I am in full agreement with Dr. Dickerson position on this matter.  These rebates and fee split contracts undercut our profession as a whole and removes diagnosis and treatment planing from the realm of the dentist.  

We already have seen our patients of record have their teeth cleaned at a discount for one time only and then return to our office for the next cleaning.  Who does this help?  We need to encourage actions which promote the dentist patient relationship and not promote offers which use price to lure patients of record away from other dentist.  Who is following up to see that all treatment was provided as specified by the agreements?  Why should we allow non-dentist to determine what procedures are sold to patients before a proper history and exam are preformed?  I support this petition.  Dag Zapatero, DDS

 Fee-splitting, rebates or commissions to a third-party for dental services are considered unethical actions for dentist members of the American Dental Association.  This has been the case for very long time.  The reason this is not a good practice and not in the best interest of patients is it creates incentives for the dentist to provide unnessecary treatment to patients who are referred through third parties.  The emergence of marketing services that sell dental services online to patients in return for splitting the fees with the dentist has made this a much more common problem than in the past.  Passing this regulation will be in the best interest of patients.

As a dental student, I am surprised to find out that this practice has not yet been made illegal. One of roles of a professional is to place the patients' interests first. This role is compromised if choices affecting patients are determined by monetary gain. Patients do not benefit from fee splitting. The referring doctor should always choose the specialist who can provide the best quality of service to the patients and not be tempted to choose specialists based on commission. Remove the temptation by formally outlawing fee splitting. How one would enforce the ban of under-the-table fee splitting is beyond me.

I support Dr Dickinson's position.  This further supports ADA's position in our code of ethics. 

Fee splitting is obvoiusly unethical and dangerous to the public. 

In addition, if fee splitting is allowed to continue, it will create a disastrous make-money-at-all-cost environment for dentistry.  It is no secret that younger dentists are facing record financial burdens, and even though they have full intentions of practiciing fairly and ethically, they have to pay loans and feed their families.  If we allow new dentists, or any dentists, to be surrounded by colleagues who split fees or insurance companies who pay to keep patients in-network, then these dentists will be forced to create their own fee-splitting practices just to stay ahead, and patients will suffer.

Lets keep our profession honest and dependent on good dentistry, not Survivor-type alliances.

Our profession is concerned with the increasing trend of unethical business practices that include fee splitting, rebates, and payments for patient referrals.  The primary goal of Virginia Dental Association dentists is to deliver quality dental care to our patients in a safe and ethical manner.  We feel that treatment decisions may be negatively impacted by these monetary incentives.  The VDA has taken an active role in addressing this activity and encourages the Board of Dentistry to support regulation that will discourage this behavior. 

Monetary payments - rewards - gifts - to third parties for solicitation of patients should be illegal.

It is considered illegal behavior by the Federal Government in their heathcare contracts and also laws deallng wih dental equipment and supply sales. Other states and professions consider it illegal. The American Dental Association states that the behavior is unethical in their ADA Principals of Ethics and Code of Professional Conduct. Numerous other dental organizations such as the Academy of General Dentistry, American College of Dentsits, Internatonal College of Dentists, dental speciality organizations and more all consider this activfty unethical.

Solicitation of patients through any monetary incentives or services  provided is a misrepresentation and harmful to the public and  reputations of all ethically practicinfg healthcare providers. This activity should be considered illegal in Virginia and now properly addressed by the Virginia Board of Dentistry.

Respectfully submitted,

William J. Bennett, D.D.S.

Fee splitting (paying someone (anyone) to have them refer a patient to you)- is unethical and should be illegal. The ADA Code of Professional Conduct and Ethical Begavior has listed fee splitting as unethical behavior for many years. If you just step back and think clearly about it- why should someone get rewarded for referring a patient for dental care? This is clearly a conflict of interest. If you were truly concerned with finding the best care for someone- would you need to be rewarded for ir? Paying for referals in any form causes the focus to go from what's in the best interest of the patient to "What's in it for me?" This does not lead to better care and can lead to referral to the highest bidder. Clearly not in the best interest of the patient. If this is matter is not settled, the Board will not be doing it's best to "Protect the public."

