Dental Service Organization affiliation: Understanding key aspects of State Dental Practice Act compliance.

Dental Service Organizations (DSOs) are an increasingly visible and available practice option for new dental graduates. While guidance has been published to help dental students make informed decisions when considering a DSO affiliation, they have not focused on the complexities of assessing compliance with controlling state laws. Accordingly, this Perspectives article provides a concise summary of the common components of state regulatory provisions across the United States to support an understanding of the corporate practice of dentistry and compliance considerations. The guiding principles to consider include ownership or proprietorship of and control over a dental practice; control over dental offices, equipment, and materials; employment of dental personnel; and control over clinical judgment. This article should be helpful to students who are considering a DSO affiliation and educators who prepare them to enter dental practice.

The corporatization of care in academic dermatology.

Concern over the corporatization of medicine has existed since the late 1800s and continues to grow today in the face of large-scale mergers, vertical integration of health care services, and private equity (PE) investment in dermatology practices. Although academic departments have traditionally been viewed as exempt from Corporate Practice of Medicine (CPOM) laws, they face the same health care landscape and cultural pressures as private and PE-backed practices, as well as some unique financial challenges. To adapt to these difficult realities, academic dermatology has embraced new models of care, some of which mirror the controversial strategies used by PE-backed practices to maximize profit. We explore the corporatization of academic dermatology and its manifestations in changing practice patterns, patient care, education, and research.

Corporate Encroachment.

Recent complaints suggest threats to Texas' ban on corporate practice.

Helping Dental Students Make Informed Decisions About Private Practice Employment Options in a Changing Landscape.

According to the 2014 American Dental Education Association (ADEA) Survey of Dental School Seniors, 45.3% of new graduates planned to enter private practice immediately after graduation; of those, while 65% planned to become an associate dentist in a private practice, 28.3% intended to enter a corporate group practice-the only category that saw an increase over the previous year. Current trends indicate that the number of new graduates choosing to enter some form of private practice without further education will continue to remain high, due in large part to the need to repay educational debt. In light of these trends, the question that must be asked is whether dental schools are optimally preparing students to make informed decisions regarding future employment options in the changing dental practice landscape. This article argues that dental schools should review their curricula to ensure graduates are being prepared for this changing environment and the increased business pressures associated with dental practice. Important considerations in preparing dental students to be successful in the process of selecting a practice model are identified.

Corporate governance and proactive environmental management in Novo Hamburgo and neighbouring cities, Brazil.

This study compiled data on environmental auditing and voluntary certification of environment-friendly businesses of the Commercial and Industrial Association of Novo Hamburgo, Campo Bom and Estância Velha and analysed them according to classical environmental management principles: sustainable development and corporate governance. It assessed the level of application of the concepts of corporate governance to everyday business in companies and organisations and estimated how the interconnection and vertical permeability of these concepts might help to make bureaucratic environmental management systemic, proactive and evaluative, changes that may add great value to the operations evaluated. Results showed that, when analysing only audited items not directly defined in legislation, no significant changes were identified. The inclusion of more advanced indices may promote the transition from bureaucratic management, which meets regulated environmental standards only satisfactorily, into proactive and systemic environmental management, which adds value to companies and helps to perpetuate them. Audited and analysed data did not reveal actions that depend on the internal redistribution of power and the interconnection or verticality of attitudes that may materialize concepts of corporate governance.

Corporate governance and proactive environmental management in Novo Hamburgo and neighbouring cities, Brazil / Governança corporativa e manejo ambiental pró-ativo em Novo Hamburgo e cidades vizinhas, Brasil

This study compiled data on environmental auditing and voluntary certification of environment-friendly businesses of the Commercial and Industrial Association of Novo Hamburgo, Campo Bom and Estância Velha and analysed them according to classical environmental management principles: sustainable development and corporate governance. It assessed the level of application of the concepts of corporate governance to everyday business in companies and organisations and estimated how the interconnection and vertical permeability of these concepts might help to make bureaucratic environmental management systemic, proactive and evaluative, changes that may add great value to the operations evaluated. Results showed that, when analysing only audited items not directly defined in legislation, no significant changes were identified. The inclusion of more advanced indices may promote the transition from bureaucratic management, which meets regulated environmental standards only satisfactorily, into proactive and systemic environmental management, which adds value to companies and helps to perpetuate them. Audited and analysed data did not reveal actions that depend on the internal redistribution of power and the interconnection or verticality of attitudes that may materialize concepts of corporate governance.

