KDA Today

KDA Today

For Immediate Release

Date: Feb 12th, 2013
Contact: Dr. Ken Rich
Phone: 800-292-1855
Email: info@kyda.org

A Profession in Flux

Now, more than ever in my experience, our profession is under assault by more forces that will more significantly than ever before, change what we do, who we are and how we practice.  These changes are being driven mostly by economics.

Healthcare accounts for 25 percent of our national budget.  This makes the U.S. government the largest payer of healthcare services in the country.  This budget item continues to grow, annually.  By all accounts, the U.S. has the most expensive healthcare system in the world, but that does not necessarily mean that we have the best.  

Healthcare spending in the U.S. is on an unsustainable tract.    As a result of this and the impact of the Accountable Care Act (ACA), our profession is sure to be affected. 

Dentistry, like the rest of the healthcare delivery system, will enter the era of “accountability.” 

Medicine has defined six “domains of healthcare,” which will be used to look at health care quality comprehensively. 

These domains define health care that is:

  • Safe — avoiding injuries to patients from care that is intended to help them
  • Timely — reducing waits and sometimes harmful delays
  • Effective — providing services based on scientific knowledge and refraining from services not likely to benefit
  • Patient centered — providing care that is respectful or responsive to individual needs
  • Efficient — avoiding waste
  • Equitable — providing care that does not vary regardless of personal characteristics

It is unclear how soon or to what extent outcomes-based financing will impact dentistry, but it will happen. Once this systems change occurs, dentists will transition from being paid for doing procedures to being paid for improving oral health.  In order to accomplish this, there are many wheels that must be set in motion. 

Data will drive the system.  At this point, data on oral health care is very closely held and the profession has very little of it.  The majority of this data is held by dental insurance companies, both private and governmental. This data is mostly claims-related, which has limited use when trying to measure “health outcomes”   Insurance companies consider this data to be proprietary.

Large corporate practices and not-for-profit clinics also collect data in order to increase their effectiveness and profitability and/or to document their progress, which is invaluable when applying for grants. The premise is that healthy patients have lower healthcare costs, and that data can define efficiencies in the system.  

In order to measure the effect treatment has on health, a system of metrics is being developed.  Medicine has had such a system for several years and it is continuing to evolve.  Dentistry has just started down this path.  The system will require codes for diagnosis and measuring outcomes, which will help answer the question “Did the patient’s condition improve or not and to what extent?”   Presently, the ADA and a coalition of oral health stakeholders, known as the Dental Quality Alliance (DQA), are developing and testing measures that will quantify outcomes.  The first set of measures is very basic. These were requested by the Centers for Medicaid and Medicare Services (CMS) for use in Medicaid.  It will take several years to come up to speed with these. 

This transition will also require diagnostic codes.  Dentistry already has a set of diagnostic codes known as SNODENT (Systematized Nomenclature of Dentistry); these have been integrated into the ICD10 codes used by medicine.    

The system will require such tools as a caries risk assessment, an electronic dental health record, additional evidence-based dentistry models of practice, a paradigm shift from disease treatment to disease management and ultimately a definition of oral health.  To date, there are multiple versions of each of these tools. At some point, there will have to be a standardization of metrics used in the system.  This too will take time as both the politics and the profit potential are worked out as well as the ability of the provider to be paid for such things as disease management and what is being termed “active prevention”

Yet another modality on the scene is the Accountable Care Organization (ACO). These organizations are responsible for improving the health of a population of patients and insurance companies will/do reimburse based upon the measurable effect on the health of a population.

Some of these companies claim to already have the capacity to measure the effect of oral health on total health.   This is another example where the need for metrics is outpacing our ability to develop a standardized code set for measuring “outcomes.”

Most, if not all, of these changes are being driven by economic forces.   Again, a healthy patient along with efficiencies in the system will decrease the cost of healthcare.

The ADA is involved with the development of many of the pieces of the new system that is being developed.  The Council on Scientific Affairs is heavily involved with the development of the electronic dental health record and with evidence-based dentistry.   The Council on Dental Benefit Programs involved with the creation and standardization of measures through the DQA. 

Delivery systems are also changing with the growth of large practice models, many of which are owned by corporate entities.  This segment of the dental delivery system is growing at a rate of 15 to 20 percent a year.  These large practices enjoy an efficiency of scale and ability to negotiate with insurance companies, dental suppliers and other administrative services. They rely on data to assure their profitability and efficiency.  These practice models appear to be very attractive to a large portion of dental school graduates, who are seeking opportunities beyond the traditional private practice model.  Employment within a large multi-state corporate practice offers portability or the ability to move from state to state without worrying about selling a practice.  New graduates have no need to borrow more money for equipment or to start their own business.  In a system with limited funds, the most cost-effective delivery system will most often be the one that survives.

