A decent summary of the Affordable Healthcare Act (ACA) as it impacts dental patient care was released recently.
The ACA has inadvertently developed many complicated twists and turns for patients and providers on the long road to a successful, comprehensive care horizon.
My thoughts:
1) Dentistry isn't about to get cheaper or easier to access with the advent of the ACA activity.
2) Maintain great communication with your employers and human resources representatives. Do your best to communicate the continued need for dental insurance policies.
3) Consider a health savings account or a flexible spending account and talk with your employer or HR about matching or funding those accounts for dental care. These types of accounts allow flexibility in how and where you get care. They can also help you and your family break through dental insurance limitations for where, when, and how you get care.
4) Educate yourself on how you can keep your children healthy under the ACA provisions. Odds are there is a state-funded program for kids in need, wherever you may live.
5) The ACA will create better access to medical insurance for our country's patients. Keep in mind surgical care in a dental office (tooth extractions, periodontal surgery, grafting, dental implants) and treatment for sleep apnea in a dental office can be submitted to medical insurance.
Showing posts with label dental insurance. Show all posts
Showing posts with label dental insurance. Show all posts
Thursday, December 20, 2012
Wednesday, August 15, 2012
Midlevel Dental Providers--Equal In Skill and Training To Dentists?
PBS' Frontline series has been a great example of quality in television journalism. I heard about the episode that was released about 2 months ago that focused on the challenges of the dental care system in America. So I went online to review it. And I drew some conclusions and formed some opinions. I also have some solid advice I'd like to offer to our readers.
Our country has a crisis on our hands. Patients can't get access to dental care as readily as they can for medical care. But from a wellness standpoint, I feel that there are a lot of patients who could manage their diet, lifestyle choices, and their own preventive dental care in much better ways. But the issue I agree with in the Frontline piece--the problem of uniting patients with affordable healthcare--is growing.
Beyond lifestyle changes, another factor in creating the growing problem is that the historically more accessible medical insurance model for care--which is also failing--is not applied in dentistry. You say, "hey, wait--there's dental insurance, and it's like medical insurance!" WRONG. There are a significantly lesser number of insurance providers and subscribers for dental insurance to create an environment for dental care that would even come close to rivaling access to medicine. Let's not forget that this is correlated with the embarrassingly low level of reimbursement and insulting iron curtain of restrictions and limitations evolved by dental insurance policies. This is not a figurative statement I'm about to make, it's a fact: dental insurance reimbursement levels are stalled at levels seen in the 1960's and '70's.
An economic downturn and high level of unemployment has created a ripple effect that I am able to gauge with just my pool of patients. I would consider my community to be an average suburban/rural community--lots of families, lots of commuting employees to distant offices/work locations, a wide variety of age groups and career types. I witnessed about 20% of the patient pool disappear from my work schedule in 2008-2009 at Cascadia Dentistry. And upon further research, I noticed that across the nation that was generally the trend. Unemployment increases led to less cash flow for dental care for a lot of patients. The fallout from the unemployment and economic downturns are still occurring in my practice and abroad.
Another truth about dental care: there are a lot of people who are more susceptible to the perils of dental disease that really need more help than they can provide themselves. Said another way: no matter how much preventive care and attention is paid to managing their lifestyle, high-risk dental patients will always exist. And if more of those high-risk patients are unemployed? The dental health epidemic starts to snowball even further.
I started to envision a hypothesis where all dental patients that 100% access to care would be able to have the properly planned and executed dental care, given the dental professionals are all made equal. BUt as the Frontline piece illuminated, that hypothesis is a fantasy. This industry has a lot of variability in the style of how healthcare is delivered, and also in how business models dictate the performance of dental care providers.
The business models profiled on Frontline seem to be god working models for dentistry to cut costs--in theory. I have some doubts about the business model of corporate dentistry. Corporations and small businesses are alike in many ways. Both entities have operating costs and profit/loss goals. The main differences between them in my view are 1) the personal approach and continuity of the doctor-patient relationship (being able to see the same doctor consistently over time) and 2) the established set of rules for meeting profit/loss and productivity goals. Tying income to productivity (which means the amount or volume of dental procedures completed), can create the wrong emphasis in a dental practice. In my opinion, creating incentives for dental care providers to generate more productivity usually results in corruption of the doctor-patient relationship. Up-selling happens in dentistry to meet production goals if that is how the business model is managed, and I don't feel good about it. I feel the true mission of dentistry and dental businesses is to meet the goals of the patient first, and introduce those patients to opportunities to have treatment they didn't know were available to meet their goals.
