Dental Care: Are Mid-Level Practitioners a Threat to Dentists?

Dental Care: Are Mid-Level Practitioners a Threat to Dentists?Can mid-level dentist practitioners give the same quality of dental care as a dentist?

This question is being raised in the Northwest where a Washington state dental practitioner bill passed through the Senate Health Committee.  The Senate version of this legislation moves out of committee and can potentially be considered by the full Senate.

If this bill passes in the Senate, Washington will be the next U.S. state to adopt a mid-level dental provider model to create both dental hygiene practitioners and dental practitioners, who will be supervised (offsite) by a dentist.

These practitioners will be allowed to provide various levels of dental care “pursuant to a written practice plan with a dentist.”

Dental hygiene practitioners would expand the scope of practice of the state’s hygienists, who can now place fillings after a dentist has done the prep work. They would receive specialized training to do extractions, handle medical emergencies, and administer some drugs.

Dental practitioners would be permitted to do everything that hygienists can do except scaling and cleanings. They could also do restorations, administer anesthesia, and extract primary teeth as well as loose permanent teeth (+3 to +4 mobility).

Both types of practitioners could work with offsite supervision if approved by their supervising dentist, but neither could do dental crowns, bridges, or complicated procedures. (Dr Bicuspid)

The Washington Academy of General Dentistry and the Washington State Dental Association oppose this bill siting, “insufficient training for diagnosis and a lack of direct supervision.”

What are your thoughts on mid-level dentist practitioners? Are they bad for dentistry?

For more: Washington Lawmakers Mull Dental Therapist Bills

Dentists Believe Affordable Care Act Is Really a Tax Increase

Dentists Believe Affordable Care Act Is Really a Tax IncreaseThe recent U.S. Supreme Court’s 5-4 ruling on the controversial Affordable Care Act upholds the healthcare provisions that established minimum health benefit packages and state health insurance exchanges that include pediatric oral health care.

The American Dental Association fought for increased pediatric coverage as part of the Act, including how the “essential dental benefit” for children would be defined.

But many dentists are also small business owners, and while the health care law offers a tax credit to some businesses with 25 or fewer employees, it will also fine businesses with more than 50 workers if they do not provide health care coverage.

Based on these facts, The Wealthy Dentist surveyed dentists to ask if they believe that the Affordable Care Act will help their dental practice.

“It sucks!” responded one Texas dentist, “Hidden in the 2700 pages are literally hundreds of tax increases by cutting deductions, raising or lowering limits to screw us out of more money as increased taxes.”

72% of the dentist respondents answered no, they think the Affordable Care Act will not help their dental practice. 9% felt it will be good for dentistry while the other 19% believe that it is just too soon to tell.

Percentage of dentists think the Affordable Care Act will help dentistry

Small businesses, like dental practices, are responsible for more than half the new jobs created in the U.S. each year. Included in the implementation of the Affordable Care Act are funds for “alternative dental providers” along with funding for training dental hygienists, which may further impact small dental practices.

Here are the dentists’ concerns —

“Are you kidding me? It may help increase my business expenses by requiring me to cover my employees and it may help to increase my taxes in order to pay for it. While I admit there are some limited ways in which it could help me personally I don’t imagine it could help my business at all.” (California dentist)

“This will put additional taxes on an already overburdened middle class! It will limit access to care as we don’t have sufficient doctors to take care of an additional 30,000,000 people. And seniors who have paid into social security and Medicare will see their benefits cut and costs go up. (If you have paid into social security and Medicare, these are not entitlements for you, but guarantees you were given by the government who is now reneging on their promises.)” (Texas dentist)

“This puts us on a track for all dentists to soon be working as governmental employees.” (Louisiana dentist)

“I believe that the increased tax burden on all Americans that directly results from this Act will significantly reduce discretionary dollars for virtually everyone, and will eventually lead to a single payer system that will be even less efficient and more wasteful than the current system. The shame of it all is that care will be rationed and take longer, just like in Canada and Europe. People in the USA will be shocked to learn that just because procedures and techniques exist to treat their medical and dental issues, the “free” insurance will frequently not cover them. Just like every other country that has adopted a similar system, some bean counter will determine if the correct return on investment exists for the government to “allow” you to be treated. It is still true that there is no such thing as a free lunch!” (Illinois dentist)

“Please keep dentistry out of it! It is bad enough that dental insurance is attempting to dictate fees.” (Oklahoma dentist)

“People will be tuned in even more to the idea that everything should be paid for by insurance. On the other hand, the current system is broken and crazy. I hope we aren’t just trading it for more broken, crazy, and unaffordable.” (Washington dentist anesthesiologist)

“It was conceived way too fast. With very little advice from health care professionals.” (General dentist)

“The most interesting comment was that made by Chief Justice Roberts himself, when he said that the voters choose their elected representatives who pass the laws, and it is not the duty of the Supreme Court to rescue the public from the consequences of their own decisions. In other words, the Chief Justice is telling the public to grow up, take the blame for electing bad legislators, and if we don’t like what those elected officials do, it is our own duty to throw them out of office and elect candidates who will vote in accordance with the public’s wishes. We can’t rely on the Supreme Court to correct our own mistakes; we have to do that ourselves. Chief Justice Roberts’ message is a wake-up call to all of us.” (California dentist)

What do you think will fix the current healthcare system? Dentists, we’d love to hear more from you on this subject.

Dental Practice Management Still Alive in North Carolina

Dental Practice Management Still Alive in North CarolinaThe North Carolina Senate agreed on a compromise in dental legislation approved by the House regarding Senate Bill 655, a controversial bill aimed at tightening rules on dental management organizations in N.C.

