#193 Hot Compliance Topics for 2025

What's on your 2025 compliance radar?  This episode will help you "dial in" important compliance topics that have captured the Divas' attention and should be on your radar. Don't miss this episode, start your year off on a great start!

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SPEAKER_01 0:04

Welcome. I'm Leslie Cannon. I'm Mary Gavoni.

SPEAKER_03 0:09

I'm Linda Harvey. I'm Olivia Juan, and together we are the Compliance Divas. Welcome to the Compliance Divas podcast. My name is Olivia Juan, and I'll be your moderator for today's episode on the topic of hot topics in dentistry and compliance. This episode will help us dial in important compliance topics that have captured the divas' attention and should be on your radar for this new year 2025. There's so much to read and content to keep up with, but we really want to boil it down to some important things that are hot topics for this year. The Divas have been talking about this and coming up with some very specific and narrowed subject matter that we thought our listeners would enjoy. You know, as the Compliance Divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please subscribe to the Compliance Divas podcast through your favorite podcast channel or on our website, thecompliancedivas.com. And we appreciate that you would give us a review. Any resources we mention during the podcast can be found on compliancedevas.com or in the show notes. So we've been talking with our diva, Mary, about some important changes that's going on in the state of Georgia. Mary, could you enlighten us on some of these changes?

SPEAKER_02 1:44

Absolutely. January 1st, 2024 saw the implementation of a new continuing education rule for hygienists and uh dentists in Georgia requiring two hours of continuing education credit, and one hour of that two hours has to be on dental unit water quality. And January 1 of this year, there is a new rule that states that all water lines for each operatory or dental unit must be tested quarterly. Now, in the past, the rules have referred to CDC guidelines, and as we've discussed before, the CDC guidelines have been in a state of flux for a while because they're going through an update. And the CDC guidelines that we have currently from 2023, 2003, and 2016 state periodically tests, but now this Georgia rule is very specific. And the rule allows for pooled sampling so that you can use one water test kit for all the lines on the same unit. And that pooled sample can have up to 10 lines included in it. And just to kind of refresh everyone's memory, a pooled sample means that you take equal amounts of water from each of the lines on the same unit. It will tell you whether the entire unit passes or fails, but it will not tell you if you have a failure if it's a specific line that is causing a problem. But for now, the pooled sample is considered to be acceptable. And you also can test each water line individually if you choose to. And all of the water for non-surgical procedures, according to the Georgia Board rules, must meet the Environmental Protection Agency or EPA standards for drinking water, which is less than 500 CFUs, colony-forming units per milliliter of water. And so any water for non-surgical procedures that's above that does not meet that rule. And keep in mind that the Centers for Disease Control and Prevention do say that sterile water or sterile saline should be used for surgical procedures, not the dental unit water. The rule also states that the licensed dentist in a practice must be responsible for recording the testing and the maintenance in a log. Doesn't mean the dentist has to do it, they can delegate that, but you must have documentation of your waterline testing and the results for up to five years.

SPEAKER_03 4:36

Lots of good information, Mary. Thank you. So just to reiterate what you said, we have this new CE requirement in the state of Georgia, as well as the water monitoring requirement. And we probably would guess that other states would soon follow the lead of Georgia, much needed, as we would all agree. Would you agree, Mary?

SPEAKER_02 5:03

I would agree. Washington State, which I did not mention, already has this in place. And the I think the impetus for Georgia, most likely, um, has been the outbreak of some Mycobacterium obsesses infections in children in pediatric dental clinics there. So I'm sure that's probably the driving force. And I would guess that probably California and Leslie can address that, and then other states are going to follow.

SPEAKER_03 5:35

Very interesting. Another hot topic is AI, artificial intelligence. And I know in my law practice, it's now part of my research database with Lexus Nexus. I know some lawyers are already using it. I've been afraid to even go there until I'm educated on how it works and how to protect the information. And I know Linda has done quite a bit of research in this area. Linda, what can you share with us on how we need to prepare ourselves for AI?

