Dr. Howard Pactovis has been in the dental field for well over forty years. He is a graduate of Tufts University School of Dental Medicine and Boston University School of Graduate Dentistry. For the last twenty-five years Dr. Pactovis has been exclusively in the safety and risk prevention area relative to the dental field. Howard is the founder of Dynamic Dental Safety, director of education for the Dental Learning Network and has presented educational courses in more than twenty states. He was a featured speaker at the Yankee Dental Congress, New Hampshire Dental Society 2008 annual meeting, Greater New York Dental Meeting 2010 and other state and local dental meetings on the subject of dental office safety and infection control. Howard is a member of OSAP and listed on their bureau of speakers and consultants page. Dynamic Dental Safety is an endorsed provider of compliance services by the Massachusetts Dental Society and the New Hampshire Dental Society. Howard is presently and has been a consultant to the ADA on the issue of “Managing the Regulatory Environment”
VIDEO - DUwHF #976 - Howard Pactovis
AUDIO - DUwHF #976 - Howard Pactovis
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Howard Farran: It is just a huge honor for me today to be podcast interviewing Dr. Howard Pactovis. I'll never, ever forget his name. Dr. Howard Pactovis has been in the dental field for well over forty years. He is a graduate at Tufts University School of Dental Medicine, and Boston university's school of Graduate Dentistry. For the last twenty-five years, he has been exclusively in the safety and risk prevention area relative to the dental field. Howard is the founder of Dynamic Dental Safety, Director of Education for the Dental Learning Network and has presented educational courses in more than twenty states. He was a featured speaker at the Yankee Dental Congress, New Hampshire Dental Society annual meeting, Greater New York dental meeting, and in other state and local dental meetings, on the subject of dental office safety and infection control. He is a member of OSAP enlisted on their bureau of speakers and consultants page. Dynamic Dental Safety is an endorsed provider of compliance services by the Massachusetts Dental Society and the New Hampshire Dental Society. Howard has been a consultant to the ADA on the issues of managing the regulatory environment and his website is dynamicdentalsafety.com. So Howard, your last name is Pactovis and you were telling me that Dukakis was Greek and Dukakis ended in "i-s", but most Greeks names end in "a-s" or "o-s". And your name is actually Hungarian. So, I wonder how Dukakis got a last name of "a-s" or "i-s"?
Howard Pactovis: I don't know. Maybe he was short like me, so they just made the slim "i" on there instead of the "a" or the "o". Who knows.
Howard Farran: Well, I think I might know. Seriously.
Howard Pactovis: Okay. Really?
Howard Farran: So, I do. So, when I first started lecturing around the world, the first thing I noticed, I remember the first time I lectured in Poland. I was there and I kept seeing one of my friends from high school. I saw like four people who look like him. When I got back home I called up. I said, “dude, is there any chance you're Polish? He goes, dude, I am 100% Polish, my parents are from Chicago,” which is the largest Polish population outside of Poland. One in every eight people in Chicago are Polish and as I went around the world, I really got fascinated with names. So then I had our family tree done because we're in Arizona, which has a large Mormon population and they're very big into genealogy. In fact, genealogy.com and a lot of those big sites are all in Salt Lake City and they use the Mormon database.
Howard Farran: I went down there and I was talking to the lady and she said, well, here's what happens. She says, when they started rolling out schools in like the eighteen hundreds, they used the church, those towns had one building, it was a church, and they used that for the school. And they tried to, during the Sunday services, tried to convince everybody to send their kids and nobody would send any kid who was useful and could plow or plant, or ride a horse. So, it was mostly young little girls before they were big enough to do manual labor. So then they would teach them English and phonetics. And so then they would ask this little girl, “well, what's your last name?” And then she would spell it out, so she said, when you're doing family trees, like all of a sudden you'll see this name appear in a county, in Ohio, and it's spelled like three different ways.
Howard Farran: So it's an art and a science. So the science says, oh, you're not on the family tree, but the art is three little different counties, had three little cousins that probably lived ten miles apart and they phonetically spelled it different. And that's why names get spelled different. So in 1880, 80% of the planet could not read or write. And the first people to read and write were little girls in one room school houses. So that's probably what happened to Dukakis. He had a great, great, great granddaughter miss-phonetically spell his name. So tell us, what do my homies find if they go to your website Dynamic Dental Safety? What is it that you, which is pretty cool because it stands for DDS, Dynamic Dental Safety. So, what do you actually do?
Howard Pactovis: Yeah, well basically, in simplistic terms, we protect the dentists, the assistant, the hygienist, we protect their license by ensuring that they are fully compliant in all aspects. Because the regulatory agencies, mainly the boards of dentistry are very, very aggressive, becoming more so and they, along with the mandates from OSHA, the CDC for infection control, all play a part in what we do. And then we throw in the HIPAA and we throw in the whole alphabet soup of compliance and it becomes almost unattainable for the office to do. So in effect, we provide a service very similar to a dental support organization, but concentrating specifically on the compliance issues. I was trained by OSHA. I lost feeling in my fingertips, I practiced pediatric dentistry for about eighteen, nineteen years and then lost feeling in my fingertips due to Raynaud's disease.
Howard Farran: What disease? Rayno's?
Howard Pactovis: Raynaud's.
Howard Farran: Spell that.
Howard Pactovis: It's a vascular spasming, so I don't have feeling in my fingertips.
Howard Farran: How do you spell Rayno's?
Howard Pactovis: R-A-Y-N-A-U-D apostrophe S. It was confused initially with carpal tunnel because that was the time when everybody was developing carpal tunnel syndrome from the repetitive stress. And so, I had a number of operations and then it was determined that carpal tunnel was a contributor, but it was actually Raynaud's. It's the vascular spasming of the end arterials. So consequently, I couldn't practice, I was a pediatric dentist. I got trained by OSHA, spent time out in Chicago with just [inaudible 6:16] at their training center and got a certificate in reading their manuals and evaluating. And they really didn't know much because blood board came in around 1991. So consequently, they really didn't have any one medically trained to know what was going on. OSHA wasn't involved in medicine and dentistry until that time. A little bit before, we had the infection control aspects with the HIV and I was on many different panels to decide how we would treat HIV, how we would practice the infection control, especially dating back to the times. I mean, you may remember the para-pros and things like that became very, very difficult.
