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.

Dental Practice Management Is Being Threatened in North Carolina

Dental practice management is being challenged in the North Carolina legislature.

Last year, The Wealthy Dentist twice reported on the story of the North Carolina Senate Bill 655 that would require the North Carolina Board of Dental Examiners to examine all business contracts entered into by dental practices in their state.

Our first article, Dentists Beware: The Government May Want To Tell You How To Manage Your Practice detailed information concerning inclusive authority over how dentists manage their business.

The second The Wealthy Dentist article, Dental Practice Management: North Carolina Senate Bill Wants Dentists To Do It Themselves discussed the dentists’ responses to the impact this bill could have on their dental practices.

The measure has already passed the state Senate and has moved on to the House, where leaders have appointed a special interim committee to study the bill and its potential repercussions to dentists.

Reports have surfaced that the legislative proposal likely to be heard this May. The basics of the bill is intended to restrict contracts dentists can build with dental service organizations and give the Dental Board control of how dentists in North Carolina run their practices.

With much at stake for dentists and dental management companies who oppose the bill, many have joined forces to form the Alliance for Access to Dental Care, a group lobbying the legislature to stop the bill, while the The Dental Society’s political action committee, a lobby for the North Carolina Dental Board, is spearheading support for the bill.

Both sides have spent considerable sums of money lobbying on their own behalf.

As the debate heats up, both recently released TV advertisements supporting their positions —

The Dental Society –

The Alliance for Access to Dental Care –

The North Carolina Office of Research, Demonstrations and Rural Health Development reports that there is a severe shortage of primary health care providers in North Carolina, particularly in the State’s rural areas.

Will limiting the ability for dental management companies to work with dentists in North Carolina further strain access to dental care?

Opponents to the bill believe if the current legislation passes, it will force some dental practices to close, put people out of work and limit dental care access for many families across North Carolina.

Whereas those in support of the bill argue that the legislation is necessary to block for-profit, investor-owned corporations from negotiating service contracts that, in their opinion, take ownership and control of dental practices away from licensed dentists in North Carolina.

What are your thoughts on dental practice management companies? Are they a help to your dental practice, or do they allow large corporations to unfairly compete with dentists?


Dentist Update: 28 States Considering Legislation on Dental Insurance Fee Capping

Dental insurance fee capping
Our latest survey revealed that 98% of dentists oppose dental insurance companies setting fees for services they do not offer. [Check out the insurance fee setting survey results]

Known as fee capping, this practice has upset dentists nationwide – and legislators have taken notice. According to the AGD, this year, “a total of 28 states introduced 46 pieces of legislation to stop insurance carriers from requiring dentists to accept caps on fees for services the carrier does not cover.

It would seem that more and more dental insurance carriers are moving into the arena of discount dental plans. The insurance companies are trying to negotiate discounts on services they don’t cover. Perhaps they’re getting ready to try both sides of the equation?

It’s important to note that discount dental plans are monitored separately from dental insurance plans. I don’t know what will happen, but I expect it will be interesting…

The AGD provides additional explanation:

Putting Caps on Fees for Non-Reimbursed Services

Several major dental benefits carriers are adding language to provider participation agreements to allow them to set fees for dental services that they do not pay for, i.e., non-covered services. That is, if a dentist agrees to the contract language, he or she will be required to charge the patient what the carrier has told him or her to charge even when the carrier will not pay for the service.

To enact a fee cap on non-covered services, a dental benefits carrier must amend the current contract it has with its existing providers. Here’s an example of such an amendment:

Dentist may bill a Member for non-covered services (which are defined as any service for which no payment is made under the applicable plan or arrangement for any reason, including but not limited to, services in excess of contractual maximums, services not covered under plan design, and services denied due to contractual limitations). Dentist’s charge to Member for non-covered services may not exceed the Maximum Allowable Charge for the applicable CDT code as specified in the most current Maximum Allowable Charge schedule. Fees for all non-covered services will be collected from the Member, and not billed to the Carrier.