So now we turn to a look at mid-level providers (MLPs). They are now being introduced in some areas of the country. They can improve access to dental care. Lower costs are important to achieve, and a mid-level provider can help. Frontline interviewed an MLP as saying her training and skill for certain procedures was "exactly like...dentists." That statement is questionable. The consequence of MLPs, is that they are unable to work unsupervised; as it stands, our nation's MLPs require dentist supervision to plan and execute care. MLPs are also limited in their scope of care; they can't perform dentistry to the same level of excellence for all the needed procedures a patient may seek. And the level of training is limited to a few restorative procedures. It is also uncertain what the continuing education expecttions or intent will be for MLPs. But my biggest concern is that MLPs run the risk of caring for a patient that requires a change in treatment while in the midst of receiving care. This could compromise the patient's treatment result. A dentist would ultimetely have to step in and complete the unfinished care, possibly not until a later date with the patient in limbo until that occurs. The expertise and vast knowledge of alternative remedies for any patient are at the fingertips of a well-trained dentist.
Also, the experience and ability for an MLP to perform the standard of care for patients is debatable. A lot of time and experience has been built by dentists to deliver the best care for their patients. Just because an MLP can fill a cavity, build a mouthguard or provide preventive care, doesn't mean they can execute an emergency root canal, manage complex infections, or solve ongoing challenges for high-risk dental decay patients in an efficient or effective way. Those few examples I listed require high-level medical and dental training that MLPs do not receive. In my opinion, the best use of MLPs is to work in tandem with a dentist, but the catch-22 is that it still bottlenecks the access to dentistry for a huge number of patients-in-need.
So what the Frontline episode showed me is that there are a number of great things happening to improve access to care, but we have a long way to go as a profession to make it work well.
Our country has a crisis on our hands. Patients can't get access to dental care as readily as they can for medical care. But from a wellness standpoint, I feel that there are a lot of patients who could manage their diet, lifestyle choices, and their own preventive dental care in much better ways. But the issue I agree with in the Frontline piece--the problem of uniting patients with affordable healthcare--is growing.
Beyond lifestyle changes, another factor in creating the growing problem is that the historically more accessible medical insurance model for care--which is also failing--is not applied in dentistry. You say, "hey, wait--there's dental insurance, and it's like medical insurance!" WRONG. There are a significantly lesser number of insurance providers and subscribers for dental insurance to create an environment for dental care that would even come close to rivaling access to medicine. Let's not forget that this is correlated with the embarrassingly low level of reimbursement and insulting iron curtain of restrictions and limitations evolved by dental insurance policies. This is not a figurative statement I'm about to make, it's a fact: dental insurance reimbursement levels are stalled at levels seen in the 1960's and '70's.
An economic downturn and high level of unemployment has created a ripple effect that I am able to gauge with just my pool of patients. I would consider my community to be an average suburban/rural community--lots of families, lots of commuting employees to distant offices/work locations, a wide variety of age groups and career types. I witnessed about 20% of the patient pool disappear from my work schedule in 2008-2009 at Cascadia Dentistry. And upon further research, I noticed that across the nation that was generally the trend. Unemployment increases led to less cash flow for dental care for a lot of patients. The fallout from the unemployment and economic downturns are still occurring in my practice and abroad.
Another truth about dental care: there are a lot of people who are more susceptible to the perils of dental disease that really need more help than they can provide themselves. Said another way: no matter how much preventive care and attention is paid to managing their lifestyle, high-risk dental patients will always exist. And if more of those high-risk patients are unemployed? The dental health epidemic starts to snowball even further.
