situated during the patient's treatment in order for it to do its job, and at the same time not disrupt practice's staff in their treatment of the patient. Staff should also be prepared to accommodate any needs the service animal may have, such as providing water to drink or a place to relieve itself. Kind communication with the patient about their service animal's needs is an example of great customer/patient care.

By understanding its legal obligations, a dental practice can ensure that the patient, service animal, and dental staff have a positive experience.

If you are an AAR subscribing client with Modern Practice Solutions (if you're not sure if you are, you can check to see if "AAR" listed in your title in Mycase), reach out to us and we'll send you a Service Dog label for free. You can email me at gracie@oliviawann.com or call (931) 232-7738.

How to Navigate Political Tensions in the Dental Office

Tue, 24 Sep 2024 15:13:56 +0000

By Olivia Wann

In the workplace, we must foster an environment that respects diverse opinions. The subject of politics can be polarizing and stir up strong emotions that are tied to our personal core values.

With the upcoming presidential election, team members might throw verbal punches at one another and debate controversial topics while on the clock.

In management, we are obliged to promote a work environment that respects one another’s opinions. Conversations are one thing, but bashing another individual is inappropriate especially when such conduct can decrease the productivity of our workday and cause work relationships to erode.

If you serve in a managerial position, you may find it beneficial to establish guidelines and clarify what the code of conduct is during this period. While we do not wish to stifle sharing of individual viewpoints and perspectives, we want workers to be able to communicate in a professional manner. Learn how to de-escalate conflict and preserve your professional relationships.

If a political topic is going nowhere fast, neutralize the topic in order to avoid slipping into a toxic argument. Avoid pressing those emotional hot buttons which end up ruining the workday and create negative team morale.

One conversation is not going to change someone else’s views. If you are in a conversation, try to keep it just that: a conversation, a two way exchange of ideas. Look for common ground. Avoid contentious issues.

If a team member becomes irrational and threatening, this conduct should be reported to management.

As we approach the upcoming months, let’s be mindful of maintaining our professional environment and avoid disrupting the workplace.

Are you in danger? OSHA is Seeking to Regulate Workplace Violence Prevention Programs

Wed, 11 Sep 2024 14:31:06 +0000

By Olivia Wann

OSHA published the Guidelines for Preventing Workplace Violence for Healthcare and Social Service Workers and now plans to release a proposed rule in December which would be effective in 2025.

Interestingly, California dental practices were required to establish, implement and maintain a workplace violence prevention plan July 1^st of this year, regardless of how many employees are in place.[1]

Earlier this year, we were quite shocked to read that a dentist in Louisiana was stabbed multiple times and may lose her eye. The criminal entered the dental office to talk to the dentist. Evidently, she chased the dentist around the office with a knife.[2]

How would you respond in such a dangerous situation?

OSHA recommends you identify and assess workplace violence hazards. A risk factor in dentistry is working with people who have a history of violence, abuse drugs or alcohol, gang members and relatives of patients.

Another risk factor is poorly lit parking lots, especially in high crime areas. If you practice in a metro city in a large office building, perhaps you can relate to the potential fear of leaving for the day and facing the possibility of being a victim of a crime while you walk to your vehicle.

Implement a violence prevention program. This includes:

Management commitment and employee participation,
Worksite analysis,
Hazard prevention and control,
Safety and health training, and
Recordkeeping and program evaluation.

As in any business endeavor, management commitment is key in order to have an effective workplace violence prevention program. This involves allocating resources—including the time to create a program, maintain the tools, possibly make some modifications to our office layout, and keep people trained.

Management should work closely with team members in identifying and assessing hazards. Just like we would incorporate an engineering control to isolate or remove a bloodborne pathogens hazard from the workplace, we can incorporate an engineering control to remove a workplace violence hazard. For example, engineering controls could include:

A barrier at the front desk with locked patient entrance doorways with a keyless door system
A well-lit parking lot
Panic buttons
An alarm system
Maintaining a clear exit route

In providing training, include ways to deal with hostile people. This could be a patient’s relative such as a spouse or significant other. I remember a case from 2012 where the dental receptionist was murdered. She was shot shortly after arriving at work. The killer was her husband who later shot himself.[3]

We’ve all experienced the wrath of a toxic patient. How do we know whether a rude, arrogant patient or family member is going to morph into a dangerous situation? It may be helpful to learn verbal de-escalation strategies. Assess if you have a safe room where team members can take shelter from a potentially violent situation.

Incorporate an active shooter plan.[4] A future article will delve into greater details on this serious topic.

Be aware that OSHA will soon adopt the workplace violence prevention program on a federal level soon and update your policies in order to keep your dental teams safe and in compliance.

[1] https://www.cda.org/newsroom/laws-regulations/workplace-violence-prevention-plan-must-be-implemented-by-many-california-dental-practices-by-july-1/

[2] https://www.drbicuspid.com/dental-practice/legal-issues/article/15663882/dentist-attacked-while-working-at-la-practice-may-lose-an-eye

[3] https://www.nashvillescene.com/news/i-cp-i-police-identify-woman-killed-in-green-hills-dentist-office/article_2a712d95-9ed2-5f22-a1f6-0682bad2ca34.html

[4] https://www.dhs.gov/xlibrary/assets/active_shooter_booklet.pdf

Where Have All the Ethics Gone?

Wed, 14 Aug 2024 14:45:12 +0000

By Olivia Wann

Perhaps you heard the disturbing news about a Knoxville, TN dental practice who shared a video on social media revealing the contents of a private journal that belonged to one of their patients.

Some people blame such atrocities on COVID; there’s a certain air of rudeness that infiltrated into our culture. Others blame it on a generational gap caused by the disconnect resulting from people being glued to their phones and social media. Call it what you will, but we have definitely slipped into the pit of undesirable customer service—whether it’s a healthcare facility or Walmart.

Anyone associated to the dental field is knowledgeable of the basic core principles of HIPAA’s Privacy Rule. However, videos continued to be made and posted on social media exposing protected health information. Despite the characters being the staff, computer monitors may display a patient’s radiographs. Content may expose someone’s personal notes and conversations that took place with a clinical provider.

It’s important to provide training on HIPAA and being specific about Privacy Rule violations and how to avoid them. It’s equally important to train on the principles of ethics. As a matter of fact, some states such as Alabama require an ethics course as part of the CE mix.

As a lawyer, I’m required to complete 2 CE credits on ethics annually. We continue to receive training on how attorneys can easily violate an ethical principle and how we can successfully avoid such a blunder.

It’s good use of your time to train your team on the principles of ethics as it relates to dentistry. The principle of patient autonomy involves the concept that dental professionals have a duty to treat the patient according to the patient’s desires, under the standard of care and also protecting the patient’s privacy. One of the number one HIPAA violations is not providing a copy of the patient’s record in a timely manner, according to federal and/or state law. The code of conduct also requires the protection and confidentiality of such data, not discussing this information beyond the dental office and certainly not on social media.

The principle of nonmaleficence expresses the concept that dental professionals have the obligation to protect the patient from harm. We keep our education and training current, know when to refer the patient out, and prohibit personal impairment of the dental team. The code of conduct includes how to terminate a patient properly and avoid allegations of patient abandonment.