Howard Pactovis: I make a statement in my trainings that they really don't teach the dentists how to sterilize instruments. I know I went to Tufts and still to this day, they don't teach the dentists how to sterilize, they may read a chapter. So, it becomes really imperative for the dentist, as well as the staff to be educated, for the whole office to be evaluated from the same perspective that the inspector might look at the office, whether they be from the state, federal, even D-E-A. So we get into all those different things.
Howard Farran: Well, you know, we were talking about the art versus the science of genealogy. There's an art and a science to dentistry and the infection control for decades, the CDC has known that there were outbreaks and they probably came from this restaurant or this dental office, but they really didn't have the science to really prove it. And now, they have the science, they can literally forensic, go back and say, here are twelve people that got hepatitis B at this dental office. And in some of these people, like there's some big cases out there that we all know about. But one of them, I know several dentists in this town that says, this was just a great dentist, a great guy. Everything was great. He had no idea his autoclave wasn't working, he wasn't doing the spore testing. I mean, he was just the all round great guy and it just ruined him. It completely ruined him. And it's so sad because the dentists have to wear so many hats. I mean, not only you got to learn root canals, and fillings, and crowns, and pediatric and all these things, but you have to understand finance, and HR, and marketing and now infection control. I mean, how does the dentist wear all these hats?
Howard Pactovis: Well, that's the real challenge in today's practice. They cannot really attain that, especially something that they really don't have that much interest in. A dentist, a technician, so we deal with our hands and our eyes, and we try to create things, both marginally and all the integrity. So consequently, we don't like to spend the time doing the paperwork, doing that didactic aspect. And also, we have staff. So, we've got staff that we depend on to do the right things, but many of them don't do the right things, because they either don't know or they take shortcuts. So, that's the challenge in dentistry today, whether it be in the solo practice, the small group, or even the large groups we deal with. Many of the large groups who have us come in to do due diligence.
Howard Pactovis: We put out fires too, in other words, if somebody gets into trouble. Recently, there was a dentist in Massachusetts got into trouble because of his restroom and you may ask why? The issue was that he went into his restroom, it was right near the reception area, and a patient called the board and said, you know, he went into the restroom but I never heard the water running. So in other words, we're getting viewed basically under a microscope from our patients. They read things, cite things from CNN, from NPR. These are very common sites that patients go to and they question us. There's a site on CNN I show almost routinely, and it's as a result of the oral surgeon in Oklahoma, about six years ago, who really wasn't sterilizing his instruments properly. So CNN published five things that the patient should look for in the dentist's office, whether it's changing gloves, whether it's pouches that change color and whether they opened the pouches, different things like that.
Howard Pactovis: And we all hear these questions and that's what we go into, in the educational aspect. We show them what's necessary to do with OSHA, with HIPAA, with specifically infection control because that is that the largest area of complaints in virtually every state dental board. And we also illustrate to the dentist and the staff that the board is not their friend, which is kind of interesting. We think of the dental board as a partner in what we do. But the dental board is actually there to support the patients and patient complaints. And there are many things, when you look at the state dental board sites, that are very, very frightening because they post the complaints and they post actions and they never leave. So, I always emphasize to the dentist and the staff that those are sites that we want to stay off of in terms of having our names there because they're there permanently.
Howard Farran: So, you said you're a consultant with OSAP. Explain what OSAP is.
Howard Pactovis: OSAP is an organizational for safety and asepsis protocols. Specific with dentistry, it's a national organization, international actually, and dedicated specifically towards infection control, disease processes. It's been in existence, I think for, I don't know, probably about twenty-five years now and really, one of the really great sites to go to for information with regard to emerging diseases, current diseases that are out there, current protocols. We put together manuals so that people can actually implement all the CDC guidelines for infection control that was established back in 2003. I got a chance to review that initially before it was published. So, it's kind of a boring document, but it's important to know how to read it, know what it means. Many of the dentists don't know, many of the assistants don't know.
Howard Pactovis: But that's where we run the risk, it's not what we know that hurts us. It's always what we don't know. So consequently, we always hear ignorance is not a defense, that's from the insurance people. The same thing goes in terms of adhering to all the guidelines. So when a dentist may get into trouble, and it could be from what you had mentioned earlier and infection control or improper sterilization or lack of spore testing. But it could even be that his assistant or her assistant, or hygienists didn't renew their license. And in certain states they're very, very aggressive with that. Certain states are more aggressive and have different requirements with each and every one of the steps in the sterilization process. So, we concentrate on that and we can concentrate on the state board guidelines to ensure that each and every office is compliant and they know that they can call us at anytime with any questions.
Howard Pactovis: We have a real open door policy when we contract with an office, or a dentist, or a group, they have unlimited access to us for questions. May not know all the answers, but we'll find them. And so, we build up a very loyal clientele. Don't do a lot of marketing, we're starting to, but we don't really do a lot. We have the ancillary website with all of our compliance trainings online as well, so that we, very difficult to get everybody in the office together all at one time. People are on vacation. People don't come for that day or something of that nature. So we always make it so that they have the ability, like a podcast, except we have a site. It's all ADA cert accredited with all continuing education courses for compliance. Love to share it with you as well.
Howard Farran: You're talking about that Dynamic Dental Safety dot com?
Howard Pactovis: Yeah. That does the on-site but we have the other site, the educational.
Howard Farran: What site is that? The OSAP?
Howard Pactovis: Yeah, no, it's actually a site called dental learning dot org. If you look at that site, I think I have listed it on that, but we've got video courses.
Howard Farran: Is that your site?
Howard Pactovis: Yeah, I'm the director of education, that's for the dental learning network, but the site is dental learning dot org.
Howard Farran: You know, I've seen that site so many times. Is there a similar name for an AGD site?
