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‘We are at the top of our game’

Dr. Jeffrey M. Cole offers insights on dental benefits, student debt, ADA Seal

October 01, 2018
Dr. Cole
Elected: Dr. Cole thanks the ADA House of Delegates for voting to name him president-elect in October 2017.
Dr. Cole and wife Linda
Together: Dr. Cole poses with his wife Linda.
Editor’s note: This is the second part of a conversation with Dr. Jeffrey M. Cole, ADA president-elect, who will be installed as the 155th president of the American Dental Association Oct. 22 in Honolulu. The Sept. 17 ADA News featured Part 1. ADA News Editor Judy Jakush interviewed Dr. Cole.

ADA News: Have you learned something about the ADA since joining leadership that you didn’t know previously?

Dr. Cole: The ADA is really big, and its scope is huge. We talk about our focus on education, science, advocacy, standards and more, but when you drill down and see up close how much is done in each of those areas, it’s incredible. I have to appreciate the complexity and expertise of what the ADA does. We have world-renowned leaders in their field. If the ADA didn’t tackle these issues with this kind of expertise, who would? What would happen? If the ADA wasn’t working on the standards, where would the dental profession be?

ADA News: Questions to the Association regarding dental benefits have skyrocketed in the last year, according to the ADA Center for Dental Benefits, Coding and Quality. The Decoding Dental Benefits series in the ADA News has become a popular feature because it addresses very specific concerns and issues that the Center has identified. What can the ADA do to showcase and boost its advocacy on this issue?

Dr. Cole: Dental benefits are a major part of the bigger picture of making our professional workforce efficient and successful. It’s just one piece, and it’s the funding piece. We’ve got to get that right on so many levels. Is what we are doing enough? Nothing is ever enough. Are we going on the right track?  Absolutely, but as we move into the future, it’s not only the financing of care — which is a big part of making sure that we can deliver good oral health to everybody — but it’s also looking at outcomes. We have seen where not having the right outcome measures can be devastating to not only the profession, but to good oral health or the health of the public.

As an example, and this is probably a controversial statement, I would look at the opioid epidemic. The previous outcome measure was that if there was any postoperative pain, then that was generally unacceptable. That led to overprescribing, and ultimately contributed to an opioid crisis. If that had not been such a mandated outcome, we may not have the crisis that we have today.

What’s most important is that we make sure that all the driving factors move the profession forward in the most positive way, which gives us the ability to deliver the best oral care most efficiently. That benefits everybody, the practitioner and the public. That helps preserve the independent practice of dentistry, while at the same time delivering good oral health. A lot of what drives insurance companies first and foremost is profits. I know they’re looking at outcomes, I know they look at other things, but we have to make sure that anything that’s being done is fair to the two bosses or constituents that we have: our members and the public. That is our barometer: the benefit to these two constituents.

ADA News: What does the Association expect to see come from collaborations we have with non-ADA entities, such as the oral health initiative we launched with CVS earlier this year?

Dr. Cole: CVS is one example of what we’re looking for moving forward. Because the business and practice of dentistry is changing so dramatically, it’s incumbent upon us as leaders to find ways to continue to move the profession forward in a positive way. To do that, we have to step out of our comfort zone, step away from business as usual and really look at what is disrupting the status quo. Are there opportunities out there to achieve what we’re looking for by engaging in new collaborative initiatives?

We are a very strong, old and big organization, which gives the impression we can do everything and do it better ourselves. What we’re finding out is, particularly if we have to be more efficient, if we’re looking at staying relevant and if we’re looking at staying financially sustainable, we have to take some calculated business risks in an exponentially positive way. With that comes risk because we’re not totally in control. We have to be on top of change, we have to make sure it’s in the right direction, we have to take proactive action, corrective action at times, but I think it’s important that we look at opportunities in a way that we did not before. We have to be innovative; we have to think more like start-up ventures as opposed to the old way of doing business. We can become irrelevant almost overnight. There’s a quote, “Change happens slowly until change happens fast.” While in the slow change mode, the Association needs to be the driver of change before it overtakes us.