The principle of beneficence is the duty and obligation to do good. Regardless of the insurance carriers’ benefit package, we have the ethical duty to put the patient’s welfare first. It requires the obligation to provide a workplace environment that supports respectful and collaborative relationships. Although silly videos can be entertaining, does it project the level of professionalism you want your dental office to be branded with?

The principle of justice requires us to treat patients fairly, never refusing a patient based on race, creed, color, gender, sexual orientation, gender identity, national origin, or disability. Our job is to treat the dental needs of people, not judge their personal lives. Be kind, caring and extend a helping hand to those who have special needs.

The principle of veracity is that of truthfulness. Never make unsubstantiated representations just to make a buck. This principle also involves the code of professional conduct not to engage in overbilling or a waiver of insurance copayments—yes, this is an ethics violation. The ethical impropriety is misrepresenting a fee, telling the insurance we charge one fee and then only anticipating another from the patient. Make full disclosure.

Never incorrectly report to the insurance payor a dental procedure that receives a higher reimbursement than the actual procedure. This is fraudulent.

Sometimes we can summarize ethics as “just do the right thing.” If you work with a team member who does not have good customer services skills, teach them. Train them to be kind and respectful. Look at the patient when you’re talking to them. Pepper your words with kindness and understanding.

We spend a lot of money to market our practices. Perhaps we should carve out some of this budget dollars for training on communication skills. Practice your skills with each other. The results will be well worth it, both for their professional lives and interpersonal skills.

Tune in for a podcast I’m moderating with The Compliance Divas on this subject matter. I’m also pleased to announce a new CE course we at Modern Practice Solutions are offering on Dental Ethics. The strength and skill of our team hinges to the level of training we are willing to provide.

New Law in Tennessee Requires Parental Consent

Wed, 24 Jul 2024 14:55:32 +0000

By Olivia Wann, JD

The Family Rights and Responsibilities Act took effect July 1, 2024 in Tennessee. Of key interest to healthcare professionals is that the parental rights are exclusively reserved to a parent of a child without obstruction of a government entity including the rights to make all physical and mental healthcare decisions for the child and consent to all physical and mental health care on the child’s behalf.

From our perspective in the dental profession, it has been customary for parents or legal guardians to sign the consent forms for dental treatment. However, prior to this new law in Tennessee, teens had access to certain health care such as birth control, treatment for STDs and pregnancy testing in public health clinics in our state, including teens as young as 14.

With the new law in place in Tennessee, health departments are required to have a parent present or provide verbal consent over the phone for such services for minors.

Reference: https://wapp.capitol.tn.gov/apps/BillInfo/Default.aspx?BillNumber=SB2749

https://www.capitol.tn.gov/Bills/113/Bill/SB2749.pdf

OSHA Updates its Hazard Communication Standard

Wed, 24 Jul 2024 14:54:14 +0000

By Olivia Wann

OSHA updated the criteria for several health and physical hazard classes to provide better information to employees. A major change involves health hazards with updated skin corrosion/irritation and serious eye damage/eye irritation chapters.

Label elements were updated for the new and revised hazard classes and categories.

Safety data sheets (SDS) updated sections 2, 3, 9 and 11.

Although the standard was effectively updated July 19, 2024, the label and SDS updates take effect 18 months after the effective date. The Updated labels, hazard communication program and training takes place July 29, 2026.

Reference: https://www.osha.gov/sites/default/files/publications/OSHA4437.pdf

CAUTION- TN Board of Dentistry Fraudulent Calls

Wed, 24 Jul 2024 14:52:05 +0000

CAUTION!!! One of our dentists reported that they received a phone call claiming to be from the Tennessee Board of Dentistry. The caller said there was a drug incident being reflected on the dentist's dental license and that the license would be suspended. The fraudulent caller had the dentist's license information, but only information that is available to the public.

The caller then asked for a secure phone number to call the dentist to speak further in regards to this issue. The dentist, suspecting that this was not a legitimate call, gave no information.

The dentist then called the Tennessee Board of Dentistry, who said that they have made no such calls. If a dentist has a drug-related incident that effects their dental license, the Tennessee Board of Dentistry will notify the dentist by mail, and not a telephone call.

Please be aware that these phone calls are fraudulent, and if you receive a call such as this, give no information to the caller.

Emergencies and Your Pets Who Are Home Alone

Mon, 15 Jul 2024 13:51:05 +0000

By Olivia Wann

As estate planners, we work closely with clients to provide a plan to protect the individuals’ assets and assure that personal and real property properly flow to the intended recipients. We also emphasize the importance of having a General Durable Power of Attorney and include a provision for the care of pets.

Have you ever thought about what would happen if you lived alone and were in an accident or experienced a sudden illness? Do you have pets in your home who require care? These are tragedies we have seen take place and it’s not only unfortunate for the person experiencing the crisis but also a tragedy for the pets who may be potentially locked inside a house or pen with no food or water.

As a pet lover with 3 dogs, 4 goats, 6 pigs and 5 horses, this is a topic I consider near and dear to my heart. Our pets rely on us to take care of them!

To assist clients with a potential emergency, we have prepared an Emergency Alert. This alerts people that if you are ill or injured, the attending persons are made aware that you have pets at home. The card includes a space to input your pets’ names, breed, ages and any special needs or medications. There is also a space to list your contacts who can be notified to care for the pets.

In addition to emergencies that may arise for the pet owners, there is also considerations for pet safety in the event of an emergency. Emergencies include a fire, hurricane, earthquake, tornado, flooding, etc. For example, if you are evacuating your home, do you have a plan in place for your pets? Never leave them behind. Determine ahead of time if you can evacuate to a pet friendly space or bring the pets to a safe place such as a doggie daycare or a friend’s home who would allow pets.

If there is a boil water emergency, not only is it unsafe for humans to drink the water, but also unsafe for pets. Use bottled water.

Check with your veterinarian to make certain pet vaccines are up to date. Provide verification to your doggie day care who requires this information prior to a visit. Consider micro-chipping.

If your pet has anxiety during a storm, consult your veterinarian about stress-relieving medications and be sure to have their favorite toy or bedding if possible.

Obviously with large pets such as horses, there needs to be an equine evacuation plan. Perhaps a friend or contact outside the emergency area can stable your horse. Find out if there are any emergency shelters in the community or farms that are able to open their barns during such a crisis.

For tornado readiness, keep in mind that the horses may be safer if outside on the pasture rather than kept in the barn unless the barn is rated to withstand a F5 tornado.

If you are driving a horse trailer, heavy winds could be disastrous.

Obviously, there are more facets of emergencies to consider as they relate to your pets. Please stop by the office for your free Pet Emergency Card. You may want one for your wallet and one to post on your front door. Our office is located at 406 Church Street, Dover, TN 37058

References:

https://www.aqha.com/-/horse-owner-natural-disaster-preparedness

https://blogs.cdc.gov/publichealthmatters/2017/06/keep-pets-safe-in-an-emergency/

Important Information on the Change HealthCare Cybersecurity Incident

Fri, 14 Jun 2024 13:55:59 +0000

By Olivia Wann

As you are aware, Change Healthcare experienced a cyberattack in early 2024. Change Healthcare is owned by UnitedHealth Group. Change Healthcare manages health care technology connected to processing insurance claims and billing. This includes Practice Works, SoftDent, Dentrix, EagleSoft, Open Dental and many more companies. They serve basically as the business associate to the covered entity. Please review your Business Associate Agreements in place with these companies.

