Will Dentists Find Dealing with Insurance Exchanges a Disaster?

Will Dentists Find Dealing with Insurance Exchanges a Disaster?As of the first of this year, dentists and health care providers have been closely monitoring the changes being implemented due to the Affordable Care Act.

Under the Act, as of January 1 all U.S. states were supposed to notify the U.S. Department of Health and Human Services if they are creating online exchanges for the October 1, 2013, deadline when Exchanges are to be made available to anyone without insurance and small businesses throughout the U.S.

The Exchanges will allow the general public to go online to compare health insurance plans and buy health insurance from the state-operated health Exchanges, as well as insurance plans being offered by the federal government.

Stand-alone dental insurance plans and pediatric dental coverage will be offered by these Exchanges, but it is still not known if adult dental coverage will be offered separately from health insurance on these Exchanges and what the requirements for dental coverage will be within the Exchanges themselves.

The New York Times reported last week that Health and Human Services Secretary Kathleen Sebelius will extend the deadline for any states that expressed interest in creating their own exchanges or overseeing insurance sold through a federal exchange.

Thus far, only 18 states and the District of Columbia intend to run their own health insurance Exchange. In the states that decide not to set up their own Exchange the federal government will implement federal health insurance Exchanges.

According to the U.S. Department of Health and Human Services, the Affordable Care Act will ensure that Americans will have access to quality, affordable health insurance.

To achieve this goal, the law ensures health plans offered in the individual and small group markets, both inside and outside of the Affordable Insurance Exchanges, will offer a comprehensive package of items and services, known as “Essential Health Benefits.”

Essential Health Benefits must include items and services within at least the following 10 categories:

1. Ambulatory patient services

2. Emergency services

3. Hospitalization

4. Maternity and newborn care

5. Mental health and substance use disorder services, including behavioral health treatment

6. Prescription drugs

7. Rehabilitative and habilitative services and devices

8. Laboratory services

9. Preventive and wellness services and chronic disease management, and

10. Pediatric services, including oral health and vision care

States will have the flexibility to select a benchmark plan for insurance coverage that reflects the scope of services offered by a “typical employer plan.” This approach is intended to give states the flexibility to select a benchmark plan that will best meet the health insurance needs of their citizens.

The health insurance plans must offer benefits that are “substantially equal” to the benchmark plan selected by the state and modified as necessary to reflect the 10 coverage categories.

Health insurance plans will have flexibility to adjust benefits, including both the specific services covered and any quantitative limits, provided they continue to offer coverage for all 10 statutory essential health benefit categories listed above and the coverage has the same value.

Dentists are deeply concerned how these changes will impact their dental practice.

Dentists who in the past have accepted a percentage of Medicaid dental patients understand all too well what it is like to deal with a government-run dental care benefit provider.

Medicaid dental care reimbursements have always been low, even before Medicaid began eliminating adult dental care from its benefit plan. Private employer dental insurance plans have offered dentists more new dental patients with better reimbursement rates.

More than 5 million children will become eligible for dental coverage under the Affordable Care Act and pediatric dentists are concerned the insurance changes implemented by the Act could result in fewer insurance companies offering dental health plans to families, thus leaving dental practices treating children with a state or government-based dental benefit plan.

The National Association of Dental Plans have made dentists aware of the rule that families who buy dental coverage on an Exchange may be subject to an annual out-of-pocket cost-sharing limit (possibly up to $1,000) for dental care.

This could have a very real impact on many dental practices’ bottom line.

The PricewaterhouseCoopers report “Patients or Paperwork” revealed that the Medicare and Medicaid “rules and instructions” are more than 130,000 pages (three times larger than the IRS code and its associated regulations), and “medical records must be reviewed by at least four people to ensure compliance” with Medicare program requirements.

No wonder dentists are concerned about federally-run health Exchanges.

The only thing certain about the Affordable Care Act is that its implementation will bring changes to dental care, dentists and their dental practices.

What are your thoughts on the future of dentistry and the Affordable Care Act?

To read more about the Essential Health Benefits see: HHS Informational Bulletin

Science Doesn’t Support Link Between Gum Disease and Heart Disease

Science Doesn't Support Link Between Gum Disease and Heart DiseaseThe American Dental Association (ADA) Council on Scientific Affairs agrees with the conclusions of a recent report that current scientific evidence does not establish a direct cause and effect relationship between gum disease and heart disease or stroke.

