ADA Return to Work Interim Guidance Toolkit and CDA Updates – April 29, 2020

 

Hello WLADS,

On Monday, the ADA published their Return to Work Interim Guidance Toolkit. The document includes patient communications, office check-lists, protections for staff and patients and more. We encourage you to download the toolkit for viewing here.

Our two fantastic Trustees participated in an emergency CDA meeting on Sunday. Their recap is included below and outlines additional steps and guidance that we can expect from the CDA.

Know that your WLADS board and staff are doing their best to provide you with information via e-blasts and social media posts as well as links to pertinent sites and webinars to help you during this period. If you have questions or need anything, please let us know.

Flatten the curve, stay hydrated and just know that we will all get through this together.

Sincerely,
David Downs, DDS
WLADS Board President

 

 

CDA Emergency Meeting Recap

The CDA Board of Trustees held an emergency Zoom meeting on Sunday. The purpose of the meeting was to discuss the current status of the healthcare landscape and the prospects of reopening our dental offices. Certain counties and localities are beginning to reopen their businesses.

According to CDA’s best information, California will require the following (in general consensus with the CDC recommendations) in order for a dentist to reopen their office:

  1. A fit tested N95 mask–the ADA is advocating for emergency use of what they feel are equivalent masks. There is information about the classification of masks and their effectiveness on the ADA website.
  2. Facial shields that extend from forehead to below the chin and fit over your protective glasses and N95 mask
  3. Fluid resistant gowns that extend below the knees
  4. A waterproof apron that covers the front of your gown
  5. Disposable shoe covers

In addition, each patient must complete a COVID-19 symptom/exposure form and have a normal temperature before being accepted as a patient. It is recommended that the dentist have only one person in the office at a time. It is expected that the office will have increased infection control procedures performed in between patients, including public spaces, but we did not discuss any guidelines in this regard. CDA has workgroups working to assess data on the evolving science of the virus and its spread. Using this information, they are researching infection control processes that will be efficacious.

When testing becomes more widely available, these guidelines will likely change. Currently there are only 4 ‘quick’ tests approved by the CDC and none of them are available to dentists at this time. While there are many antigen/antibody tests on the market, many have long turnaround times and many are fraudulent or provide inaccurate results.

Currently, there are no N95 masks available to dentists. The federal government has directed that all N95 masks be sent FEMA. FEMA is currently providing these masks to the first responders and none have been allocated to dentistry. TDSC has tried to obtain N95 masks, but those that appear to be available have been found to be counterfeit or offered in fraudulent deals. The ADA and Schein are working to get FEMA to distribute some N95 masks to dentistry. TDSC will partner with Schein to make these masks available to CA dentists.

In Washington D.C., dentistry is considered as a business entity rather than a healthcare industry. This misclassification is confusing to legislators and making it harder for dentistry to enter into the pandemic planning. The ADA is trying to educate legislators about our role in healthcare, especially in responding to COVID-19 testing. The ADA asserts that dentists have a valuable role in testing while acknowledging that diagnosis based on the tests belongs to the medical profession. The Dental Board of CA has indicated that it agrees with the ADA stance and that testing is within the scope of dentistry. The DBC has not put this into writing as yet.

The ADA and CDA are urging 3rd party payors to reimburse dentists for the increased costs of PPE and office infection control upgrades that will be required when we reopen our offices. Nothing is guaranteed, but each dentist should assess their costs and bill accordingly regardless of insurance benefits. Currently, code D1999 should be used to bill for the increased infection control costs. The ADA has a standing committee that maintains and changes the ADA codes and they will address adding a new code.

CDA has a combination of workgroups developing a library of resources for returning to work addressing issues specific to CA regulations. It will contain tools and resources for returning to work, suggested communications to use for staff and patients, clear and informative guidelines on the new Family Leave regulations. It intends to provide clear office protocols based on the CA Department of Health, CDC, and industry standards. Look for it soon!

In terms of reopening, dentists should observe their county or local regulations; however, state regulations would supersede county or local regulations. CDA has found that generally the county and local regulations are in step with the state regulations. As the state continues to receive data on disease exposure and transmission rates, ‘regional’ reopenings may be based on this data. CDA recommends that dentists assess their level of safety and liability before deciding to reopen.