The Office of Civil Rights enforces the HIPAA Privacy, Security, and Breach Notification Rules. Affected individuals must be notified of this breach. This includes patients and individuals whose information was in your system that was breached. Notification must also be made to the Department of Health and Human Services and in accordance with state breach notification requirements.

Most of the dental practices we serve do not have the time or the resources to manage breach notification. The Office of Civil Rights Director indicated that affected covered entities that want Change Healthcare to provide breach notifications on their behalf should contact Change Healthcare.

HIPAA’s breach notification requires notification within 60 days of discovery of the breach. The 60-day clock for Change Healthcare to notify their covered entity customers begins when the breach was discovered. The Office of Civil Rights has yet to receive a breach report from Change Healthcare.

We are sending you this letter to alert you of the required breach notification and that according to the Department of Health and Human Services, you may delegate to Change Healthcare the tasks of providing the required HIPAA Breach notifications on your behalf. If Change Healthcare performs the required breach notifications in a manner consistent with the HITECH Act and HIPAA’s Breach Notification Rule, you would not have any additional HIPAA breach notification obligations.

I personally corresponded with Optum Privacy who is handling the breach incident for Change Healthcare. According to the Associate Director, Shelley Violette indicated that they are conducting an investigation, and no final incident report was available at that time. However, to help ease reporting obligations on stakeholders whose data may have been compromised as part of this cyberattack, UnitedHealth Group has offered to make notifications and undertake related administrative requirements on behalf of any customer. She further indicated that they would do appropriate notifications in the most efficient way possible as required by law. This would involve some form of direct mail and website notice as well as other notices required by HIPAA and applicable state laws. She hopes to provide additional information very soon on an opt out process to ease the burden on dental practices.

As we learn more information, we will continue to update you.

Where have all the employees gone?

Tue, 04 Jun 2024 15:04:39 +0000

By Olivia Wann

Recently I co-presented a course on how to do risk assessments for the Association of Dental Safety (formerly OSAP). A top down strategy to assess risk is to evaluate the areas of strategic, technology, financial, operations, legal/regulatory and human capital.

Based on the audience’s participation, it appears that most practices in attendance are struggling with human capital. Between the labor shortage and having to employ dental assistants and administrative team members with little to no dental background, practices are struggling.

As a matter of fact, when I presented for the Star of the North, hosted by the Minnesota Dental Association, there was a lot of buzz about the shortage of dental assistants and hygienists.

Dr. Rose Perpich was quoted as saying, “Hygienists and dental assistants, there’s quite a shortage in both of those areas to the point where some offices have to cut back their hours because they can’t find staff.” [1]

I presented a program that was sold out entitled, “From Acceptable to Exceptional: How to raise your team’s performance and keep them engaged” at Star of the North. The content focused on how to contribute to workplace satisfaction. I addressed symptoms of drifting and quiet quitting. We came up with ideas of how to overcome the workplace shortage such as outsourcing administrative work, recognizing talent, encouraging work-life balance, and paying employees competitively.

Dental practices experience much frustration when much time is consumed training new hires only for them to quit within months. New hire candidates do not show up for job interviews. Those who are employed may appear disengaged while others are working a double load.

Hang in there! We are all dealing with this crisis together! A few considerations:

Practice within the scope of license in your state. Avoid being the subject of a dental board complaint by having dental assistants function beyond what they are licensed to do in accordance with the state’s Dental Practice Act.

Sterilization Assistants should be trained! If you are engaging new workforce members to work in central sterilization because licensure may not be required, provide training. This is a critical area of your practice. All protocols must correspond with CDC’s infection control guidelines and the state’s infection control policy. It is important for these workforce members to understand the science of why certain protocols are in place to avoid an infection control breach.

Hiring high school students? You must comply with federal and state law. Check your state’s department of labor webpage for information on the child labor laws. For example, in Tennessee, the Tennessee Child Law includes protections for 14 to 17 year olds who are employed.[2]

If you are interested in scheduling a training session on “From Acceptable to Exceptional: How to raise your team’s performance and keep them engaged,” contact the office. We will offer this program live via Zoom on request.

[1] https://www.kttc.com/2023/10/17/dental-shortages-continue-across-minnesota-local-providers-discuss-issues-solutions/

[2] https://www.tn.gov/workforce/employees/labor-laws/labor-laws-redirect/child-labor.html

Life Estates and Irrevocable Trusts: A Comprehensive Guide

Wed, 29 May 2024 15:21:56 +0000

As trusted attornies at The Law Office of Olivia Wann & Associates, located in Dover, Tennessee, we focus on estate planning and elder law. In this blog, we will explore the concept of life estates, their advantages and disadvantages, and how they differ from irrevocable trusts. Additionally, we will discuss the benefits of irrevocable trusts, particularly when a Trust Protector is involved, compared to life estates.

What is a Life Estate?

A life estate is a form of property ownership where an individual, known as the life tenant, has the right to use and benefit from a property during their lifetime. Upon the life tenant's death, the property automatically passes to the designated remainder beneficiaries without the need for probate. This type of arrangement ensures that the property remains within the family or is transferred to specific individuals chosen by the life tenant, providing a level of certainty about the property's future ownership.

Advantages of a Life Estate

**Avoids Probate:** Since the property transfers directly to the remainder beneficiaries upon the life tenant's death, it bypasses the probate process, saving time and costs. This can be particularly advantageous in states with lengthy and costly probate procedures.
**Retains Control:** The life tenant retains control and use of the property during their lifetime, allowing them to live in or rent out the property. This means they can continue to benefit from the property, whether by residing in it or earning rental income.
**Protection from Creditors:** In some cases, the property may be protected from the life tenant's creditors, as the life tenant does not own the property outright. Creditors cannot claim the property as part of the life tenant's estate, offering a layer of financial protection.
**Medicaid Planning:** A life estate can be useful in Medicaid planning, as the property is not considered part of the life tenant's estate for Medicaid eligibility purposes, provided the transfer was made outside the look-back period.

Disadvantages of a Life Estate

**Irrevocability:** Once a life estate is created, it is difficult to change or revoke without the consent of all parties involved, including the remainder beneficiaries. This lack of flexibility can be problematic if circumstances change or if the life tenant needs to sell the property.
**Limited Control:** The life tenant cannot sell or mortgage the property without the agreement of the remainder beneficiaries. This limitation can hinder the life tenant's ability to manage their financial affairs effectively.
**Medicaid Penalties:** If the life estate is created within the Medicaid look-back period, it may result in penalties or affect Medicaid eligibility. It's important to plan the creation of a life estate well in advance to avoid these issues. Otherwise, the property must be quit-claimed back to the land owner.
**Potential for Family Disputes:** The arrangement can lead to conflicts among family members, particularly if there are disagreements between the life tenant and the remainder beneficiaries. It is important to define the expectations in order to mitigate these risks.

How an Irrevocable Trust Differs from a Life Estate

An irrevocable trust is a legal arrangement where the grantor transfers assets into a trust, relinquishing control over them, and appoints a trustee to manage the assets for the benefit of the beneficiaries. Unlike a life estate, an irrevocable trust cannot be modified or revoked without the consent of the beneficiaries. This provides a higher level of asset protection and ensures that the grantor's wishes are honored over the long term.

