A patient walked in to see me last week, middle aged gentleman, energetic, talkative, friendly. Not the least bit stressed-out from all outward appearances. But his blood pressure was 210/130! His readings came down modestly as we sat and talked. But I booked him a visit at his primar care doctor's office before he left. Upon examination, I recognized he had lots of risky physical characteristics and a positive history for sleep breathing obstruction. I told him he could manage his blood pressure by managing his breathing. His eyebrows went up.
It's true--blood pressures are reduced in patients treat their obstructive sleep apnea. The atricle I attached goes on to describe the study was performed with patients using oral appliance therapy.
I am a member of the AADSM--The American Academy of Dental Sleep Medicine. Call today to begin your treatment.
Thursday, January 10, 2013
Monday, January 7, 2013
Mid-Level Dental Providers--An Update
The idea of MLPs was introduced by advocacy groups to aid the most under-served portions of the population at large. MLPs have been suggested to work independently of dentists, possibly in their own clinics, and begin helping patients in geographic areas where providers are needed most. So with the unchanging tooth decay epidemic, the question is: are MLPs valuable for Washington State's future? The answer: not really. Over time we will likely see the value of MLPs diminish after they are introduced. The answer lies in the eventual failure of the economics behind the model for MLPs.
The American Dental Association (ADA) released a recent report about mid-level dental providers. (MLPs) The upshot is MLPs can perform valuable skills to improve patients' dental health. However, there is no obvious economic value in having MLPs incorporated into the dental industry. The ADA report states that regardless of how may providers treat dental decay, the population at large will not see a reduction in dental decay. Dental decay is an epidemic, and MLPs would not reduce the incidence of tooth decay.
If you recall, I have been against MLPs for a few reasons. MLPs could create catastrophic changes to our dental system for patients and dentists. The principles that I want you to consider were summed up nicely by an amazing colleague of mine, Dr. Christopher Jean, in a recent message:
"If independent mid-level providers have the capacity to operate a clinic independent of a dentist, the following will most likely occur:
1. The (midlevel providers) will apply for and eventually receive acknowledgement from insurance companies to perform many of the same clinical functions as Dentists. The reimbursement rate as set by the insurance companies will be the same. In fact if mid-level providers can operate clinics, they can now hire dentists to perform ancillary procedures in much the same manner as denturists currently do. Nothing will change, especially for the consumer. The equipment costs will remain the same and the costs of day to day operations will still be the same. Instead of a flood of midlevel providers going to areas to serve the poor, they will gravitate to where the money and jobs are.
2. The wages for midlevel providers can initially be set (at a certain level), but with several years of experience, the market will eventually dictate what they can make and that is usually productivity based. If a midlevel provider can produce what a dentist can produce, then they can make what a Dentist can make within a comparable scope of practice for how quickly they can turnover a chair...If hygienists can command (a higher wage) to go to an office for a day, but a midlevel provider can do so much more, it is doubtful that after several years the rate of pay for midlevel providers will be less than that of hygienists. The demand for hygienists will go down and the cost of midlevels will eventually exceed (the hygiene wage). The cost benefit ratio for becoming a therapist will exceed the motivation for becoming a hygienist. The quality of applicants for hygiene programs which is very high will drop. Therapists will have a broader focus of practice. This can be beneficial in certain instances, but nobody is better at the focus of prevention and maintenance than hygienists. There will be a drop off in quality of personal focus on this one key gate-keeping responsibility if there are fewer hygienists who practice as a proportion of the whole field. Studies have never decried the importance of hygienists, just their average hourly wage within the state of Washington as an economic obstacle to affordable healthcare for the working poor and to medicaid patients.
3. Public health clinics will restructure their personnel to take advantage of midlevels. Dentists will be more responsible for specialty procedures because there will be fewer of them. Their practice risk and stress will increase. Subsequently the retention rate will be more difficult and the turnover higher if salaries do not increase. If private practices pay more for Therapists, public health will need to up their payroll ante as well. The payroll savings will still be there but it won't be at (the same initial rate) after a few years. The real effect won't trickle down to underserved areas because it would take several years to construct new clinics in underserved areas and by the time they are ready to run and people start to access care which may take a few more years, the wage cost savings may diminish significantly to have any concrete impact upon the patients they were intended to serve.
4. The true beneficiary to the addition of a midlevel are corporations if they are heady enough to be opportunistic and take advantage of this. They can offer a fixed salary, benefits plus productivity bonuses that public health and Mom and Pop private offices either can not or are not accustomed to providing. Corporate chains already form a growing segment of the whole dental health field. Although many are not as efficiently run office to office, they play an important part in the whole economic landscape of the field that their presence and impact cannot be dismissed. They can draw upon that demographic that used to be the bread and butter of most dental practices. Yes, I'm referring to the trade unions who have traditionally had the best insurance benefits, the members who actually needed the most amount of care and who had the most amount of flexible time to access the care. If corporate offices strike a deal with unions that represent that majority demographic (for dentistry), it sets a precedent by lowering the value for services and treating the rendering of procedures as more of a product that is wholesale rather than treatment as part of a disease process.
And this is the whole point...we need to assess the impact of what this bill can really effect rather than what some advocacy groups hope it will effect.