In terms of employees, dentists cannot compel their employees to return to work as long as a ‘Shelter in Place’ order is in effect. Please consult the CDA COVID-19 response guidelines for recommendations on getting your employees back to work. CDA strongly recommends that dentists honor the ‘Shelter in Place’ orders and only treat definable emergency patients.

The CDA Foundation has made the decision to cancel CDA Cares in Long Beach this summer. The cancellation is indefinite, but the plan is for the next CDA Cares to serve this area. Rescheduling will not be considered until the Foundation can assure the safety of the patients, dentists, and other volunteers. Supplies of PPE have been donated to Long Beach area hospitals.

TDSC CEO Jim Wiggett is asking anyone with a lead for PPE to forward to him. There are four employees working exclusively to chase down leads. In addition to N95’s, they’re also considering KN95’s and level III’s.

 

 

 

CDA is preparing a suite of practical, how-to resources for members to restart routine care in their practices once shelter-in-place orders are lifted. Those tools are being prepared as companion documents to the ADA’s interim guidance and with the support of experts and input from members to ensure that comprehensive needs are met.

As CDA’s two workgroups on clinical care and economic recovery continue their work, other issues will emerge and guide the development of additional resources and communications for members.

Dentistry is specifically highlighted in this document. CDPH has set an expectation that it will update the current guidance on the provision of non-urgent dental services:

  • Previously canceled or postponed patients
  • Preventive services
  • Dental procedures
  • Routine dental services

CDA is advocating with administration officials to ensure the particular needs of dentists will be met. In addition, CDA is preparing a suite of practical, how-to resources for members to restart routine care in their practices when safety protocols for PPE and COVID-19 testing are established and met.

California Department of Public Health released an expanded outline to set guidance for health care providers. With lack of proper personal protective equipment in the global supply chain and reliable, available COVID-19 testing still distant, Resuming California’s Deferred and Preventive Health Care sets important benchmarks for the full reoperation of the state’s health care system, including dentistry. This document does not provide additional insight or guidance on a set date for returning to routine care.

– CDA Live Webinars

 

 

– Return to Work Interim Guidance Toolkit

– Statement on Third Party Payer Reimbursement for Temporary Procedures

– Statement on Third Party Payer Reimbursement  for Costs Associated with Increased Standards for Personal Protective Equipment (PPE)

 

Emergency Dental Service Availability & Supply Donations

– If you haven’t already done so, we kindly ask that you fill out this survey to let us know if you are open and which procedures (if any) you are doing. This information is for WLADS office staff only and will be used as a resource only.

– Los Angeles County created a website for vendors who are interested in providing supplies and PPEs

 

CDA Practice Support is available at 800.232.7645 but is experiencing a significant increase in calls, so wait times may be longer than usual. CDA can also be contacted via e-mail at contactcda@cda.org. CDA Practice Support analysts and TDIC Risk Management analysts continue to field thousands of calls from members who are concerned about their practices, employees and patients’ care.

You can also see WLADS updates on Facebook, Twitter and Instagram as well as our Web site.

We encourage you to continue to check reliable sources for the latest information:
– CDA’s news page
– ADA’s COVID-19 information page
– CDC Web site
– Los Angeles County Department of Public Health
– California Department of Public Health
– World Health Organization

Center for Disease Control & Prevention – Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response

Los Angeles County COVID-19 Dashboard
– The site includes the latest county information as well as dashboards for Case Count, Emergency Proclamations, Parks and Recreation Closures and School Closures.

Mental Health & Wellness Resources
– California Department of Mental Health
– ADA: COVID-19 Mental Health Resources
– ADA: Mindfulness Techniques to Help You Reduce Stress Videos
– U.S. Centers for Disease Control and Prevention (CDC): Managing Stress and Anxiety

 

 

WLADS Upcoming Events – please continue to check our Web site for the latest information on dates and locations.

 

 

If you have any questions, please contact WLADS at (310) 349-2199.