Thursday, July 10, 2014

RECENT CHANGES IN THE DENTAL PROFESSION

Prior to the 2008 economic crisis, the most significant changes to affect dentistry in over a decade had been: (1) increasing regulations via OSHA, HIPPA, EPA, and a number of other government regulations and monitoring agencies, and (2) changes in third party payer rules, regulations, and payment schedules. Shortly before and certainly following the 2008 economic turndown, many additional factors began to affect the dental profession.


Among these factors: passage of the Affordable Care Act; new dental care delivery models with wrangles over independent practice for hygienists, expanded duty auxiliaries, “whitening clinics”, and sealants applied by non-dentists; gigantic, multi-location practices; practices owned by management companies; PPOs and other preferred provider networks; changing payment schedules by third party payers; reduction in consumer demand for dental care; etc. We are also seeing the construction of more dental schools, among them for-profit schools; rising debt of dental students; lower income for many dentists; changes in dental benefits provided by employers; and changes in consumers’ choices of dental services.
Specifics about some of the changes:
  • The impact of the Affordable Care Act (ACA) is unclear, primarily due to the continuing number of revisions. There is also on-going confusion among insurance companies, Federal and State insurance exchanges, and consumers. Predictions are that under the ACA, payment for all healthcare services from any third party payer (private dental insurance, private-pay patients, or Medicaid) will be based on outcome or value rather than basing payments on      procedures as has been done historically. (Does that sound confusing? IT IS!!) Obviously, a successful outcome and perceived value of dental treatment are     subjective, not objective, judgments. Therefore, it remains unclear how payment schedules will be set.
  • 1990-2002—patient spending on dental care increased 3% to 4% annually. 2002-2008—flat to slight spending increases.
    2008-until now—spending flat or slightly decreased.
  • The percentage of adults without a “dental home” continues to increase, resulting in doubling the number of people who seek emergency dental care in a hospital emergency room.
  • In a 2012 survey, 42% of solo practitioners reported a “busyness” problem with open chair time that resulted in reduced production.
  • In spite of a decline in General Dentistry practice owners’ earnings for the past five years, non-owner dentists’ salaries have rebounded to the pre-2006 level which was a peak for dentists’ earnings. (Does this say that practice ownership is or may become a disadvantage? That concept flies in the face of the historically independent nature of the majority of dentists.)
  • Between 2000-2012, there was a significant decline in the demand for dental care by patients ages 21–64. However, dental spending for children and seniors (65 and over) increased during this same time period.
These and many other changes portend a new dental marketplace. All involved in the dental profession—private practitioners, administrators, educators, researchers, product and service vendors, and dental professional organizations must use all available data to plan successfully for the future. The one assurance is that the practice of dentistry will not remain as we’ve known it in the past.
The American Dental Association Health Policy Resources Center is the source of this information. For further details in the report plus many other facts about changes in the profession, go to www.ada.org. Choose the Science/Research heading and click on Health Policy Institute (formerly the Health Policy Resources Center).

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