Howard Pactovis: Yeah, there's one called dental learning dot com. That's a commercial site.
Howard Farran: Is it a commercial or the AGD?
Howard Pactovis: No, it's one of the publisher in, I think they're in New Jersey. I'm trying to think. One of the dental product reports or something like that.
Howard Farran: So, I'm on learning dental dot org and that is your site?
Howard Pactovis: Yes.
Howard Farran: And why should they go to dental learning.org versus dynamic dental safety dot com?
Howard Pactovis: Well, dynamic dental safety does the on-site services, on-site evaluations, provides all the written materials, the documentation or materials, whether they'd be the HIPAA manuals on the OSHA manuals or anything of that nature, all the safety data sheets. The educational site just enhances the opportunity for them to get additional learning, and additional courses. And it also fills in for employees who miss the training at the site, at that time. We've got a lot of subscribers who are big, the big national dental groups. So, in order for them to really comply, they would have to have a trainer. This way they can go on the site, they can have administrative access, people can track each and every employees required trainings. So it makes it seamless in terms of monitoring, in terms of having people access. And we try to do it a little differently. As you can see down at the bottom of the compliance section, there are some video courses, which again makes it much more interesting than just reading a pdf or something of that nature. When you look at those, you'll be able to see both the video and download the pdf of the slides that go along with it. So it can be used as a training session in the office where we doing a lot of them now in shorter formats. Again, trying to get them mobile so people can look at them on their phones. Just like you have on your site with the podcasts.
Howard Farran: You know what's funny on the OSAP, it's the organization for safety, asepsis and prevention. Asepsis, that's a pretty ancient word. I mean, asepsis means the absence of bacteria, viruses, and other microorganisms, the exclusion of bacteria. But, when you look at the use over time, it was a hot word between 1850 and 1930. So it was pretty much dead by 1930 and then they started in 1985 and used a fifty year old. I mean, it's funny, you know that line from Star Wars when Obi wan Kenobi says, ah, now that's a name I haven't heard in a long time. So I didn't know if OSAP's [inaudible 20:09]. But when he said asepsis, I thought asepsis? Now that's a name I have not heard in a long, long time. I felt like I went full Star Wars when I heard that name.
Howard Pactovis: I wasn't responsible for the names.
Howard Farran: Yeah. So, this dental learning dot org is a pretty neat deal. Let's go through the bad guys. Who should dentists be most worried about? I mean, who ruins your day more? Is that OSHA? Is it HIPAA? Is that the CDC? Is it the state board? Who are you seeing out there on the field, getting the [inaudible 20:42].
Howard Pactovis: The two top right now would be the state dental board, as well as HIPAA, which is administered by Health and Human Services, the office of civil rights. So those are the ones, the two primary. Then you get into the fraud, waste and abuse and there are many, many instances that come up there of...
Howard Farran: You said HIPAA was Health and Human Services and office of what?
Howard Pactovis: The office of civil rights, who administers the HIPAA.
Howard Farran: You know, what's funny is when I was in MBA school. There was a lot of attention placed on org charts and there were matrix organizations, and org charts and it was a really interesting deal in organizational psychology and organizational management. And then they tried to show you an org chart of the federal government. It looked like somebody on LSD fell down with a pen in their hand. I mean, it's like, oh my God.
Howard Pactovis: And they had spasms at the same time.
Howard Farran: It's completely insane.
Howard Pactovis: Well when you see some of the things that, and again, the CDC makes all the guidelines for infection control as well as educates about all the disease processes. What they don't do is, they don't enforce anything. They have no enforcement ability whatsoever.
Howard Farran: The CDC doesn't?
Howard Pactovis: The CDC, no. Right. Correct. So the state board takes it upon themselves. And very interestingly, when you read the CDC guidelines, certain things will be recommended and certain things will be required. However, most of the state boards right now are saying that everything that's recommended is required. For example, the low speed handpiece, just the motor part, many of them can be sterilized now. They have a little tiny square on them. And in that little square, it will say 375 degrees centigrade. I forget what the number is actually. I show it, but I don't remember it unless I look at it unfortunately.
Howard Pactovis: But we never used to sterilize those. And now, the different states are requiring those to be sterilized, which many of the offices don't even realize, so they may be violating something without even having the knowledge that they have to do it. That's the real scary point. So, I was in New Jersey the other day and right on the state board website, the front page of the State Board for New Jersey, one of their mandates is to prosecute dentists who violated the laws. That's pretty scary words when you read the front page of a state board website and it says prosecute dentists. That's kind of a frightening thing. So, I say the state board is the one that we're most concerned with. HIPAA from the fining aspect, fines and violations for privacy can begin at $50,000. So again, those are important things for the office to understand, not just to educate, but to really put in place all the regulations.
Howard Farran: I really love the slow speed handpiece. You know, why?
Howard Pactovis: Why is that?
Howard Farran: Because I'm slow.
Howard Pactovis: Oh, you're not slow.
Howard Farran: I have a lot of similarities to the slow speed handpiece.
Howard Farran: Just recently, it was all over the news, where some dental assistant turned in, she got fired from her company. So, the first thing she did is she told the board that they weren't sterilizing their hand pieces. And what sad thing about that is because of social media, I mean that was all over Facebook, and Twitter, and Linkedin, and Google. And I only post those things on Dentaltown because I don't want to slam all these people in the public. But probably a million people in America saw that he was accused of that. If you're accused of something, you know, in America you are kind of guilty til proven innocent.
Howard Pactovis: Yeah, very sad. But on the websites, on each one of them now, or most of them, the sites that I go into, they actually show the exact agreement, a consent agreement that a dentist or assistant, or a hygienist may have signed. And it stays up there forever. It's very, very frightening because we all make mistakes. No one's perfect. So the key is to stay off of those and stay out of trouble. How do you stay out of trouble? Well, you got to spend hours and hours to research and know what you have to do, or you can call someone like me and the people that work alongside with me. I've got people that are risk managers that work alongside. I've got other retired dentists. It's a great, a great little jog for retired dentists because they can do it at their leisure, different things like that.
