Dentistry Uncensored with Howard Farran
Dentistry Uncensored with Howard Farran
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1164 Bracken Killpack MBA, Dennis Bradshaw DDS & Todd Irwin DMD discuss WSDA lawsuit with Delta Dental of Washington : Dentistry Uncensored with Howard Farran


3/29/2019 7:05:43 PM   |   Comments: 0   |   Views: 330

VIDEO - DUwHF #1163 - WSDA Lawsuit

AUDIO - DUwHF #1163 - WSDA Lawsuit

Mr. Bracken Killpack has been the Executive Director of WSDA since January 2015. Prior to that, he ran WSDA’s Government Affairs program.  Bracken has an MBA from the University of Washington’s Foster School of Business and a BA in Politics from Willamette University in Salem, Oregon.  Bracken and his wife, Kate, were volunteers with the United States Peace Corps in Panama from 2009-11.

Dennis received his dental training at Loma Linda University, graduating in 1986. He returned to Tri-Cities and joined his father Robert in their Pasco dental office where they worked together till early 2010. Dennis and his wife Traci have two grown children and love being together with family for holidays. Dr. Bradshaw enjoys keeping up to date with the ever changing and advancing field of dentistry. This commitment puts him in advanced classes many days each year, which helps him provide his patients what really works and is worthy of incorporating into his dental practice. Dennis also enjoys being involved in organized dentistry and has served the Washington State Dental Association on numerous different committees. He is also a member of the International Seattle Study Clubs local chapter.

Dr. Irwin is a Pacific NW native. After attending college at University of Utah for undergraduate studies and University of Louisville Dental School in Kentucky, he returned to Washington State to be closer to family and friends. Dr. Irwin is passionate about dentistry and is known to use vacation time to further in dental education by either taking courses or reading dental material. Dr. Irwin and his wife have five children. When he isn't working he enjoys playing golf, basketball, cycling, spending time with his family and friends and traveling.

Howard: It is just a huge honor for me today to be podcast interviewing Dr. Todd R Irwin DMD, Dr. Bracken Killpack and Dr. Dennis Bradshaw. This whole podcast is about what everybody's talking about the Washington State Dental Association lawsuit with Delta Dental. Let me just introduce everybody the most handsome guy you're saying is the other bald guy Dr. Todd R Irwin DMD of Irwin Dental Center who's the president-elect of the Washington State Dental. He's a Pacific northwestern native after attending college at University Utah for undergraduate studies and University of Louisville dental school in Kentucky he returned to Washington State to be closer to family and friends. He is passionate about dentistry it is known to use vacation time to further in dental education by either taking courses or reading dental material. Dr. Irwin and his wife have five children when he isn't working he enjoys playing golf basketball cycling spending time with family and friends and traveling. Bracken Killpack, wave Bracken so they can they can see you has been the executive director of the Washington State Dental Association since January 2015 prior to that he ran double USDA's government affairs program. Bracken has an MBA from the University of Washington's foster School of Business and a BA in politics from Willamette University in Salem Oregon. Bracken and his wife Kate were volunteers with the United States Peace Corps in Panama from 2009 to 2011 and then last but not least is Dr. Dennis L Bradshaw of Dennis Bradshaw Dentistry he is the president-elect of the Washington Dental Association. He received his dental training at Loma Linda University graduating in 86. He returned to tri-cities and joined his father Robert in their Pasco dental office where they worked together until early 2010. Dennis and his wife Tracey have two grown children and love being together with family for holidays. Dr. Bradshaw enjoys keeping up-to-date with ever-changing advancing field of Dentistry this commitment puts in advanced classes many days a year helping his patients enjoy his dental office. Gentlemen what was going on in your life where you decided to launch a lawsuit against Delta Dental? Did you make a wrong turn at an intersection?

Dennis: No we made the right turn at an intersection Howard. The lawsuit was just the latest attempt to try and bring Delta Dental back to focusing on patient care and prove its accountability to the member dentist here in Washington. Delta's policies continue to interfere with the doctor-patient relationship time and time again and the company keeps interjecting what they want for the patient as opposed to what the patient needs and what the patient and their dentists have found out as they work together one on one and that's just not right. We tried to work through Delta's original established channels their bylaws so that we could work to move the actions back more towards patient centered but even with the overwhelming support from the member dentists their board of directors vetoed all of the changes essentially that had any significance that we've made so far. They've also not held their annual meeting which not only is required by the bylaws of Delta Dental but it's also required by the state law of Washington, so just cutting down another avenue for member dentists to give input to Delta Dental. So we believe that Delta's actions are illegal and that this lawsuit is essentially just an effort to force Delta to follow the rules, their own rules so the members can bring things back to Center.

Howard: So can you summarize in general what the lawsuit is about?