Advantages of an Irrevocable Trust

**Asset Protection:** Assets placed in an irrevocable trust are protected from creditors and legal judgments against the grantor, as they are no longer considered part of the grantor's estate. This is particularly beneficial for individuals concerned about potential lawsuits or creditor claims.
**Tax Benefits:** Irrevocable trusts can offer significant tax advantages, including reducing estate taxes and potentially lowering income taxes for the beneficiaries. By removing assets from the grantor's estate, the overall taxable estate is reduced, which can lead to substantial tax savings.
**Flexibility with a Trust Protector:** A Trust Protector is a third party appointed to oversee the trustee and ensure the trust is administered according to the grantor's wishes. This adds an extra layer of oversight and flexibility, allowing for adjustments in response to changing circumstances without court involvement. The Trust Protector can make necessary changes to the trust to address unforeseen issues or to take advantage of new opportunities.
**Control Over Distribution:** The grantor can set specific terms and conditions for how and when the assets are distributed to the beneficiaries, providing greater control over the estate planning process. This can include setting milestones for distributions or specifying how funds should be used.
**Medicaid Planning:** Similar to a life estate, assets transferred to an irrevocable trust are not considered part of the grantor's estate for Medicaid eligibility purposes, provided the transfer was made outside the look-back period. This can help protect assets while ensuring eligibility for Medicaid benefits.

Why Choose an Irrevocable Trust with a Trust Protector Over a Life Estate?

While both life estates and irrevocable trusts offer unique benefits for estate planning, an irrevocable trust with a Trust Protector provides superior asset protection, flexibility, and control. The Trust Protector's role ensures that the trust can adapt to changing circumstances, making it a more versatile and secure option for long-term estate planning.

Olivia prepares what is known as a Medicaid Asset Protection Trust. This is an irrevocable trust drafted in a manner to move the asset out of the estate for purposes of Medicaid planning and yet maintain the step-up in basis for capital gains purposes.

At The Law Office of Olivia Wann & Associates, we are dedicated to helping you navigate the complexities of estate planning and elder law. Contact us today to discuss your options and create a tailored plan that meets your needs and protects your legacy.

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For more information or to schedule a consultation, visit our website or call our office in Dover, Tennessee. We are here to assist you with all your estate planning and elder law needs.

Does it violate HIPAA to have security cameras in the dental office?

Mon, 20 May 2024 17:36:56 +0000

By Olivia Wann

We’ve addressed this support question regularly over the years when dental offices inquire whether their surveillance system violates HIPAA compliance and patient privacy.

Let’s explore the topic balancing HIPAA compliance and job safety.

Surveillance cameras are beneficial for the security of the dental office. This may be part of the employer’s job safety plan. According to the International Association for Healthcare Security and Safety (IAHSS) Foundation, the types of crimes reported in hospital settings include violent acts by criminals who entered the facility to commit robbery or another crime. Several years ago, IAHSS reported ten types of crimes in hospital settings:

Murder
Rape
Robbery
Aggravated Assault
Simple Asssault
Burglary
Theft
Motor Vehicle Theft
Vandalism
Disorderly Conduct[1]

Granted, hospitals and dental offices are different types of healthcare settings; however, take a look at recent violent crimes that occurred in dental offices. In February of this year, a young dentist was stabbed multiple times by a patient. In March of this year, we learned of a California dentist gunned down by a disgruntled patient. These incidents do not take into account other crimes occurring in dental practices such as theft and vandalism. Recently I worked in a dental office that had a full-time security officer on duty.

Surveillance cameras can promote greater security of the dental office grounds. On the other hand, are the cameras a risk for patient privacy and a potential violation of HIPAA? First, let’s consider the three main safeguards under the Security Rule. The basic compliance with the HIPAA Security Rule includes:

1) Administrative safeguards,

2) Technical safeguards, and

3) Physical safeguards.[2]

As far as physical safeguards are concerned, having physical safeguards in place could be part of your HIPAA compliance. Physical safeguards involve limiting access to the facility to ensure that only authorized access. For example, unauthorized persons should not be able to access the file server closet. The video surveillance is proof of who accessed these restricted areas.

However, there is a stark contrast to videoing public areas such as the parking lot, parking garage, entrance and exit doorways, reception area and hallways where there is no reasonable expectation of privacy versus a treatment room where people expect privacy. Therefore, if you incorporate surveillance cameras, placement of the cameras is critical to avoid violating HIPAA.

Caution must be exercised to ensure that protected health information (PHI) is not recorded near or around the reception area without built in security protections. For example, if the camera footage captures the front desk area, the computer monitors should not be visible and audio being recorded, if any, should not capture PHI.

Any PHI that is captured triggers HIPAA compliance and this includes whether the patient consented to the camera footage, who can access the footage, and how the video data is stored.

Ensure end-to-end encryption and incorporate evaluation of the surveillance systems as part of your HIPAA Security Risk Assessment to detect any system vulnerabilities.

In summary, if you are going to incorporate surveillance cameras, placement is critical to avoid violating a patient’s PHI. Work with a reputable HIPAA-compliant security professional who understands the parameters of compliance.

[1] https://iahssf.org/crime-surveys/2023-healthcare-crime-survey/, accessed on May 10, 2024

[2]https://www.hhs.gov/hipaa/for-professionals/security/laws-regulations/index.html#:~:text=The%20Security%20Rule%20requires%20covered%20entities%20to%20maintain,all%20e-PHI%20they%20create%2C%20receive%2C%20maintain%20or%20transmit%3B, accessed on May 10, 2024

Can Associate Dentists Throw Away Non-Compete Contracts?

Thu, 02 May 2024 15:00:35 +0000

By Olivia Wann, JD

As many of you are aware, the Federal Trade Commission issued its final rule on April 23, 2024 banning the use of non-compete agreements. Dentists fear that the provisions of their employment agreements with associate dentists will not be upheld. This means that potentially an associate could easily set up their own practice within minutes of where they associated and pull patients away from the practice where they were employed. How should we react to this ban on non-compete agreements?

First, the non-compete ban does not go into effect until 120 days after publication in the Federal Register. The U.S. Chamber of Commerce has not wasted time in filing a lawsuit challenging this ban. In the meantime, dental practices should take steps to understand what will take place should the new law survive being challenged.

It appears that all new non-compete agreements are banned. Review existing employment agreements and consult with legal counsel about revising the language in agreements that are being utilized.

This new law does not, however, apply to non-compete agreements for a seller dentist who is selling substantially all of the dental practice’s operating assets.

Non-compete agreements already in place will no longer be enforceable once the new law is in effect.

Dentists who have non-competes in place must notify their associates that by the effective date, non-compete clauses will not be enforced.

What should you do right now? Take a deep breath. The new rule does not go into effect until late August or early September. This gives you time to prepare and consult counsel.

If you are in negotiations with an associate dentist, you may want to replace the non-compete language with simply a fixed-duration employment contract. Make certain that no PHI is in the possession of the associate dentist who is leaving your practice. This includes lists of patients.

What Can I Do with a Gun Trust?