The demographics of the potential ADA membership pool are changing.  Of the five thousand dentists graduating per year, according to the ADA 2010-2011 Survey of Dental Education*, nearly half are female, 58 percent are white with the other 42 percent being ethnically or racially diverse.   The demographics of the average class show that they are much more diverse than ever before.  Few people live in the same town or city all their life and few hold the same job till retirement.  More are becoming employee dentists rather than business owner dentists.  

The issue of changing practice models and that of diversity pose possibly the greatest challenge to the American Dental Association.   Our membership is increasingly becoming less reflective of the profession or the population.  The needs of the profession are also becoming more diverse.  The ADA leadership is and will increasingly face the challenge of providing “member value” to a profession that will continue to become more diverse.  Their efforts will be confounded by a governance model that is large, slow to respond, and also does not mirror the profession, despite the sincerity, dedication and earnestness of those who make it up. 

By now, I’m sure many have asked, “Why does dentistry want to be involved in this “madness?”

To quote Dr. Marko Vujicic, health economist at the ADA, “You can never outrun the economics.”

To do nothing is an option, but to do so is to let someone else determine our future.

This data-driven system is being developed.  We are a profession of oral health providers, who consider ourselves to be the authority on oral health.  As such, we have a responsibility to develop a system, given the environment that will enable us to provide the highest possible quality of oral health care to our patients. To do this we must be relevant to our profession, which is our membership.

The technical expertise and resources necessary to address all of these issues are housed at 211 East Chicago, IL, home of the ADA. 

The concern is whether or not we have the will to do so. 

 *Source ADA 2010-2011 Survey of Dental Education, Academic Programs, Enrollment and Graduates, Volume 1

Now, more than ever in my experience, our profession is under assault by more forces that will more significantly than ever before, change what we do, who we are and how we practice.  These changes are being driven mostly by economics.

 

Healthcare accounts for 25 percent of our national budget.  This makes the U.S. government the largest payer of healthcare services in the country.  This budget item continues to grow, annually.  By all accounts, the U.S. has the most expensive healthcare system in the world, but that does not necessarily mean that we have the best.  

 

Healthcare spending in the U.S. is on an unsustainable tract.    As a result of this and the impact of the Accountable Care Act (ACA), our profession is sure to be affected. 

 

Dentistry, like the rest of the healthcare delivery system, will enter the era of “accountability.” 

 

Medicine has defined six “domains of healthcare,” which will be used to look at health care quality comprehensively.

These domains define health care that is:

Press Releases

Click on any title below to read the press release. The release will open up in a new browser window with no menus or images, so that you may print or copy the press release without extraneous graphics.

