For Immediate Release
Date: Dec 17th, 2018
Contact: Dr. Sharon Turner
2018 ADA Meeting Highlights
The 2018 ADA Meeting was held at the Honolulu Convention Center in Honolulu, Hawaii from October 19 to the 22. As is the custom for this meeting, Thursday, Friday, Saturday, and Sunday morning there were multiple high-quality continuing education courses available. The House of Delegates (HOD) met on Friday and Monday, with the four Reference Committee Meetings held on Saturday, October 21 to consider the ninety or so resolutions that were submitted to the HOD for consideration. Elections for President-Elect and Second Vice President were held on Monday, October 22, and Dr. Chad Gehani of Queens, New York was elected President-Elect and Dr. Craig Herre of Kansas was elected Second Vice President.
All of your KDA Delegates were in attendance for all proceedings of the HOD: Delegates Bill Lee, Fred Howard, Andy Elliot, Dennis Price and Kevin Wall. Executive Director Rick Whitehouse and Secretary/Treasurer Sharon Turner were also seated on the delegate floor, but hand no voting rights. Sixth District Trustee Roy Thompson of Murfreesboro, Tennessee was also present for the entire meeting. The Sixth District Caucus was held on Sunday from 7AM to 4PM and was chaired by our own Dr. Bill Leslie of West Virginia, it being West Virginia’s turn to host both, the pre-meeting district caucus and chair the district caucus during the ADA Meeting. Alternate delegates Barry Curry, Mark Moats, and Jonathan Rich also attended meetings of the HOD. Alternate Delegate Ansley Depp was not able to attend.
Attendance at the meeting was again reported to be less than the number of persons that were anticipated to attend, and there was some speculation that the cost of attending the meeting in Hawaii may have been partially responsible for the decreased attendance.
The Treasurer’s Report was presented by Treasurer Ron Lemmo, who is completing his sixth and final year in this position. He indicated that he felt that it was his job to be totally transparent about budgetary matters and to consider how best to position the ADA to achieve goals from its strategic plan. He reported that 2017 ended with a positive bottom line, but that has continued to decline impacting dues revenue, and that non-dues revenue has not grown at the level anticipated. The budget presented for 2019 reflects revenues of roughly $133 million dollars and expenditures and taxes of roughly $135 million dollars, thus showing a deficit budget without the proposed $22 dues increase. Dr. Lemmo pointed out that the problem with not having continuous small dues increases to keep up with inflation is that when dues increases then are levied, they are larger in amount and more difficult for members to budget in their own personal budgets. Dr. Lemmo reported that the three reserve funds balances as of July of 2018 were as follows: Capital Replacement $5 million dollars; Investments $85 million dollars; and Membership Royalty from Great West, $46 million dollars. He pointed out however that the Membership Royalty Reserve is an account that is designated for saving, not spending, and that the strategic plan calls for growing this fund to $100 million and then designating the investment income from the account for use in the annual operations budget so that dues increases can be minimized. The projected annual investment income from the Royalty Reserve is estimated to be about $7 million dollars once its balance reaches $100 million dollars. The budget includes a new $2 million-dollar line item for search engine optimization. Expenses are currently growing at the rate of 2.8% per year, whereas non-dues revenue is growing at a rate of 1.5% per year and dues revenue is growing at a rate of 0.2% per year. ADA policy requires that uncommitted liquid assets in the amount of 50% of the annual operating expenses must be maintained, and this target has been easily met. Reserve accounts have been used the last two years to finance the Find-A-Dentist marketing program at $6 million dollars per year. The Treasurer and the Board of Trustees unanimously recommended that rather than draw down the reserve accounts for a third straight year, that a one-time special assessment of $58 per member be collected to finance the program for the third year of its pilot period, and that thereafter, this expense be folded into the annual operations budget if the program is to continue. The program appears to be highly successful for those member dentists who have submitted profile information to the ADA.
There were three Resolutions related to the budget. Resolution 34 was presentation of the 2019 Budget. It was passed. Resolution 35 was for the $22 due increase, and it passed. Resolution 36RC was substituted for Resolution 36, by Reference Committee A: Budget, Business Membership, and Administrative Matters. The original resolution called for payment for the Find-A-Dentist program via a one-year special assessment of $58 per member. The substitute resolution changed the funding source to be from ADA reserve accounts. The substitute resolution passed after much debate. At some point, this Find-A-Dentist program is going to have to be either discontinued or funded by the operations budget with a dues increase!
Other Resolutions of interest from Reference Committee A included defeat of Resolution 18, submitted by the Board of Trustees (BOT), which called for all resolutions having a financial impact to be submitted at least ten days before commencement of the last regular board meeting prior to the annual session so that it can be assessed considering the association’s strategic plan and finances. This resolution was on the Consent Agenda for this committee and therefore was not discussed by the House. It appeared to have been unpopular in the various district caucuses because of the time of the pre-caucus meetings in many districts. However, it appears that the BOT is again thinking of long-term fiscal responsibility.
Resolution 56 amends the ADA Governance and Organization Manual to strike fee waivers of 25% and 75% and 50% or all of a current year’s dues to be waived in the case of financial hardship of a member and urges state and local societies to remove the limit on the number of hardship waivers that a member can receive.
Resolution 70 calls for a change in the method of election of the ADA President-Elect and as such would require a change in the Constitution and By-laws, which in turn requires a one-year notice. The proposal is to have the President-Elect elected by the BOT rather than the HOD and was submitted by the First Trustee District. This is therefore a notice resolution for next year.