Fri, 19 Apr 2024 16:40:27 +0000

By Olivia Wann

Are you aware that in the year 2016, Stewart County, Tennessee, was rated number one in the top 20 most armed counties in the country? Yes- indeed! Stewart County, which includes the towns of Dover, Indian Mound, Bumpus Mills, and Cumberland City has the highest percentage of residents who keep firearms around their homes.

With numerous firearms in your possession, you may be considering whether you should explore a Gun Trust.

This article is a brief summary of some benefits of a Gun Trust.

Acquire and Possess Rifles, Pistols, and Shotgun (Non-NFA or GCA) Firearms

A trust is not a person under Title I of the Gun Control Act so that no background check can be performed at an FFL for a direct purchase by a trust or trustee. This is different from an NFA firearm under Title II. However, your trust can acquire non-NFA firearms directly from a private party if no FFL or background check is required, and it can possess firearms lawfully transferred to it with an assignment or bill of sale.

State law governs the requirements for firearm possession and transfer.

Acquire and Possess NFA Items

Prior to July 13, 2016, using a trust expedited the process of purchasing NFA firearms like silencers. Federal law, effective July 13, 2016, requires each “Responsible Person” to provide documentation (Form 23) when filing an application to make (Form 1) or transfer (Form 4 or 5) an NFA Firearm. This requires you (Grantor), each serving Trustee, and anyone having specific power or authority over the trust and trust property to provide a copy of Form 23 to the local Chief Law Enforcement Officer (CLEO) as notification. The application (Form 1, 4, or 5) and all required documentation (Form 23, fingerprints, photographs) and payment are submitted to the NFA Branch. The NFA Branch conducts a background check as part of your application.

Check out www.atf.gov/firearms or contact our office for more information.

Lawfully “Share” Your Firearms

The trust provides information about the lifetime enjoyment of trust firearms, which can be complicated under federal and state law. Generally, though, your Gun Trust is a superior way to acquire and possess firearms and accessories and to share them with some protection against the commission of an “accidental felony.” This is our catchphrase to describe an unlawful transfer made resulting in unlawful possession and transfer of a firearm… and you and the other person truly believed you were acting lawfully.

Why is it so useful? You can document why someone other than you is in possession of your firearm! Both federal and state laws can make it criminal for another person to possess your firearm. Title I firearms have different requirements than Title II firearms, and each state may also have its own requirements.

Several states, such as Washington, Oregon, and Colorado, are prime examples of transfer laws that can be surprising to gun owners. These and other states impose criminal penalties for transferring a firearm between persons absent a background check or a statutory exclusion or exception.

Here are some general guidelines to follow:

First, the trust has language about trust beneficiaries, i.e. those persons entitled to “enjoy” trust assets/benefits. First, it addresses those you would consider a “Lifetime Beneficiary,” someone you want to enjoy trust assets under the Trustee’s authority. Remember, a Trustee has the legal power to possess to benefit the beneficiary. Now, an NFA firearm MUST always be under a Trustee’s actual or constructive possession. The lawful owner is the trust, and the Trustee is the only person who can possess it. While a non-NFA firearm might be transferable to a beneficiary to possess individually, we believe this creates risk better avoided. The best practice, which we highly recommend, is for you or a Trustee to be in constructive or actual possession at all times, especially if you have a beneficiary who is not also an appointed Trustee.

We would provide a portfolio that contains forms to appoint persons in various capacities. For example, you can formally appoint and remove “Lifetime Beneficiaries.” A Lifetime Beneficiary is only a beneficiary during your lifetime and is not entitled to receive assets at death unless also named as a Remainder Beneficiary or on your Firearms and Accessories Memorandum. A Lifetime Beneficiary cannot independently possess a trust firearm unless a Trustee is present.

Second, the trust also has inclusive language, allowing certain individuals to enjoy trust property during their lifetime. This language addresses social situations where firearms are commonly shared.

It is important to know state law and the definitions of possession, transfer, person, and what law applies to the particular firearm. Should there be a conflict between your trust and the law, the law controls, not the language of your trust.

Make Specific Gifts of Firearms to Individuals

The trust allows you to distribute your firearms by using a written memorandum. The Firearms and Accessories Memorandum (a customized personal property memorandum) allows you to designate a beneficiary of a specific firearm or accessory.

Avoid Probate on and Publicity about Your Firearms

The Gun Trust protects your firearms from going through the probate process, a court proceeding to administer a deceased person’s assets. If you have a will or if you have no estate planning documents in place, a probate may result. Remember, probate can make your guns and other assets publicly available, so you may want to use your trust to bypass it. Your Gun Trust helps you to pass on your firearms to those you want to have and enjoy them.

Protect, Preserve and Pass On Your Firearms Legacy

Legacy planning starts with planning for your own needs first. Then you plan for the needs of others. In this way, you can effectively make a difference. We help others best when we are on a solid personal footing.

It is clear that firearms are an important part of your life. A Gun Trust is a written plan to help you and those you care about lawfully enjoy your firearms during your lifetime. When it is time to pass on, though, the memories you created can be passed on, honored, and continued by those you select to receive your firearms.

7 out of 10 Americans have no estate plan for their assets, and a Gun Trust is one piece of a greater whole. Planning for your firearms is a way to protect, preserve, and pass on something that is important to you. But remember, if you have no estate plan for other assets or if you have a will-based plan, a public probate is likely to occur.

Call us if we may be of further service to you.

Are gel and acrylic nails safe and are they appropriate for clinical dental team members?

Wed, 17 Apr 2024 14:17:06 +0000

By Olivia Wann

Gel nails and acrylic nails continue to be popular in today’s world. This article explores the safety of gel and acrylic nails and whether these trends are appropriate for clinical dental team members.

Unfortunately, adherence to hand hygiene among healthcare providers is only estimated between 20 – 40%.[1] Non-compliance with hand hygiene has been a major contributor to outbreaks of infection according to CDC in healthcare settings.

CDC further reports, “Hand carriage of gram-negative organisms has been determined to be greater among wearers of artificial nails than among non-wearers, both before and after handwashing. In addition, artificial fingernails or extenders have been epidemiologically implicated in multiple outbreaks involving fungal and bacterial infections in hospital intensive-care units and operating rooms.”[2]

CDC recommends that natural nail tips are less than ¼ inch long and healthcare providers should not wear artificial or extensions when having contact with high risk patients such as those in intensive-care units or operating rooms. The reason is due to the fact that germs can live under artificial fingernails despite handwashing or application of alcohol-based hand sanitizer.

As a matter of fact, artificial nails in healthcare have been linked to various outbreaks of infection due to gram-negative bacilli such as Pseudomonas aeruginosa, Serratia marscescens, Klebsiella pneumoniae and Candida albicans.[3]

We suggest addressing fingernails in the Employer’s Handbook in the attire section. As part of the onboarding process of new hires, the new team member should review the entire handbook on company time and sign an Acknowledgment of these policies. The subject matter can also be addressed in the Infection Control Policy for the dental office.

Aside from the risks to patient care, what about the risk to you personally? The area of concern for wearing artificial nails is the lack of proper infection control in the nail salon. Tools may not be properly sanitized between clients in some nail salons. Clients “dip” their nails into shared containers which is the process for “gel dip” nails. Several years ago, a woman experienced a cut on her finger while the nail tech was filing her nails followed by the gel dip. Her nails started to swell and bleed. She was diagnosed by a dermatologist as having a nail fungus.[4] One dermatologist indicated when filing of the nails and if the sandpaper touches the skin and/or the cuticle around the nail, an infection may result.