ADA News: Student debt is an ever-present topic. The ADA endorses Laurel Road Bank to help dentists refinance dental school loans. How important is this effort?

Dr. Cole: It’s extremely, extremely important. The cost of dental education keeps going up and we continue to be one of the top professions people seek. I’m extremely proud of what we did with Laurel Road because we not only gave them the best refinancing option that was possible, but we also changed the whole refinancing marketplace, particularly for professional students.  The marketplace became more competitive.

We’re also advocating for lower student debt when it comes to dental school costs. It’s extremely important that at the federal level we do what we can to make each and every one of those loan programs available to professionals.

ADA News: What can you say about the ADA’s relationship with other organizations?

Dr. Cole: We are huge, and we do so much, but we also can’t be everything to everybody, or else we would dilute our expertise. We have to have very collaborative relationships with other groups. It’s important that specialties have their groups. It’s important that we support them. It’s important that other ethnic groups have their own societies that address their specific needs. I think we have to be the umbrella and the actor that brings everybody on board so each of us can do better. Our dental students represent a diverse population. But up close we see it’s not as diverse as it should be, relative to the overall population. There are still pockets not represented, where we really need to be. And that’s in the Hispanic population, the African-American population, as well as the Native American population.

My concern is that, if there are people out there like me who made up their mind at age 12 that they were going to be a dentist, who is reaching out to encourage that excitement and interest in underrepresented populations so that they too at age 12 know they want to become a dentist?  I think we can partner with groups that know the specific populations and who interact at an earlier time in their lives than we can.

ADA News: What are your thoughts on issues related to Medicaid or even the possibility of a dental benefit in Medicare?

Dr. Cole: Whether we’re talking about Medicare or Medicaid or even dental benefit programs, we’re talking about funding.

For me, when we’re talking about Medicaid, we’re talking about delivering good oral health to those who don’t have the means or can’t pay. When we talk about Medicare, we’re delivering good oral health to an aging population. While Medicare is all about funding, I think the bigger question for the Association is how we can help our members better treat a growing elderly population. What is the best science and evidence for treatment? Because people are living longer we are looking at conditions that were rarely seen or didn’t exist 30 years ago. That’s where we can help our members.

When we start talking about individual government programs, I don’t want to sound like a cynic, but I can rarely find in history where government alone came up with the right answer to anything. I think that it’s extremely important what the government does, and we have to work in collaboration and partnership with it the way we do with the dental industry, academia and other groups. I also think that when it comes to oral health, when it comes to how to treat patients, how to advance the profession forward, we’re the experts. We can use that expertise to educate the government to help ensure we can work together to find a solution that is sustainable for all.

ADA News: Is there a message you want to give to members about our Action For Dental Health and other advocacy efforts?

Dr. Cole: Many dentists join the ADA for education and camaraderie, and they stay for the advocacy. When we look at how effective we are on Capitol Hill, when we look at the dentists that are entering Congress, when we look at the presence of the American Dental Political Action Committee and when we look at our physical locations on Capitol Hill, it’s not only that we’re better than any organization at this, but that we are really better than any industry. We are at the top of our game. And I think there’s a real respect there.

With Action for Dental Health, the ADA is working with Congress to help break down barriers to essential oral health care for the vulnerable and underserved, whether they are children, adults or older adults. SB 3016 is in the Senate and would allow organizations to qualify for oral health grants to support activities that improve oral health education and dental disease prevention, activities like Give Kids A Smile. Another aspect is support for reducing the number of emergency room visits for dental reasons through referral efforts. That’s just part of the effort.

ADA News: What is the relevance of the ADA Seal of Acceptance in 2018?

Dr. Cole: I think the Seal of Acceptance and the respect and brand awareness that the public has for it is incredible. We have the market research that says people will even spend more knowing that the product has the ADA Seal of Acceptance. It’s part of who we are, and it’s part of the reason why the public trusts the American Dental Association. It’s terrific public outreach that helps consumers as well as our members. I think patients look more favorably on what we do as an organization, and I think the respect they have for the organization includes respect for our members.