The newly compromised legislation will require the State Board of Dental Examiners to adopt rules giving greater regulatory oversight of the contracts that dentists reach with the management companies in the future.

Part of the measure will require dental management contracts to include warnings encouraging dentists to obtain legal advice before signing them.

The compromise between the parties involved was reached after months of negotiations involving lobbyists, political leaders, and heavy spending on TV ads. Other states with similar dental management organizations have been watching how North Carolina would rule on this bill.

The Senate hopes the bill will clarify the existing dental law in N.C. and reduce litigation with the state dental board, which currently reviews all dental management contracts that dentists sign in North Carolina.

However, the bill still neglects to state exactly how dental management agreements would be scrutinized further.

A six-member task force, which includes two representatives from dental management companies, have been selected to make recommendations to the N.C. dental board, but the board still doesn’t have to follow their recommendations.

The task force is an attempt to ensure proposed rules will promote dentistry and alternate business models within the industry, according to Tom Fetzer, a former Raleigh mayor, ex-state Republican Party chairman.

The legislation is due to be signed by the N.C. Governor this week.

What are your thoughts on Senate Bill 655 and what has happened in North Carolina?

For more on this story see: NC Dentist Group, Office Managers Reach Agreement

Whose Responsibility Is It to Provide Affordable Dental Care?

Whose Responsibility Is It to Provide Affordable Dental Care?Vermont U.S. Sen. Bernie Sanders and Maryland Congressman Elijah Cummings have introduced Senate and House bills that would expand dental care coverage under Medicare, Medicaid, and the Department of Veterans Affairs for millions of Americans.

The Comprehensive Dental Reform Act of 2012 aims to increase spending to expand oral health providers in under-served communities, boost oral health care literacy, provide affordable dental care, and fund dental research programs.

Even though the U.S. government is in a fiscal crisis, Sander’s legislation proposes to provide and incentive to states to make Medicaid participation more attractive to dentists by boosting the federal government’s contribution by 10%.

Sander’s plan to offset costs is to create a new dental program in Medicare that would provide coverage to all beneficiaries, including those who can pay, along with a 2.5¢ tax on security transactions.

Think about this for a minute folks . . . a “securities transaction tax”?  This is means every time you buy a stock, use an ATM machine or cash a check . . . you may be facing a new tax.

Also included in the bill is a oral health professional student loan program for the training and employment of alternative dental healthcare providers. I think this “government-speak” for “non-doctor” providers . . . fill in the blank.

The American Dental Hygienists Association (ADHA) has come out in strong support of the bill along with the American Dental Association (ADA) who has written to Sen. Sanders to express their support for much of the bill. Go . . . Go . . . ADA!

“The ADA is pleased that Senator Sanders’ bill recognizes that the barriers that impede too many Americans from attaining good oral health are numerous, and that addressing only one or a few of them will not appreciably improve what all agree is an unacceptable situation. The ADA has written to Sen. Sanders to express support for much of the bill and to offer suggestions intended to strengthen some provisions, but also to express the Association’s continued opposition to expending precious federal dollars on unproven and, we believe, unnecessary programs to expand the use of so-called mid-level dental providers.”

“We hope that our few areas of disagreement do not obscure our welcoming Sen. Sanders to this fight. His bill aims high, and that has long been needed. We fully support his intent, to help extend good oral health to all Americans, and we applaud his leveraging his influence as a United States senator in pursuit of that goal.”

What are your thoughts on the Comprehensive Dental Reform Act of 2012?

To read more about this bill see: U.S. Lawmakers Propose Sweeping Dental Reforms 

North Carolina Bill 655 Reveals Divide Over Dental Practice Management

North Carolina Bill 655 Reveals Divide Over Dental Practice ManagementOver the past month, The Wealthy Dentist has been covering the North Carolina Dental Management Bill 655 and the reactions by dentists on both sides of the debate.

The bill, which is heavily supported by the North Carolina Dental Society and their state dental examiners board, attempts to place tougher restrictions on dental management companies.

Opponents argue that dental management companies help dentists with expensive dental practice start-up costs and dental practice management operations which allow dentists to spend more quality time with their patients.

The bill attempts to toughen a state law that stipulates how dentists own and control their dental practices.

Last week, the Obama administration joined a list of big-name Republicans like Jeb Bush, Bill Frist, Haley Barbour, and Tommy Thompson, in opposition to the bill.

The bill already passed the North Carolina Senate and now rests with the House, where leaders have stalled in their decision about the bill and its potential repercussions to dentists.

No other state in the union has attempted to implement such restrictions on dental practice management, or sought such inclusive authority over how dentists manage their business.

Fueled by the recent reports of several dental management companies coming under scrutiny by authorities in five states to investigate allegations of excessive Medicaid billings, attention has now turned to North Carolina Bill 655.

Lisa Ward, director of government affairs for the North Carolina Dental Society told Bloomberg News, “They’re looking at North Carolina as their test case and they’ll do anything they can to win here.” Yet Ward herself has admitted hiring five lobbyists and spending about $400,000 in support of the bill.

The Federal Trade Commission is against the bill and backs the use of dental management companies. They expressed concern that the regulations in the North Carolina Bill could reduce the number of dentists practicing in under served communities throughout North Carolina.

A recent The Wealthy Dentist survey revealed a major reason dentists would not choose dentistry again is having to deal with the management aspect of their dental practice. Dentists want to practice dentistry.

Having a dental management company manage the administrative part of their practice allows dentists to do what they were trained to do: be a dentist.


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