All resolutions referred to Reference Committee B: Dental Benefits, Practice and Related Matters were originally placed on the consent agenda. Several resolutions were removed from the consent agenda for discussion on the floor. Resolution 25RC, which was substituted by Reference Committee B for Resolution 25, was adopted after debated and calls for the establishment of a comprehensive clinical data warehouse/registry to support development of health policy, treatment guidelines, medical necessity rules and to define population health and quality of care with a report back to the 2019 HOD. In a similar vein, Resolution 75B, was also adopted and calls for a study outline for measuring quality of care and access to care to allow future comparison studies of the effectiveness of different practice delivery models with a report back to the 2019 HOD. Both resolutions are aimed at developing proprietary association data that is not skewed by insurance company coverage biases so that evidence-based dentistry and dental practice can be advanced.
Resolution 82 was amended from the floor by its proponent, Dr. Prabu Raman, from the Sixth Trustee District, in order to get a favorable vote. It proposed the development of a free smart phone app for use by consumers or employer benefits’ selection personnel that would allow a rating of dental insurance plans based on coverage parameters. The questions used to drive these ratings are already available on the ADA website, but are not easily available and not quantified based on comparisons of plan elements. After much debated, the resolution was defeated.
Resolution 33RC, substitute by Reference Committee B for Resolution 33 with a recommendation to refer to an ad hoc committee for consideration and report back to the HOD in 2019 received a great deal of comment in the reference committee. This amended resolution calls for the ADA President to appoint an ad hoc committee with relevant expertise to review and rewrite Res. 5H-2006, Comprehensive Strategy on Elder Care, to identify an implementation plan and timeline to address financing of dental care for elders, to include the possibility of including dental coverage in Medicare. The original resolution was driven in part by a push from Oral Health America, which has elicited the support of ADA in pursing dental care benefits coverage under Medicare. Oral Health America has indicated its intention to move forward in this direction with or without the participation/support of the ADA. Many members voiced strong opposition to the inclusion of dental benefits in Medicare, while others were strongly in support of this. Others requested that other funding mechanisms be pursued. As somewhat of a compromise between the two positions, Resolution 33B was also referred to the same ad hoc committee. This resolution outlines the minimal elements of dental benefits coverage that should be required IF Medicare were to include a dental benefit.
Reference Committee C: Dental Education, Science, and Related Matters handled quite a few “housekeeping” resolutions to change wording in the Governance manual to make certain that the Commission on Dental Accreditation (CODA) maintains the autonomy necessary to be at the appropriate arm’s length distance from the ADA to satisfy the US Department of Education. By far, the most discussion on resolutions referred to this committee related to Resolution 26 and Resolution 26S1, the latter having been submitted by the Second Trustee District. This resolution is entitled Comprehensive Policy on Dental Licensure and comes from a two-year study and development process by the Council on Dental Education and Licensure. The original resolution was adopted after significant debate. The substitute resolution had inserted a requirement that any remaining live patient licensure examinations be administered only with the Curriculum Integrated Format whereby dental students are evaluated on their own patients of record with ongoing sequenced treatment plans. While this format is ideally the most ethical way to conduct a live patient examination, it is simply a logistical nightmare for most schools. Dr. Henry Gremillion, President of the American Dental Education Association (ADEA) and Dean of Louisiana State University School of Dentistry spoke out against the amended resolution. The ADA remains on record as opposed to live patient high stakes examination for licensure. This is a policy and value statement that has no impact on licensure laws among the states. Implementing this stated value would require strong grass roots advocacy at the state level where licensure laws are passed and would require organized opposition to the regional examination boards who are making a lot of money administering these one-shot high stakes examinations.
Resolution 53 urges dentists to support the use of the Human Papillomavirus (HPV) as recommended by the CDC and to encourage appropriate external agencies to support research to improve understanding of the natural history of the oral HPV infection, transmissions risks, screening and testing. This resolution was adopted, but there was considerable debated about Resolution 53RC, which would additionally urge that dentists be urged to administer the vaccine in their offices. Because the vaccine has not been approved for oral pharyngeal cancer prevention, dentists using the vaccine for this purpose would be using it “off label,” which could create liability issues, especially if a patient experienced a severe adverse reaction to the vaccine. Also, the HOD heard testimony that there is currently no mechanism for drug companies to sell vaccine vials to dentists, directly.
Resolution 71 urged the creation of an ADA Taskforce on Student Debt, but was defeated with delegates from the American Student Dental Association speaking against it. They did not believe that it would be helpful to them.
Resolution 83 requested that the Council of Dental Education and Licensure (CEDL) explore the feasibility of requesting development of an accreditation process and accreditation standards advanced education programs in geriatric dentistry by CODA. This resolution was referred to CEDL or other appropriate committees, councils or workgroups for discussion.
The most significant resolution referred to Reference Committee D: Legislative, Health, Governance and Related Matters, was Resolution 32, which was submitted by the Washington State Dental Association from the Eleventh Trustee District and amended on the floor to call for the creation of a task force to minimize the interference of third party payers in dentist/patient relationships in lieu of legislation passed in Georgia, Louisiana, California, Delaware, South Dakota, Pennsylvania, and Washington in the last two years. This district believes strongly that support needs to be developed for state public affairs support. This resolution was adopted after being amended. Also of interest is Resolution 81, which was adopted. It urges the ADA to pursue federal legislative or regulatory efforts to require financial support for dental care be included in child custody as is done for medical care AND that the ADA pursue individual state legislative efforts to require support for dental care in child custody orders as an obligation.
For additional details about the meeting, send questions to Sharon Turner, Rick Whitehouse or Bill Lee.