Todd: You bet so and thanks again for having us Howard and I do want to make one little correction and I'm very happy to make this correction actually Denny is the president-elect and I am coming so...

Howard: I was trying to pad you resume.

Todd: I appreciate that, thank you.

Bracken: Maybe in a few years how's that?

Todd: Yeah well we'll see we'll see you know I've got a lawsuit on my hands to deal with first. Now so why we filed this lawsuit basically was that we were we were out of options to be honest. I think that you know as Denny said we tried everything we could to work with Delta and once we weren't able to work with Delta then we tried to use the things that were in place in the bylaws because this was a company started by the dentists of Washington back in the 50s so there were things in the bylaws that allowed us some governance of the Association excuse me the company. So once we once we really exhausted all those we and the whole time Delta acted like you know they didn't know what we were talking about and finally we just you know it at after calling two special meetings and having over ninety percent of the members vote that were they're voting voted for these amendments that were were aimed at transparency and they were aimed at accountability we finally said okay I guess the only option we have is to find ourselves in court unfortunately and it feels a little bit like that saying I don't know if you've ever heard this it's something my wife says and she probably is talking about me when she said that but you know you can't wake up someone who is only pretending to be asleep and so when we're trying to when we're trying to deal with Delta if it felt like they were pretending there wasn't a problem and finally it was to a point where we had to do this we had to just decide to find herself in court.

Howard: One of the things that's confusing to me and I assume it's confusing to many dentists is that Delta is a nonprofit but I mean you just google Delta executive pay the first thing it comes up is that 8 Delta Dental CEOs make over a million dollars a year in compensation. So how do you have a non-profit million dollar compensations I mean how does I mean just sounds confusing to a young dentist coming out of school but the guy running the nonprofit makes a million dollars a year while they're telling you...

Dennis: Multi-millions not a million

Bracken: Yeah and actually I'll give you some data on that Howard this is Bracken we do have annual reports that Delta Dental of Washington also they used to be known as Washington dental service so we might switch back and forth between those two names yeah they have to do and reports every year and they have to disclose compensation of their board members and their CEO and other top employees and in 2013 Delta dental's CEO was compensated one point two six million dollars fast-forward to 2017 which is the year we have the most recent data available for it was 2.6 million dollars. So you can see that there's been a significant increase in the compensation that the Delta employees that the top have had over that course of time and the other top employees have a similar trajectory that I just laid out that that was in place for the CEO. You're right that Delta is technically a nonprofit organization and how the nonprofit laws work in our country is that in return for not or being exempted from paying certain taxes the organization is supposed to provide a social benefit and I think that there's you know there's concerns that many have raised over the years about what exactly is the social benefit that this organization is providing and you know the compensation is concerning I would say that the trend lines that we're seeing over the last several years it is particularly concerning.

Howard: Well you know a lot of people ask me if I'm like anti DSO or anti PPO or anti Delta I always tell them I mean I had four children and they've made me five grandchildren I just tell my grandchildren and for me I think a dental office I think the decisions in a dental office should be made by a dentist. Do you think the decisions in a non-profit dental insurance company should be made by dentists? I mean aren't some of the greatest companies like Henry Ford was an engineer hewlett-packard Dave they were both electrical engineers I mean do you think these things should be guided by a dentist or as opposed to an MBA not knocking your MBA I have one to Bracken congratulations on getting your MBA but it does I don't want my grandchildren I don't want to pass on and have my grandchildren be taken care of at a dental office that's not owned or guided by a dentist.

Dennis: We feel really strongly in Washington that that's the way it should be, our laws in Washington say that no one can own a dental office unless you have a dental degree and we have fought that tooth and nail in the legislature to keep it that way. Should Delta Dental be run by a dentist there's no there are several words I'd like to use right now that our attorney said I couldn't use on this call today.

Howard: Well did you tell them it's dentistry uncensored you can say anything you want.

Bracken: Well I think I think the thing that we're concerned about is as as I believe Todd brought up earlier washing and dental service was founded in the 50s as a partnership with dentists and dental benefits carrier to improve oral health for to the citizens of Washington and over the course of time over many decades the dentist's voice in that company has been diminished has been minimized and has been replaced by channels that are completely controlled by the Washington dental service Board of Directors and its key management. So in the past where you would have had elections to the board of directors for the dentist members you know selected by the dentist which is what we're one of the things we're trying to do with this lawsuit instead they're handpicked by the nomination and Governance Committee that is completely controlled by the board of directors of WDS and so I think that the key to what we're trying to do here is we're trying to bring the role that the member dentists of Washington Dental service delta Dental of Washington have they can be put back into the forefront of the discussion, we're working to change the culture at the top of the organization by holding them more accountable to their member dentists and so you know I ultimately from a governance perspective in my mind the board of directors is ultimately charged with selecting who the CEO is they need to look at the situation on the ground they need to look at their strategies and what they're going for and they need to they need to find an executive that matches that and so I think that it certainly could be a dentist it's ultimately a decision for the board of directors and we think that the WDS member dentist should have a say and who those those member Dennis are that serve on the board of directors.