SPEAKER_00 6:11

Olivia, AI is a sizzle hot topic. You're right. And we do need to prepare ourselves and educate ourselves. It seems like it's the bright new shiny object throughout society and especially in our world of dentistry, but there are some considerations that we must take into place. And before I discuss those, I'd like to go back and just talk about what is AI. It seems magical to some way. You know, you put in some verbiage or you ask a question of this program on your phone or on your computer, and you get an answer. And so it seems like you're talking to a crystal ball almost. But actually, AI, you know, refers to the simulation of human intelligence through computer systems. And with that, these processes include the learning aspect of the AI, which is when they're acquiring information and the rules for how to use it. Then, second is the reasoning. It's the using of these rules to reach approximate or definitive conclusions and help you give back the answers that you want when you're asking a question. And then three, the ability of the AI program for self-correction. So those are the three components when you think about just the AI and how it tries to simulate human intelligence. But AI creates machines or softwares that essentially can think, learn, and adapt like humans. So on one hand, it's scary. On one hand, it could be exciting, but I'm like, yeah, I want to take a step back and make sure I know all about it because this field does encompass a wide range of techniques and technologies in various industries. And it's not just in healthcare, it's not just in dentistry, but it's used in finance and transportation and many other areas, you know, across across our world, if you will. So in thinking about what to know about it, my first experience has been with reading some articles going back as far as last year in some of the healthcare publications that I receive, where risk managers and compliance officers were talking about some of the risk of AI, and particularly when it comes to software programs that help us provide better quality care. We have to bear in mind that an AI program cannot make a diagnosis. Only a licensed individual, such as a dentist or physician, can make that diagnosis. Or in some states, you know, hygienists can make, depending on the practice level for nurse practitioners and hygienists. But essentially we have to be mindful of that. The AI is not creating the diagnosis for us. It's a tool that we use in providing better care. So there's two or three things I'd like to mention, Olivia, when it comes to understanding uh and the exact is how to use the program safely. First is security. Just as fast as we're learning how to use AI for the benefit of patient care and to make our work lives easier, maybe even our personal lives, the cyber care cyber thieves and hook and crooks are using deep fake to create AI with social engineering to trick us into giving information away. And I just had a thought occur to me today. I received a call. Um, there was nobody on the other end. And oftentimes, you know, within the first few seconds, if somebody doesn't come on, I'll say somebody, um, then you know it's a rope, something's wrong. It's a robocall, or there's just nobody's there. So in this case, it made me wonder when I thought about I answer the phone and say, hello, this is Linda. Was I being recorded on the other end to be used in a deep fake? So it just makes you think about the possibilities that could be out there. And this was how you read in some of these companies where um a CFO almost gets tricked because they they feel like it's this the CEO is contacting them for wire transfer for information, and it's actually all a fake. So it's called social engineering. And then I like to enlighten our listeners about the use of free AI programs in dentistry because they are not HIPAA compliant. And think about the one that comes, you know, Microsoft Copilot, you know, Gemini with Google and Chat GPT. Whether you're paying for a service or not, it doesn't matter. But any of the programs that we're using that aren't particularly healthcare programs are probably not HIPAA compliant. So we should not be using them to upload our chart notes, Olivia, to get better versions written or to create an insurance narrative, because simply removing the patient's name or date of birth does not necessarily mean that you have properly DI de-identified the protected health information according to the requirements of the privacy rule. It's very specific on how to do that. And third, when working with any of these AI programs, and talk to just in our field of dentistry, we want to be sure we have a business associate agreement in place with them. Just like we would with any other company that we work with, whether it's our IT company, a shredding vendor, our software vendor, um, AI programs that are providing services to your practice that have anything to do with patient care, answering the phones for you, um, helping with claims, anything that whatever that service is, you need to have a business associate agreement in place. And on top of that, I would encourage our listeners to go one level deeper with all your companies that you have business associate agreements in place, not just the AI programs, but ask about their security credentials. You see, business associates under the high-tech rule and omnibus rule are required to be HIPAA compliant with the security risk analysis and certain aspects of the security rule. In addition, they should have what's called a SOC 2 certification. And that's SOC, standing for the system and organization controls. That's a security framework that was developed by the American Institute of uh the American Institute of Certified Public Accountants for Security Levels. And unfortunately, many times over in Olivia in our industry, business associates who have the SOC2 aren't willing to share their credentials to let their customers know that they do possess them. And that's something that should be shared willingly, at least a deck sheet, to be able to prove and have the business, the covered entity prove and have documentation and assurances according to the way the rule reads that their business associate is actually HIPAA compliant. So that's that's something that we're going to be talking about more with our programs and with our clients this year and different companies that we work with and partner with to keep our customers safe and compliant, is making sure those security credentials come front and center. Because if they're not compliant, as you mentioned in other podcasts, Olivia, sometimes the IT company is not um sophisticated enough to handle these. There might be a break fix person who's not even involved in that aspect of the practice. So there's so many things to think about when we think about AI. Yes, that's exciting. I love the idea of having better quality care for all of us. And we just want to go into it with our eyes wide open, as the saying goes.

SPEAKER_03 13:04

That's a great summary, Linda. Thank you. And it's so tempting to use those uh free programs to make things sound just perfect, but when it relates to protected health information, it could actually cause a violation. So thank you for sharing all that great knowledge. Our Leslie, our California diva Leslie, uh, she has done a great job in keeping our audience up to date on California specific changes. And I think that's important for this year for people to be aware of what's been going on in California. Leslie, can you give us a summary and reference the episode that you did uh exclusively on these changes?

