Compliance Framework
Commitment to Compliance. Transparency and Integrity
WEST COAST DENTAL and its affiliated practices, including Magicland Children’s Dental & Orthodontics (collectively, WCD), are committed to providing accessible, affordable, high-quality patient care, and an excellent patient experience, in the culturally diverse communities we serve so that we may improve the health and well-being of all of our patients.
For our Patients: We endeavor to improve the health and well-being of all of our patients through education and by providing quality and accessible health care at each and every visit.
For our Providers and Team Members: We strive to create a quality work environment that promotes teamwork and a positive and inspiring work experience for each Team Member. We hire and train our Team Members to enable them to deliver high quality patient care and a great patient experience.
WCD’S Leadership Team is committed to providing the support and resources necessary to sustain comprehensive, flexible and meaningful compliance initiatives. Compliance, transparency and integrity are indispensable components of our ability to achieve our mission.
A Robust Compliance Program
WCD has developed detailed compliance policies and procedures describing the duties and obligations of Team Members. We individually and collectively demonstrate our commitment to these policies and procedures by creating pathways to keep them up to date and by measuring our performance in achieving them.
We expect Team Members to know, understand and follow all policies and procedures that apply to their work, to seek clarification from their supervisors if they have any questions, and to report potential compliance issues. In addition, providers are expected to carry all required licenses and follow the ethical and professional standards dictated by their respective professional organizations and licensing boards.
i.Purpose
The purpose of the Quality Management (“QM”) Program is to monitor and promote quality of care, and assure the existence of a system for detecting systemic deficiencies in the quality of dental care provided throughout the organization. The QM Program includes policies and procedures to address all major aspects of dental care activities, including all major regulatory compliance requirements, credentialing and re-credentialing, data collection and analysis of procedures for quality indicators.
ii.Goals
The QM Program addresses various service elements and monitors the provision and utilization of services to ensure they meet professionally recognized and required standards of care and compliance with WCD policies and practices.
The QM Program includes, but is not limited to, the following goals:
- Monitor and analyze the quality of dental care on an ongoing basis
- Monitor and analyze the quality of the patient experience on an ongoing basis
- Foster the provision of appropriate and effective quality dental care in accordance with professionally recognized standards of care and legal requirements
- Foster continuous quality improvement in the delivery of dental care and the clinical support systems relating thereto
- Monitor and analyze compliance with applicable regulatory requirements, including those promulgated by the California Dental Board, Cal OSHA, and other regulatory bodies
- Reduce or minimize opportunity for adverse impact in patient interactions
- Improve proficiency, efficiency, and value in the delivery of oral health services
- Evaluate the effectiveness of the QM Program on an ongoing basis
iii.Quality Management Activities
WCD conducts a range of review, monitoring and goal setting efforts intended to evaluate whether dentists and their support staff are providing appropriate, quality dental care in a timely and respectful manner with the end result of delivering the ultimate patient experience. These efforts include:
- Clinical chart reviews for providers
- Clinical facility reviews
- Addressing patient grievances and complaints concerning quality of care and patient experience
- Monitoring utilization information and other clinical indicators
- Monitoring regulatory compliance
iv.Corrective Actions
Quality of care issues are subject to review and appropriate corrective actions. As cases with quality concerns are identified, they will be investigated and adjudicated, and addressed with patients, based on levels of severity. Corrective actions will be prescribed. Any treating provider as to whom deficiencies are determined will be informed of the deficiencies and given an opportunity to respond before finalization of the adjudication process.
v.Patient Satisfaction Surveys
Patient satisfaction surveys will be performed on a periodic basis. Patient satisfaction is a key outcome measurement for the QM Program. Dentists and support staff will provide services to and interact with patients in a courteous, prompt, professional and respectful manner.
vi.Dental Record Audits
Dental care evaluations and utilization data are used to assess, track, trend and evaluate the quality of dental care and services delivered. Data is confidential and as such must be safeguarded from inappropriate public disclosure. WCD will respect all federal, state and local laws governing the confidentiality of dental records and data. Dental records are essential sources of data for a continuous monitoring process in the QM Program.
vii. Provider Education
The QM Program includes the recognized that quality improvement is enhanced with increased knowledge and training of the dentists and other dental staff. WCD encourages and supports educating providers and staff regarding the quality management process and compliance with the QM Program.
viii. Patient Inquiries, Grievances and Complaints
Patient inquiries, grievances and complaints should be dealt with promptly through direct communication, orally or in writing. Inquiries, grievances and complaints received via online or by course of Social Media will be dealt with in the same fashion as oral, direct communication or written communication. An inquiry may involve questions seeking further information, while a grievance or complaint may involve criticism, dissatisfaction or disagreement regarding the patient experience—clinically or experientially—possibly with the provider, staff, benefits, exclusions, financial, operations or management.
It is WCD’s aim to satisfy patients and provide an excellent patient experience in each instance, and hence inquiries, grievances and complaints should be addressed and attempts should be made to resolve them and satisfy the desires and needs of the patient with these aims in mind. It is desirable, although not mandatory, that resolutions of these matters be documented with notes in the patient chart.
ix. Provider Credentialing / Recredentialing
- All staff dentists must be properly credentialed in order to meet all governmental and office standards.
- All dentists must maintain licensure, malpractice insurance, and meet all governmental requirements to practice dentistry. Dentists must submit copies of valid state licenses, copies of malpractice insurance, and other documentary requirements when requested for credentialing and re-credentialing purposes.
All dentists must submit written, verified documentation regarding the existence of any new medical condition that would affect the dentist’s ability to effectively render care or of any conviction of a crime involving moral turpitude or of any action that would be a basis for suspension or revocation of the license to practice dentistry in the state by the State Dental Board.