Note that this is just one of many variations of such a provision that you may find in your participation contract. The provider then has the choice of signing the new contract, thus accepting the new fee caps, or terminating his or her contract. If the provider elects not to sign, then he or she will be excluded from the provider networks presented to patients by that carrier’s dental plans.

What are the non-covered services?

Non covered services are those services that a patient’s dental plan has chosen not to pay for. Note that a carrier may offer numerous dental plans. Often however, dental plans without coverage for expensive, cosmetic, or other dental services are cheaper for employers to purchase for their employees. This is especially attractive to employers in the current economic climate. Each dental plan may have a different list of non-covered services, and therefore one cannot specify any particular services as universal ‘non-covered services.’

Rationale of carriers enacting such policy

To stay competitive with one another, dental benefits carriers use the argument of market pressure or gaining a marketing advantage as one of the reasons they are implementing this policy. Market need, the carriers assert, is being driven by patients who can save money on services not covered by their dental benefits plan and see value in limiting their out-of-pocket expenses. However, limiting dentists’ charge to patients for non-covered services allows these carriers to market their dental plans as costing patients less without bearing any of the financial risk of the discount; that is, these carriers gain the marketing advantage by shifting the risk to the providers. Therefore, the market trend will drive all carriers to implement similar restrictions in order to avoid a competitive disadvantage. Accordingly, any legislation enacted against the practice of fee-capping for non-covered services must be sufficiently broad to prevent all carriers from engaging in this practice.

Impact to Patients and the Practice of Dentistry

As primary care providers of oral health care, general dentists strive first and foremost for access to quality care for all as the ultimate goal of the profession. However, to serve its patients, a dental office must be viable and sustainable. Today, more patients than ever rely upon dental insurance to be able to afford oral health care. Studies have shown that, without dental insurance, far fewer persons will choose to see a dentist. Understandably, in the present economy, each of us must make cutbacks to our expenses in order to survive. Public awareness and understanding of the impact of oral health on systemic health issues such as diabetes and cardiovascular afflictions is still at its fledgling stages. Therefore, out-of-pocket expenses for oral health are often among the first to be avoided by the public.

Concurrently, businesses including those of dental benefits carriers and employers are also seeking cutbacks. Carriers striving to maintain or increase their revenues and marketshare in this economy offer employers cheaper plans for their employees by covering fewer services and paying less than true market value even for those services they cover. However, by covering fewer services, carriers compel patients to pay for more services out-of-pocket, which they may be unable or unwilling to do. Second, by paying less for the services they do cover, carriers compel dentists to function at a net loss when providing these covered services.

Therefore, today’s dentist must often rely upon billing at market rates for non-covered services to compensate for the loss he or she absorbs in accepting paltry fees from carriers for covered services. However, unlike the carriers’ actions of limiting services they cover, the dentists’ actions do not impose an undue burden upon patients. Here’s why. In the absence of fee-caps for non-covered services, dentists work with each patient on a case-by-case basis to charge what each patient may be able to afford with an understanding that some patients may be able or willing to afford more than others.

Fee capping takes away this opportunity! If fees for non-covered services are capped across the board without regard to what each patient can afford, the practice of the participating dentist may become unsustainable. The result may be two-fold. He or she may no longer be able to offer that specific service to that carrier’s patients, thus limiting the patients’ treatment options. In some markets, providers may feel compelled to stop participating with certain carriers in order to survive. In either case, the patients would face decreased access care.

Call to Action

AGD is currently tracking legislative activity in all states, including fee capping legislation. To see whether your state has a fee capping bill, please click here. The AGD’s Legislative & Governmental Affairs Council and the Dental Practice Council have also approved a legislative lobbying guide called a ‘toolkit’ for AGD constituents. The toolkit will help constituents push the passage of state laws to stop insurance companies from capping fees for services they do not cover. The AGD asks you to contact and work with your constituent organizations to help them use the toolkit to lobby for these state laws. Several states have already introduced legislation to prohibit fee capping by insurance carriers; AGD members are asked to contact their legislators to encourage them to pass this legislation. Click here to see if your state has an action alert on fee capping, or to find your state’s elected officials.

AGD Advocacy: Caps on Fees

Dentists: what are your thoughts on the subject?


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