Howard Pactovis: That's part of the reason we go to the other meetings to see who's available, show what we do and there's a lot of interest. We design a program and PowerPoint that basically you just follow along and identify as all of the issues. And then you fill in with your own examples, like you filled in like different things in your upbringing and schooling and things like that. I use examples from my years in dentistry and make fun of myself because we all make mistakes and that's how we learn. And, that self-effacing aspect is what I really enjoy about presenting and really bonding with the with the staff.
Howard Farran: Do you guys go into offices?
Howard Pactovis: Oh yeah.
Howard Farran: Because you have forty online courses. If you to dental learning dot org, you have forty courses.
Howard Pactovis: Right, we've got those. But the core of the business is to go into your office and evaluate the office, from soup to nuts, the same way that a state board inspector or an OSHA inspector would look at. And we document that with digital photographs and we use those as part of the presentation to show what's good about the office, what's missing. Example, I was in an office this morning, took a picture of their alcohol [inaudible 27:46]. Illustrate what it is and some of the dangers with it and it had an expiration date on there that ,was 2017. Now you and I both know that that probably doesn't expire, but we also don't want our patients to see that and say, think less of us because we're using things that are past expiration, or we don't want any state board inspector to come in and look at it from that perspective either.
Howard Pactovis: So, we use those items in the office to illustrate both how good the offices and where the improvement could be made. Because that's the key aspect is, we look at our home, we look at our office on a regular basis and I always make mention that somebody could come into my house and see the picture that's crooked and straighten it out. And yet I've grown accustomed to it, so it's fine that way, but we don't want our office to be that way. I do a lot of presentations at district dental societies and I was thinking that they're all the same. And I would love to see something instituted, like a dental office tour. In other words, you know, my wife goes to a host tours, garden tours once, once a year. Why don't we open up like five or six different offices and have a cocktail in one, cheese and crackers in another, and all you got to do is look at someone else's office and say, Geez, you know, I never thought of that. Maybe I could do that. Maybe I could implement something like that. As dentists, we typically go in in the morning, we work all day, and then we go home and we do it all again the next day. We don't really look at another office. So the office evaluation is a critical aspect to what we do.
Howard Farran: That is a very cool concept. You could kind of do that video. You could walk in with just your iPhone and you walk in the front door and meet the dentist and walk around. That's pretty cool, office tours.
Howard Pactovis: Yeah, we could even do it remotely. We could have someone else do it and then we could evaluate the office. Because we've established some proprietary checklist that we go over, and they identify everything from the housekeeping aspects, to the Osha, the infection control, sterilization areas, labeling. One of the big things is, OSHA has specific required labels, and they've changed everything recently, to that globally harmonized system. It sounds so wonderful, but no one really understands it, so we do have to implement it and that's typically what we do. We keep our clients all up to speed, all up to date on those things.
Howard Farran: So, what about money? Who's fining more? Is it OSHA or HIPAA and what are the size of these fines you're reading about? I mean, how big are these fines?
Howard Pactovis: Well, the HIPAA fines can be very, very large and you can find them online. You can see many different aspects of those. They're keying in on hospitals more so. But even go back to ten years ago, one that I show is George Clooney, he was brought into a hospital in New Jersey. He had a little motorcycle accident. Twenty-seven people actually went in to the computer to get his email address and cell phone number. They just wanted that information that it was very attractive. The government wanted all of them fired. He said don't fire them. They had to suspend them from work for a month without pay. And the hospital got fined $250,000 back then. okay. OSHA fines. OSHA, just in August was allowed by the government to increase their fines by a factor of ten. So, years ago the fines were maybe in the thousand, two thousand, three thousand range, even though they stay on a website, now there'll be ten thousand, fifteen thousand, twenty, $30,000.
Howard Pactovis: Just as an example of one thing, we recap syringes in dentistry. I've worked with a group down in New Jersey. They called me in after they had a big problem and one of their eight locations, they did not have a recapping device. No, I don't know how you recap. I was taught with one hand at school. There are recapping devices available, but we can safely, the CDC says, we can do that. However, in one of the locations they did not have a recapping device. The fine for that was fifteen thousand dollars because they didn't have it. So I'm interfacing with the attorney from OSHA in region one, in New York. And the attorney explained, they said, well, we read our guidelines to mean that if it's available you have to have it, you don't have to use it. So it's a matter of learning how they react, how they make their rules and regulations, and how they interpret them and that interpretation becomes, say, the focal point of what we illustrate and educate the staff about.
Howard Farran: So you do in office locations, but mostly just greater New England, New York, New Jersey, or you do all fifty states?
Howard Pactovis: Well, we'll go into states as required. I'm looking for more people to assist in doing other states because I think it's a valuable. We're expanding. We have people located in North Carolina, in Florida, New Jersey all through New England, so we cover mainly the east coast, but we go out. I've done a lot in the Chicago area, as well as down Louisiana, Texas and things like that. So it's a challenge to get there because of the travel, the accessibility and the time because we try to keep our pricing very, very reasonable so that the dentist can afford it. Because there's too many people that are taking advantage of the dentists as we know, we won't name them, dental supply companies. So we try to keep our service at a very reasonable price point so that the dentists not only will use it once, but will call us back year after year because most of us don't remember things from day to day, let alone from year to year. And that's where, again, we run a risk.
Howard Farran: It also is a huge argument for reducing staff turnover because you train these people with your online videos, you've taken the courses. And when you're trying to run a knowledge based organization and you have high employee turnover. I saw my first program, when it started on Dentaltown in 1998. My office manager has been there seventeen years. My Laurie's been there nineteen years. And when a dentist is trying to wear all these hats, it's impossible. So then you try to train all these staffs, but they haven't controlled their staff turnover problem. And the only way you can have a knowledge based company is to reduce staff turnover. By the way, if you're looking for consultants, one of the most overlooked places on Dentaltown is we've had free classified ads forever and they're in categories, associates looking for a job, a dentist looking for associate, selling used dental equipment. But my gosh, if you place an ad, I think, the ads all expire, so they're all fresh. So every ad you look at there, is a relatively new. I think they expire after a hundred and twenty days or something like that, but there's fifty-seven hundred classified ads on there and they're visited daily by a thousand unique visitors a day.
