Episode 24 – PEER REVIEW: ONE OF THE MOST VALUABLE AND LEAST UNDERSTOOD MEMBER BENEFITS

SUMMARY: Richmond dentist Dr. Bob Bigelow discusses the Virginia Dental Association’s peer review/patient mediation benefit. Bigelow, involved for about three years, explains how mediation can resolve many patient complaints before they reach the Board of Dentistry, reducing stress and time for dentists and patients. Common issues include clinical problems, missed appointments, and misunderstandings about insurance or collections. 

GUEST: Dr. Robert W. Bigelow has been a tripartite member of the VDA for almost 17 years and owns a restorative dental practice in midtown Richmond. He enjoys collaborating with other VDA members to enhance patient care. Outside of work, he enjoys spending time with his family and friends.

HOST: Paul Logan of the Virginia Dental Association. Paul focuses on member advocacy, developing resources for dental students and early career dentists, and working with a broad array of stakeholders to elevate and address Virginia’s dental workforce needs. Paul currently serves on the executive committee of the Coalition for Modernizing Dental Licensure and the College Board of J. Sargeant Reynolds Community College. Outside of work, he’s trying to keep up with his young daughters.

MENTIONED IN THIS EPISODE:

VDA Peer Review - Additional Information: https://www.vadental.org/peer-review

EPISODE CREDITS

Producer: Paul Logan

Host: Paul Logan

Guests: Dr. Robert W. Bigelow

Post-Production/Editor: Shannon Jacobs

Subscribe, share, and send your feedback and topic ideas to thefulcrumpodcast@vadental.org.

The information, opinions, and recommendations presented in this Podcast are for general information only, and any reliance on the information provided in this Podcast is done at your own risk. This Podcast should not be considered professional, medical, or legal advice. 

Music in this episode from Epidemic Sound

Transcript

SPEAKER_01 0:09

Welcome to another episode of the Fulcrum, a Virginia Dental Association podcast. I'm Paul Logan, and our guest today is Dr. Bob Bigelow, a VDA membered dentist in Richmond. At the most recent VDA House of Delegates meeting, there was a discussion on membership, and Dr. Bigelow stood up and shared, and I'm paraphrasing, that the VDA patient mediation process is one of the VDA's most valuable and least understood member benefits. So today we're going to dive into the VDA peer review benefit with Dr. Bigelow and also share some advice around patient communication and setting patient expectations that can prevent these issues from happening in the first place. Dr. Bigelow, welcome to the podcast. Thanks, Paul. To open, can you share how long have you been involved in the peer review process?

SPEAKER_00 0:53

I think it's been about three years now. I was nominated and I said, sure, I'll do that.

SPEAKER_01 0:58

Aaron Powell About how many cases do you all typically see at the state level a year?

SPEAKER_00 1:04

Aaron Powell I'd have to check with the chair of the committee on that, but I typically get about two cases a year, maybe two, three. Okay. Some are more complex than others.

SPEAKER_01 1:14

Aaron Powell So I was at the Board of Dentistry meeting and they reported on complaints received by the board over the last six months. They noted that patient complaints at the board are on the rise. Over 90% of those cases open at the Board of Dentistry are closed with no finding of violation. Now, a case being closed with no finding of violation would certainly be the preferable outcome for a dentist, but that complaint also comes with a cost of stress, time away from a practice, fear of what it might mean for a dentist's license, their patients, their livelihood. Can you tell me at a 10,000-foot level how the VDA's peer review process can help in mediating some of those patient complaints that don't rise to the level of a disciplinary action from the board of dentistry, but that a dentist hasn't been able to resolve directly with the patient?

SPEAKER_00 1:59

Some of those are communication issues, and obviously there's unclear expectations for both parties. You'll have a patient who expected one outcome and the dentist goes, hey, this is what we expected to do. And no, no, no, I wanted this, I wanted that. You know, so that's probably the biggest thing right there. But if you can keep something away from the board of dentistry, it saves a lot of grief and heartache. Right. I mean, I had a case years ago, and it was such that I didn't find out about the patient issue until I received a notice from the board of dentistry. And it was about sensitivity from tooth color fillings. And I told the board, I said, hey, I wish I would have known about this. The patient never contacted me. I'm always here for the patient. Long story short, it was closed, and that was that. But man, they wanted information yesterday.

SPEAKER_01 2:47

Yeah. And that takes time from you, your practice. Uh it's a distraction. It takes the board's time away from doing doing work that they need to do. Uh what does the mediation process look like from start to finish uh from a patient perspective?

SPEAKER_00 3:03

I get an email from Lynn Wisman and basically giving me all the information of the case. The patient's complaint, who the patient is, how to reach out to them, and the dentist with whom they have the complaint. And usually the case the dentist is a VDA member. I've had one case now where they're not a VDA member, and so that's not applicable. I can't delve into that with the non-VDA member. I will generally reach out to the patient first and say, hey, tell me about this. What's going on? Just leave it open-ended. They can tell me all their stuff, and I will next try to collect as much record information as possible. Sometimes it's tricky getting it from the dentist, other times it's very easy. And then I'll reach out to that dentist and say, Hey, this is what the story is. Tell me about it. Tell me your side. So it's let me get information from both parties and then try to put this together. And sometimes I tap my fellow colleagues on an anonymous basis anyway, and say, What do you recommend? I've even reached out to my office manager for certain non-clinical things.

