Saturday, April 4, 2020

Fight to Overturn the Department of Treasury and SBA Interim Guidance on the SBA 7(a) PPP Loan and EIDL Loan



As if the pandemic weren't bad enough, now we've got the "bureaucracy-demic".  It seems that after all the assurances that the federal government would help small businesses, they are now trying to make sure that doesn't happen.  Dentists need to read this and follow this link at the bottom to make their voices heard. 


Fight to Overturn the Department of Treasury and SBA
Interim Guidance on the SBA 7(a) PPP Loan and EIDL Loan
Hello, Fellow Dentists:

Since the COVID-19 pandemic began, dentists and dental offices across the country have been feeling the strain. We have seen the federal government issue numerous regulations and guidance. Along the way, we have told you that we need to be prepared to deal with unforeseen government edicts—particularly with respect to regulations and guidance—that do not consider the impact they may have on many sectors of our economy and our profession.

Today, we are faced with such a circumstance.  

The U.S. Small Business Administration has just issued interim guidance pertaining to the SBA Economic Injury Disaster Loan (EIDL) and 7(a) Paycheck Protection Program. The guidance stipulates, in effect, that small businesses must choose between the two loans; small businesses can’t receive both loans unless a qualified business receives their EIDL loan money on or before April 3.  

The guidance clearly contradicts the law (CARES Act) as written and as interpreted by the very committees of jurisdiction who drafted the legislation. The committee summaries and Q&A documents make it clear that qualified small businesses can apply for both the EIDL and Paycheck Protection Program loans, without specific date restrictions.

If this interim guidance stands, it would pose great harm to the vast majority of our dentist owners and other small businesses who have applied for but have not received any EIDL loan money by April 3.

The Grassroots Action Alert that we are asking you to respond to today is being sent to U.S. Department of Treasury Secretary Mnuchin and U.S. Small Business Administration Administrator Carranza, and much like the letter the ADA sent to them last night, we are “strongly recommending that the SBA work with Treasury to change the interim rule to clearly indicate that entities can apply for both loans and that they are still eligible to apply for both, even if EIDL loan funds are received after April 3. This would ensure that SBA and Treasury are following the congressional intent of the CARES Act…”

You should know that when you send your action alert to Secretary Mnuchin and Administrator Carranza, a copy of the alert will go to your Representative in the House as well as your two Senators. Your members of Congress will also know of the harmful effects of this interim guidance to your practice, your patients and the public.

This is interim guidance that we must oppose, and oppose with the same intensity that we brought to bear when we sent nearly 400,000 emails to Capitol Hill from more than 120,000 dentists regarding final passage of the CARES Act.

Please click on the link and let Secretary Mnuchin and Administrator Carranza know your opposition to this SBA interim guidance.

Thank you for what you are doing for your practice, your patients and dentistry!

Stay well,

Chad P. Gehani, DDS
President

And the Pandemic Goes On...

 


This whole Covid-19 thing has put pretty much everything into a tizzy in my life (not sure what a “tizzy” actually is, but my grandma used the word a lot and I really like it).  Like most dental offices, we are only seeing emergencies until at least May 1 and probably longer thereafter, but at this point no one really knows...

I have several unique perspectives on this whole pandemic.  I’ve got the healthcare view and that means I’ve got to protect my fellow man while being as careful as possible not to spread this thing.  I’ve got the business owner view and that means I’m dealing with furloughed employees that I’m worried about.  I’m a doctor with a recurring schedule of patient care and that means I worry about my patients even if it has nothing to do with dentistry.  My patients are people I care for but also care *about* and I want them all to be safe and well

The other perspective I have is due to the fact that I live in Kansas and practice in Missouri.  The state of Kansas is on a governor ordered “shelter at home” while Missouri is not.  Because of that I am seeing the virus spread more rapidly just to the east of my home.  It also means that the virus is more prolific in the area where my business is located.  In the big picture will that make a difference?  At this point everything is a guess, however I do know that keeping away from others is the best way to prevent spread of the infection.

Yesterday I did a virtual presentation on Chartless Dentistry for the Western Regional Dental Experience.  I’ve done a fair number of webinars in my career, but never one that was 3 hours long.  I have to confess, that it’s tough to talk to your computer screen for that long when the only live person you can see is you in a small thumbnail on the screen.  However, the event came off really well.  There were *a lot* of people logged in and I got some good immediate feedback.  There were a couple of tech glitches, but they were overcome.  I think this very well might be the CE platform of the not too distant future.  We’ve all seen how popular Zoom has become and with the proliferation of broadband connections, this will only get better.