Fee splitting is already illegal in several (many) other states.

I believe the Board of Dentistry regulations say a dentist can be reprimanded for unethical behavior- but there is no reference to what ethical behavior is. The ADA and The American College of Denists both have specifc Codes. Pehaps these should be adopted by the Board to have a reference for "Ethical behavior." Again, I believe several states have adoted the ADA Code of Professional Conduct as a guideline document in reference to ethical behavior.

Patients are best served by an ethical, well behaved and intentioned profession of Dentistry. While the Board may not see itsself as the enforcer fo ethical conduct- it should be- that would help promote better dental care within the Comonwealth,and as a result, further protect the public.

The world has changed a great deal since I began practicing dentistry, when advertising was illegal and we had to practice only under our own name.  Now we have drug companies advertising medications of all types directly to the public, we have lawyers advertising their services to right all wrongs nightly on TV, and we have dentists advertising in all media- including on the sides of a car which the dentist drives around town for a year,  then promises to give it to the lucky winner of a contest for people who refer a new patient to that dentist. In fact,  the ethics of the entire population is questionable if one bases one's judgement on current events in the entertainment industry and politics.  However, it's time to draw the line somewhere and this is at least a place to start to control the excesses and to keep the playing field level for all dentists and their patients.

When I first saw GroupOn, I thought what a great way to drive patients in the door. I buy a GroupOn on occasion like many women I know. The thought that this new form of advertising was fee splitting never crossed my mind. However, once I learned that physicians and dentists are held to higher advertising standards, I understood why it was technically considered fee splitting.

GroupOn and other internet coupons are here to stay. We’re in the Information Age. Time has shown that those practices that market heavily benefit financially. There are Invisalign practices that give away I Pads to every new patient and Align Technologies promotes these marketing ideas. I don’t have an MBA to know what works and what doesn’t; there is too much risk involved for my participation. I’m also of a different generation where such practices were frowned upon by colleagues.

I don’t envy you and the decisions that you will be making in the future. I do see plenty of healthcare providers using these internet advertising devices and I do not think the majority of the public think it distasteful or illegal. It’s a part of daily life.

The law was probably written before the internet explosion. Its purpose was to prevent doctors from paying for referrals. GroupOn is a form of advertising. Certainly those who receive partial payment are in the advertising business and not endorsing these doctors.

There are new regulations for HealthCare companies to report how much money is being spent on entertaining clients. I can’t believe how much money some of my colleagues spend on general dental office staff to generate referrals. The gift giving to them and patients is staggering, but apparently quite effective. This upsets me more than GroupOn; however, both degrade the profession.

I'm not sure how I want the board to rule on this. Advertising is different from buying referrals from other professionals.

Fee splitting is considered unethical for American Dental Association members. The ADA Code of Ethics is an appropriate guideline for the Virginia Board of Dentistry to endorse. The public would be adequately protected if all dentists were to abide by the Code.

Marketing a business is part of the modern day philosophy for all types of industry. However, in dentistry, paying a third party to refer you patients is not only unethical but very dangerous. By paying an individual or a group for a referral, the individual is walking down a slippery slope of unethical behavior. This clearly shows that the Dentist does not have the best interest of the patient at hand. Hence, the Dentist will try to sell the patient unwanted treatment or better yet, sell treatment that is not needed for the sake of the almighty dollar. Our profession deserves better and needs to stand up to the unprincipled Dentists. This change in the regulation does two things; it will help ensure that the Board is protecting the public from injury and ensure ethical behavior in our profession. The Board should consider adopting the ADA code of ethics as a model behavior for all Dentists in Virginia. The Board of Dentistry’s sworn obligation is to protect the public from harm. By allowing fee splitting to occur in the Commonwealth, the patient is held hostage to the highest bidder and possibly an incompetent Dentist. Fee splitting encourages fraudulent behavior and I know the Board will act appropriately on the petition.   