If you go to a nail salon, look around and assess the surroundings. Are the tools being used on a client and then merely wiped off and placed back in the drawer or container, or are the tools placed properly sterilized? When a client’s services are completed, is the countertop properly disinfected and the tech’s hands washed, or do they simply bring back the next customer? Do you see the nail techs licenses properly displayed?

One dermatologist recommended bringing your own pumice stone or emery board and tools.[5] If you suffer with poor circulation or diabetes, avoid going to a typical nail salon and consider getting a medical pedicure at a podiatrist office instead.

Despite style trends, the goal in healthcare is to provide safe care to our patients. Additionally, if we are accessing services such as manicures/pedicures, we expect the delivery of safe care. Any deviation can result in infection.

[1] Can J Infect Dis Med Microbiol. 2021; 2021: 8860705.

Published online 2021 Jul 17. doi: 10.1155/2021/8860705 accessed: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8313351/#:~:text=However%2C%20the%20presence%20of%20frequent%20nosocomial%20infections%20indicates,has%20been%20estimated%20at%2020%E2%80%9340%25%20%5B%2011%20%5D

[2] https://www.cdc.gov/mmwr/PDF/rr/rr5217.pdf

[3] https://www.ajicjournal.org/article/S0196-6553(02)59151-3/abstract

[4] https://www.health.com/condition/skin-conditions/dip-powder-manicure-infection

[5] https://www.tmc.edu/news/2019/01/nail-hygiene-are-manicures-and-pedicures-worth-the-health-risks/

Employer Cited for Illegally Employing Children in Tennessee

Tue, 09 Apr 2024 13:18:31 +0000

by Olivia Wann

Recently, a Tennessee parts supplier for John Deere and Yamaha was fined $296,951 after the Wage and Hour Division confirmed that as many as ten children as young as 14 years old were working in the factory. According to Jessica Looman in a press release, she indicated that even one child working in a dangerous environment is too many. Evidently, there has been an alarming increase in child labor violations where children are in danger. One child was operating a power-driven hoisting apparatus like a forklift. Workers under 18 years old are not permitted to operate dangerous machinery.

The factory claims to have employed a temp agency and does not employ minors. According to Knox News, the factory is required to set aside $1.5 million in profits made during the children’s employment, which will be distributed to these children.[1]

According to the Department of Labor, minors must be at least 14 years old to be employed in non-agricultural workplaces. Certain restrictions apply, such as not working before 7 am or after 7 pm.[2]

The Department of Labor’s Wage and Hour Division administers and enforces federal labor laws. The Fair Labor Standards Act sets the minimum age for workers at 14 for non-agricultural jobs, provides restrictions on work hours for children under 16 and prohibits workers under the age of 18 from working in hazardous occupations.

In addition to the federal child labor provisions of the Fair Labor Standards Act (FLSA), 29 U.S.C. 292(c), and the FLSA regulations at 29 CFR Part 570, employers in Tennessee are subject to Tennessee’s Child Labor Act. Basically, the law is designed to ensure that any work performed by youth does not jeopardize their health and well-being, nor does it affect their educational opportunities.

Working hours for 14- and 15-year-olds in Tennessee while school is in session are no more than 3 hours a day, no earlier than 7:00 am and no later than 7:00 pm, and no more than 18 hours per week. When school is not in session, working hours are no more than 8 hours per day, no earlier than 6:00 am and no later than 9:00 pm, and no more than 40 hours a week.

For 16/17 year olds employed in Tennessee, these youth may not be employed between the hours of 10:00 pm and 6:00 am, Sunday through Thursday, preceding a school day.

Additionally, meal periods for minors in Tennessee are mandatory thirty (3) minute unpaid breaks or meal periods if they are scheduled to work six (6) consecutive hours. Minors are prohibited from working in dangerous jobs such as:[3]

Minors are prohibited from working in dangerous jobs such as:

Meat processing and slicing
Power-driven saws
Power-driven woodworking machinery
Roofing
Driving
Compactors and balers
Explosives
Forklifts and skid-steers
Demolition
Mining
Logging, forestry and sawmilling
Power-drive bakery machines
Radioactive material
Brick and tile
Working with metal
Trenching and excavation[4]

You may download the Tennessee child labor poster from this link that outlines the rules: https://www.tn.gov/content/dam/tn/workforce/documents/Wage_Poster.pdf

In conclusion, many of us well remember our first job. Let us make sure that when minors are in our workplace, we are in compliance with the law and we are contributing to a positive experience that inspires our youth.

[1] https://www.knoxnews.com/story/news/crime/2024/03/26/tuff-torq-corp-owes-penalty-compensation-child-labor-violation-us-deparment-labor/73104203007/

[2] https://www.dol.gov/agencies/whd/fact-sheets/52-healthcare-child-labor

[3] https://www.tn.gov/workforce/employees/labor-laws/labor-laws-redirect/child-labor.html

[4] https://www.dol.gov/agencies/whd/child-labor/what-jobs-are-off-limits

Are you being fair to pregnant employees in a dental office?

Wed, 03 Apr 2024 16:21:37 +0000

By Olivia Wann

Recently Walgreens was ordered to pay $205,000 in EEOC pregnancy and disability discrimination lawsuit. Evidently a Walgreens store located in Alexandria, Louisiana refused to let an employee take emergency leave to seek medical attention. The pregnant employee suffered with diabetes and hypoglycemia and was spotting. The store manager refused to let the employee leave until she found a replacement. The employee had no choice but to resign so that she could seek medical care. The employee miscarried that day. Walgreens violated Title VII of the Civil Rights Act of 1964 and the Americans with Disabilities Act.[1] Are you in compliance with state and federal laws?

There is a fairly new federal law, the Pregnant Workers Fairness Act (PWFA), passed June 27, 2023.[2] This federal law requires covered employees (those with 15 or more employees) to provide “reasonable accommodations” to a qualified worker’s known limitations related to pregnancy, childbirth, or related medical conditions unless the accommodation will cause the employer an “undue hardship.” An undue hardship is one that causes significant difficulty or expense.

There are also state laws. For example, in Tennessee we have the Tennessee Pregnant Workers Fairness Act that was signed into law June 22, 2020[3]. This state law which applies to employers with 15 or more requires the employer to provide reasonable accommodations which may include:

More frequent, longer, or flexible breaks;
Private place, other than a bathroom stall, for expressing milk;
Assistance with manual labor and lifting limits;
Job restructuring for light-duty if available;
Providing or modifying equipment;
Providing time for prenatal visits.

The federal Pregnant Workers Fairness Act which applies to employers with 15 or more employees requires reasonable accommodations to include:

Being able to sit or drink water;
Receiving closer parking;
Flexible hours;
Appropriately sized uniforms and safety apparel;
Receiving additional break time to use the bathroom, eat, and rest;
Taking leave or time off to recover from childbirth;
Being excused from strenuous activities and/or exposure to chemicals not safe for pregnancy.