As a final note to this post, hats off to whoever created the hash tag #FlattenTheCurve!  It sums up exactly what we all need to do right now.  We are living in perhaps the most uncharted time in recent memory.  We’ll get through this, but it’s going to take some time.

I’ll continue to post at pace that is stranger than normal.  You may see one post a day like always, or you may see 3 a day.  In times like these, nothing is a sure thing.

Stay safe and be well! 

Friday, April 3, 2020

ADA Extends Closure Recommendation Through April 30th



In a statement issued April 1, the ADA issued an interim recommendation that “dentists keep their offices closed to all but urgent and emergency procedures until April 30 at the earliest.”

The ADA’s original recommendation, issued March 16, was set to expire on April 6.

The interim recommendation is in keeping with the recent U.S. Centers for Disease Control and Prevention’s recommendation to perform only emergency or urgent dental care.

According to the statement, “The ADA also recognizes that existing and future local or state government mandates supersede ADA recommendations. In addition, state dental associations may best understand local challenges being faced and make recommendations appropriate to members in their areas.”

In addition, “The ADA believes individual dentists should exercise professional judgment and carefully consider the risks outlined in the ADA’s interim guidance and weigh those risks against any possible benefit to the patient, the practice employees, the community at large, and the practitioner. Critically important is the availability of appropriate personal protective equipment (PPE) to minimize any risk of transmission during emergency and urgent care. Due to the proximity of individuals during dental procedures, and the generation of aerosols, dentists, staff and patients are at high risk of transmission.”

The statement concludes, “The PPE required to reduce the risk of transmission during dental treatment to its lowest levels — as noted in algorithm No. 3 of the ADA Interim Guidance for Management of Emergency and Urgent Dental Care — are scarce. Asymptomatic patients cannot be assumed to be COVID-19 free. As of March 31, point of care tests exist, but are extremely difficult to obtain. Unless point of care tests are readily available to the dental practice, no one can be assured that they are treating a non-infected individual. The safety of their patients, staff and themselves should be foremost when dentists exercise their professional judgment, and information regarding the relative risks is available from the ADA, via the Interim Guidance, to assist in making those decisions.”

Monday, March 30, 2020

A Nifty DIY Respirator that has the Potential to Provide Better Filtration than N-95

     

 


One of the things I truly love about dentistry is the passion that many of us feel for the profession.  This morning's post is going to go right along with that sentiment.  As we all know, the big news story of the last month has been the novel Corona  Virus with can lead to Covid-19.

The virus originated in the province of Wuhan, China and then rapidly spread across borders, demonstrating how amazingly contagious the virus is.  As it initially began to infect people in China, doctors, public health officials, and epidemiologists tried to get a handle on how the virus managed to spread so rapidly and efficiently.

A virus has always been trickier to deal with than a bacterium for a variety of reasons.  We won't get into all of those here today, however I would like to detail ONE trait that a lot of folks  outside  of medical realms are unaware of.  A virus (or viral particle) is *tiny* compared to a true bacteria.  Due to their size, they can frequently get through filtration mediums that stop other infectious agents in their tracks.

In many practices of medicine, dentistry included, a surgical mask is part of the everyday PPE (Personal Protective Equipment) that practitioners wear.  The surgical mask is a 2 way street.  It not only protects the healthcare worker from receiving infectious particles from the patient, but it also prevents the patient from receiving infectious particles from the healthcare worker.

It's also the same story for gloves.  Studies that had been done back in the times when dental professionals worked without gloves found that bacteria from the mouths of patients seen on Monday could be cultured from under the fingernails of workers on Friday afternoon.  Basically that meant that every patient seen for a week left their bacteria on the dentist's hands and therefore into the patient's mouth.  Scary right?

But for this discussion we're going to concentrate of the mask.  Recent studies of the Novel Corona Virus show it to be somewhere between 140 nanometers and 60 nanometers in size while the average size of bacteria is around 300 nanometers.  Surgical masks usually filter to about 100 nanometers while N-95 respirators filter to 30 nanometers.

Surgical masks are designed to cover the moth and nose loosely but are not sized for individual fit.  However, N-95 Respirators are designed to fit the wearer closely.

As the Covid-19 pandemic has progressed we, in healthcare, have seen an incredible shortage of N-95 masks as there is a scramble to protect healthcare workers from becoming infected and potentially passing the virus along to other patients and healthcare providers.