Todd: Howard I was just gonna say that the makeup is currently six independent directors that have a majority obviously in four dental directors and so one of our bylaws amendments that we had were to you know we want to be able to say who those four are right now they just select four people and it doesn't seem that those people that they've selected from the dental community have the patient's best interests in mind otherwise there would be some there would be some answering for the way that the company the direction it's gone I think that does that...

Howard: Well it seems like when I was when I got out of dental kindergarten in 87 it seems like the board that the main dentists at the Arizona State Dental Association were also the Maine dentists on Delta Dental of Arizona and now three decades later that seems to have drifted apart do you agree with that?

Todd: Yes so there was a different there was a trustee kind of position that we used to have that was kind of elected out of our tripartite I mean I what they weren't actually related but it seemed like if you were involved in one you also kind of gravitated towards being in on the Delta trustee board and at some point fifteen years ago maybe a little bit more we saw some kind of switch in their governance and I think most of us just we were complacent to be honest I mean we were just doing our work we take care of our patients that's what we're programmed to do and so as that change happens someone must have gotten wind that there was some money to be made if they just ran it like a corporation and what we saw was the goalposts continually moving towards a much more profit centered less patient driven organization so yeah that's the way it used to be.

Howard: and you know I guess so I guess so frustrating when dentists on dentaltown are saying that they're not gonna be a member of the ADA because of some thing it's like it's like do the ADA are your parents that they they are fighting at federal and state legislations all day long to save your profession and when you say you don't like them because I did something like that well you could say the same about your parents you might not agree with everything your mom and dad told you but it's your only mom and dad I mean you know and the reason I bet a dupe a member my entire career and in dental school is because these dentists that are sitting there doing dentistry all day trying to take care of their patients they don't realize all the wars going on between all the different insurance and like you said just just a something simple like you have to be a dentist own a dental office I mean that should just be a no-brainer but that's not a no-brainer now that's a fight going on in all 50 states. I sometimes I wonder Delta dental should even be a non-profit they say ultimately lawsuits are usually about money my dad used to always say money's answer what's the question and remember in Watergate they kept saying just follow the money follow the money is this lawsuit ultimately about money?

Todd: You know it's not we're acting asking for injunctive relief we're asking for a court to acknowledge and enforce Delta to actually just play by the rules that were already established and can stop moving the goal posts for us so we can we can actually have that set of rules that should mean something these bylaws and if we can just get them to follow the bylaws then we can we can work within those rules I mean I grew up in this country thinking that if you don't like the system work within the system and change it that's how we were all raised that's our civic responsibility but when the powers that be actually ignore your proper attempt to change the things you don't like about it then there's a big problem there that's why we're asking for free and open elections of our dental directors I mean it's pretty it's pretty much an American value that we're asking for at this point.

Howard: You know I was telling my boys you know when they complain about something I always say you know anybody can blow up a bridge but it takes a hell of a person to design and build a bridge. So that person over there designed and built a bridge if you don't like it well go design and build a better bridge I just don't sit there and throw rocks and snowballs at some bridge that you didn't even build. So what would proposes have you what changes have you proposed to Delta where they were rejected?

Bracken: Yeah sure so I think the other thing I just point out is we've attempted to work within the confines of the governance documents for for two years now and we did two different rounds of bylaws amendments with the special with calling special meetings of the members of WDS and these bylaws amendments all got over 90% of the vote of those that participated a couple of things that we that we work to get done that were approved but were vetoed by the WDS board independent directors one was for a loss ratio which is something that's often discussed in dental benefits these days for many years WDS claimed in communications to a member its members that 94% of premium Avenue went towards patient care. So in one of the vetoed bylaws amendments we we recommended that they implement a 94% loss ratio so that they put their money where their mouth is and that if the premium revenue less the 94% of it was spent on patient care then the policyholders would be refunded that amount so that it would go up to 94%. This is something that's done in medical now that only a certain there's a cap on what can be spent on an administrative expense and we think that there should be something similar WDS especially since that they've claimed for many years that they operated it you know 6% operating expense essentially because they had 94 % of their of their premium revenue going to patient care that was vetoed. Another one that was was vetoed was was they wanted to limit transparency and how provider input is taken and considered by the leadership of the organization, for many years they had a member advisory panel and they do in to some extent now although they did remove it from their bylaws without telling the member dentist to fill out a nondisclosure agreement so in many cases we don't exactly know what what's being discussed by the with those member advisory panels. One of the bylaws amendments we put forward was that the member advisory panel could provide recommendations to the WDS board of directors about claims and other and other issues and that those recommendations would be required to have a up or down vote by the board of directors and that that vote would be public to the membership of WDS that was vetoed. Another one that's an important patient protection is what's called an independent review board once again this is something that's done in medical benefits but Delta has been successful in exempting dental benefits carriers and then themselves and concluded from having to follow these laws in Washington that medical has to follow. What all an independent review board is is the neutral third-party arbitrator that you can go to if you've gone through the claims appeal process so either a provider a patient or both if Delta you know says no we're not gonna pay this if there was an independent review board there would be a neutral third party and in our state it's our insurance regulator its Insurance Commissioner's Office that would serve as a mediator to resolve the issue and so it prevents the carrier from being the judge and the jury entirely on on claims decisions, another common sense patient protection that exists in Washington but doesn't exist for dental benefits. We already sort of talked about the board compensation we did have an amendment to put put a reduction in that, board compensation overall is increased 125% from 2013 to 2017 meaning the total expenditure for board compensation outside of the CEO was five points five hundred sixty thousand dollars in 2013 and that jumped to one point to three million five years later 2017 for the most recent data we have available.