O presente estudo é uma compilação dos dados resultantes das ações de auditoria ambiental da certificação ambiental voluntária empresa amiga do meio ambiente da Associação Comercial e Industrial de Novo Hamburgo, Campo Bom e Estância Velha, os quais são analisados, considerando as premissas mais clássicas da gestão ambiental, quais sejam, o desenvolvimento sustentável e governança corporativa. O objetivo é avaliar o nível de aplicação das concepções de governança corporativa no cotidiano das empresas, empreendimentos ou organizações e verificar o quanto a permeabilidade e imbricação vertical destes conceitos poderia auxiliar na transformação da gestão ambiental burocrática numa ação de gestão ambiental sistêmica, proativa e valorativa, trazendo maior valor agregado para as operações avaliadas. Os resultados demonstram que quando são analisados itens auditados que não estejam diretamente relacionados com legislação e sanções aplicáveis, não ficam claros os possíveis indicativos de melhorias de gestão e processos. A inclusão de indicadores mais avançados significaria a passagem de uma gestão ambiental burocrática, que atende apenas satisfatoriamente normas regulamentadas a uma gestão ambiental sistêmica e proativa, que possa trazer maior valor agregado e perenização aos empreendimentos. Todas as ações que depende mais de redistribuição interna de poder e imbricação vertical ou permeabilidade de atitudes que materializem concepções de governança corporativa não são identificadas pelos dados auditados e analisados.

Is the swiss health care system a model for the United States?

Both supporters and critics of the Patient Protection and Affordable Care Act (ACA) have argued that it is similar to Switzerland's Federal Law on Health Insurance (LAMal), which currently governs Swiss health care, and have either praised or condemned the ACA on the basis of this alleged similarity. I challenge these observers on the grounds that they overlook critical problems with the Swiss model, such as its inequities in access, and critical differences between it and the ACA, such as the roots in, and continuing commitment to, social insurance of the Swiss model. Indeed, the daunting challenge of attempting to impose the tightly regulated model of operation of the Swiss model on mega-corporations like UnitedHealth, WellPoint, or Aetna is likely to trigger no less ferocious resistance than a fully public, single-payer system would. I also conclude that the ACA might unravel in ways unintended or even opposed by its designers and supporters, as employers, confronted with ever-rising costs, retreat from sponsoring insurance, and workers react in outrage as they confront the unaffordable underinsurance mandated by the ACA. A new political and ideological landscape may then ensue that finally ushers in a truly national health program.

Liability of physicians supervising nonphysician clinicians.

Physicians confront a variety of liability issues when supervising nonphysician clinicians (NPC) including: (1) direct liability resulting from a failure to meet the state-defined standards of supervision/collaboration with NPCs; (2) vicarious liability, arising from agency law, where physicians are held accountable for NPC clinical care that does not meet the national standard of care; and (3) responsibility for medical errors when the NPC and physician are co-employees of the corporate enterprise. Physician-NPC co-employee relationships are highlighted because they are new and becoming predominant in existing healthcare models. Because of their novelty, there is a paucity of judicial decisions determining liability for NPC errors in this setting. Knowledge of the existence of these risks will allow physicians to make informed decisions on what relationships they will enter with NPCs and how these relationships will be structured and monitored.

The evolution of dental group practices.

Dentists and the dental profession are changing. One significant change in the deliver of dental care is the evolution of group practices to include networks of dental practices with central management by various service organizations that are owned or financed by private equity firms. This article discusses their evolution and potential advantages and disadvantages for dentists who join them. The article concludes with a prediction about the future heterogeneity of the dental care system.

Power, ethics, and corporate dentistry.

The North Carolina Dental Association recently sought to place clear statutory limits on the influence of corporate, nondental interests over dentists practices' decision-making. This report describes the two-year legislative battle with well-funded and politically connected parties that ultimately resulted in laws that protect patients' rights to be treated by a dentist free of outside commercial interests.