90: The ADSO DSO Secrets Edition with ADSO's Senior Director and Counsel of Government Affairs Bradley Rightnowar: Why You Need To Care About Bills and Policies

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Hello, everyone, and welcome to another episode of DSO Secrets. I'm your fearless host, Emmett Scott. And today we have a special DSO Secrets edition. I'm calling it the Adso DSO Secrets edition. And we have Bradley Reitnauer, general counsel of Adso here with us today. Bradley, thank you so much for being on the show.

Emmett, thanks for having me excited to be here.

You know, Bradley is one of the ones that's behind the scenes looking at the different bills that are going through states and through the federal government and frankly any county, city, et cetera. And he's combing through these and tell me if this is a good representation, Bradley, of what you do and looking to say, okay, how does this affect one person? And that is the dental industry? Is that pretty much your day to day job is to look for those opportunities?

It's certainly a part of every day that I report to the office. You know, it. Understanding how laws, regulations are moving through processes Both in Washington, D.C. the individual state capitals, and then the larger municipalities across the country are something that's important not only to our members, but to the people our members serve.

Yeah. And then as you recognize, you know, different laws, bills, etcetera, that might be going through the various houses and you say, okay, are these gonna have a positive impact or a negative impact on the dental industry? Then you work with the lobby teams with general counsels of our membership to help organize and say, okay, what's the best path of action to ensure that the dental industry is protected?

I think that's a fair representation. I mean, we are a member driven association. So we want to make sure that we're getting feedback and input from our general counsels and our other strategy leaders within the association. We have lobbyists retained across the country. I work hand in glove with those lobbyists to make sure that Adso's interests and messaging is pushed home in the state capitals and then also into the various departments that have administration responsibilities.

Now, the reason I asked Bradley to be on the show is because I think for many of us as entrepreneurs, we really look at the government process as, you know, kind of this black box where we don't really understand what's going on. And I thought it would be great to start getting more and more educated, not only about what's happening, but how we could influence the process. Tell me if this is a fair representation. But oftentimes we think of government as being kind of all knowing on many topics, et cetera, and that they're making very conscious decisions about the side effects of bills they might pass, et cetera. But I think a better comparison would be that like any human, they kind of see the benefits of something, oftentimes not recognizing maybe what the side effects could be. And so a little bit like my kid who sees the candy across the street but doesn't recognize that they're stepping off of the curb sometimes, some of these bills, some of these laws may be very beneficial for a certain thought process, as long as you exclude all of the negative effects that can happen. And I think a big role that Adso plays and your role, Bradley, with your team, is to make sure that lawmakers understand that there are side effects to certain actions that they're taking. And though they might say, well, this is going to be awesome because it will increase revenue for the state, they don't say, oh wait, this is going to decrease access for patients or this is going to increase the cost of health care for patients. So some of those things just, they need help in connecting. I think sometimes people think of lobbyists as maybe this negative, big corporate item. But every association is going to have lobbyists to help educate lawmakers, and lawmakers really rely on them. Right. In order to understand what's going to be the impact of the decisions that they're making. Is that a fair.

I think that's incredibly fair. I mean, I would say governors, legislators, they want to get it right. I mean, they want to get the right policy in place for reasons. And given the scope and breadth of what we ask our policymakers to take on, there's no way that any individual member of a state legislature or the Congress or even the executive branch officers could understand the high level of intricacies that are involved in the policy decisions

that they make on a day to day basis.

And so your Adso government affairs team is here to make sure that the correct messages are being communicated to those members that we're answering the technical questions as to how changing one Dial here might infect other things, both upstream and downstream. And that all comes from really a robust discussion that we have both internally and externally with the elected officials, their staffs, and any other departments.

So I wanted to use this time on this podcast, and I'd love to keep having you back, because this is an ongoing issue and opportunity that we need to constantly be addressing. We've all felt the difference of having, let's say, executive orders changing the ground underneath us every week. And it's very hard to build a stable business model, a stable patient care model, when that much is changing. So we know in a very real sense what it's like to have a stable government system or one that's constantly evolving in a negative way or changing in a negative way. And so as these different bills come up, you know, we'd love to reveal those to our membership and to our listeners so that they can take action where appropriate or be just very self aware so that as it comes to a theater near you, you know what to be looking for and what actions to take. I think a lot of times, Bradley, too, it's easy to say, well, that's happening over there. That doesn't really impact me. Right. And one of the ones that we wanted to talk about is something that's happening in the state of California. And, you know, especially being in the state of Texas, where I stand right now, it's easy for me to say, well, of course, California, who cares about California? That'll never affect Texas. In fact, Texas will probably do the opposite. But the reality is much different than that. Right? The reality is lawmakers not only use lobbyists, not only use their constituents for feedback, but they use one another. And if bills pass in, in a certain state, they might look at that and say, oh, we should follow the same pattern. And if, if we don't step in and say, hey, guys, this is the danger of that, then we could see something spread across all 50 states that becomes very difficult to uproot.