Todd: Let me just kind of give you an example of what that is that is, a board member who has a career and has maybe eight or ten meetings a year at you know in 2013 was making $40,000 a year for that time at 8 or 10 meetings you know day-long meetings. As of last year the chair of the board again eight or ten meetings made a hundred and sixty seven thousand dollars for their time on the board that's more than many of our dentists make in a whole year and so that to me is excessive. Sorry interrupt Bracken.

Bracken: No no and I was just gonna say the last thing is even in some cases where we we were able to get some bylaws amendments passed without a veto even there they aren't following the bylaws one of them required WDS in their annual report that they share to provide detailed financials of all of their affiliated entities and that was adopted it's in their bylaws now but their annual report that they they gave they're not providing the detail for many of those entities. Actually Delta Dental of Washington has a cincher capital company called spring rock ventures anyone can go online and look at their website it's completely owned as far as we can tell by Delta Dental of Washington in their most recent annual report they said that they spent 1.2 million dollars operating that venture capital fund so those those are you know from the dollars that they collect from premium revenue every year and they didn't provide any financial detail there they just said that they spent one point two million dollars. So they're required to provide detailed financials and and there and in other instances they haven't so it's an ongoing effort an issue where we dentists and raise concerns provide solutions for addressing those concerns and they're either outright vetoed or not necessarily fully implemented.

Howard: One thing I would ask about is um some dentists on dentaltown might like when I posted this lawsuit on there by the way you know so many dentists are there on dentaltown they're all encouraging to do this all day but some people say ask some good questions one says um but what's the difference between the ADA, Delta Dental if the current executive director at the ADA formerly served as president CEO dental services of Massachusetts, Delta Dental of Massachusetts the previous executor James Branson went on to serve as united concordia's Chief dental officer. How am I mean it's like little insurance organized dentistry how do you juggle that the conflicts of being for the provider verses that people selling that dental insurance? I mean you know it's a revolving door you see that in Washington DC's where people who serve in the Pentagon then they go into other offices and they go back to the Pentagon how do you how do you see the relationship between the ADA and these big dental insurance companies or at the state level the Washington Dental Association with your local Delta Dental of Washington? Does that question make any sense?

Bracken: Yeah I'll jump in here on that one so I'll just assure you that it at least did the Washington level there there's not a door here we we are pretty squarely focused on on minimizing third party interference and the doctor-patient relationship at the wsd a level and and one very clear manifestation of that is this lawsuit that wsd a and and Ben Todd and Denny and another dentist of ours who have filed against Washington Washington dental service. You know with regards to the to the that larger macro issue that you've identified I would just go back to what I said earlier the board of directors of the ADA has a fiduciary responsibility to find an executive that they feel is best positioned to succeed and take the organization forward and while I don't want to speak exactly to the details with the current executive situation you know I will say that our relationship and communication with the ADA on dental benefits advocacy issues has generally been positive they've been a partner with us on identifying solutions that state dental associations and other groups can partner on to move the agenda forward on improving improving laws and regulations and to improve the minimize the interference of third party carriers in the doctor-patient relationship. So I guess what I would say is is that in any organization it's not entirely driven by the chief executive it's it's it's driven by many factors and at the ADA level it's the Board of Trustees it's the House of Delegates and all of its committees and other involvement and there is a lot that is going forward to improve the doctor-patient relationship and to work on dental benefits advocacy and you know in a few conversations that I've had with the current CEO of ADA to Dr. O'Laughlin I you know I think she's generally supportive of the ongoing on because the efforts around that. So I don't know if that addresses your question but really I think it's ultimately up to the boards to decide the right CEO and there might be situations where having someone that has had dental benefits experience from the inside and understand that could be an asset a benefit to the organization.

