COVID-19: Information for Your Practice

LOCAL RESOURCES:

Alaska

Alaska Department of Health and Social Services: http://dhss.alaska.gov/Pages/default.aspx

State of Alaska Board of Dental Examiners: https://www.commerce.alaska.gov/web/cbpl/professionallicensing/boardofdentalexaminers.aspx

Alaska Dental Society

Alberta 

Alberta Ministry of Health: https://www.alberta.ca/health.aspx

Alberta Dental Association & College

Arizona 

Arizona Dental Association

Arizona State Board of Dental Examiners: https://dentalboard.az.gov/

Arizona Department of Health Services

British Columbia 

British Columbia Ministry of Health: https://www2.gov.bc.ca/gov/content/governments/organizational-structure/ministries-organizations/ministries/health

College of Dental Surgeons of British Columbia: https://www.cdsbc.org

British Columbia Dental Association

California 

California Department of Public Health: https://www.cdph.ca.gov/

The Dental Bureau of California: http://www.dbc.ca.gov/

California Dental Association

Hawaii 

Hawaii State Department of Health: http://health.hawaii.gov/

Hawaii State Board of Dental Examiners: http://cca.hawaii.gov/pvl/boards/dentist/

Hawaii Dental Association

Idaho 

Idaho Department of Health and Welfare: http://www.healthandwelfare.idaho.gov/

Idaho State Board of Dentistry: https://isbd.idaho.gov/IBODPortal/Home.aspx

Idaho State Dental Association

Nevada 

Nevada Division of Public and Behavioral Health: http://dpbh.nv.gov/

Nevada Board of Dental Examiners: http://dental.nv.gov/

Nevada Dental Association

Oregon 

Oregon Health Authority, Public Health Division: http://www.oregon.gov/oha/ph/pages/index.aspx

Oregon Board of Dentistry: http://www.oregon.gov/dentistry/Pages/index.aspx

Oregon Dental Association

Saskatchewan

Saskatchewan Ministry of Health: https://www.saskatchewan.ca/government/government-structure/ministries/health

The College of Dental Surgeons of Saskatchewan

Washington 

Washington State Department of Health: http://www.doh.wa.gov/

Dental Quality Assurance Commission: https://www.doh.wa.gov/LicensesPermitsandCertificates/ProfessionsNewReneworUpdate/Dentist

Washington State Dental Association 

National

Centers for Disease Control

Public Health Agency of Canada: https://www.canada.ca/en/public-health.html

American Dental Association

Canadian Dental Association

AAO RESOURCES:  

• The AAO has created a webpage for members for COVID-19, including resources on office closures, practice reopening considerations, staff & HR information, and more.
• In addition, the AAO joined the Organized Dentistry Coalition in asking for protection for dental practices after Congress passed H.R. 6201, the Families First Coronavirus Response Act. A copy of the letter can be found here.
• The AAO has been vocal in defining emergency orthodontic care to include care that will relieve pain and/or infection, is trauma-related, or is critically necessary to prevent harm to the patient. The AAO also intends to shape orthodontic-specific guidelines post COVID-19 as it is anticipated that regulatory agencies will seek to impose new restrictions on medical practices.

RECORDED WEBINARS:  

• “Facts Not Fear | Discover what parents and dentists are really thinking about dentistry once the world awakens”: This is a follow-up to the previous webinar conducted by Wendy O’Donovan Phillips of Big Buzz. View a recording here:https://zoom.us/rec/share/2P1tIbj91X1JR7Pfr0eBeKwxMqDGeaa80yYbqKcEnk_o9n0MGkdmCeTNnSud9qcN?startTime=1587483950000
• “Recession-Proof Your Practice” with Wendy O’Donovan Phillips of Big Buzz: View a recording of the webinar here. Note: the actual webinar begins around minute 27. If you are interested in any of the resources mentioned, please contact us.
   
  Access Password: pcso2020
• Compliance with the current OSHA and CDC guidelines and the Coronavirus with Andrea Cook. View the webinar here. 
• The AAO is providing free COVID-19 webinars for members on urgent topics. In addition, to enhance skills during any downtime you may have, the AAO is offering complimentary access to their entire online CE library. Access AAO’s online recorded lecture series at https://aaoinfo.digitellinc.com/aaoinfo/conferences/1/view. The online CE library offers convenient, 24/7 access to over 500 hours of CE for you and your team.
• COVID-19: Shaping the Business of Orthodontics Today, Tomorrow, and Years to Come by Bentson Copple & Associates (https://aaoinfo.digitellinc.com/aaoinfo/sessions/2761/view)
• High Touch Patient Contact in the Age of Social Distancing by Nancy Hyman (https://aaoinfo.digitellinc.com/aaoinfo/sessions/2771/view)
• CARES Act: What It Means for Small Businesses (https://vimeo.com/402400048)
• Resurrecting Your Practice after the Shutdown (https://vimeo.com/407601789)

PATIENT EMAIL TEMPLATE:

In the spirit of community and in accordance with the guidelines from the <Insert Dental/Medical Association or State-Province>, we are suspending all non-essential care for at least the next <Insert Number of Weeks>, to and including <Insert Actual Date of End of Closure>.

