By Laura Thill DSOs offer greater legal oversight and protection to practitioners than solo practices As DSOs continue to expand, they have become increasingly aware of potential legal issues - including cybersecurity, government regulation and labor laws - and the necessary steps to protect themselves and their members. Thats not to say the growth of these organizations has been accompanied by more - or more serious - legal issues. In fact, its often the solo practices that must contend with legal conflicts, says Rich Beckman, CEO, Great Expressions Dental Centers (GEDC). Because DSOs manage the bulk of business-oriented tasks, such as marketing, human resources, IT and insurance claims, dental professionals can stay focused on their clinical duties. It is a partnership that facilitates better oversight and greater protection from legal issues. Still, DSOs today keep taking steps to protect themselves and their members. For example, to address the shifting landscape in the dental industry, GEDC has established a National Doctor Panel - a group of 10 dentists, orthodontists and other licensed specialists who oversee and train the DSOs dental professionals, as well as manage clinical issues that may arise. In addition, GEDC has organized an Enterprise Risk Management committee, which oversees training, education, safety and more. A chief compliance officer oversees infection control and its own education department, GEDC University. DSOs are big entities, dealing in big numbers (over $1 billion in some cases), says Beckman. So we all have become more sophisticated. Groups such as the Association of Dental Support Organizations (ADSO) help set and maintain industry standards, he adds Cybersecurity Large national DSOs are not the only ones at risk for legal issues, says Stuart Oberman, Esq., Oberman Law. Mid-level DSOs face similar issues. Cybersecurity is the big issue today, he says. When dental practices are purchased by large companies, but fail to put cybersecurity protocols into place, they become a target. Today, we see computers being hacked by people overseas from the Eastern bloc. The challenge for DSOs is to incorporate cybersecurity protocols into their corporate practices, whether they have six, 10 or a 100 practices, he points out. Another potential legal issue DSOs face is regulation, he continues. The question is, how much impact on clinical care can the DSO have? As states increase regulations, dental boards are getting more involved. Equally important are issues related to employee safety and gender, including protocols for pregnant employees. As more women enter the dental industry, DSOs face more gender issues. Employment law (e.g., the Fair Labor Standard Act) is another consideration. For example, if there is a break in the patient schedule, what is the hygienists or dental assistants job, asks Oberman. Are they being paid fairly? Often their schedule is autonomous to the dentists schedule. If there is a break in patients, they still want to be paid. We are seeing this issue continuously evolve, especially with regard to hygienists. The bottom line, he adds, is that issues such as these are here to stay, and DSOs must have greater oversight than ever before. As a whole, dentists are generally very poor managers of dental practices, says Oberman. DSOs are better equipped to provide more and better protocols, controls and education for their employees. When a dentist receives a complaint - whether from a hygienist or from OSHA - the DSO must step in and handle the issue, he points out. DSOs must develop, implement and track protocols to manage the dentist, staff and patient matters - particularly as services and technology become more sophisticated and complicated - or these issues could have a substantial negative impact on the operational side of a DSO. I think some DSOs have a great structure in place, with good doctor/staff education and solid standards and compliance. That said, its not only the DSOs that have their work cut out for them. Just as the DSO must ensure the doctors adhere to standards, so too must dentists joining DSOs make sure their DSO has protocols in place to maintain the highest standards of care, says Oberman. There must be checks and balances in place. More Growth, More Protection DSOs provide many services to dentists, says Great Expressions Dental Centers CEO Rich Beckman. By assuming business responsibilities, they help dental professionals lower their costs for patients and live a more balanced life. Thats why DSOs will continue to grow, and why participating dentists will continue to enjoy greater protection from a legal perspective. Dentists in DSOs do better, and their staff can work part time if they choose and enjoy a better quality of life, says Beckman. Today, solo practitioners account for 85 percent of the market, he continues. But, that is quickly changing, he points out. In the next five years, we will see DSOs take a larger market share. As the states provide more and more [healthcare] services for more people, and this model extends to the dental world, DSOs also will extend more services to more people. As that happens, we want to see our doctors become more involved in the dental industry and help shape the change taking place, he says. DSOs may not be for all dentists, he points out, but this model does appeal to many young graduates coming out of school with huge debt, who face the high cost of starting their own practice.
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