Howard: So I love her and she's been on this show I think she's a fine person but I want to clear some things that I hear the young kids that are dentist that are still in dental school they just been open for year two they think Delta Dental is like McDonald's where it's just one company but Delta Dental is really a lot of different companies. Like Delta Dental of California owns Delta Dental of California, Texas, New York, Maryland, Washington DC, Delaware, Louisiana, Mississippi, Montana, Pennsylvania, Florida, Georgia, they're like the 400-pound gorilla. Is your Delta Dental of Washington just for the state of Washington?

Bracken: Yes yes they are but they have some large contracts that have influence across the country the two largest they have or Boeing and Amazon and so you can see that they'll have footprint larger than just our state. I think a good analogy that maybe would be helpful for for how Delta works is a lot of ways it's sort of like the NFL where you can have the NFL franchise and logo almost be like the national Delta charter and then different organizations sort of get territories and rights to different states and so Delta of California they mentioned has more than just California they have the rights in multiple states for Washington they just have Washington I know our partner our the in the south in Oregon Mota health which used to be or is still Delta Dental of Oregon they also have the Delta Dental of Alaska right. So it just does vary and our lawsuit is focused specifically on Delta Dental of Washington and it you know the governance rights have to stem from the fact that several decades ago Washington Dental service was created by dentists in Washington and affiliation with the Washington State Dental Association.

Howard: Yeah history is no doubt um so what kind of how many dentists are in the state of Washington and of those how many members are the Washington State Dental Association or the Washington Dental Association?

Bracken: Our market share of Denis's of just about 70% of the state we have 4,400 dentists members so I'll let you do the math there. There isn't necessarily a hard-and-fast number of dentists in Washington we know how many dental licenses there are but not everyone practices in the state even if they have a Washington license.

Howard: How many how many dental licenses are there?

Bracken: It's somewhere between sixty five hundred and seven thousand.

Howard: Sixty five hundred and some that if I tell you the story you're not even gonna believe it I was doing a partial adjustment on a 92 year old man turns out he's a licensed dentist in Arizona. There are dentists retired here from all over and a lot of them they just it's an emotional thing it's it's just hard to not renew your license someday and then there's dentists hanging on to them until they're 92 years old and wearing partials. Well what kind of support are you having from your dental members your 4400 dental members are they cheering you on or is it a controversy what's your members think about all this?

Dennis: The members are definitely behind this movement we've had an uptick in membership and in support since we started down this road two years ago. The overall consensus of our governing board the House of Delegates gave us a green light to move forward and to pursue this thing to the very end and we've had great support. The first special meeting we had would we have 2600 dentists that showed up only on a weekday took off of work to be there to cast their vote for the amendment changes and then the second special meeting we had we had over a thousand members and proxies there both times we had over 90% support for the amendments that we submitted. So we've had a very very strong support from our membership and definitely encouraging us to move forward.

Howard: Wow that might have been the was that the biggest meeting you guys ever had, WSDA 2,000 dentists?

Todd: Biggest one I've been involved in.

Howard: Are you sure that wasn't a Nirvana concert? [Laughter]

Todd: Well I remembered this meeting so I don't think I remembered the Nirvana concert I went to. Anyway so I wanted to circle back a little bit to something that you said that I thought was very interesting and appropriate with the in relationship to the ADA being like mom and dad I mean there's like Denny said we've had an uptick in membership since we took on this battle and I'll give you a little example I have a neighbor who for years just a dental neighbor the dentist next door just wouldn't join the ADA and the Washington State Dental Association and then as soon as we started doing this and I think he didn't join because he said he didn't find any value in it and as soon as we started this fight he was a member it like that and I feel like that's the reception we get with this. It's definitely got a lot of energy it certainly is an emotional thing for people I mean if you work hard you know Howard if you work hard for those patients you you scratch and we do everything you can to get these people in your practice and then you take care of them like they're your family and then to have a dental benefit company come in and try and say no these are our patients and you're gonna you're going to do what we tell you to do with them it's very it's very emotional obviously and just so for those 10,000 or never meet people are driving to work right now that are listening to what we're saying and they're wondering if they should be a member of the ADA or not or their or their state association I will say that there is nobody else that loves you more and is looking out for you like your mom and dad then the ADA because if that's it's our only chance to organize and if you don't take advantage of it you know with seventy percent of our state and we're doing pretty good compared to most medical organizations but how would how would look if we had 85 percent and we can't get that done without those young kids that are coming out joining and helping us with this fight.

Howard: Yeah I always tell those young kids I'll say did your mom or dad cry at your graduation middle school I mean I know my mom was bawling they'd say yeah I said well you know who made him cry organized dentistry you lose organized dentistry you're gonna be some commodity molar mechanic. You know the people that are keeping it by the way how many people went to that WSDA meeting you said?

Bracken: We don't know we don't know the exact number of it is because the vote we know how many votes were cast we don't know how many of those were in the room because of proxies?

