The Future of Dentistry: Insights by Dr. Jeffrey Chaffin
Dr. Jeffrey Chaffin, Delta Dental of Iowa's Dental Director, provides an update and insight on the continued revolution of public healthcare and the future of dentistry.
Earlier this year, the Supreme Court's ruling on subsidies associated with the Affordable Care Act (ACA) reaffirmed the continued revolution in public healthcare coverage. There have also been numerous reports citing increased Medicaid coverage for adults in many states and increased Medicaid reimbursement for providers.
The increase in publicly-financed dental insurance programs started with the implementation of the State Children's Health Insurance Program (SCHIP) which was authorized in 1997 under Title XXI of the Social Security Act. Some states increased their Medicaid dental benefits prior to the enactment of the ACA, but there has been much more rapid change since healthcare reform. The Medical Expenditure Panel Survey (MEPS) is the most complete source of insurance data in the United States and is administered by the Agency for Healthcare Research and Quality (AHRQ). MEPS reports that 20.5 percent of all dental benefits for children were paid by public programs in 2000 and this number has increased to 36.8 percent in 2011. This clearly shows a very large increase in dental benefits being paid by public programs.
I spoke to a group of dental students at the University of Iowa last winter. One of my comments was that, in my opinion, all the future dentists in the room would be involved in providing care as a part of publicly-financed dental programs – based solely on the fact that these programs are increasing in size.
There are other trends on the medical side that may be a predictive part of the future of dentistry. There is increasing attention towards a reimbursement form called Accountable Care Organizations (ACO) and value based payments. The driver for these changes are increasing overall health costs with a lack of quality outcomes. Insurance carriers and payers are searching for ways to potentially decrease healthcare spending while increasing quality and outcomes. Essentially, more and more of healthcare reimbursement will be based on outcomes and quality of care and less based on fee-for-service for particular medical procedures. Currently, most ACOs do not include dental services, but as the trend towards an inter-professional approach between medical and dental evolves, could this change in the future?
Are dentists and our professional dental organizations preparing for future changes in reimbursement? I am not suggesting that the traditional cottage industry of dentistry goes away, but I think it's best to be aware of the trends in medicine and engage in these discussions proactively, before something is forced upon dentistry. All too often I see a reactive approach and a lack of realization that the force of change may be bigger than the individual or the profession.
Going forward, those in the dental profession who begin to position themselves from a quality and value perspective now, instead of simply a fee-for-service dental provider may be able to stay current with the future of healthcare and consumer needs.
Here are a few questions I'd like you to think about:
• Have past trends in medical financing come to fruition in the dental profession?
• What is the typical delay for medical financing trends to be adopted into dentistry?
• Should a young dental provider think that fee-for-service dentistry will be the prominent form of reimbursement for his/her career?
• Besides the Dental Quality Alliance, what should dentistry do to start addressing value and quality?
I am interested in your thoughts — please leave a comment below or send me an email at [email protected].