Additionally, the evidence does not establish that gum disease increases the rate of heart disease or stroke.

The report, which examined 537 peer-reviewed studies on the subject, was published this month in Circulation, the journal of the American Heart Association.

Although there is a body of research showing that gum disease is associated with several health conditions such as heart disease, stroke, and diabetes; just because two conditions are associated with each other does not mean that one causes the other. Both heart disease and gum disease share common risk factors, such as smoking and diabetes, which play a role in the development of both diseases.

The American Heart Association (AHA) report acknowledges the value of good oral hygiene to maintain good overall health but noted that current scientific data do not indicate whether regular brushing and flossing or treatment of gum disease can decrease the incidence of atherosclerosis, which is the narrowing of the arteries that can lead to cause heart attacks and strokes.

The ADA’s Council on Scientific Affairs, which is made up of ADA member dentists who are scientific experts, appointed a representative to the American Heart Association expert committee that developed the report. The ADA Council on Scientific Affairs then reviewed the report and agreed with its conclusions.

As a science-based organization, the ADA supports research on the risk, prevention, management and treatment of oral diseases, as well as research that helps clarify relationships that may exist between oral health conditions and systemic diseases. The ADA encourages patients to talk to their dentists about the role that good oral health plays in their overall health.

Gum disease is an infection of the tissues that support the teeth and is a major cause of tooth loss in adults.To avoid gum disease and maintain good oral health (including prevention of tooth decay or cavities), the ADA recommends the following to dental patients:

  • Brush teeth twice a day with an ADA-accepted fluoride toothpaste.
  • Clean between teeth daily with floss or an interdental cleaner.
  • Eat a balanced diet, limit between-meal snacks.
  • Visit a dentist regularly for professional cleanings and oral exams.

What are your thoughts on the recent reports that gum disease is related to heart disease?  Have you noticed this with your dental patients?

SOURCE: AHA statement: No causative link found between periodontal disease and heart disease. For more information about the ADA, visit the Association’s website at www.ada.org

Science Friday: Medicated Patch Fights Oral Cancer

As reported by Health News Digest, researchers at The Ohio State University Comprehensive Cancer Center have developed a medicated oral patch that allows a chemoprevention drug to be released directly into precancerous lesions in the mouth over an extended time.

In the study published online by the journal Pharmaceutical Research, Dr. Susan Mallery and co-investigator, Dr. Peter Larsen of Ohio State, tested a patch using simulated saliva as well as lab animals.

From the Heath News Digest article –

The study evaluated the drug fenretinide, a synthetic derivative of vitamin A that has highly promising anti-cancer properties. Until now, scientists have failed to achieve a therapeutic, systemic dose of fenretinide because of drug toxicity and rapid release from the body. By using a new mucoadhesive patch invented by a team from Ohio State’s Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC-James) and the University of Michigan, the researchers developed a delivery system that can provide continuous drug therapy to saliva-coated oral tissue.

In an online report published March 7 in the Journal of Clinical Oncology, the authors found an alarming trend: incidences of oral tongue cancer climbed 111% in young white females. This patch is an important step in fighting this rising cancer epidemic.

For more on this story see: Medicated Patch Shows Promise in Oral Cancer Prevention

Tooth Whitening Can Improve Seniors’ Dental Health

Dental health in elderly patientsNew research suggests that carbamide peroxide (a popular tooth whitening agent) may have dental health benefits for elderly patients.

Co-author Dr. Van Haywood remarked, “What we’ve noticed through whitening patients’ teeth over the years is that as they bleached, their teeth got squeaky clean and their gingival health improved.”

Custom-fit mouth trays with carbamide peroxide can improve tooth and gum health in patients who lack the dexterity for regular brushing and flossing, and can improve symptoms of dry mouth (xerostomia) as well.

Read more: Tooth whitening may improve oral health of elderly

Extra Weight Ups Risk of Gum Disease

New research from the Harvard School of Public Health has linked obesity with gum disease.

Obese men (with BMIs above 30) had a 25% higher risk of periodontal disease than men of normal weight (BMIs from 18.5-25). The correlation also held true for other measures of obesity, including waist circumference and waist-to-hip ratio.

It’s well-known that Americans are particularly prone to being overweight, and evidence suggests the obesity epidemic is only getting bigger. And that affects all aspects of public health – including dental care.

Read more about it


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