It is the opinion of many (myself included) that Fee Splitting with regard to health care is unethical practice.  Hopefully the Virginia Board of Dentistry will be of a similar mindset.

It's my belief that the practice of fee spltting or rebates for referrals  should be disallowed.  The ADA has a paper positioning their stance on ethical guidelines concerning Groupon, Living Social and other arrangements.  Monetary incentives for coming in for care often lead to unappropriate care.  Please consider what is best for dental citizens and reduce the impact of all forms of fee splitting.

Fee splitting or paying a third party for patients goes beyond an ethical issue alone.  Our patients are degraded when we buy them.  They should come into our practice based on an intelligent decision, not becuse we paid for them.  When we pay for a patient, we might have the tendency to seek a return on our investment; possibly resulting in over treatment.

The Virginia Dental Association has a Code of Professional Conduct and Ethical Behavior. This is something the VDA takes very seriously. We believe that our member dentists  put the interest of their patients first. The VDA works to keep our members aware of and in tune with these beliefs.

 Fee Splitting, we believe, is one of those principles that all dentist should abide by, not just members of our Association. Because the VDA has no jurisdiction over non-member dentists,  we ask the Board to do its part to "Protect the Public" and create regulations that discourage fee splitting.

Solicitation of patients through any monetary incentives or services provided is a misrepresentation and harmful to the public and reputations of all ethically practicinfg healthcare providers. This activity should be considered illegal in Virginia and now properly addressed by the Virginia Board of Dentistry.

Respectfully submitted,

ROBERT B ALLEN, DDS

The American Dental Association has a Code of Ethics in place for a reason. It is not simply an "opinion paper" that has been drafted to have language in place that suggest dentists have an option of adhering to. Is moral and ethical behavior an option?  At this point in time, unfortunately, it is.  With no legal grounds to stand on, ethical and legal acts have been put into two distinct categories.  In other words, I can choose to be unethical in dentistry, but still be perfectly within the construct of the law. The current rules and regulations of the Virginia Board of Dentistry allow this to take place with regards to fee splitting.  Why should the majority of dentists adhere to this Code of Ethics when a few receive a relative slap on the wrist for unethical behavior? This creates a divide within the dental community, when at this point in our profession we need to be doing everything we can to unite it.  Please pass the appropriate regulations eliminating these questions by making fee splitting illegal in the Commonwealth of Virginia.  This regulation should be written in terms which provide detailed examples as to what is determined to be illegal.  

I agree with the proposal and ask the Board to recognize fee splitting an a unethical practice. Please help to maintain our profession in the highest regard by our members. Thank you for the consideration.

A dental patient is in the position that they must place their full faith in the judgment and ethical principles of their dentist. Anything, such as fee spliting, which may compromise this faith and trust that the patient must have in their dentist is clearly not in the best interest of the dental patient.

I understand the issue with the problem of fee splitting.  I don't know anyone who is doing it, but if it is occurring, I'm certainly against it.

The problem I have with Proposition # 3 is that "gifting" has been lumped into this proposition and Proposition # 3 does not differentiate the two.

If this proposition becomes a Board regulation or law, then any "gifting" becomes illegal.  At the current time, "gifting" by dentists in Virginia may be at most unethical. I personally give Christmas gifts to my referring doctors during the Holiday.  Under the proposed Proposition # 3, this would be against the law and would be board violation.  I also give out movie passes and thank you notes to patients and parents for referring patients in the office.   In addition, I give out gift cards when these patients actually initiate treatment.  All of the above would become illegal acts if this Proposition was adopted by the board as regulations.  

When proposing a law or change in the regulations, one must considering all aspects and repercussions of the regulation.  Thus, I am opposed to this proposition and would request that the above acts remain as ethical questions not laws or regulations.

I think fee splitting is very tricky, and each office should have the right to inform patients about their payment policy.

It is time for the BOD to take the proper position on ethical practice of dentistry and to prohibit fee splitting and any other schemes that place financial incentives above quality patient care.  The ADA Code of Ethics should be the model to guide the regulations that govern advertising and a dentist's self promotion.