Howard Farran: Or you should start a thread on Dentaltown. We have several categories, so we have fifty categories. You know, CAD/CAM, computers, continuing ed. Oh, here it is. Regulation. So it's arts, all at the very bottom. So under Dentaltown, there's fifty categories and one of them is documentation, HIPAA, infection control, injury prevention in the workplace.
Howard Pactovis: Oh good.
Howard Farran: So you should post an ad there.
Howard Pactovis: I will.
Howard Farran: There's threads on there. Like, HIPAA, you talked about George Clooney's email and his cell phone number. Your email has to be HIPAA compliant, doesn't it?
Howard Pactovis: Yes. Yeah. It should be.
Howard Farran: And look at this thread. You should post on this. Here's a thread today. Guitar Hero writes, “my staff need HIPAA and OSHA training. Who does anybody recommend?” You should go on there and say what you do.
Howard Pactovis: Yeah. No, I definitely will. We pretty good with the young dentists on Facebook. I keep hearing from them that we're all over Facebook that way, but I will go on the Dentaltown. I've got the app right on my phone, so I'm going to do that.
Howard Farran: Yeah, I would. And that's what's neat about message board as opposed to Facebook, the search ability of it. So you can go onto Dentaltown and you can either go to the categories and go to regulation, then go to HIPAA or you can just search HIPAA or you can search HIPAA compliance. But what I like about it, there are so many... I mean, it just goes on forever. They're asking should you buy HIPAA insurance, or is there HIPAA insurance?
Howard Pactovis: Yeah, there is HIPAA insurance, I don't really recommend it, unless you're a very big organization, I don't really recommend it because if we have a three-pronged approach, if we have the proper HIPAA manual in place, we have the training of our staff and then the follow-up, then we're doing everything that we can do,
Howard Farran: So the three-prong is proper manuals, proper training...?
Howard Pactovis: The follow-up and the proper materials in place, of proper forms, proper types of any of the educational materials, whether they be in the appropriate languages. The permissions example, we have eighteen year olds, technically they're adults, so we should make sure that they're signing their own informed consents. Very few offices even realize that. The oral surgeons deal with it on a very high level because that's what they're doing. They're taking out those, third molars for the eighteen, nineteen, twenty year olds. They should be signing their own informed consent and also giving permission to speak with a mom or dad because they're the ones who want to know all the information. But you know, if you have someone in college who can’t even get the grades, even though you may be paying for the tuition. So we educate with regard to that. And then there are constant reminders. We give our offices reminders on a quarterly basis.
Howard Pactovis: Bottom line is if you do those things, if you have those things in place, along with your risk assessment, you may have seen the one from the American Dental Association that is barely readable, but we've made it into an English format. In other words, understandable English so that people can do it. If you do the risk analysis, you have the manuals in place and you do your training and you have the reminders, then there's really almost no need to buy HIPAA insurance because you have the plausible deniability. Example, we have got a group of offices down in Florida. We did their basic training, which includes an overview of HIPAA, it doesn't include the manuals or anything of that nature unless people want them and are willing to pay for them. But, we got a call about a year and a half afterwards and they said, “do we have HIPAA manuals?” And I said, “no, you don't, but we can create them if you'd like.” And I said, “why do you need them?” They said, “well, about five years ago we had a staff member walk off with about five hundred charts and they started investigating and then it stopped. Nothing happened. And all of a sudden, it reared its ugly head again. There was a new director down there in Health and Human Services and they wanted to see the HIPAA manuals.” So I said, “well, for a small fee we can create them.”
Howard Pactovis: And they said, “what does it entail?” I said, “well, we'll get your risk analysis, we'll do a walk through the office and then we'll create the manual specific.” So we did that, in matter of about a week and a half, and they got those over to the Health and Human Services down, I think it was in Miami. And the comment that they got back was, you know, if everybody had this, they wouldn't have a problem. So, the bottom line is having things in place and that's not our strong point as practitioners. So, we really should rely on somebody who has the knowledge base and I farm out some of the things that I don't know and don't have an interest in, but I bring in experts to do that when it's necessary. So we've got a whole group of experts in the different fields, whether they be in risk assessment, whether they'd be risk management, primarily from the insurance point of view coding and compliance. So we can always reach out and bring in the experts when it's necessary.
Howard Farran: On Dentaltown, some guy saying, does your dental malpractice have HIPAA violation on coverage. And one guy said that he tracked his policy and had $25,000 covered, but he could buy up to five hundred thousand. Then another guy was saying that he bought cyber liability insurance for $1,000,000 coverage. This is kind of getting scary when the government passes regulations and you need to buy a million dollars of cyber liability insurance just to cover because some of these cases are crazy. Like this one dentist said, he bought new computers and he discharged or got rid of his old computers.
Howard Pactovis: That's a big deal.
Howard Farran: But the data was still on there and then, fast forward twelve years before someone found that data and then that guy was doing something. And next thing you know, when patients were searching their name on the Internet, it was going to that server and pulling up their damn dental records. I mean, that's just crazy stuff.
Howard Pactovis: Well, that's the scary point that we have. When I first started, we had paper charts, we wrote very cryptic type progress notes, all abbreviations. We didn't really include everything. Now you've got the kids coming out of school writing paragraphs and writing almost chapters for each visit. That's necessary, but then that's all on a computer. The computer is, it never goes away unless you, demagnetize things. Again, things that are beyond my knowledge base, but I always say render any type of electronic information unrecognizable. Here's the big issue though. You ask someone, I'll ask you in your office, do you where all of the electronic protected health information, the P-H-I, is kept and people say, Oh yeah. I said, but do you use a camera that has a small SD card in there? You got a hard drive on your cone beam or something of that nature?