Absolutely. Absolutely. And you know, part of what the association is here for is to help drive those discussions and to identify kind of those big picture items that can materially impact the business model. And quite frankly, our ability to provide outstanding care to as many people as we can and really meet that access to care issue, that is something that we see in every state, in just about every community. So we want to be there for you.

All right, so let's dive into one that's happening right now that we can use as a case study and that we can get Educated on. And I think there's actually some action and some voice that we can take on this one. And as I mentioned, this is in the state of California. And do you want to just kind of give us a framework of what this bill is about, just in general terms and then we can kind of talk about the trickle down effect that could be very concerning for many of the dentists out there.

Well, Senate Bill 977, Emmett, is an initiative of the California Attorney General. It's presented as a maintaining access to care bill. I think that the attorney General is concerned that within those areas that may not be as strong economically, those communities, those neighborhoods, that they are losing hospitals and that as those hospitals undergo consolidation, that access to care goes down, cost goes up. And so that at first blush that is the underlying intent of this bill.

Yeah, that seems very reasonable and something all of us would raise our hand and say we want to make sure that there's hospitals in underserved areas. Right. So very easy to support that underlying premise.

So but the question then becomes, all right, how does the bill accomplish those, those goals? And this Senate Bill 977 casts an incredibly broad regulatory net. And so that regulatory net clearly picks up hospitals, urgent care centers, prompt cares and other medical physician centric medical buildings. But it also lops in podiatrists. There's a argument that dentists are included. Certainly they're included within the definition of a provider. Ambulatory centers and a whole host of other healthcare providers that may not be that hospital centric, physician centric status.

And kind of it's hard. What is it utilizing in order to do this mission? Because sometimes I can say, hey, here's my mission. And everyone says well that's brilliant. And I say yeah, the way I'm going to accomplish it is X, Y and Z. And everyone looks and says, well hold on, those don't really connect as well as you think. Or like you said, that casts a broad net and rather than kind of being a sniper rifle towards the real issue, it starts having side effects towards a bunch of other things. So what are they trying to specifically pass in this?

So you know, having cast a broad regulatory net, anytime there is a, a transaction that results in a change of ownership, a transaction that may change how the organization is controlled. Anytime there's an acquisition of any type that triggers a review by the attorney general's office, who as a former baseball player, they get a call, balls and strikes as it relates to whether or not this is anti competitive and whether or not those issues the access to care issues, at least within the Attorney General's mind, are met. There's a lot of opposition to the bill, as you can imagine. There's 15 different trade associations that are actively engaged, ranging from public hospitals to private hospitals to the Med Society. California dental associations opposed the abso. We've entered our opposition both in the House committee, and then from a global opposition standpoint, the bill is really seen as overly broad. It encompasses so much of the business that it's going to make it very, very challenging. And I think one of the other arguments that really has a lot of merit is that it undermines the bedrock principles of due process

and an element of capitalism. Right. I mean, you really are getting rid of free trade, which means for a dentist to sell their practice to another dentist or to sell it to a larger group of practices now has to be approved by government. And as you go down that path, you lower the economic value of health care practices. Right. So we could actually see dental practices, their values start to collapse simply because those who are doing transactions say, well, to get a transaction done and your state has to be approved through attorney general, it takes X amount of time. There's high likelihood that it will or will not be approved. And so all that gets factored into the value of those practices. Right. And do I buy in the state of California or do I go somewhere else where that doesn't, and pretty soon the values of those practices. So I think when I heard this, I was thinking about a lot of my friends who have individual practices or have groups of practices in the state of California, and I saw the value of that asset and that hard work just kind of collapsing underneath them. Not because their business model changed, not because they're doing different, not because they're not providing great patient care. In fact, they might be providing even better, but simply because the government decided that they wanted to change the process of transactions.

Yeah, Emmett, those are all wonderful and great points. I really see from the Adso standpoint, as you know, we want access to care.

Right.

I mean, one of the great things about the dental support organization business model is that it allows dentists to get into those communities that traditionally may be underserved, traditionally may not have that neighborhood dentist that we all want to have. And there's a lot of reasons for that. You know, the cost of opening up a practice, the cost of getting to

dental school, the risk of opening in

those, having the expertise to manage all of the components that go into an active and vibrant practice that meets the needs of its patients. And so this Senate Bill 977 is. Is meant to keep hospitals in those communities and neighborhoods. Well, we wanna go there, and our members want to go there. And I think if you look at the studies, you see a couple of great trends as it relates to dental support organizations is that we're getting into those rural areas and those urban areas where dentists are needed, and Senate Bill 977 by mandating that anytime a dentist wants to have a conversation with another dentist about how they get alignment, how they get partnership, how they might increase access to capital. Our fear is that Senate Bill 977 triggers that as being a review, though.