Howard: How many votes were cast?

Bracken: Twenty twenty six hundred I think.

Howard: Twenty six hundred, you should make a meme top four concerts in Seattle Washington number one Nirvana, two Pearl Jam, three heart and for the WSDA meeting.

Bracken: I bet we're high up there I figure out what attendees in particular we'd be way up there on the concert list.

Howard: Yeah Washington is known for so many things I mean Boeing, Amazon, Starbucks, rock-and-roll I mean it's it's an amazing place do you think they do you guys kind of feel extra pressure that everybody's watching you and whatever goes down right now with what you guys are doing could be a domino effect for Delta's from coast to coast?

Dennis: We certainly hope that other states can find a way to chip away at their Deltas, because when Delta exerts the type of influence that they do on the membership I mean we've had dentists that have complained to us that their patients have received letters from Delta telling them that they should look for another dentist who has a better working relationship with Delta Dental that's wrong that shouldn't happen and that shouldn't happen in Washington State it shouldn't happen in Arizona or any other state, that is just the type of thing that gives us the courage to go out and and file this lawsuit the follow through with it to the end.

Howard: and I mean when you said earlier Todd that you know the people who love you is organized dentistry I mean look at your suppliers you buy all your supplies from some big dental supplier and what do they do they give it the same supply is twenty thirty percent cheaper to the big DSO's it's like God I thought you're my friend you actually turn and then dental insurance companies a lot of these DSOs are spreading because when they buy your office they negotiate a higher fee schedule with the DSOs and they call that their uplift. So it's like so I'm sitting here one-on-one and my supply guy is giving all the DSOs discount that I'm providing for a DSO insurer I mean a PPO insurance like Delta and then if I'm bought by somebody who owns a hundred offices they're gonna call him up and negotiate a higher reimbursement who's fighting for the who's fighting for the individual the little guy that the private practice guy who just has one dentist in there.

Todd: Yeah I think that I think you're right organized dentistry is the only it's the last bastion of hope so to speak for the small business owner in dentistry. You know I think but that's okay I mean like we had talked about following the rules I mean we know what corporations are about we know that they are there to generate profit but really what it comes down to is who is going to advocate for the patient and we understand I think as dentists that were the only ones that are going to do that corporations are going to try and figure out how to get in people's pockets that's just that's how they're wired that's what they do and so when it comes down to who's going to take care of the patients is it going to be Delta Dental is it going to be Schine, Patterson or whatever I mean you know it's it is that relationship and that that is really the basis for why we're all here right now and why we're passionate about this none of us volunteer dentists that put our name on this lawsuit we're volunteers, we are a volunteer board that are putting our targets on our back and and taking one for the team so and that's because we love our patients that's really that's what it boils down to.

Howard: but in all honesty was that a little did you have kind of a pit in your stomach when you did this I mean you know when you when you shoot a big boy like that where you're a little scared to that mess up some of your sleep?

Dennis: Stomach lining sleep yeah few more gray hairs up here all those things it over here it doesn't feel super comfortable.

Howard: Yeah I mean that's know I mean people don't realize that you know you climb up a telephone pole that's who they throw all the arrows at I mean you guys cleaned up a really tall telephone pole and you went after I mean it's kinda like David and Goliath and I think you're the one with the slingshot.

Todd: Yeah you know the here's the deal though is uh and that's why you see and we have one other dentist whose name is on there and he's a little bit younger than we are but you know we're on the back nine so to speak of our careers I wouldn't expect someone at the beginning of their career to want to take on this fight but that's why this organization is valuable you've got a lot of experience and you've got someone like Denny and I have been doing this for a long time and you know what it what's the worst case scenario they're already taking most of the profits out of this and so it's like they can't hurt us that way and we don't even that's not why we're doing it anyway. So someone's got to take you know jump on the grenade so to speak and so that's I think that's what we're we're doing.

Howard: Do you Delta Dental of California just let their CEO go does that have anything to do with again if you're a young kid and you're working on you graduating dental school you're working at dental loves you here Delta Dental there's so many different Delta dentals but Delta Dental california CEO is the biggest one and they just fired their CEO are you seeing the new CEO maybe having a different vision for the future or is it same same ol same ol?

Bracken: I think for the California case we don't know if I'll just say in Washington there has been a turnover for our CEO as well the long-term CEO of Washington Delta Dental of Washington Jim Mcguire retired and as a new person take over who actually previous to working for Delta Dental was an executive at Amazon.

Howard: Your talking about Mark Mitchke?

Bracken: Yeah and so and so I think the general consensus that we're hearing from people is that he is talking a talk that is more engaging and more collaborative with dentists but I think we're all still waiting to see what actions will results of this it was not lost on us that his name was on the letter that went out to all WDS members in addition to the board the vetoed the latest round of by law is amendment. So that is a pretty a pretty clear action that he's taken that perhaps I would say is contrary to the words that he said so far in his early tenure CEO of Delta Dental of Washington.