The field is changing...the aspect of personalized care with a single doctor/ single hygienist model is becoming less of a standard. The common idea of addressing a patients dental/medical needs and putting them on preventive maintenance is gradually being replaced by a greater profit driven second tier of money management which typically focuses more on productivity and return as opposed to the relationship based doctor patient approach. Eventually the societal perception will slowly gravitate even more towards receiving dentistry as a product rather than a doctor-managed service. There is much more to being a good healthcare provider and a good doctor than just drilling, filling and cleaning. Every procedure that is done and every word of advice that is communicated bears a relevance to the overall totality of a patients general health and where that patient is or is not headed as they age and pertains directly to their quality of life."
Dental Health Day is this week in our state's capital, Olympia, Washington. There is still a possibility that the health bill to allow MLPs in Washington, HB13, may move into the legislature for more activity. Please show your support to cancel this bill. The economics of MLPs are too complex and not beneficial to the dental industry at this time.
The American Dental Association (ADA) released a recent report about mid-level dental providers. (MLPs) The upshot is MLPs can perform valuable skills to improve patients' dental health. However, there is no obvious economic value in having MLPs incorporated into the dental industry. The ADA report states that regardless of how may providers treat dental decay, the population at large will not see a reduction in dental decay. Dental decay is an epidemic, and MLPs would not reduce the incidence of tooth decay.
If you recall, I have been against MLPs for a few reasons. MLPs could create catastrophic changes to our dental system for patients and dentists. The principles that I want you to consider were summed up nicely by an amazing colleague of mine, Dr. Christopher Jean, in a recent message:
"If independent mid-level providers have the capacity to operate a clinic independent of a dentist, the following will most likely occur:
1. The (midlevel providers) will apply for and eventually receive acknowledgement from insurance companies to perform many of the same clinical functions as Dentists. The reimbursement rate as set by the insurance companies will be the same. In fact if mid-level providers can operate clinics, they can now hire dentists to perform ancillary procedures in much the same manner as denturists currently do. Nothing will change, especially for the consumer. The equipment costs will remain the same and the costs of day to day operations will still be the same. Instead of a flood of midlevel providers going to areas to serve the poor, they will gravitate to where the money and jobs are.
2. The wages for midlevel providers can initially be set (at a certain level), but with several years of experience, the market will eventually dictate what they can make and that is usually productivity based. If a midlevel provider can produce what a dentist can produce, then they can make what a Dentist can make within a comparable scope of practice for how quickly they can turnover a chair...If hygienists can command (a higher wage) to go to an office for a day, but a midlevel provider can do so much more, it is doubtful that after several years the rate of pay for midlevel providers will be less than that of hygienists. The demand for hygienists will go down and the cost of midlevels will eventually exceed (the hygiene wage). The cost benefit ratio for becoming a therapist will exceed the motivation for becoming a hygienist. The quality of applicants for hygiene programs which is very high will drop. Therapists will have a broader focus of practice. This can be beneficial in certain instances, but nobody is better at the focus of prevention and maintenance than hygienists. There will be a drop off in quality of personal focus on this one key gate-keeping responsibility if there are fewer hygienists who practice as a proportion of the whole field. Studies have never decried the importance of hygienists, just their average hourly wage within the state of Washington as an economic obstacle to affordable healthcare for the working poor and to medicaid patients.
3. Public health clinics will restructure their personnel to take advantage of midlevels. Dentists will be more responsible for specialty procedures because there will be fewer of them. Their practice risk and stress will increase. Subsequently the retention rate will be more difficult and the turnover higher if salaries do not increase. If private practices pay more for Therapists, public health will need to up their payroll ante as well. The payroll savings will still be there but it won't be at (the same initial rate) after a few years. The real effect won't trickle down to underserved areas because it would take several years to construct new clinics in underserved areas and by the time they are ready to run and people start to access care which may take a few more years, the wage cost savings may diminish significantly to have any concrete impact upon the patients they were intended to serve.
4. The true beneficiary to the addition of a midlevel are corporations if they are heady enough to be opportunistic and take advantage of this. They can offer a fixed salary, benefits plus productivity bonuses that public health and Mom and Pop private offices either can not or are not accustomed to providing. Corporate chains already form a growing segment of the whole dental health field. Although many are not as efficiently run office to office, they play an important part in the whole economic landscape of the field that their presence and impact cannot be dismissed. They can draw upon that demographic that used to be the bread and butter of most dental practices. Yes, I'm referring to the trade unions who have traditionally had the best insurance benefits, the members who actually needed the most amount of care and who had the most amount of flexible time to access the care. If corporate offices strike a deal with unions that represent that majority demographic (for dentistry), it sets a precedent by lowering the value for services and treating the rendering of procedures as more of a product that is wholesale rather than treatment as part of a disease process.
And this is the whole point...we need to assess the impact of what this bill can really effect rather than what some advocacy groups hope it will effect.
The field is changing...the aspect of personalized care with a single doctor/ single hygienist model is becoming less of a standard. The common idea of addressing a patients dental/medical needs and putting them on preventive maintenance is gradually being replaced by a greater profit driven second tier of money management which typically focuses more on productivity and return as opposed to the relationship based doctor patient approach. Eventually the societal perception will slowly gravitate even more towards receiving dentistry as a product rather than a doctor-managed service. There is much more to being a good healthcare provider and a good doctor than just drilling, filling and cleaning. Every procedure that is done and every word of advice that is communicated bears a relevance to the overall totality of a patients general health and where that patient is or is not headed as they age and pertains directly to their quality of life."
Dental Health Day is this week in our state's capital, Olympia, Washington. There is still a possibility that the health bill to allow MLPs in Washington, HB13, may move into the legislature for more activity. Please show your support to cancel this bill. The economics of MLPs are too complex and not beneficial to the dental industry at this time.
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