ADA Discussion on Future Payment for Dental Care
I have spent the past few days at American Dental Asssociation with a full agenda of activities. My primary role was serving as an alternate delegate from Virginia to the ADA House of Delegates (HOD). Virginia is part of the 16th District of the ADA that includes South Carolina and North Carolina and all the 16th District delegates meet as a caucus to discuss and develop positions to help delegate to intelligently vote on the House business. The resolutions voted on range from government and legislative, legal and financial, practice and membership, and science and education. Another important decision was election of new ADA officers and these candidates came to the caucus meeting to campaign for their election. Dr. Chuck Norman from North Carolina was elected President-Elect of the ADA. Congratulations Chuck and the 16th District.
I had the opportunity to participate as a table facilitator in the HOD Mega Topic Discussion on “Oral health care in five years. Who pays for it and how will it impact the practice of dentistry and the profession?” The format of this program was short presentations from various speakers on topics of health economics, dental insurance, health care law, dental trade industry, and practice models. Following the presentations our tables used a facilitated process to report actions the ADA should take to better position dentistry for the future. Below are some points from each speaker which are worth keeping in mind as we make decisions. The ADA will publish a compilation of the table reports.
Marko Vujicic – Managing Vice President, Health Policy Resources Center, American Dental Association
- $350/person dental expenditures per year currently
- A slow down in growth of this metric started in 2000 and went flat in 2008 and then declined
- GP earnings started to decline in 2005 and flattened in 2009
- In 2005 the percent utilization of adult dental care services began to decline. For every 1% decline this is estimated to be 18 patients per dentist. Adult utilization declined in all income groups but largest decline was in poorer adults.
- Percent utilization of children’s dental services has continued to rise. The gap between poor and nonpoor children in dental services utilization has closed.
- A shift in where benefits have come from has taken place. Private insurance has declined and Medicaid and the uninsured has increased and this is seen in both adults and children but the number of uninsured children has declined.
- It is expected that 20.8M more adults and 3M more children will be covered by Medicaid by 2018. It is not clear how this will impact demand for dental services.
Ron Inge – Vice President of Professional Services and Dental Director for Washington Dental Services (Delta Dental of Washington)
- The impact of the requirement in the Affordable Care Act (ADA) that a pediatric dental benefit must be included in health insurance provided in the exchanges will be disruptive and confusing.
- People may choose to spend all their premium dollars on medical coverage and this could lead to more urgent or episodic dental care since people will only go to the dentist when that have pain or infection.
- Dentist will need to work to convince their patients of the importance of purchasing dental insurance in the exchanges.
- Large group benefit plans will likely stay out of the exchanges and continue to negotiate their own plans.
- The use of patient care quality measures are emerging such as payment based on risk assessment. And example is applying evidence based principles to prevention.
Tim Rogan – Vice President for Marketing and Merchandise, Patterson Dental
- In 2009, solo dental practices make up 78% and he expects this to decline by 3%.
- In 2009, dental services organizations made up 4.5% and in 2012 they made up 11%. He predicts it will increase to 15% by 2017.
- He stated that the ROI of solo practice is still high and appealing.
- His bottom line is we need to improve the dental experience – people will pay for value.
Rick Workman – Founder and CEO of Heartland Dental Care
- Heartland employed 1% of all new graduates and all dental services organizations combined employ 1,000 graduates per year
- Dental services organizations share metrics to improve performance
Jane Grover – Dental Director, Center for Family Health, Jackson, Michigan
- 1% of dentists work in Community Health Centers and they contract with private practices to meet their missions.
- Her center is shifting toward patient care outcome evaluation such as measuring the rate of treatment plan completions, satisfaction surveys and number of children who return with no new caries.
Chris Salierno – Private Practice Dentist
- He feels more than the economy is having a negative affect on dental practices. He specifically mentioned increased consumerization of the public and bargain hunting. He said dentist have to be active business owners and always evaluating their practices for areas to improve. He gave the example of using open appointment time to work with his staff on finding improvements to implement.