Editorial: It's Time for a Reset at DQAC

While much attention is appropriately paid to legislative activities in Olympia, rulemaking that occurs just a few minutes down the road in Tumwater has the same or greater ability to impact the way dentists care for our patients and run our practices. 

As former commissioners, we fully understand the important responsibility of serving on the Dental Quality Assurance Commission (DQAC). Protecting the public’s health and safety is our primary duty, and the commitment to serve on the commission is a significant one. When serving as commissioners, we remained practicing dentists, who, like you, sought to provide the best quality care to our patients while also trying to run a successful practice. For some who currently serve on DQAC, this dynamic prompts them to be mindful of the balance that must be struck between ensuring practices are safe and remain viable businesses.

Unfortunately, some current commissioners are not as mindful of this balance, and have displayed behaviors that suggest decisions based on logic and practicality have become secondary to those based on emotion. Decision-making based on emotion can greatly complicate the dental rulemaking process, especially when coupled with a lack of strong scientific evidence or a consideration of implementation feasibility or associated costs. 

At first blush, any regulation by itself sounds good. Why shouldn’t we wholeheartedly support better care and improved quality? 

The problem is, we are already drowning in regulations. Arguably, the busiest commission in terms of rulemaking these days, DQAC is currently considering modifications to several dental rules that will significantly impact how you practice and your ability to remain a successful practice. For example, in order to comply with the many requirements of the proposed infection control rule, dentists could be looking at a hefty price tag. Add that to the anticipated costs of DQAC’s proposed on-site inspections for dentists with moderate sedation with parenteral agents or general anesthesia permits. On-site inspections by an approved organization could cost upwards of $20,000. 
And if that doesn’t seem daunting enough, DQAC is also tossing around the idea of requiring general dentists to “recertify” every 10 years by undergoing an extensive “competency” assessment. We are unaware of any other state in the nation requiring this.

Where does it stop? 

Regulations such as these force dentists to spend ever-increasing amounts of time and money for what may be de minimis or non-existent improvements in care. Every new regulation needs to be considered in respect to its marginal benefit to patient care and its marginal resource cost. Increasing costs reduces access to care; if the marginal benefit of a regulation does not exceed its reduction in access to care then it shouldn’t be enacted. 

Not only are the potential impacts of the pending rule changes listed above unnerving, but so is the recent lack of time and consideration given to stakeholder comments in rulemaking. Earlier this year, when the proposed opioid prescribing rule — a pared-down 20-page document — came before the commission for review, it was clear there was no intention of discussing the numerous stakeholder comments submitted. Even worse, over the course of the meeting, it became apparent that the majority of the commissioners had not thoroughly reviewed the rule itself, much less the comments received. 

Ignoring stakeholder input is alarming for many reasons, but at the most basic level it shows that some commission decisions are being made in a vacuum. And, while stakeholder comments are solicited, as required by law, there is minimal consideration being given to dentists and other stakeholders who take time out of their busy schedules to provide the commission with thoughtful comments. 

Rulemaking of this nature is simply unacceptable. There needs to be less of an “us vs. them” mentality, more collaboration between commissioners and stakeholders, and a recognition that raising concerns about the unintended consequences of a burdensome regulation does not equate to putting patient safety on the backburner. 

As dentists and as commissioners, we share a common goal: providing optimal care to our patients. We cannot forget that. As we move forward, let’s adopt rules that make sense and enable us to deliver the best care possible, without being bogged down in a sea of unnecessary, expensive, and potentially counterproductive red tape.