- Email: [email protected]
Changing dental practice
Dentistry at the Crossroads Changing dental practice Background.—The practice environment of US dentists is changing as a result of the collision of significant economic, demographic, and political forces. The American Dental Association (ADA) recently conducted an analysis of the dental care sector based on research into various topics. An executive summary of the key findings of a group of external thought leaders who have diverse backgrounds and perspectives was released. Changes in Dental Care.—Structural changes occur in response to changes in the underlying behaviors of various groups and are not the same as cyclical changes that result from the effects of economic cycles. The structural changes affecting dentistry have been focused on dental care use. Since the early 2000s, dental care use among working-age adults have declined, with the fall noted in all income groups and regardless of whether the patient had dental benefits. Currently the decline is widespread among this age group of adults. However, children’s dental care use has increased, with gains driven entirely by lower-income groups. Senior adult dental care use has also increased. Reasons for these changes in dental care use patterns include shifting dental benefits patterns, with coverage for adults being eroded but coverage for children increasing steadily. Most states offer limited dental benefits through Medicaid to adults, and these have been scaled back gradually over the past decade. This increase in the share of adults who have no dental benefits is the major factor driving reductions in dental care use, although
demographic shifts in the population (specifically, an increase in the share of adults who are Hispanic) and sluggish household incomes have also contributed. Medicaid coverage has expanded and now mandates extensive dental benefits for children, driving the increased use of dental care in children with low-income backgrounds. Another change in dental practice involves the use of emergency rooms (ERs) by young adults to manage dental conditions. This is wasteful and expensive and often does not address the underlying problem. Costs to the health care system for this practice are up to $2 billion each year. Because of these changes in dental care use, national dental spending has slowed considerably since 2000 and remains at 2008 levels. Public financing accounts for more of this spending than it did previously. The average net income of dentists has declined considerably and does not appear to be rebounding beyond the 2009 level (Fig 2). What Does the Future Hold?.—Various models of the future show that if current trends continue, dental spending will show no increase for decades. The decline in dental care use and spending by working-age adults will offset the increased use by children and senior adults, with no significant growth resulting. Dental benefits may continue to erode for adults, partly as a result of the Affordable Care Act (ACA), which does not have specific provisions related to adult dental benefits.
Fig 2.—Average inflation-adjusted annual net income for general practitioner (GP) dentists. The blue bars denote recession years according to the National Bureau of Economic Research. Gross domestic product (GDP) is deflated using the GDP deflator. Net income is deflated using the all-time consumer price index. All values are shown in constant 2012 dollars. Source: Vujicic and colleagues.5 (Courtesy of Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014.)
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The establishment of future benefits will rely on how employers and individuals react now that health insurance marketplaces are up and running. Rates will depend also on state policies, which will remain voluntary but are eligible for enhanced federal matching grants in states that choose to expand Medicaid eligibility. The ACA will expand the number of children who have dental benefits and will likely reduce the number of uninsured children in the United States by about 55%, although this may be reduced if the ADA dental benefits coverage for children becomes watered down during the implementation phase. There will also be a move to increase value and reduce costs from government, employers, and individuals driven by a shift toward value-based payments in dental plans. Health care consumerism will become an even stronger force for change in dentistry, with all health care providers pressured to deliver value-laden care. The consolidation of practices, making them large, multisite endeavors, will likely continue. Instigating forces for this include changes in the practice patterns of new dentists, desire for greater efficiencies, and increased competition for patients. Innovation will also be spurred by this pressure to reduce costs and may create alternative care delivery models. The trend toward fewer dentists in solo practice is already happening and this is expected to continue (Box). Care will become more coordinated among the various health care professionals. The gap between dental care and primary care will be bridged, with greater understanding of the interactions between oral and whole-body health. The role of oral care providers in the total health care system may undergo a re-examination. New opportunities will arise to increase the visibility of oral health and engage dentists in primary care networks and in more extensive interprofessional collaborations. Recommendations.—With the profound changes awaiting the dental profession, dentists need to determine what their destiny will be. It is unwise to ignore what is
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Dental Abstracts
Box.—Key Characteristics of Tomorrow’s Dental Practice Environment* ▬ Provider consolidation is likely to continue ▬ Growth in large, multisite practices is likely to continue ▬ Interest in midlevel providers is likely to continue ▬ Commercial plans increasingly will use selective networks and will demand increased accountability ▬ Premium will be placed on good practice management * Source: Diringer and colleagues.7 (Courtesy of Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014.)
happening, and payers/consumers/patients will continue to exert pressure for change. It will be important to shape a strategy for meeting the upcoming challenges and determining a course that will successfully navigate through the difficult waters ahead.
