Bill Klaproth (Host): This is an AAOMS On The Go podcast. I'm Bill Klaproth and I'm pleased to welcome with me, the Chair of the AAOMS Committee on Governmental Affairs, Dr. Erik Warren, as we discuss state laws and oral and maxillofacial surgery and what's in store for 2024. Dr. Warren, thank you so much for your time and being here.

Erik Warren, DDS, MD: Thank you so much for having me, Bill. I really appreciate the opportunity and excited to talk with you on the podcast.

Host: Absolutely. So it's always good to understand the advocacy efforts of AAOMS. So let's talk about the AAOMS Committee on Governmental Affairs and what you're expecting to see in terms of state legislation or prominent issues in the coming year.

Erik Warren, DDS, MD: So yeah, that's a loaded question to start with. And always a big piece of legislation that we're concerned about is anesthesia. It's always an area where we see states changing legislation and changing regulations to, to adapt to new environments. And one of the avenues they do this is through dental board regulatory revisions.

And it's very dynamic and the revisions are unique state to state and constantly changing and adapting to the standards of care that we're meeting and excelling at every year. And there's always a chance of a scope of practice challenge for oral surgeons and in any state. And we really have to stay involved and vigilant to defend our scope of practice. If we're not at the table speaking for ourselves, then there'll definitely be somebody else there speaking for us. So it's something that we are vigilant about and always on, have our thumb on the pulse of each state. There's quite a bit of CRNA activity throughout the country.

And I attributed that to, there's a lot of CRNAs and they're very well organized and they're always looking to expand their privileges and expand their abilities in hospitals and in dental offices. So that's something that we really keep track of and pay attention to the legislation challenges from the CRNAs.

And I think at this point it's important to talk about the percentages of what oral surgeons do as far as the moderate IV and deep sedation and general anesthetics performed in dental offices. And we have, AAOMS did a great job of putting together a lot of data from privately insured dental claims, and oral surgeons deliver 78 percent of the anesthetics in dental offices in the country.

So, because of that, we provide the overwhelming majority of the sedation and general anesthetics in the United States to the patients that have private dental insurance. So any kind of policy decisions on patient care or any kind of decision making at any level, oral surgeons and oral maxillofacial surgeons should definitely be involved in those decision making processes.

Host: Yeah, having a seat at the table is really important.

Erik Warren, DDS, MD: Absolutely. And so we do the majority of the anesthetics, so we should be involved in the decision making. And the data also shows a very low rate of incidences in oral maxillofacial surgeons offices compared to the total anesthetics performed. So that's definitely a feather in our cap as well.

Host: So anesthesia is always a big one. So what other prominent issues should we know about in the coming year?

Erik Warren, DDS, MD: Sure. There's also the issue of workforce, and this is something that's touching every sector, whether you work in a bakery or a Tesla factory or in an oral surgery office. And there's really a shortage of auxiliary personnel throughout the country. And the big question throughout all these sectors is how do we address that?

There's been legislation addressing changes to licensure, such as we have the DAANCE program that we use through AAOMS, which is an incredible program. It's a very difficult test. So it's rigorous, and it only helps with safety margins in the office, and it helps education of our auxiliary staff, but it's workforce issues are complex, because it's not just auxiliary personnel, it's we're talking about access to care, getting the right people in the right places, meaning, okay, so we are training oral surgeons and they have a ton of student debt.

Are they making decisions to go to underserved communities or are they going to lower Manhattan where they're going to be able to pay back debt faster or something like that. So it's a complex issue that we see attacked from a bunch of different avenues in the legislation.

Host: And any other big issues that we should know about?

Erik Warren, DDS, MD: Yeah, absolutely. There's one more that's kind of a Pandora's box, and it's dental insurance reform, which is obviously something that's always near and dear to any oral surgery provider or any medical provider as a whole. And there's again, a lot of different avenues that reform is attempted at, and including assignment and coordination of benefits, non covered services, craniofacial cover mandates, network leasing, balance billing, and virtual credit card payments, and we've seen different legislation go through states addressing all of these, and one piece of reform that's has a lot of activity right now is something that's called a dental loss ratio.

And what a dental loss ratio is a percentage that dental insurer, insurers can spend on nonpatient care, like salaries or bonuses and administrative expenses. And so in 2022, Massachusetts passed a ballot measure that address this dental loss ratio, and their dental loss ratio is 83%. So that means 17 percent of what the dental insurers can spend would be on the non patient services, like salaries, bonuses, admin, etc.

And what this really stems from is the Affordable Care Act, or better known as Obamacare. And they mandated that for medical insurance providers, that 80 percent for small group insurers or 85 percent for large group insurers is their loss ratio. So this is something that's already been done in medicine and there's really been a lot of activity at the state level to have the dental insurers use the same formula.

And it really increases the value of dental insurance to make it focused on patient care and not company profits. The measure from Massachusetts takes effect on January 1st in 2024, so it'll be interesting to see how that's going to play out.

And there's currently 17 bills that are introduced in 12 different states in 2023. And Colorado and Nevada have passed and so there's a lot of activity on this dental loss ratio and I think frankly it's really exciting for oral surgeons and frankly our patients because we're going to get a lot more value out of the dental insurances, because they're mandated to spend at least X amount, depending on the state, on patient services and not just on administrative services and profits and those types of things.

Host: Well, there certainly is a lot on the plate for 2024. You're mainly talking about anesthesia, workforce issues, which are another major issue, and then, of course, dental insurance reform. All things to watch in 2024. So thank you for bringing us up to speed on that, Dr. Warren. So what are some of the other emerging trends or shifts in the political climate that may affect OMS's interest in advocacy efforts in the coming year. This, of course, being an election year in 2024. So tell us about that.

