The Morning Drill: July 5, 2011

A collection of dentistry and health related links/comments to start your day.

Medicaid changes on the horizon for Arkansas dentists

A North Little Rock oral surgeon who was paid $100 per hour to be a Medicaid watchdog said he doesn’t remember rejecting a single claim out of the tens of thousands he reviewed over the past decade. And in an interview, he said he won’t deny any claims in the future if he is asked to review them.

As an oral surgeon, Dr. Robert Jolly Jr. relies on referrals from dentists. As an oral-surgery consultant assisting the Arkansas Department of Human Services, Jolly was tasked with evaluating dentists’ claims and either approving them - fully or partially - or denying them.

From July 2008 through April 2011, for example, Jolly was paid $100 an hour to review claims. He collected $17,030 during that period, according to the department.

A department official said Friday that her agency was unaware, before being contacted by the Democrat-Gazette, that Jolly was unwilling to reject claims.

“We didn’t hire him thinking he was going to say ‘yes’ to all of them. That was not our expectation,” said department spokesman Amy Webb.

In part because of complaints of abuse in the Medicaid dentistry program, the Department of Human Services will retool its oversight system for dentistry claims after a longtime consultant criticized the agency and the state dental association.

It will take several months to create a new process and details are still being worked out, Webb said.

SoundBite Dental Hearing Aid Now Also for Conductive Hearing Loss

Sonitus Medical has received FDA clearance for a second indication for its innovative dental hearing aid, the SoundBite. In addition to single-sided hearing loss, for which the company previously received FDA and CE approvals, it is now also approved in the U.S. for treating conductive hearing loss.

This further establishes SoundBite’s position as an alternative to bone anchored surgical implants, while another indication, mixed hearing loss, should also follow soon. In the meantime, the SoundBite system has yet to come to market, with a planned U.S. release sometime early this fall.

New Study Implicates Environmental Factors in Autism

A new study of twins suggests that environmental factors, including conditions in the womb, may be at least as important as genes in causing autism.

The researchers did not say which environmental influences might be at work. But other experts said the new study, released online on Monday, marked an important shift in thinking about the causes of autism, which is now thought to affect at least 1 percent of the population in the developed world.

“This is a very significant study because it confirms that genetic factors are involved in the cause of the disorder,” said Dr. Peter Szatmari, a leading autism researcher who is the head of child psychiatry and behavioral neuroscience at McMaster University in Ontario. “But it shifts the focus to the possibility that environmental factors could also be really important.”

As recently as a few decades ago, psychiatrists thought autism was caused by a lack of maternal warmth. And while that notion has been discarded in favor of genetic explanations, there has been growing acceptance that genes do not tell the whole story, in part because autism rates appear to have increased far faster than our genes can evolve.

“I think we now understand that both genetic and environmental factors have to be taken seriously,” said Dr. Joachim Hallmayer, an associate professor of psychiatry and behavioral sciences at Stanford and the lead author of the new study, which is to be published in the November issue of Archives of General Psychiatry.

Other experts have cited factors like parental age, multiple pregnancies, low birth weight and exposure to medications or maternal infection during pregnancy.

Advice on Tweeting for New Medical Residents

The medical residents starting their training today belong to a generation that doesn’t think twice about broadcasting even intimate details of their lives via texts, Twitter and other social media.

That can get tricky when those doctors’ lives begin to include patients.

To help spark discussions of how residents can negotiate this new ground, the folks at the Mayo Clinic Center for Social Media have put together a video with advice from doctors who are active on Twitter, blogs, Facebook or other forms of social media.

The project “was born from this idea that there are currently no well-defined guidelines about digital behavior” for physicians, says Bryan Vartabedian, a pediatric gastroenterologist at Texas Children’s Hospital in Houston who appears on the video and who blogs at 33 Charts. “Our initial goal is to initiate a dialogue about professionalism by physicians” who have an online presence he tells the Health Blog.

Privacy violations are one big pitfall. While it’s desirable for physicians to discuss patient cases, when they do so on Twitter or Facebook they have to “recognize that they are having a conversation in a hallway, not in a conference room with the door closed,” says Victor Montori, a Mayo endocrinologist and medical director of the clinic’s social media center.

Even discussing patient cases without using names or identifying details is troublesome, says Vartabedian, because patients may see a post or Tweet and recognize themselves, particularly if it’s a rare or embarrassing condition. (He recently blogged about just such a case.) Not only might those details violate patient confidentiality, they erode trust and professionalism, he says.

Enjoy your morning drill!