If you have an appointment in our office within that time period, we will be calling you as soon as possible to reschedule your appointment. Please be patient with us and allow us to call you to reschedule. This will help us to manage the overall appointment schedule in order to best address everyone’s needs.

<Insert Doctor Name Here> is reviewing each patient’s treatment status as appointments are rescheduled to minimize the impact this delay will have on your overall treatment time. Your understanding and patience with this very challenging situation is appreciated.

If you have an urgent need during this time, we will be available for emergency appointments. Please call our office as soon as possible so we may determine the best course of action for your specific situation.

We look forward to seeing you back in our office soon.

Sincerely,

<Insert Doctor/Practice Name>

OFFICE CHECKLIST FOR EMERGENCY ONLY TREATMENT:

Patient Scheduling:

1. Email patients directly (template above), add to social media and website.

2. Update phone answering message: Thank you for calling <Insert Doctor‘s Name> office. We are currently on another call or away from the scheduling desk. Due to the growing concerns surrounding COVID-19, the <Insert Dental/Medical Association or State-Province> has recommended we suspend nonessential care for the next <Insert Timeframe>. If you have a routine appointment scheduled between now and <Insert Date>, we will be calling you soon to reschedule your appointment. We will continue to provide emergency care for our patients during this time period. If you have a question or urgent need, please leave a message and we will return your call as quickly as possible.

3. Print a list of scheduled appointments by appointment type/by day for the next <Insert Timeframe> before beginning to reschedule patients:

To avoid chaos, be direct with the rescheduling and set a time period to reschedule (e.g. current appointment + 5-6 weeks since this is a reasonable sequence; we may lose one appointment within the treatment cycle but most cases can handle this reasonably).

Sample Script for the Front Desk to use in rescheduling: In an abundance of caution and in accordance with the recommendations of the <Insert Dental/Medical Association or State-Province> we are closing our office to all but emergency care for the next <Insert Timeframe>. We need to reschedule the appointment for <patient name>. The appointments we currently have available are tments>.

Use this list to review patient’s treatment cards and progress so that follow up treatment recommendations can be made (elastics, aligner changes, turning expanders etc.).

Set up video conferences with Doctor via FaceTime, Skype, Zoom etc. as needed for patient consults.

4. Set up a schedule for emergency care with as few people in the office as possible (this will place clinical staff on rotations and allow for childcare for staff whose children are out of school).

5. Create rotation for administrative staff and forward calls as needed.

***

Waiting room environment:

1. Determine individual patient/caregiver current health situation (e.g. take temperatures).

2. Minimize the number of people in any space.

If a patient needs to be seen ask that one caregiver or parent accompany the patient and reside in the waiting room or wait in their car while emergency treatment is rendered.

If parents or caregivers bring additional individuals with them ask that they wait in their car and let them know the office will call them on their cell phones when the treatment is complete to update and to reschedule

3. Remove all magazines, toys, games, iPads, etc. from the waiting rooms.

4. If possible, schedule the next appointment by phone.

***

Clinical environment:

1. Ask patients to wash their hands before and after brushing their teeth and rinse with 1% hydrogen peroxide prior to being seen (research suggests coronavirus is vulnerable to oxidation and this will reduce the salivary load of oral microbes).

2. Provide maximum space between patients in any clinical setting (at least 6 feet).

3. Minimize any use of rotary instrumentation (hand pieces) that can create aerosols.

4. Render palliative emergency treatment only or refer the patient to an emergency room if necessary.

VIRTUAL VISIT RESOURCES:

Maintaining contact with your patients while suspending nonessential care can be done through virtual visits. If you choose to implement virtual visits with your patients, you can use the sample materials here to give your patients and their families an understanding of how they work.

Sample Email/Script to Introduce Virtual Visits:

Dear Patients and Parents,

While we may be postponing your routine care visit, know that the materials we use today for orthodontic treatment have the ability to move you toward our goals for quite some time. For patients in braces, be assured that we use long acting wires that continue to work for several months. For our patients in aligners, if you have been wearing them as instructed, your treatment is progressing even though you are not here for an office visit.