Erik Warren, DDS, MD: And you really hit the nail right on the head immediately, Bill, when you mentioned that it was an election year. And it's an election year and a presidential election year. So, so that really affects the legislation that gets introduced and the legislation that passes because candidates, whether at the state level or the federal level, have to run on that legislation.

So there's a lot more trepidation to reach across the aisle and make bipartisan legislation. And the interesting part at the state level, that I wasn't really aware of until being on this committee and serving on this committee, is that state legislatures work incredibly different and from state to state.

So there's some legislators that are not meeting this year in Texas, Montana, North Dakota and Nevada, which falls into their normal operation. And they're very unique in how they operate through the country. One unique example is Nebraska. So they actually have a unicameral or one chamber legislature.

So every other state has a bicameral legislature, meaning, I know you know this Bill, but it's more for the listeners that I'm explaining this, meaning they have a House and a Senate or two houses, so they can bounce stuff, legislation back and forth. And the idea from Nebraska, they thought that a smaller legislature would be more efficient and obviously more, less expensive to the citizens of Nebraska, which is definitely true superficially. As a comparison, Nebraska has 49 seats, they call them state senators, and New Hampshire has 400. So it's kind of wild how different the states are. So really what I've learned from knowing this information and seeing how well AAOMS responds to these state issues, really working at the state level and being able to adapt quickly and having lobbyists and being advocates at the grassroots level really helps stay in touch with these state issues that are so dynamic.

Host: Which is really important to get in there on that ground level. So, the AAOMS Committee on Governmental Affairs, you're advocating for the specialty in all 50 states. Is that right?

Erik Warren, DDS, MD: Correct. We do. And that's one of the things I wanted to talk about as far as advocacy. It's, when you see a problem, or you predict a problem, or you see something happening in your state, please reach out to AAOMS because there's already lobbyists in place, or if there's not a lobbyist, they can work with getting you a lobbyist. And they have formed lots of relationships throughout all 50 states to be able to address these unique problems and opportunities and legislations. So the membership should definitely reach out when there's any kind of issues that they want to address at, at the state or federal level, to be frank.

Host: Yeah, that's a great point. So let's talk more about that, Dr. Warren. Do you have any advice you can give to an OMS to engage in advocacy efforts at the state level? Are there any more things that we should know or talk about?

Erik Warren, DDS, MD: Yeah, absolutely. And it's the old boy scout in me is prepared today for what may happen tomorrow, right? It's there's going to be challenges and there's going to be legislation that is put on somebody's desk that we don't like, or is not favorable to us, or it could be the opposite. There's something that's very favorable and we want to be active on and advocate for. So if you face an issue, contact AAOMS Governmental Affairs, and there's lots of resources and people that can help with any of these unique situations. And members should really stay informed and answer the calls to action.

I would encourage people to do the grassroots, the Twitter and the emails that are sent to legislators that are so easy to do, and they're so powerful. So just doing, taking five minutes and answering that call to action with the grassroots through AAOMS makes a huge difference.

And work with your state society, and that's really with, as far the state legislation, we work with the state societies so we can be abreast of any changes in state regulation or any changes with the legislation in the states. And the state societies are who we work with through funding a lobbyist and those types of situations.

So, and the action needs to be coordinated and strategic to, to be effective. And because we have such a strong group of people and a strong precedent that's been set to how we respond to these different legislative problems; we can definitely be a huge help to the state societies and the members.

And probably the biggest commercial I want to throw in is that if you want to become involved, please let leadership know that you want to be involved. And one really easy way to do that is the Day on the Hill. And it's March 6th through 7th, 2024 this year in DC. And that's a great way to get introduced to how the legislative process works, how we are advocating for a specialty, how are we, how we are meeting with congressmen and senators and people in D.C. and you can see how much work AAOMS is doing on your behalf to protect the specialty and to protect our interests and protect our patients going forward. So I encourage everyone to whether you're a first time attendee or it's your 25th time going, I encourage everyone to come to the Day on the Hill and really use your voice to advocate for our specialty.

Host: Day on the Hill not only sounds informative and educational, but what a great opportunity to be at the seat of our government and really see how it works. One of the bigger points that I got from you, Dr. Warren, is to let leadership know if you want to be involved. And we need people to be involved. Is that right?

Erik Warren, DDS, MD: Right, absolutely. And it's always who's the next man up, who's the next man or woman up is what I should say. Who's the next person up? So we're always looking for another person to make a relationship, whether their brother in law's buddy is a congressman. Those types of things and those relationships, they mean a lot because when there's issues that come up at the state or federal level, and you can call on a relationship that's been formed, whether it's a staffer in the, in your dis, in your congressman's district office that you've talked to over the past three or four years. When you can make those quick phone calls and say, hey, this is what we think, we want to make sure that you understand that where we stand on that, it really makes a big difference.

Host: Very well said. And another thing that you mentioned, stay informed, answer calls to action, and work with your state society and AAOMS as action needs to be coordinated and strategic to be effective. Dr. Warren, this has really been fascinating and very informative. Thank you so much for your time.

Erik Warren, DDS, MD: Thank you so much, Bill. I really appreciate it.

Host: And once again, that's Dr. Erik Warren. To learn more about AAOMS's advocacy efforts, visit aaoms.org/advocacy, and be sure to stay up on updates from the association and state affiliates. And if you enjoyed this podcast, please share it on your social media and make sure you subscribe so you don't miss an episode. Thanks for listening.