How do we apply these accommodations to a dental office environment when necessary? In working with dental groups, I have observed pregnant workers with lab coats that were too small. Rather than wearing cloth lab jackets, it may be wise to consider disposable jackets or gowns and in the correct size for the pregnant workers.

The schedule may require adjustments to allow more time between patients to drink adequate fluids particularly since food and drink is prohibited in the clinical areas.

Rather than using glutaraldehyde which is used as a “cold sterile,” ensure that items are either disposable or heat sterilizable. The National Institute for Occupational Safety and Health (NIOSH) provides information to raise awareness on the adverse health effects of glutaraldehyde and how you can be exposed to it plus work practices to prevent or reduce your exposure.[4]

Allow unpaid time or accumulated paid time off if available for prenatal care and time off to recover from childbirth. It may be helpful to seek out a temporary to fill in to avoid gaps in the schedule.

The question also comes up regarding taking radiographs during pregnancy. According to the American Dental Association, it is recommended that dentists provide pregnant staff members with dosimetry badges and limit exposure to 0.5 mSv/month (or in accordance with state requirements). Even though the radiation exposure is extremely low in dental radiography, this is a good risk management tool to prove that the radiation exposure was not above the recommended limits.[5]

When dealing with a pregnant worker and there is question of whether an accommodation should be made or could be made, consult with your legal counsel.

[1] https://www.eeoc.gov/newsroom/walgreens-pays-205000-eeoc-pregnancy-and-disability-discrimination-lawsuit

[2] https://www.eeoc.gov/wysk/what-you-should-know-about-pregnant-workers-fairness-act#q5

[3] https://www.ctas.tennessee.edu/tennessee-pregnant-workers-fairness-act

[4] https://www.cdc.gov/niosh/docs/2001-115/default.html

[5] https://www.ada.org/resources/practice/practice-management/radiographic-imaging#:~:text=The%20ADA%20suggests%20that%20employee%20policy%20manuals%20include,and%20that%20they%20limit%20exposure%20to%200.5%20mSv%2Fmonth.

Can We Stop Using Lead Aprons & Thyroid Collars on Dental Patients?

Tue, 12 Mar 2024 17:14:57 +0000

By Olivia Wann

Are you confused by all the changes? Shield or don’t shield?

The ADA updated their recommendations for radiography safety in dentistry on February 1, 2024. The use of lead abdominal aprons or thyroid collars on patients when taking x-rays is no longer recommended. This decision was based on the ADA’s expert panel after reviewing published studies on radiography for dental patients. This applies to all dental patients, including, quite surprisingly, pregnant patients. According to them, the lead aprons and thyroid collars can block the primary x-ray beam diminishing the quality of the radiograph resulting in more exposures.

Radiation associated with imaging modalities used in dentistry range from low-dose intraoral digital radiographs to higher-dose imaging procedures using CBCT, according to ADA. These modalities are generally low compared to medical radiographs.

The key factor to focus on is the fact that clinicians should order radiographs in moderation to minimize exposure. Use the ALARA (as low as reasonably achievable) principle for the safe use of radiographs and also as low as diagnostically acceptable for CBCT. Radiographs should be ordered based on diagnostic and treatment planning needs. Make a good faith effort to obtain previous radiographs from the previous provider. This is part of the right-to-access rule embodied in HIPAA.

Keep in mind too that ADA and CDC are not regulatory agencies. Federal, state and local agencies may enforce their regulations as it relates to lead aprons and thyroid collars. For example, California law requires use of lead or lead equivalent aprons during dental X-rays as published by the California Dental Association on December 7, 2023, as set forth in section 20211 of California’s Code of Regulations.

Based on our understanding of the state of Tennessee, the laws are still the same regarding shielding. However, it appears that the new director of inspections would not be enforcing lead apron requirements in the dental settings, only medical.

There are a few recommendations made by the ADA for the safe and appropriate use of ionizing radiation in dentistry well worth summarizing in addition to what has already been stated:

Follow the law regarding safe and effective use of x-rays.
Follow the manufacturer’s instructions for safe and proper operation, maintenance, and infection control for x-ray procedures.
Implement a radiation safety program.
Those who take X-rays should have the necessary qualifications, education, training, and licensure as required by federal, state, and location regulations. For example, in Tennessee a dental assistant must hold a certificate in dental radiology from the Tennessee Board of Dentistry to operate dental X-ray equipment.
When barrier protection is not available for intraoral imaging, the operator shall stand at least 2 meters from the tube head and out of the primary beam path.
Handheld and portable devices shall be safely secure to prevent unauthorized use.
Dental staff members who take X-rays who may be exposed to an annual dose that may exceed 1 mSv, or as otherwise determined by state or locate guidance, should consider wearing personal dosimeters regardless of anticipated exposure levels.
Before jumping in and taking X-rays, the clinicians should complete a comprehensive clinical examination and patient assessment, with consideration of the patient’s oral and medical histories, including previous radiographs as well as the patient’s specific oral disease risk.
Prescribe dental radiographs and CBCT scans only when the clinician expects that the diagnostic yield will benefit patient care, enhance patient safety, or substantially improve clinical outcomes.
Before you ditch the lead aprons and thyroid collars, be sure you are in compliance with your state.

For more information regarding ADA’s updated recommendations, https://www.ada.org/about/press-releases/ada-releases-updated-recommendations-to-enhance-radiography-safety-in-dentistry.

Please be sure to update your radiation policy.

Defibrillators: Are Yours Ready and Set?

Mon, 22 Jan 2024 16:15:25 +0000

By Gracie Hogue

We all work from day to day without thinking of the possibilities of a dire emergency happening. But in the offhand chance that someone needs to be revived, is your AED ready?

Imagine this scenario: a patient suddenly needs a defibrillator. The team gets it and brings it to the patient, and it’s covered in a thin layer of dust. The team tries to use it. It is not in working order, and the patient is lost.

The AED monthly checklist is a great way to make sure that your AED is ready to rock and roll if an emergency arises. A checklist can be made easily with these items:

Visual check of device - no visual damage or missing parts
Battery check
Pads are in-date and sealed
Spare pads are in-date and sealed
Accessory equipment present and in-date (towel, razor, scissors, gloves, paperwork)
Storage cabinet secure
Checklist signed/initialed

Making a monthly check on the condition of your AED is a great way to ensure that if it is needed, it can save a life.

Corporate Transparency Act

Thu, 11 Jan 2024 19:49:34 +0000

Are you a LLC, a PLLC or corporate entity? Be aware that Congress passed the Corporate Transparency Act in 2021. The new federal reporting requirement for beneficial ownership information goes into effect beginning January 1, 2024. The goal of this new law is to prevent money laundering and other financial crimes, including terrorist financing.

Individuals who own or control the company are referred to as “beneficial owners” and are required to report their beneficial ownership interest (BOI) to the federal government. In the words of the U. S. Department of the Treasury Financial Crimes Enforcement Network, this new law will make it harder for bad actors to hide or benefit from their ill-gotten gains through shell companies or other opaque ownership structures.

There are exemptions to the law. Publicly traded companies, nonprofits and certain large companies are exempt from reporting. Also exempt are sole proprietors.

There are actually a total of 23 exemptions listed in FinCEN’s Small Entity Compliance guide.