Nevertheless, we know you may have questions about your treatment progress. In an effort to address those questions during this challenging time we are introducing virtual visits for our patients. The attached virtual visit guide provides step by step instructions that will enable us to monitor your progress, even if we cannot see you in person.

Please know that we are committed to excellence in your care. We look forward to seeing you in person again soon!

Sincerely,

Video Option:

If you prefer to create a video resource, you can use this example from CAO Member Dovi Prero to create a video to share with patients on your practice website and/or social media platforms.

Dr. Michelle Neal has provided a virtual visit workflow (https://assets-prod-www1.aaoinfo.org/assets-prod-www1/2020/04/Virtual-Visit-Workflow-Dr.-Neal.pdf). Dr. Kyle Fagala has also provided a video walkthrough (https://youtu.be/X9dgS34GXMg).

GUIDANCE FOR UNEMPLOYMENT FOR TEAM:

Here is some additional information for you in this time of turmoil as it relates specifically to your employees. If you find yourself having to temporarily lay off employees or decrease hours due to the coronavirus pandemic, the U.S. government is allowing states to expand eligibility for unemployment benefits.

It is important to note that some states do have a waiting period to receive these benefits, however, so it would be good to inform your employees of their options right away so they can be prepared.

• Employees should have their information ready to file. The employment agency will need to verify employees’ income, so it is important that they have documentation of this. They will also need verification of their work situation (communication from management about reduction of hours). In addition to documentation verifying income and work status, employees typically need the following as well.

1. 1. Social Security number 
   2. Home address and mailing address (if different)
   3. Telephone number
   4. Email address
   5. Bank name, address, account number, and routing number for direct deposit
   6. Employer’s name, address, and phone number
   7. First and last day worked with employer
   8. Reason for leaving
   9. Pension or severance package information (if applicable)

• Employees should file online as soon as possible. Due to the influx of claims, it may take longer than normal to get benefits, so action sooner than later is to their benefit. The U.S. Department of Labor has a helpful tool where each state’s direct unemployment website and contact information can be accessed. https://www.careeronestop.org/LocalHelp/UnemploymentBenefits/Find-Unemployment-Benefits.aspx

Canadian employees can access information on Employment Insurance by visiting the Employment and Social Development Canada page: https://www.canada.ca/en/employment-social-development/corporate/notices/coronavirus.html. Please note that when employees are directly affected by COVID-19 and are not working, an ROE must be issued. For Box 16 – Reason for Separation, you can use the following codes: Code D (Illness or Injury) if the employee is sick or quarantined, Code A (Shortage of Work) if the employee stops working due to shortage of work or shutdown due to COVID-19, or Code E (Quit)/Code N (Leave of Absence) if the employee is not sick or quarantined but not working due to other reasons related to COVID-19. (Adding comments causes the ROE to be pulled from the automatic processing queue and will slow down the process.)

• Encourage employees to apply even if they/you are not sure they are eligible. The process to file varies by state but there are two key questions that are typically asked: Did you lose your job through no fault of your own? Are you able and available for work? Even if an employee has had hours reduced, they may qualify for partial unemployment.
• Employees have the right to appeal if their claim is denied.

FINANCIAL RESOURCES:

• The AAO has compiled financial resources relating to COVID-19 from a variety of sources to help members and updates the information as additional resources become available. https://www1.aaoinfo.org/covid-19/financial-resources-related-to-the-covid-19/
• Bentson Copple and Associates Resource – CARES Act
  Chris Bentson and Shannon Patterson (Bentson Copple and Associates) have developed a summary and FAQ sheet to educate members on the CARES Act, the Paycheck Protection Program and how it affects small business owners.
• Cain Watters Guidance on Cash Flow and Staffing:
  • • “Managing Cash Flow, Staffing during COVID-19” — lists recommendations for maintaining or increasing a practice’s cash flow if needed
    • “Options Available if You Make the Decision to Close or Limit Hours and Staff” — provides direction on furloughing staff and working with state unemployment agencies.  Additional options discussed include allowing staff to use accrued sick leave/vacation time and continuing full pay.
• Paycheck Protection Loans Available Via the CARES Act
  The Coronavirus Aid, Relief and Economic Security Act, or CARES Act includes $350 billion set aside as part of a new federal small business loan program. AAO Members should plan to familiarize themselves with the Paycheck Protection Program (PPP) loan, a provision included in the recently passed CARES Act.

REOPENING RESOURCES:

• 90 day cash flow plan for reopening your practice from Cain Watters & Associates – guidance and a worksheet to create a plan for your practice
• Practice Rehire Checklist from CEDR HR Solutions – checklist to make sure you are prepared when your state begins to reopen