Howard: So we're where we are at now and what's the process moving forward and what do you need your dentist in the state of Washington to do?

Bracken: So well great question we filed this lawsuit last month and it's in the early stages there's going to be multiple rounds of discussion and we are preparing for this to go to court and that's really about it this is not something that will be over the next week or next month it is a longer process and there will likely be periods of time where there aren't too many updates just because you know there's action going on that you know sort of takes place in the standard course of action of litigation. So we will provide updates as they're available I think a place that your listeners and Watchers could go if they want to we do have a page on the wsd a website that's and we will be putting up information regarding this lawsuit and other activities as it becomes available.

Howard: Delta Dental

Bracken: Oh no go to WSDA

Howard: Oh that's that's ok I'm sorry

Bracken: Yep


Bracken: Yep

Howard: It took me to Delta Airlines flight center and make a reservation to Hawaii.

Dennis: That's a good idea.


Howard: Ookay and Dennis you're the president-elect of the Washington State Dental Association?

Dennis: Yes I am

Howard: so I'll just gonna post right now that Dennis can I post Dennis L Bradshaw DDS president like Delta Dental president like no Washington Washington Dental Association or Washington State Dental Association?

Dennis: Washington State Dental Association

Howard: Ok says go to membership Delta and do what?

Bracken: That's where you can get updates on what's going on.

Howard: To get updates ok very good because there's a big thread on dentaltown but by the way everyone's just cheering you on and on dentaltown they really think this is just the the big long overdue fight and like say if you're as old as I am 31 years I mean gosh Delta is a completely different beast than it was 31 years ago. I mean I could even televise going to a Delta Dental meeting or a Arizona State Dental Association. I mean it was the same all you're all back then you know when I got asked oh I was 25 all the 60 year olds that were running the show were on both sides of the aisle there and now it's it's a gone apart significantly and also I want to say something else I'm not back to due's is it just it it really hacks me off and I'm paying for the other dentist sitting across the table from me you know watching a sun's game that he doesn't want to be a common member cuz he they always find something they don't like I'm like yeah you have 1500 reasons why you can find one thing wrong with them so you don't pay but I want to ask you Dennis Bradshaw is that president elect of the Washington State Dental Association how many volunteer hours have you spent in your career I mean were you paid $175 an hour for all these Washington StateDental Association meetings and conventions and I mean talk about your journey they don't realize that they're dues would probably be 5,000 a year if you guys are all getting paid an honest wage for all the time you spent volunteering.

Dennis: It's a lot of hours Howard. My wife would probably be a better one to ask how many hours it has been but you know I will countless thousands I've been on the board for six years I've been an officer for a year now before that I served nine years ten years planning our big state dental meeting our continuing education meetings it's been going on a long time but the reason why is kind of like what Todd said before I was raised in a family that said you give back you get involved and that's how you make a difference in your world and since you know I get a lot out of it I get a lot out of it.

Howard: Well that I mean that's amazing but there's just so much volunteerism going on I'm telling you kids that you after work you want to drive home and pick up your daughter from daycare and go do something fun with her there's other dentists who after a long day at work they're driving downtown to the Washington State Dental Association and having meetings and some of these meetings on drag on forever because it's when you get five dentists in the room, it's hard to get them to agree that today's Monday. I mean if you want everybody to agree with you you need to go be a captain in the army where all your players are 18 to 25 years old but when everybody's sitting around the table as eight years of college it's it takes a lot of time to get all those people on the same page.

Dennis: Yep it does some days more time than you can imagine.

Howard: Yeah you know and sometimes I've saw some of those meetings and you just want to stand up says who cares who cares just make a damn decision and let's all go home but they want to argue until three o'clock in the morning and I always tease them I say you know why you argue so much because the stakes are so low it's a statement on gum disease who cares the patient how do you know what gum disease is. So basically so we gave them a place to go we gave an action to go to it's actually last member center/Delta.

Bracken: The Delta one will redirect to that as well.

Howard: Okay okay so you gave them an action.

Todd: Howard I was going to give a quick little shout out, you said when you're talking about all the different opinions at one of these meetings you know the young guys sitting here on the on the call with us Bracken has it's like herding cats quite often I'm sure but he does a great job of keeping us focused and so I just want to give you Bracken just a you know a pat on the back for a lot of this energy and where we are with this really has come from that guy's noggin right there so.

Dennis: Yeah leadership at the top we've got the best executive director in the country.

Bracken: Well it's a definitely a team effort we've got a good organization good team great board we're doing great things.