To meet the large operating entity exemption, the business must meet all three of the following thresholds: 1) operate from a physical commercial street address in the U.S., 2) have 21 or more full-time U.S. employees, and 3) generate more than $5 million in annual U.S. gross receipts as reported on the prior year’s tax return. However, we anticipate this new federal law to affect many of our business clients.

In order to achieve compliance, you must report personal identifying information to include name date of birth physical home address and your photograph.

If you formed your business prior to January 1, 2024, you have one year to comply with reporting. If your business is formed after January 1, 2024 through December 31, 2024, you have 90 days to report. For businesses formed after January 1, 2025, you have 30 days to report.

Who has access to this information that you report? Law enforcement at the federal, state and local levels have access, but such information will not be available to the general public. If you fail to report, the fines range $500 per day up to $10,000) per incident.

You report your beneficial ownership interest through FinCEN’s website: www.fincen.gov/boi.

Corporate Transparency Act for Dental Offices

Thu, 11 Jan 2024 19:50:06 +0000

By Olivia Wann, JD

There are exemptions to the law. Publicly traded companies, nonprofits and certain large companies are exempt from reporting. Also exempt are sole proprietors.

There are actually a total of 23 exemptions listed in FinCEN’s Small Entity Compliance guide.

In order to achieve compliance, you must report personal identifying information to include name date of birth physical home address and your photograph.

You report your beneficial ownership interest through FinCEN’s website: www.fincen.gov/boi.

The First Phishing Attack Settlement $480,000 Announced!

Tue, 12 Dec 2023 16:49:44 +0000

By Olivia Wann, JD

The OCR settled with a medical group in Louisiana for a phishing attack that affected 35,000 patients for $480,000.

Phishing attacks can result in identity theft, financial loss, discrimination, stigma, mental anguish, negative consequences to reputation, health, or physical safety of the individuals, or to others identified in the individual’s protected health information, according to the Office of Civil Rights.

Modern Practice Solutions has been providing on phishing attacks for quite a few years in our standard HIPAA- Cyber courses. We demonstrate how the cybercriminal mimics a reputable site to pretend the email is from that organization. For example, rather someone@amazon.com, the email may be from someone@mazon.com. Without carefully reviewing the sender’s information, the person receiving the email may be deceived. The body of the email may indicate that the person’s account was compromised and to click on the link to secure the account. By clicking on the link, the receiver has now compromised the data.

When the OCR investigated this recent phishing attack, they learned that the medical group did not conduct a risk analysis. This process is required and critical to identify potential threats or vulnerabilities to electronic protected health information. Have you conducted your HIPAA Security Risk Assessment? If not, please schedule this important service.

The OCR also noted in this recent breach that the medical group did not have policies or procedures in place to regularly review information system activity to safeguard protected health information. Have you contracted with your IT group or 3^rd party to review your system activity? This is critical in order to safeguard the information you maintain on patients against cyberattacks.

The medical group was required to complete the following:

Establish and implement security means to reduce security risks and vulnerabilities to ePHI ;
Develop, maintain and revise written policies and procedures to comply with HIPAA;
Provide training to staff.

Compliance with HIPAA and recognized security practices are not simply a good idea—it’s required. If you experience a cyberattack and you have no proof you’re endeavoring to be in compliance, you too will be subject to hefty penalties.

Protect your practice. Protect your reputation. Get into compliance!

ABC's of an Office Christmas Party

Tue, 14 Nov 2023 18:23:31 +0000

By Olivia Wann, JD

Are you counting down the days until Christmas? With the holiday season fast approaching, questions arise for employers and their teams. Let’s talk about the ABC’s of Christmas in the workplace.

A. Alcohol

If you are planning a Christmas party in the evening or on the weekend, many employers like to serve alcohol during their festive event. There are a few considerations to make in keeping your party safe and the employer’s liability limited.

One idea is to engage a professional catering service and bartender. In this manner, you are employing a licensed and insured server/bartender who is trained to spot the signs of an individual over-indulging. You may want to consider a “drink ticket” limited to one or two tickets. I find this to be typical at large conferences. One client I’ve worked with actually arranges transportation during his work-sponsored events to minimize the risk of an employee driving under the influence.

Employers may opt to refrain from serving hard liquor and limit the choices to beer and wine.

If your holiday event is during the day, especially during the week, you may opt to not serve alcohol at all and instead serve mocktails.

B. Bonus

Provision of a holiday bonus is not required. According to the Bureau of Labor Statistics survey of employers with less than 100 employees, 14% of this size employer provides a year-end bonus while only 9% provide a holiday bonus.

Some employers opt for a year-end bonus. The bonus may reflect the profitability of the practice. The bonus may factor in the net income, personnel expense, individual incentive programs (such as a hygiene bonus, collection bonus, etc.), or simply a surprise bonus amount. It also accounts for the length of service.

Keep in mind that the bonus is subject to tax. It is also noteworthy to point out that if the bonus system is not set up correctly, this can actually be harmful to the practice’s profitability and frustrate staff members. Consult your practice management consultant and/or CPA to determine how you can set up the right bonus system to benefit the practice and incentivize the team, whether it is a Christmas bonus or year-end bonus.

Maybe query your team. One idea is to skip the elaborate Christmas party and use the money saved to distribute among the staff members as a bonus. Others may prefer a team trip.

C. Compensation

First, let’s discuss compensation for attendance at a holiday event. If attendance is mandatory, then employees would be paid for their time. The same holds true for employees organizing the event, whether it’s meeting with a caterer or spending time ordering supplies for the function. Also consider the agenda of the event. Is it strictly festivities or are you planning to cover goals for the following year and a recap of the practice’s productivity? If you’re talking about work and people are required to attend, it sounds like work and people are paid to work, especially if the party is held during normal business hours.

In practices I’ve personally served over the years, most of these practices pay the employees for Christmas day and New Year’s Day. If the holiday falls on the weekend or on an ordinary day off, the practice observes the paid holiday on a different day. Paid holidays are one of the strategies to retain staff and be competitive in the job market.

What about holiday shutdowns? Well-established dental offices or those who find that the period between Christmas and New Years Day is typically down time may choose to close down the practice entirely for a week or two.

Most employers shut down without pay. The Department of Labor does not require the employees to be paid – that is of course true only of hourly employees. If you have a salaried exempt employee, this employee is paid if any work is performed, even answering an email or work-related text message can trigger a workday.

On the other hand, some employers may require reservation of employee’s accumulated vacation or paid time off to be utilized unless prohibited by state law during the shutdown. This usually requires providing employees adequate notice such as publication in your employer’s handbook.

In reviewing the ABC’s of Christmas in the workplace, let’s not overlook the fact that not everyone celebrates Christmas.

Exercise caution in being sensitive to team members who don’t observe the holiday, whether they are atheists, Muslim, or of other faiths who do not observe Christmas. Inquire of these employees what their preference is whether they prefer not to participate in a holiday event or not. In this case, it may be best to plan a holiday party on the weekend rather than during working hours. The main thing to focus on is holiday parties should be voluntary and usually the point is to inspire our team.

May your holiday season bring you and your practice much joy and the New Year be filled with happiness, health and success.

References: Salary: https://www.dol.gov/agencies/whd/fact-sheets/17g-overtime-salary

Vacation Time: https://www.dol.gov/general/topic/workhours/vacation_leave