I started to envision a hypothesis where all dental patients that 100% access to care would be able to have the properly planned and executed dental care, given the dental professionals are all made equal. BUt as the Frontline piece illuminated, that hypothesis is a fantasy. This industry has a lot of variability in the style of how healthcare is delivered, and also in how business models dictate the performance of dental care providers.
The business models profiled on Frontline seem to be god working models for dentistry to cut costs--in theory. I have some doubts about the business model of corporate dentistry. Corporations and small businesses are alike in many ways. Both entities have operating costs and profit/loss goals. The main differences between them in my view are 1) the personal approach and continuity of the doctor-patient relationship (being able to see the same doctor consistently over time) and 2) the established set of rules for meeting profit/loss and productivity goals. Tying income to productivity (which means the amount or volume of dental procedures completed), can create the wrong emphasis in a dental practice. In my opinion, creating incentives for dental care providers to generate more productivity usually results in corruption of the doctor-patient relationship. Up-selling happens in dentistry to meet production goals if that is how the business model is managed, and I don't feel good about it. I feel the true mission of dentistry and dental businesses is to meet the goals of the patient first, and introduce those patients to opportunities to have treatment they didn't know were available to meet their goals.
So now we turn to a look at mid-level providers (MLPs). They are now being introduced in some areas of the country. They can improve access to dental care. Lower costs are important to achieve, and a mid-level provider can help. Frontline interviewed an MLP as saying her training and skill for certain procedures was "exactly like...dentists." That statement is questionable. The consequence of MLPs, is that they are unable to work unsupervised; as it stands, our nation's MLPs require dentist supervision to plan and execute care. MLPs are also limited in their scope of care; they can't perform dentistry to the same level of excellence for all the needed procedures a patient may seek. And the level of training is limited to a few restorative procedures. It is also uncertain what the continuing education expecttions or intent will be for MLPs. But my biggest concern is that MLPs run the risk of caring for a patient that requires a change in treatment while in the midst of receiving care. This could compromise the patient's treatment result. A dentist would ultimetely have to step in and complete the unfinished care, possibly not until a later date with the patient in limbo until that occurs. The expertise and vast knowledge of alternative remedies for any patient are at the fingertips of a well-trained dentist.
Also, the experience and ability for an MLP to perform the standard of care for patients is debatable. A lot of time and experience has been built by dentists to deliver the best care for their patients. Just because an MLP can fill a cavity, build a mouthguard or provide preventive care, doesn't mean they can execute an emergency root canal, manage complex infections, or solve ongoing challenges for high-risk dental decay patients in an efficient or effective way. Those few examples I listed require high-level medical and dental training that MLPs do not receive. In my opinion, the best use of MLPs is to work in tandem with a dentist, but the catch-22 is that it still bottlenecks the access to dentistry for a huge number of patients-in-need.
So what the Frontline episode showed me is that there are a number of great things happening to improve access to care, but we have a long way to go as a profession to make it work well.
Tuesday, May 3, 2011
There's A Storm On The Horizon For Patients, Thanks To Insurance Carriers
A few months ago, the largest dental insurance provider in Washington, Washington Dental Service, sent me a foreboding letter. The company announced that it would soon be reducing reimbursements to participating dentists, like me, who care for patients that carry Washington Dental Service (WDS) insurance plans.
People who are aware of this upcoming WDS change may think that change is a benefit to patients everywhere. Some may believe insurance companies like WDS with buying power and large numbers of insured may be capable of controlling rising costs in the dental care market, and that must mean patient spending might be reduced. And some may feel that access to dental care could be easier to come by for would-be patients in need. I wish that were the case. On the contrary, it is detrimental to everyone in the dental care system: patients, dentists, and insurance carriers.
As a dentist who started a practice from scratch, I have grown my business of health care over the past 12 years. I have fostered some amazing relationships with many patients, and love this career because I can help people become healthier and improve their quality of life. Every year, my costs to support patients go up. And every year, my patients count on me to maximize their insurance contributions for their care.
I've been happy to do what I can in recognizing the importance of their insurance assistance. I have felt a connection with their insurance carriers has been an important facet of the doctor-patient relationship. I signed a contract to become a partner with WDS promising to offer dentistry at a specific cost to patients who have that insurance plan. This is a very popular insurance plan in the state, and it has been estimated WDS supports over 4 million insured in Washington.