Howard Pactovis: Again, it's limitless in what we have and how to protect it. I use Gmail as one of my email addresses. The issue with Gmail is that Google is reading it all the time. If I sent you an email about shaving, I get razor blade as a pop up. Okay. So, they're looking at it. So there are simple solutions out there that we, again, show people that they can do that they can have some encryption on their email without spending a lot of money. My whole goal is to try to engineer out the problems, for us to identify them, engineer out the problems, and then have it so that it doesn't cost the office a ton of money in order to do it. Because again, very similar to what we do, we do a program in the office, we provide three continuing education credits for the OSHA, infection control, with HIPAA.
Howard Pactovis: That's done in about a two and a half hour periods because there's no break. So consequently, we have the fifteen minutes for a per C-E-U there. And so it's done in the office. They take maybe an hour that they would have for staff time, another hour, so that they, the minimization of loss of production is something that I'm very, very much aware of. And that's one of the selling features of what we do, so we can provide quality services, minimize the loss of productivity and enable the office to be in full compliance because we provide everything electronically for them so that they have it, whether they read it or not is up to them, but they have it.
Howard Farran: You know, the one thing that blows my mind with people is, they know if they go to the store and buy bottled water, they know it's going to cost a dollar. But every time some politician has a great idea and passes a regulation, they never comprehend the cost. And when you study PHDs in economics that they spend their whole life on this stuff, they say the regulations cost more than our taxes. And they call it the largest hidden tax in America's regulation. I mean, you got to have your M-S-D-S sheets all compliant. I can't believe if these dentists are dispensing narcotic pills for convenience. I mean that's something you should just get rid of immediately because you prevent a whole other thing that can go wrong. And then there's your x ray equipment. I mean, there's just so much. HIPAA and OSHA, sometimes you even wonder if the good it does for society is worth all the compliance and bad. I mean, if you were the world's dictator, if you're the dictator of the United States, what would you do with OSHA? Would you let it run? Would you shut it down? Would modify it? What would you do?
Howard Pactovis: Well, I think I'd try to make it manageable, try and make it reasonable, I guess. And again, that's what I do and we do when we do a presentation. We take it and and we put it into a perspective of what's reasonable, what's manageable, what can we do. No one can do everything. No one's perfect. I put it this way, I have an ex wife that would tell you that about me, but that's okay. That's her deal. But nevertheless, I would try to make it, number one, understandable. If you read most governmental documents, and I'm sure you have, they're written in legalese. They're not written so that the average person can really understand them. The healthcare laws, the CDC, for example, you read that. It's confusing and it shouldn't be. I would like to see things more bullet pointed have one, two, three, four, five understandable. If we understand what we can do. Example, we were in dental school, we all learned how to do a class two. We knew what was expected in doing that class two because they told us, these are the expectations, one, two, three, four, five. There's a friend of mine, again, he belongs to OSAP and he wrote an article. He happens to be a pilot for, it's either Delta or Northwest, in addition to being a dentist. And he said, you know, we don't have a good checklist in dentistry. We have them in the airline industry. And he actually took and adapted some of the airline industry checklists. And there's an article in the ADA journal that goes back about five, six years. I'll send it to you. It's very interesting.
Howard Farran: No, post it on Dentaltown. It will start a great discussion? ]. Back to the airlines check list. I mean, my pilots patients, because I'm fourteen minutes from Sky Harbor Airport. So I would [inaudible 50:26] he has tons of pilots for Southwest Airlines, American Airlines, because you can get to the airport in fourteen minutes. That pilot's always telling me that everything is a checklist because if they get everything ninety-nine point nine, nine, nine, nine, four nines long, ninety-nine point nine, nine, nine, nine, that means four airplanes a day fall out of the sky.
Howard Pactovis: Yep, that's scary, isn't it. There's actually a book that I read called the Checklist Manifesto. I don't know if you've read it. It was written by an ER doc here in Boston. And he was asked by the World Health Organization to do pre-surgical checklists for use in third world countries to minimize post-surgical infection rates. And he said that's a great idea, except I don't know how to write a good checklist. So he actually chronicles his time spent out of Boeing, where they write all the checklists. And it's kind of fascinating because it changed the way that I put my checklist together so that they're easily understandable, attainable. And if you follow the checklist and you follow the guidelines, which makes it simple, you asked what I would do, I would make it simple. Right now, it's not simple, it's complex. You don't even know where to get the information, let alone how to implement it.
Howard Farran: There's so many regulations that these, specifically the kids don't even know about it. Like a lot of states, you have federal government, you have OSHA, and HIPAA and CDC federal guidelines. But then you got fifty states making up stuff for their state boards that a lot of people don't even know. Like a lot of states, you have to keep your models for seven years. And you know how I keep my models, how I always keep mine? In the city landfills. I throw them away and the landfills, they pick them up and they preserve them and they bury them. And I think my stone models will be there for a hundred years, but I mean, there's just so much. That's why there's a market need for people like you, Dynamic Dental Safety, right?
Howard Pactovis: I think so. I mean, it's proven. You know, we started in 2001, and we're in existence and thriving and growing day by day and it's kind of exciting to be able to make things understandable and attainable for the small dentist or the big group. It can be scaled in either direction.
Howard Farran: I think this podcast is great exposure for you. I think a lot of people are going to hear it. But my God, I think you should go into Dentaltown and just go to regulations and we've got documentation here. I mean, there are so many questions. I don't think you can answer all these questions.
Howard Pactovis: I think that'll be my weekend though.
Howard Farran: There's people asking about safety glasses, those laws. Dental waterlines, CFU testing.
Howard Pactovis: We get into all that.