SPEAKER_01 4:08

And that's a good place to mention the peer review process isn't designed to handle every type of situation. For example, you're not considering cases in litigation, dentist-to-dentist complaints or allegations of fraud or violations of the state dental practice acts. It's it's really a narrow set of issues where, as you said, there's often just a disparity in the patient expectation or what's been delivered. Uh, it might be a payment issue that that they're concerned about and an opportunity to sort of help bridge that divide between what they're expecting and what what they received.

SPEAKER_00 4:46

If the patients felt like the dentist has done them some sort of wrong in a way, I'm going, well, okay, let's let's figure out how to rectify this situation. Yeah. Make it as easy as possible for both parties, at least leave both parties saying, we're going to split mutually amicably. And you know, the patient will go find another dentist and leave it at that. So I've I've kind of gotten it to the point for a couple cases where, okay, you take care of this, this is your end of the bargain, and the dentist, the patient will take care of that one item, and the dentist will take care of another item. And once I know they've taken care of, and I email them both and separately and say, This has been taken care of, let's close this case. And usually it's done. And that has to feel good. Yeah, it feels great. And um, then it's less work for the board to take care of.

SPEAKER_01 5:32

And the patient can feel like I was heard and they're better educated on what actually should have happened. Or in some cases, the dentist might say, Okay, I I need to rework my internal processes to make sure this isn't a misunderstanding that's repeated in the future.

SPEAKER_00 5:47

Yes, yes, definitely. Yeah, we're always trying to figure out and make things better. Yeah.

SPEAKER_01 5:51

So going to some of the specific categories of cases, and this is a confidential process, so please don't go into specifics, but what types of issues do you all deal with in the peer review patient mediation uh process?

SPEAKER_00 6:05

The biggest things I think is when clinical care goes awry, something falls apart, something uh causes the patient pain. Those are the biggest things. Yeah, I had a case where a tooth had a crown prep done on it and it was cracked, and immediately the patient was in pain after the local anesthesia wore off. And so the dentist tried to fix everything, tried to make it better, and yet nothing was working. And so it turned out that they got an oral surgeon to look at it, had an infection after a while. So you could see the bone loss with the infection after the time elapsed. So it had to be taken out, grafted for a future implant. And so I got it to the point where I said, Look, the patient was upset about the whole process. And I said, Let's see if we can do this where the oral surgery bill can get taken care of. And then you're back to square one. You can decide what you want to do after that. And it turned out to be an amicable solution to that. But it meant talking to the dentist, it meant talking to the patient. That was one of them. Another one was where and it actually went to the board. The patient escalated to the board where the dentist was very good with their records, had a policy about no shows. They followed that policy, but then the dentist even gave the patient another chance, like, hey, come on in. I'm willing to see you. And the patient was like, I'm expecting treatment. You know, I told the dentist, I said, Look, you're doing in another evaluation because time had elapsed, and if something else needed to happen, you needed to look again and see what happened. But I told the dentist, I said, Your records are good. And when my dad was on the board, he says, You can't miss appointments. It was off my thing once the patient escalated. Yeah. And so that was one case. Another one was where a dentist sent a patient to collections because there was not enough insurance information gathered. And so we were we actually found out through the discovery process from both the patient and the dentist's office, the EOBs from the insurance company were being sent to the patient. And the patient never got them to the dentist. Yeah. And so the dentist goes, there's no insurance information. Here are my fees. I can't change it based on the insurance. And so the patient was upset about that.

unknown 8:27

Yeah.

SPEAKER_01 8:27

And that's where there's a a breakdown in communication and process that if that was resolved, that it was all there. It's just there's a disconnect that someone needs to come in and help walk everyone through it and someone who they can trust as a third party. Right.

unknown 8:45

Dr.

SPEAKER_01 8:46

Bigelow, thank you so much for joining today to share about this benefit. And this is a benefit for VDA member dentists. As you said, it's a benefit that is easy to overlook, but can be extremely valuable to a dentist and to their patient when problems arise and give them a structure and process to resolve those challenges. And it's one you might not think about until you need it. Is there anything you would like to add or that I should have asked and didn't?

SPEAKER_00 9:12

I would recommend that all VDA member dentists post somewhere in their office, put their VDA membership. You know, I've got mine on my front door. They know that I'm a VDA, ADA, Richmond Dental Society member, tripartite thing. Put that out there. Make yourself known because you're part of a wonderful group of people. And and if patients know that you're part of that, they know that they have that opportunity to reach out to the VDA to be a part of this peer review thing. Maybe the VDA needs to highlight this peer review because the peer review process keeps all that information from being legally discoverable. Right. Which is a wonderful thing because everything can get taken care of. And once it's legally discoverable, it's almost such I can't touch it. None of our committee members can touch it because it's out of our realm. Yeah. And it's something that can keep a dentist in much better shape and hopefully rectify it sooner for the patient.

SPEAKER_01 10:08

Thank you. And for member Dennis, or even for other patients and other people listening to this, that patient mediation form can be found at vadental.org on our website. We'll post a link directly to it in the show notes. And thank you for listening to another episode of the Fulcrum, a podcast of the Virginia Dental Association. Please send comments, feedback, and ideas for future topics to the Fulcrum Podcast at vadental.org. And Dr. Bigelow, thank you so much for joining us.