Now one of my pet peeves, as many of you know, is that when someone asks why we do something a certain way, the answer is "because we've always done it that way."  That's just a plain lousy answer.  So the question I've been asking the past week or 2 is "why do we always buy masks from distributors" and the answer is... you guessed it.

Then I came across a small website called www.firedbycorona.com  This website was put together by Dr. Mark Causey who is an orthodontist in Georgia.  Dr. Causey is a forward thinking guy and uses a 3D printer in his office.  His idea was, rather than buy N-95 masks and then throw them away, why not print a N-95 framework that you could theoretically use for years and simply replace the filtration when it was no longer working.  Genius!  Dr. Causey even designed the framework, saved it in an stl file, and made it available *for free* on his website.

His thought process is that if everyone that has a 3D printer started to produce these frameworks, we might very well cut the N-95 mask shortage.  His website goes through the entire process of creating a N-95 mask from a printed frame and readily available HEPA filters.

Since discovering this website, I've been printing these mask substructures pretty much non-stop on my Ender-3 printer in my home.

We are now creating masks that help prevent the spread of the Novel Corona Virus while also keeping masks out of the landfill.

I'll be doing more posts on this fascinating subject in the next few days.  I'm proud of Dr. Causey for his hard work and outside the box thinking.



Friday, March 27, 2020

More Information from the Academy of General Dentistry

AGD Special Alert
Special AGD Update: COVID-19 Relief and Resources
Dear Member,
 
I hope this note finds you safe. These are trying times for us as general dentists but also as family and community members. Our profession and the world around us are changing so rapidly. I encourage you to continue to connect with your AGD colleagues. We are all in this together, and we will get through this together. 

Today I want to remind you that AGD remains available to support you during this tumultuous time. Here are a few updates:

Economic Relief Legislation
The economic stimulus legislation being finalized in Congress will serve as a lifeline for most dental practices. Our team has broken down some highlights to help you understand how to access the financial relief opportunities. We are also monitoring the U.S. Small Business Administration for loan opportunities that might be beneficial to members. We ask that you watch for AGD requests to communicate with legislators to ensure that the needs of general dentists are not forgotten. 
 
Center for Disease Control Guidelines Updated
The CDC has released Interim Infection Prevention and Control Guidance for Dental Settings during COVID-19 Response. Check out the update.
 
AGD Webinar Series: Staying Connected During COVID-19 
We are launching a free webinar series to help answer questions about how COVID-19 is impacting general dentists. All programs are scheduled from 7:30 to 9 p.m. CDT. The first three in the series are below:
Don't forget the Tuesday, March 31 free webinar: Patients Judge Your Practice by Your Online Reputation. Watch for additional webinars in the series.  Many other events are being added or made available free of charge. Visit our website to see the full list of offerings.

AGD2020
We are preparing for any influence this pandemic may have on AGD's upcoming meetings, including our scientific session scheduled for July 15–18 in Las Vegas. We want you to assure you that if AGD2020 is cancelled as a result of COVID-19, all registered attendees will receive a full refund, including conference registration and course fees.

Help for your practice now
Addressing your business operations and staying in front of your patients and communities are as important as ever. We have contacted several of AGDs Exclusive Benefit providers to ask them to help you now.
  • Stay in Touch with Your Patients: AGD's new Exclusive Benefit provider Optio Publishing has generously offered to provide all AGD Members with free social media content to help you communicate with your patients about COVID-19. Check out the free content. Watch for more news about other offers from this new Exclusive Benefits provider.
  • Cash Flow Help: A new Exclusive Benefit provider, U.S. Bank is now offering temporarily reduced pricing on its Quick Loan and Cash Flow Manager products. For more information, contact Jeramie Eimers or 651.681.7371. Please note that they do not cover all states.
  • Payment Deferrals: Hagan Insurance Group employees are available to answer coverage questions. If these hard times are causing issues with paying your insurance premiums please do not hesitate to contact their office at 877.280.6487 to see what payment options may be available to help you through this difficult time.  
  • Keep Your Dental Team Sharp: All-Star Dental Academy is making its Survival Kit: Resources for Dentists including a video on "Training While Your Office is Closed" available to all AGD members free of charge. It outlines issues to address during this crisis and steps to ensure that your practice can continue to grow.
PPE Supplies
AGD is encouraging members to donate surplus personal protection equipment (PPE) to your local public health offices or first responders. Please retain the supplies you need to cover emergencies and to re-open your office when the time comes, but also consider how you can support the safety of healthcare professions on the frontlines. AGD has been reminding the public to avoid hospital emergency rooms if they have a dental need during this time. We want to reduce the burden those dental visits would have on sites that are focusing on the diagnosis and treatment of COVID-19 patients.