Howard: Well Bracken my understanding of all my friends who are dentists and physicians and lawyers they don't know anything about business you went and got your MBA. I got my MBA in 98 and I didn't get any of that training in dental school, what was going on in your journey to get your MBA and is this helping you right now in your lawsuit?

Bracken: Well I think it's I mean I definitely didn't take any law classes in Business School but you know I think for me it was a sort of a capstone in education for me I you know in undergrad I mainly took political science classes and other things that I thought was interesting and to kind of have that background in accounting and finance and economics and you know there was several strategy classes I took as well I think was a great way to sort of round it out and you know I think that there are you know I know I know several dentists who have gotten MBAs or you know taken sort of business classes but you know a lot of the fundamentals you can get without getting that those letters behind your name there's a lot of opportunities to do that and some people just have it as a practical background that they just sort of understand how business works and and you know some of the key key financial you know literacy that you need to have to sort of see how making budget work and how to you know sort of create efficiencies to get where you need to go.

Howard: I'm going to make another comment and and there's a question at the end of this believe it or not but I've lectured in 50 countries and one of the neatest things I like to do you can always see the Mormon missionaries because they're hard to miss her on bicycle as a white shirt and a tie and they're bright-eyed young bushy-tailed and I always stop to go to them because I'm lecturing this country and I'm like well what and I was asking the same questions like well what do you think about this country and more importantly like what do you think about its economic development compared to like where you're from in the United States and to see these young minds try to summarize like why is this country so poor, why is it so backward and when I when I got my MBA I started seeing everything so differently and the one thing that scares me is I'm when about socialized medicine is you start hearing all the Millennials talking about how healthcare should be free it should be right and all this stuff but when you go to civilizations that are advanced like Tokyo Paris London and you try to wonder why implants are exploding it's because they're socialized medicine only pays $100 for a molar root canal in Tokyo London and Paris, so all the dentists are saying well my breakeven is about three or four hundred dollars so I can't lose $300 I have to extract the tooth and then do an implant because the implant is covered is not covered by the insurance so I can charge $1500 and I'm sitting there saying I don't know anything about oncology and cardiology and all the other providers and health care and if you think insurance doesn't matter then how would you like to have a molar toothache in Tokyo and you just assume you live in a great society with great cars and Yamaha and Honda yet that doctor is pulling your molar because the insurance only is gonna pay $100 and they have to go out-of-network the point I'm trying to make is the details of dental insurance matter it's like when I got to Arizona a long time ago my first run-in with the Medicaid lady is I went down there with Jack DylanBerg to tell her that every time I worked this Medicare at this clinic I would say well it's for its forty five dollars to pull it and it's 50 dollars to do the filling and the mom and say well it's cheaper to pull it I said we it can't get out of the extraction less than the damn filling because it's cretin father you know so I said you have to make pulling it a dollar more than saving it and they're like and they're looking at me like oh do you think it even matters I'm like yeah it absolutely matters I'm on the front lines of doing this. So man dental insurance medical insurance it really really matters and the devil is in the details and the difference between a very rich country like Denmark Sweden Canada Australia the United States versus 200 countries that are basically third war old I mean there are some exact MBA answers to why either living in poverty and these answers are gonna affect dental insurance and it's gonna come back and bite you so you dentists need to be members of organized dentistry and the devil is in the details and I'm just so proud of you guys for fighting the good fight.

Bracken: Can I just say can I just say one thing to that Howard is I think it's important for people to understand that dental is not really insurance there isn't sort of anticipated loss there isn't catastrophic loss like there is in medical my brother had a had a catastrophic medical accident you know several years ago and you know he had insurance and and was able to get the care that he needed and is back today at you know full strength and there isn't no there is no such thing of that in dental they really don't have to plan for loss in dental like like you do and in medical and part of the reason we know that is because they almost have it down to a formula of how much money they're gonna spend on dental claims based on the premium that they bring in. It's almost like two lines if you were to look at it over time that are just exactly parallel and that tells us that there really isn't risk into this they don't they know how much they're gonna pay on a macro level they sort of rig the system to get that that profit out and it's a prepaid dental benefit so I mean you you hit on some very good points there and you know insurance is is not what dental Delta Dental is it's a prepaid dental benefit that you know you're right to say studies show that and practical experience shows that people are more likely to go to the dentist if they have a benefit and bet that's sort of the conundrum that we're in is that the benefits carriers have have made a way to sort of maximize and get the the profit they want out of it and then they just sort of dial the the issues off when they then they do it so that's the last thing I'd say about the whole thing.

Howard: Well I just wanted to tell you I just am so honored you guys are so busy it's on a Monday y'all had 10,000 other things you'd rather be doing it was just a huge honor for you guys to come on the show. I cannot wait to post this on podcast online especially on the message boards where everybody's discussing it. Again I know you're busy thank you so much for taking an hour out of your life and coming on the show to talk it's a dentist today.

Todd: Thanks for having us. 


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