SPEAKER_01 13:47

Well, yes, Olivia, we had an episode number 180. We talked about some new regulations for dental assistants. In California, the Senate bill passed and becomes effective on January 1st, 2025. It's actually a sunset bill, and it requires unlicensed dental assistants to complete a border-proofed eight-hour infection control course prior to performing any basic supportive dental procedures that to involve any potential exposure to blood, saliva, or other potentially infectious materials. And this regulation actually went into effect uh for all dental assistants who were hired after January 1 of 2010. So about 15 years ago was the first time we saw this regulation. But those dental assistants who were not RDAs that were hired before 2010 didn't have to comply with this. In other words, they weren't uh necessarily grandfathered in, so to speak, but they they dodged a bullet. They didn't have to take this course because they were hired prior to the deadline of January 1, 2010. But that all changed with this new Senate bill. It doesn't matter when a dental assistant was hired, and the employer of an unlicensed dental assistant is now responsible for ensuring that they complete this course as of January 1 of 2025. But the problem with this is um there's been other changes to this eight-hour course that uh makes it impossible for an employer to comply with the new 2025 regulations, in that uh the instructors of this course, who are special providers, I'm one of them, uh, are now supposed to rewrite their course so that it is eligible for uh being fully online instead of in four hours of it hands-on and four hours of it in person. The Dental Board of California has not implemented the application for providers to be able to apply to provide this program fully online. So it's created quite a conundrum. And just recently, um, I had an email from the executive officer of the Dental Board of California instructing me to continue to teach the course as I had done in the past, which is four members of it have to be live, hands-on in person, and four members of it can be online if chosen. So now dentists are still required to make sure that their dental assistants go through this eight-hour course, uh, but it's going to be a little tough to get it done by January 1 of 2025 because the deadline has passed. And being that it's hands-on in person, there's very few places that this the dental assistants can get this training. So it's um it's now uh up to the dentists to inform their assistants that they need this training, and that puts it in the lap of the assistants to go out and find the courses. So the dentists are still ultimately responsible for making sure that this training is completed, but they um also are now sharing that responsibility with the dental assistants that they employ. I've had several calls from dental assistants who say, I can't come back to work until I get this training. Tell me where I can get this training, how I can get this training. So it's a bit of a conundrum. We're gonna find out, I guess, after the next board meeting, which is gonna be sometime in February, uh how they're going to implement this program, whether they're going to allow it to be fully online and allow the providers who give it now to just be grandfathered into being able to give it online, or whether all the providers who provide it will have to reapply to become providers. It is uh confusing to say the least, but uh I think in the long run, it's important for the general public to be having dental treatment in a facility where the team members who are usually the ones responsible for infection control be trained at least at a minimal level, so that then only do they know what they're doing when it comes to processing instruments and disinfecting surfaces for patient safety, but also for their own safety, proper PPE, how to place, how to remove, uh, you know, how to look up the instructions, how to find the CDC guidelines, things like that, or you know, at least minimal basic information that anyone should have who's providing any kind of sterilization and disinfection or or chair side care for patients.

SPEAKER_03 18:30

Thank you, Leslie. So, once again, for our listeners, the new California Dental Assisting Rules, what you need to know is episode 180. And Leslie does a great job in keeping everyone up to date on those changes. A couple of things before we close, you know, one of my, I guess, my goals for 2025 is to really infuse more information, not just OSHA compliance. And I think, you know, people they'll call infection control OSHA and they'll call OSHA infection control. And it does intertwine quite a bit. But with the labor shortages that dental offices continue to experience, it's critical that our team be trained properly, particularly when states are able to recruit individuals who do not have a background or license, and all of a sudden now they're in the sterilization area, handling such a critical component that not only involves employee safety, but safety of our patients. And so we're trying to get back to basics with some infection control as it relates to instrument management, surface disinfection, even how to wrap the instruments properly. What may seem very simple, but some of the basics of infection control. And we also understand that quite a few states require infection control training as part of their CE. And I wish all of the states would do that so that we could keep people on the same page. It's valuable information. And we see California has really taken the lead, as Leslie pointed out, in making some of these requirements, which may seem rigid, but they are also beneficial in keeping our practices up to date and current. So whether it's an infection control plan that's written and in detail, or it's the basic training of covering topics with our staff and our team, we want to keep it in the forefront of our programs and never take it for granted. You know, when I get a call that there's been a breach in a dental office, it's usually something that's so basic, such as, oh, well, we didn't notice that the the indicators didn't change on the pouches, you know, just very simple things like that that have occurred. So there is a need to do ongoing training and reminders so that we can help each other, you know, watch each other's backs, so to speak, so that we never compromise safety or infection control, uh, whether it's our employees or our patients. So these are some of the hot topics that the divas have been talking about, and we hope that these are helpful thoughts for you to bring to your practices and those that you serve. We really appreciate that you take the time to tune into the podcast each week because as the compliance divas, we bring clarity and simplicity to compliance by navigating regulatory compliance to keep you on course. Please submit your questions to support at the compliance divas.com. And please check the show notes for any resources that we discuss. Thanks for tuning in, and we'll see you next week.