Our website, agd.org, has special COVID-19 updates. Events, news, analysis and other links to helpful resources are being added regularly, so please check in periodically for updates.

On behalf of the AGD family, I want you to know that we stand ready to help you through this unprecedented time. Please let us know how we can help.
 
Sincerely,

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Connie L. White, DDS, FAGD
President, Academy of General Dentistry

Wednesday, March 25, 2020

Academy of General Dentistry says Let's Work Together and Get Through This



Here is a letter I received yesterday via email.  I've known Dr. Connie White for over 30 years.  She is a dedicated professional with a heart of gold.  We couldn't ask for better person at the helm of the Academy right now.  Read on to see what Dr. White has to say...

Dear Member,

I know you are facing an unimaginable level of stress and anxiety because of COVID-19. Despite the uncertainty for the future, I am optimistic. AGD is here for you.

We continue to post information about the coronavirus to www.agd.org/coronavirus. This week we will add a new section on the AGD website that will direct you to resources, tools and options to assist you, our AGD family members, during closures and once operations resume. In the meantime, I wanted to list some of the other ways we are working to assist you.

No-Cost Webinars and Online Learning: We know our members want CE that will help them manage their financial and staffing needs during this crisis, as well as provide guidance on how to plan for the future. Our Education team is currently developing several webinars that address these needs, and we plan to roll these out as soon as possible.

We are also waiving the fees for upcoming CE, including the tonight's webinar "The Science of Sleep and the Importance and Management of Oral Appliance Therapy." The March 31 webinar "Patients Judge Your Practice by Your Online Reputation" is a free course sponsored by Henry Schein One. 

The AGD Online Learning Center continues to provide a wealth of educational content, and we are working with the Dental Education Council to expand free offerings. We will provide updates as those details become available.

Financial Relief for General Dentists: AGD sent a letter to Congress strongly recommending that general dentists be compensated in the amount of $500 million to make up for lost patients. Further, the AGD Government Relations and Dental Practice teams are reviewing the economic stimulus package and other policies that are in place or being discussed that could help our members. We are distributing information to members on ways they can advocate for the profession by contacting federal legislators. (See how New Jersey AGD members are working locally.) We will continue to report on these details in the coming days and weeks. 

Other Support Options for You: We have already arranged with an AGD banking partner to offer reduced interest rate loans. The ability to check it out and apply online should be available in the coming days. 

Please contact our Membership Services team if we can be of assistance with dues payments. We will work with you to ensure you are able to continue benefiting from your AGD membership. 

We are also working directly with our Exclusive Benefit providers and corporate sponsors to help our AGD family during this time of need. 

Don't Isolate Yourself: We are being asked to distance ourselves socially, but this isn't a time to isolate from your colleagues and the profession. To help you connect with other general dentists about ways they are navigating this new territory, AGD has created online communities so that you can share information and connect with other members. We have created a new one devoted to allowing members to share specifically about their experiences and suggestions to others in the AGD family about COVAD-19. To sign up for these communities, please email AGDConnect@agd.org

We fully expect our profession to rebound. I've heard remarkable stories about members helping members, colleagues, students, families and communities. Now more than ever, we must remain strong to support each other. 

Please keep watching for updates and let us know if you have additional needs, requests or suggestions on how we can serve you.

In the meantime, stay safe and healthy.

Sincerely,

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Connie L. White, DDS, FAGD
President, Academy of General Dentistry

Tuesday, March 24, 2020

Shelter at Home... Day One

 


I’m posting this from my office where I’m still open on a limited basis for emergencies.  This is day one of the greater Kansas City area “Shelter at Home” directive.  As a healthcare provider I’m exempt from the restriction as dentistry is considered an “essential” business.

Traffic on the way to the office was light… as in really light.  It seems that most people are following the guidelines.

Amazingly for the office, we have seen more emergencies than normal.  However, with that being said, we will be going to a much more abbreviated schedule next week.  While we are seeing more emergencies than normal, that certainly does not mean we’re dealing with a full schedule.  It’s been interesting the last few days.  Yesterday I was contacted via Facebook Messenger from a nurse on the east coast who works in the ER.  She was having trouble finding dental offices that were open and she was seeing quite a few dental emergencies that were creating backlogs in the ER.

I would strongly urge offices that are completely shut down to consider at least a limited schedule to help those in need.

More news as things progress...