Howard Farran: Gosh, I mean, needle stick protocol, disposing of sharps. Now, I mean, back in the day we would just take our sharps and when the whole thing was all filled up, we would just mix up about quart of a plaster, pour it on there and then just throw it in the dump. My dad used to always tell me when I'd ask him about things being tax deductible. He said, Howard, everything is tax deductible until you're audited. So it's one of those things where dentists do all these things. But when the shit hits the fan, it can get really, really bad. Like dental waterline testing. I know a dentist friend of mine who couldn't believe he had like three root canals in a month where it just completely blew up. And he was posting about this on Dentaltown, and realised something went wrong. And then someone said, dude, it seems like maybe you might have an infection problem. And then he started asking him about his lines. Two weeks later, the guy posts on Dentaltown that, holy crap, he checked into his lines. It was totally infected, he was blowing water into these lines. So he went to a rear end car delivery where he had sterilized bottled waters. He had no idea that is endo failure rate was from infected water lines.
Howard Pactovis: Exactly. No, we don't think of it because it doesn't occur daily. It doesn't occur with every patient. So it's when we look and we see a grouping, a family of them, then we say maybe we should look at things. But these are things that we should be looking at proactively, whether it be the water lines, whether it be the infection control that we've talked about exhaustively, whether it be the OSHA in terms of the protective garments and how we deal with them. All of these things. And they can be put into simple checklist format so that we know what we're doing. Is it going to change next year? Yeah, it's going to change year in and year out depending on which state you're in. And do we have to date the pouches that they go through. Certain states say yes, certain states say no. Do we have to wear x ray badges? Yeah. Certain states will say yes, certain no. You've got to be able to go into each state board guideline to find out what's there. That's what's confusing, especially when you know, I'll go to areas where there'll be a practice in Delaware, Maryland, and in New Jersey. They're literally ten miles apart, but there are three different sets of regulations that have to be adhered to.
Howard Farran: You know a pediatric dentist, I'm not going to give any names. But you heard about this case where, it's all over the news, all these children ages three to nine underwent baby tooth root canals at the blankety blank children's dental group. Between these months, and so far, five water samples from the clinic had tested positive for mycobacterium chelonae-abscessus group. That clinic is continuing to cooperate with the authorities. And again, these are really good guys. It's not like it's malicious. It's not like it's somebody who sets out and leaves her house with the intention of breaking into your garage and stealing your bicycle. I mean, these are good guys.
Howard Pactovis: Howard, there are very few bad actors, okay. And, we can all identify them in our communities. We know who they are. Very few of them. Most of us want to do the right thing, but how do you do the right thing all the time. That's the question. Who do you rely on, who can you call? Do you call your dental supply rep or do you call someone who is versed and knows all the regulations and that's all they do is their business. So that's why we're in business. Basically, to be that resource to any of the dentists and we get calls every day from our clients, things that you never hear of. And then all of a sudden you hear two or three at once, whether it be the water lines, whether it be how to dispose of a certain thing, whether it be a HIPAA question. And I get calls from risk managers, from insurance companies about HIPAA because it's sort of become a sub specialty because there's so much that's involved in it. It's really scary when you think about all the things, like you said, when I first started, we just hung up our shingle. We put our name out there. No one ever came and said, look, we have a trust factor. Patients were also much more loyal than today. We also realized that now they shop and price, they shop and whatever the case may be. But they're also getting bombarded with the Internet. A lot of misinformation. So they come in and they ask certain questions and that's where the challenge is. How do we know that we're doing the right thing? And so, that's where part of our niche is, in terms of advising the dentists, consulting with them and not charging them every single time that there's a phone call.
Howard Farran: Well, I'll tell you what what, I can't believe we went over five minutes over the hour, an hour and five minutes. I love talking to you and I want to tell my homies that this is not going to go away. I mean, this is in the Boston newspaper. The third biggest killer in the nation, medical errors. The leading causes of death is heart disease. Number two is cancer, and according to new research, number three is medical error. The study published estimates two hundred and fifty one thousand people die every year due to medical errors in hospitals and other healthcare facilities. That's more than respiratory disease, accidents, strokes and Alzheimer's combined. The study's author, a professor at John Hopkins University, it boils down to people dying from care that they receive, rather than the disease that they were seeking care and the national patient safety foundation for... I mean, it just goes on and on. I mean, I just can't believe what's on out there. So if you think OSHA, and HIPAA, and the CDC, and your State Board are going to go away, what's really going to happen is it's going to get ramped up. It's going to get ramped up. Some of the low hanging fruit that I can't believe. I mean take Phoenix. You got three point eight million people. When you're sick and dying, you go to this hospital and so other people are in the hospital for routine stuff and they get visitors. And who do they bring, their children, their grandchildren. I got patients that went and visited their grandma in the hospital and now they have those big red splotches all over their body. What is that called?
Howard Pactovis: Shingles or something.
Howard Farran: So this building is twenty stories high in downtown Phoenix with three point eight million and the sickest, sickest, dying, worst diseases in the world are in this building. So you decide to take your two year old in there to visit grandma and then she's [inaudible 1:1:18] and they let other people in there. And they need to crack down on. I mean, when two hundred and fifty one thousand 251,000, look what they did on nine eleven. I mean basically three thousand people died. Thirty six hundred people died and they spent a trillion dollars in Afghanistan and Iraq. I mean, you have a quarter million people dying every year and they don't redo the hospitals. They don't make the infections units that they are. I mean, it should be quarantined.
Howard Pactovis: Well, they should. There's a saying that says if you want to get sick, go to the hospital, and it's true because they're filthy for the most part. Just look at dentistry
Howard Farran: I mean, one of our fat drinking cheeseburger buddies had a heart attack and all the other dentists, their best idea was let's go visit him. Let's go visit him? We can frigging Facetime him. And I'm not a germaphobe. I just think that a quarter of a million people dying each year in America is nothing to sneeze at.
Howard Pactovis: Well, you want me to tell you one thing that I emphasize right now is hand-washing. And most people wash their hands. They miss the thumbs. If you think about how you wash your hands, you typically wash your hands, but you don't wash the thumbs. So, if you take a little bit of extra time and you wash your thumbs, you're going to be much cleaner individually, much less prone to getting diseases. So it's kind of interesting. We go into all the different aspects of how to protect yourself, both in the office as well as outside. And when you're think about that, you can raise people's awareness. You end up with a much healthier population. Obviously, like you say, stay away from certain areas that you know you're going to get sick. My wife has a flight attendant, you mentioned you lived next to Sky Harbor. She has been a flight attendant for a long time and there's so much sickness on an airplane and you can't get away from it.