The goal is to not have this consolidation into big towns and limit access in the underserved. What's happening is dentistry is. Is actually the opposite, I think, is to your point. And so we want to make sure that you don't throw the baby out with the bathwater here, which this absolutely could do. It would also really limit, let's say a dentist buys a group of practices and a couple of them are underperforming. They might not even be in small towns. All of that would get limited as well. And so it just makes everything extremely clunky and difficult. At the end of the day, it lowers the value of dental practices in the state of California. So I think this is extremely helpful to understand. It's extremely helpful for dentists to understand and to make sure that anywhere that they can, you know, kind of raise their voice around this as they hear about it, you know, raise their hand and say, listen, dentistry needs to be carved out of this. You know, whatever you need to do with hospitals and their industry, it's different. We'll let them fight their own fights, but when it comes to dentistry, we just need to be carved out of this. So. Great. Anything else on that, Bradley? I think that's really helpful. And again, this is kind of the stuff behind the scenes that Bradley and his team is working on that we want to bring to the forefront, because I think the better educated we are, frankly, the better we can be at helping pass positive bills as well. Now, there's some interesting stuff happening with ppe. Can you kind of talk about that? And some of the moves being made, even at the federal level with.

So to try to frame out this PPE issue. As you can imagine, with the. With the national mandates that have come out, both state and federal, as it relates to PPE usage, when you walk into a dental office, one of the safest places to be in a dental office, you're going to notice. The first thing you're going to notice is a receptionist that's in ppe. And then as you walk back, maybe to get your teeth clean, to get your teeth fixed, you're going to see dentists and other clinical folks in full ppe. So the cost associated with those PPE

is ramped up greatly.

The other side of that coin is as a result of the restrictions in the number of patients that dentists can safely see, you've got an increased cost

in PPE and then a decrease in patient flow. Right. Decrease in patient flow cadence that you would typically have within your dental practice.

And so we have had a lot of insurance groups step up and say, we recognize this is an issue, our providers are important to us, and so they've instituted some programs. Unfortunately, not every insurance group has done that.

Yeah, I mean, some have been absolutely ridiculous and saying things like, oh, this was already built into the fee schedule. Like they had been thinking for the last 20 years that there would be a global pandemic and they've been prepaying us for the ppe. Right. That was about to happen at some future point. I mean, it's just the most ridiculous argument ever. And so, yeah, we really applaud those who have stepped up. And there's been, like you said, Bradley, quite a few that are very logical. And frankly, they've been collecting premiums while people have been stuck at home.

Exactly. Well, they have been collecting premiums during the entire shutdown. I mean, it's. And I think that's why Congressman Pallone, who's the chairman of the House Committee on Commerce and Energy, or excuse me, House Committee on Energy and Commerce, is starting to look at what's going on within this particular space. You know, asking questions, how are you helping providers? And ostensibly, how are you helping patients get the care they need? I mean, all the studies that we are seeing as an organization and I think as an industry, are pointing to the fact that, you know, oral health care is healthcare, and oral health care is critically important to maintaining good overall systemic healthcare.

Healthcare starts with a smile. Right. So everything starts here, works its way down. So it's absolutely critical. I love that Energy and Commerce has launched this investigation into the insurance industry and saying, listen, you all are making record profits and on the other side, unwilling to help cover ppe. That seems a little bit ridiculous. Right. And so this is something that I think we're all behind and want to encourage, kind of, again, just fair trade around. Listen, if you guys are making profits collecting premiums the purpose of insurance? Collect premiums while things are good, to be able to pay out when things are bad. I mean, that's the basic concept of insurance. If you collect when things are good for them and then don't pay out when the need arises, you've really undermined what the whole purpose of insurance is in the first place. Right?

Absolutely.

Absolutely.

Good.

Any other topics that we need to know today? We will keep this cadence going, Bradley, and bringing these up. I really appreciate everything you're doing. I appreciate you coordinating, too. With the recent response that we put out about the whole and what they've said. Obviously, we feel like it's dangerous and ridiculous. And so I really appreciate Dr. Jack Dillenberg joining with us and making those statements. We're going to continue to be very active, and what we really want to do is also be transparent and educate our members and our listeners so that they can be involved and in lockstep with us along the way to ensure that dentistry really takes its place at the top of healthcare and helps to lead this market. So any final words here, Bradley? No.

I think your statement on the World Health Organization and the fact that there's been approximately a million patient visits, 1 million patient visits since COVID 19 started in over five months, and neither the CDC nor the World Health Organization has attributed a singular transmission of COVID 19

within the clinical space.

That's an important fact.

Yeah. Thank you so much. I really appreciate you being on the show today and really look forward to having you back and continuing to keep us apprised of what's happening in the government. I think as we look on the defensive side and make sure we protect the industry and then also look on the offensive side where we can be assertive and continue to grow the industry, you'll be a huge help in that progress. So thank you again for being on the show. For anyone who wants to continue this conversation, come over to our private Facebook page. So Secrets, I encourage you to check out Adso as an organization that's really moving dentistry into the future. Its goal is to be a support organization. We're very much focused on aligning the industry, making sure clinicians have the support that they need, making sure that patients have the access that they need, continuing to push dentistry to the top of healthcare and integrate that in and making sure that we're prepared for the future. We're really looking at what patients want, and they want more and more convenience, and we have to prepare for that. So, again, Bradley, I appreciate you being on the show. Thank you. And until next time, everyone keep smiling.

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