Over the past several years, I have changed my business strategy so I could offer the best possible quality dental care and the best customer service in my area, even in the face of increasing limitations and restrictions insurers have made. WDS reimbursements for the dental care I provide have continually decreased relative to the cost of doing business. My expenses are not decreasing at the same rate, so my ability to provide the same excellent care is becoming harder to provide to the WDS patients and their families I love to treat.
In January, I received the aforementioned letter, which contained a shocking plan to significantly reduce reimbursements to member dentists, in some cases up to 15% for some dental treatments. In addition, WDS decided that there would be no increase in reimbursements in the foreseeable future. I have talked with dozens of dentists, and read comments from countless others, and the discussions are all the same; WDS has done something that has made Washington dentists unhappy about the future of patient care. And that includes me.
So it is obviously going to hit me hard as a dental practice owner. I care most about how it will affect the level of care I provide to my patients. But it's not just about the consequences my business and my career will suffer. This change is going to affect patients and dental insurers, notably WDS. I can't possibly cover the entire scope of the fallout this WDS decision is creating now and in the future, so I will pass on articles, stories, and broadcasts that relate to this situation as they become available. Here is are two news stories that broke recently.
http://www.seattlepi.com/local/article/WA-s-largest-dental-insurer-to-cut-reimbursements-1351909.php
At this point, I have to decide whether or not to pass the WDS limitations and restrictions on to my patients in certain ways. In the past, I didn't have to bill my patients for certain things associated with dental care. For example, I didn't consider charging patients for local anesthesia to have a crown or a filling done. I didn't consider charging to adjust a restoration after it was placed in or on a tooth. I didn't consider charging additional costs for medications I routinely use to treat periodontal disease. These things were included in the basic cost of the treatments. Now that WDS has significantly reduced the reimbursements for everyday fillings, crowns, and gum infection procedures, I can't make up enough of the costs in other ways within my business. What were once "bundled" services could be "unbundled"services at additional fees. These services are not typically covered by WDS or other insurers. This results in greater out-of-pocket expenses for patients.
These options are not being considered to increase profits; rather, they are measures to preserve our ability to deliver the same great care to patients. I want to let you know that I am not the only dentist who is considering these options. There are hundreds of Washington dentists who are being affected by this. And that translates into thousands of patients who may suffer this fallout.
WDS has continued to spin these changes to its member dentists as "competitively priced" insurance options for Washington companies searching for reduced-cost insurance plans for their employee benefit packages. But these changes are almost certainly going to be passed on to the patients, and patient spending will increase. Patient access to care will be restricted more and more. Because the cost of providing dental care isn't going down for any dentist who wants to do right by patients with WDS dental insurance.
WDS and other insurers are looking to cut THEIR costs, not patient costs. I believe patients will start to complain to their HR reps and employers, and search for different insurance options.
If dentists decide to break their contracts with WDS, and patients have insurance plans that require treatment by WDS contracted dentists in order to receive reimbursement for dentistry, patient access to care will be restricted further. Fewer available dentists will result in more patients waiting for solutions to their infections, pain, and inability to function. Without a certain level of participation by dentists and employers, carriers like WDS will succumb to losses and not be capable of offering insurance products.
Patients will have fewer options for support and reimbursement. And that possibility, created by insurance companies like WDS, makes me sad and embarrassed as a dentist, as a patient, and as a business owner.
I want you all to remember that you have a voice in this matter. Talk with your employers and HR representatives. Call Washington Dental Service. Let any and all know that these changes are not creating excellence in dental care.
I am committed to giving you my very best as a dentist. I'll keep you posted about our efforts on this issue. Please send questions or comments to chris@cascadiadentistry.com.
I want you all to remember that you have a voice in this matter. Talk with your employers and HR representatives. Call Washington Dental Service. Let any and all know that these changes are not creating excellence in dental care.
I am committed to giving you my very best as a dentist. I'll keep you posted about our efforts on this issue. Please send questions or comments to chris@cascadiadentistry.com.
Subscribe to:
Posts (Atom)