Howard Farran: Well, yeah, when you're sitting in the airplane and you're looking down that aisle and you realize, okay, everybody in this airplane is using one of two bathrooms.
Howard Pactovis: Oh yeah. Not just that, but they're sneezing and that sneeze comes out at a hundred miles an hour and most of the people don't cover their nose and you can't get away from it. You can't open a window if you do, you're in real trouble. But nevertheless, you know where dentistry, I'll end with this. Dentistry has made more progress in elevating itself with infection control in virtually any of the other medical professions. When you look at it, we've come from a time when I started with no gloves, no mess, no eye wear, no lab coats, short sleeves. Dentists were smoking in the operatories, patients were smoking.
Howard Farran: The greatest dentist, when I got to Phoenix, Arizona, the coolest dentist in the world was like, I don't know how old he is, but he wore he was this white curly wig that you could tell was a wig from about a hundred feet and had a cuspidor, which they don't have any more. And he smoked these cigarettes in this long filter thing and his cuspidor was the ashtray, and he had a hundred cigarettes in the ashtray. And when I was in his office, his patient was smoking in the chair too. And they were both using... I mean, it was just a different era.
Howard Pactovis: So in forty, forty-five years we've come a lifetime in dentistry. We've elevated ourselves as clinicians, as practitioners, and it should do us well in the future even though people, you have to drag them kicking and screaming into doing the right thing. But once they do, then they realize it's for their benefit and for their patients benefit. The other thing that I make mention of is, in my state, Massachusetts we're required to have a defibrillator in the office. okay, which is great, but I think what we really need more than that, it's probably a lie detector because I don't think we get an accurate medical histories. So I am trying to invent the combination lie detector-defibrillator. So we give him a little shock if they don't give us the right answer. No, I'm just teasing. But we don't know. And that's the challenge in dentistry. With physicians, they're much more forthcoming. When you're a pediatric dentist, you get very accurate medical histories for the most part. But maybe they don't give them the hepatitis B vaccine or anything like that. So I always emphasize to staff that we wear the protective equipment to protect ourselves from the patient, not to protect the patient. And that's the key.
Howard Farran: Well, on that note, I hope you get on Dentaltown and [inaudible 1:06:14] we have fifty categories and it's searchable. And another thing you might want to do is, we put up four hundred and eleven courses that are coming up on a million views and you've got forty plus hours of online [inaudible 1:06:35] . You might want to put one of those on the online deal and then say as a teaser, if you want forty more hours of this, go to Dynamic Dental Safety dot com or dental learning dot org, [inaudible 1:06:45] . But a lot of people like, they'll have week long courses at the Panky Institute. They've got week one, week two, week three, week four. So what the Panky Institute did is they had a one hour greatest hits album of each one of their week continuums.
Howard Farran: And they said it was just amazing marketing because it's hard for somebody to say, well, I'm going to block off patients for a week, fly all the way to Key Biscayne, Florida and I don't even know why I'm going there. But by having a one hour course, kind of talking and teaching what this week is about, it was very informative and it kind of bridged the gap. I mean, think about you're reading a magazine, you see an ad to go to Panky for a week. Well that's a big jump from reading an ad, to canceling a week's of production. I mean say you had $5,000 a day, that's 25 grand, miss production, plus airfare, hotel. But to have a bridge like... the ad should say, watch this course for an hour. Kind of like when they're selling reverse annuities on your home. They're not going to convince you to do that on a one minute ad during the news.
Howard Farran: So what do they do? The whole ad is to get you to call this number and order the DVD. And then the whole deal of the DVD is to get you to call Dr. Howard Pactovis because until you tell him your address, he can't tell you what kind of pain that you're looking at. And so they deconstruct the sales process. So a podcast is one way. Posting on Dentaltown is another way, doing an online CE course is another way, doing an article on Dentaltown is another way. But I really enjoyed talking to you for an hour or so. My final question is, which was more stressful, being a pediatric dentist with all this crying and screaming or working to save dentists from the federal government's crying and screaming.
Howard Pactovis: It's not more stressful, but more intense is doing what I do now because no one likes you for coming in and nobody wants to do it, number one. Number two, they don't really understand why they have to do it, so that makes it more of a challenge for that. Being a pediatric dentist was easy because if you treated the kids like adults and the adults like children, then you will find the kids were great. I miss it totally. But nevertheless, I think I'm providing a valuable service to the dental community and I love what I do. It doesn't seem like work.
Howard Farran: That's awesome. If you love your work, you'll never work another day in your life. I can seriously say that at fifty-five years old, I've never worked a day in my life. I worked for my old man for ten years. That was the greatest. And Ryan's working for his dad for two years and he's now dead inside. [inaudible 1:09:55] my father.
Howard Pactovis: I was going to say, he helped me out a lot getting this thing set up.
Howard Farran: A great kid, man. When he graduated from college, he said, “Dad your podcast is embarrassing. I'm either going to change my last name or fix your show.”
Howard Pactovis: Don’t change your last name, don’t change your first name.
Howard Farran: So, so he did both and now he goes by Ryan Long John Silver. I don't know where he got that name. But, anyway, thank you so much for coming on the show.
Howard Pactovis: Thank you.
Howard Farran: And it'd be an honor and a privilege if you went into regulations and start answering these questions.
Howard Pactovis: I'm going to.
Howard Farran: And remember what's neat about Dentaltown is there's no spam a lot. So you answer the question, but in your signature, very nicely and your signature can be Howard Pactovis, dentallearning.org, your phone number, website. So it's really neat. So by having that just in your signature, it lets you answer questions while still self-promoting yourself without it looking like spam.
Howard Pactovis: We're going to do it because I'm excited.
Howard Farran: And plus, since you're a pediatric dentist you already have instant credibility on Dentaltown. Thank you so much for giving me an hour of your life. I hope you have a rocking hot rest of your day.