Clinical Significance.—Dentistry is a-changing and we can either let others determine what the future will be or we can become involved in the process. We will never be able to return to the practice patterns of last century, so we need to decide what we would like to become in this century. It is indeed a pivotal time in the history of all health care professions.
Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014 Reprints available from M Vujicic, ADA Health Policy Resources Ctr, American Dental Association, 211 E Chicago Ave, Chicago, IL 60611; e-mail: [email protected]
demographic shifts in the population (specifically, an increase in the share of adults who are Hispanic) and sluggish household incomes have also contributed. Medicaid coverage has expanded and now mandates extensive dental benefits for children, driving the increased use of dental care in children with low-income backgrounds. Another change in dental practice involves the use of emergency rooms (ERs) by young adults to manage dental conditions. This is wasteful and expensive and often does not address the underlying problem. Costs to the health care system for this practice are up to $2 billion each year. Because of these changes in dental care use, national dental spending has slowed considerably since 2000 and remains at 2008 levels. Public financing accounts for more of this spending than it did previously. The average net income of dentists has declined considerably and does not appear to be rebounding beyond the 2009 level (Fig 2). What Does the Future Hold?.—Various models of the future show that if current trends continue, dental spending will show no increase for decades. The decline in dental care use and spending by working-age adults will offset the increased use by children and senior adults, with no significant growth resulting. Dental benefits may continue to erode for adults, partly as a result of the Affordable Care Act (ACA), which does not have specific provisions related to adult dental benefits.
Fig 2.—Average inflation-adjusted annual net income for general practitioner (GP) dentists. The blue bars denote recession years according to the National Bureau of Economic Research. Gross domestic product (GDP) is deflated using the GDP deflator. Net income is deflated using the all-time consumer price index. All values are shown in constant 2012 dollars. Source: Vujicic and colleagues.5 (Courtesy of Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014.)
Volume 59
Issue 5
2014
e131
The establishment of future benefits will rely on how employers and individuals react now that health insurance marketplaces are up and running. Rates will depend also on state policies, which will remain voluntary but are eligible for enhanced federal matching grants in states that choose to expand Medicaid eligibility. The ACA will expand the number of children who have dental benefits and will likely reduce the number of uninsured children in the United States by about 55%, although this may be reduced if the ADA dental benefits coverage for children becomes watered down during the implementation phase. There will also be a move to increase value and reduce costs from government, employers, and individuals driven by a shift toward value-based payments in dental plans. Health care consumerism will become an even stronger force for change in dentistry, with all health care providers pressured to deliver value-laden care. The consolidation of practices, making them large, multisite endeavors, will likely continue. Instigating forces for this include changes in the practice patterns of new dentists, desire for greater efficiencies, and increased competition for patients. Innovation will also be spurred by this pressure to reduce costs and may create alternative care delivery models. The trend toward fewer dentists in solo practice is already happening and this is expected to continue (Box). Care will become more coordinated among the various health care professionals. The gap between dental care and primary care will be bridged, with greater understanding of the interactions between oral and whole-body health. The role of oral care providers in the total health care system may undergo a re-examination. New opportunities will arise to increase the visibility of oral health and engage dentists in primary care networks and in more extensive interprofessional collaborations. Recommendations.—With the profound changes awaiting the dental profession, dentists need to determine what their destiny will be. It is unwise to ignore what is
e132
Dental Abstracts
Box.—Key Characteristics of Tomorrow’s Dental Practice Environment* ▬ Provider consolidation is likely to continue ▬ Growth in large, multisite practices is likely to continue ▬ Interest in midlevel providers is likely to continue ▬ Commercial plans increasingly will use selective networks and will demand increased accountability ▬ Premium will be placed on good practice management * Source: Diringer and colleagues.7 (Courtesy of Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014.)
happening, and payers/consumers/patients will continue to exert pressure for change. It will be important to shape a strategy for meeting the upcoming challenges and determining a course that will successfully navigate through the difficult waters ahead.
Clinical Significance.—Dentistry is a-changing and we can either let others determine what the future will be or we can become involved in the process. We will never be able to return to the practice patterns of last century, so we need to decide what we would like to become in this century. It is indeed a pivotal time in the history of all health care professions.
Vujicic M, Israelson H, Antoon J, et al: A profession in transition. J Am Dent Assoc 145:118-121, 2014 Reprints available from M Vujicic, ADA Health Policy Resources Ctr, American Dental Association, 211 E Chicago Ave, Chicago, IL 60611; e-mail: [email protected]