Aug 21st, 2014KENTUCKY HEALTH NOW: The GOALS of our GOVERNOR
Aug 21st, 2014Synergy
Aug 21st, 2014Nobody Goes Into Dentistry Because They Love Molars!
Aug 21st, 2014Your KDA is Working Hard for You!
Jun 16th, 2014YOU HAD TO BE THERE!
Jun 16th, 2014Think Big. Think Positively. Think Proactively.
Jun 16th, 2014Denigration
Jun 16th, 2014New Friendships and Lasting Connections Creating a Stronger Interest in Organized Dentistry
Jun 16th, 2014New Friendships and Lasting Connections Creating a Stronger Interest in Organized Dentistry
Apr 24th, 2014I Only Have A Loose Screw!
Apr 24th, 2014The Dentist’s Guide to Social Media Marketing
Apr 24th, 2014I am the KDA! You are the KDA! WE are the KDA!
Apr 24th, 2014Dare to Dream!
Feb 20th, 2014Where Do We Go From Here?
Feb 20th, 2014Medicaid: An Example of Missing the Goals for Oral Health in Kentucky
Feb 20th, 2014UKCD’s First Regional Dental Program: The First Ten Years
Feb 20th, 2014UofL Brightening the Smiles of Children
Feb 20th, 2014Go Tell It on the Mountains
Dec 23rd, 20132014 Kentucky Meeting Details
Dec 23rd, 2013Welcome Dental Students and New Dentists!
Dec 23rd, 2013Listen to Interviews with our Speakers!
Dec 23rd, 2013Dr. John Thompson Awarded Distinguished Editor Award
Dec 23rd, 2013It Is What They Left Behind
Dec 23rd, 2013Letting the Secret Out
Dec 23rd, 2013Teamwork Creates Champions: the Kentucky Meeting: March 13-16, 2014
Oct 17th, 2013I Still Like Maps!
Oct 17th, 2013Ground Game
Oct 17th, 2013Kentucky Department of Insurance, HB 497 and Non-covered Services
Oct 17th, 2013Dr. Janet Faraci Lee Leadership Development Award
Oct 17th, 2013Dr. Janet Faraci Lee’s Legacy
Aug 12th, 2013The Affordable Care Act: What does it mean for Our Members?
Aug 12th, 2013All Membership Is Local
Aug 12th, 2013White Crosses
Aug 12th, 2013KDA Membership…Where Do We Go from Here?
Aug 12th, 2013Thoughts from a New Dentist: the Top Three Reasons that I am Involved with Organized Dentistry
Aug 12th, 2013How can KDAIS Benefit You, as a KDA member?
Aug 12th, 2013Beyond the Website: Marketing on the Modern Web
Aug 12th, 2013Delinquent Accounts….Collections…..YUCK!
Aug 12th, 2013Every Patient Matters. So Does Every Transaction.
Jun 13th, 2013Preaching to the Choir
Jun 13th, 2013Something I Wish I Didn't Know!
Jun 13th, 2013The Foundation of the Kentucky Dental Association: Positioned to Make a Powerful Statement
Apr 15th, 2013United We Stand, Divided We Fall
Apr 15th, 2013So Long, Farewell, Auf Wiedersehen, Adieu
Apr 15th, 2013Exchange What?
Apr 15th, 2013The Pediatric Dental Benefit: Must Offer, May Purchase…
Apr 15th, 2013Participate in Your KDPAC! Contribute and Deliver
Feb 12th, 2013It’s a Dentist Thing
Feb 12th, 2013A Profession in Flux
Feb 12th, 2013Living Is What You Do When Life Gets In the Way
Feb 12th, 2013The Tip of the Iceberg: Actions by the Kentucky Department for Medicaid Services Which May Sink KMAP
Oct 19th, 2012Self-Regulation
Oct 19th, 2012House Bill 1 and What It Means to You
Oct 19th, 2012Membership Matters
Aug 21st, 2012Sarrell Dental: Beyond the Operatory
Aug 21st, 2012The Perception of Dentistry
Jun 18th, 2012I Had an Uncle…
Jun 18th, 2012What Part of the “Affordable Care Act” Has Been Affordable?
Jun 18th, 2012Leadership or Politics?
Apr 6th, 2012The "New Old" Still have Teeth
Apr 6th, 2012What a Year, so far!
Apr 6th, 2012Many Thanks for a Great and Memorable Year
Feb 21st, 2012All for One and One for All!
Feb 21st, 2012Happy New Normal
Dec 19th, 2011Access to Care?
Dec 19th, 2011The Wide World of Sports
Oct 28th, 2011To the KDA Executive Board and the entire KDA
Oct 28th, 2011Report of the Sixth District Trustee
Oct 18th, 2011Managed Care and Dentistry in Kentucky: a Dentist’s Dilemma
Oct 18th, 2011Word-of-Mouth on Steroids!
Oct 18th, 2011Why We Shouldn't Lose Sight of Our Purpose...
Aug 4th, 2011Mentor a Young Dentist and Change a Life
Aug 4th, 2011OMG, what is EBD?
Aug 4th, 2011CAPWIZ: Legislative Advocacy Made Easy
Jun 13th, 2011Outside Our Line
Jun 13th, 2011I Might Soon Be Coming to a Town Near You...
Apr 18th, 2011On Your Side, Not Your List
Apr 18th, 2011Blindsided
Apr 18th, 2011I Pledge to Be your Humble Servant…
Apr 18th, 2011Let Me Ask For a Minute of Your Time
Feb 17th, 2011Dr. Andy Elliott for President-elect of the American Dental Association
Feb 4th, 2011A Little Planning Really Helps
Feb 4th, 2011Adjusting Attitudes
Jan 4th, 2011Dental Management of Patients Taking Antiplatelet Medications
Nov 30th, 2010Dental Education Found Worthy
Nov 30th, 2010Delegates Report from the 2010 American Dental Association House of Delegates, Orlando, Florida
Nov 30th, 2010Holiday Greetings to All
Oct 25th, 2010Delegates Report from the 2010 American Dental Association House of Delegates, Orlando, Florida
Oct 7th, 2010What Happens in Alaska, doesn’t Stay in Alaska
Oct 7th, 2010We Need To Do a Better Job of Communicating
Oct 7th, 2010What If …?
Oct 7th, 2010I’m in a Hurry!
Oct 7th, 2010Who Will Speak for Me?
Aug 6th, 2010Kentucky's Dental Practice Act: The Passing of an Old Friend
Aug 6th, 2010The Times They Are Changing
Jun 10th, 2010How a Star was Born
Jun 10th, 2010I Need Your Help…
Apr 20th, 2010KDA and Louisville Water Company Share 150th Birthday and Public Health Vision
Apr 20th, 2010President's Message MA 2010
Apr 20th, 2010Getting It Right!
Feb 25th, 2010Please Join Us for an Exciting, Event-Filled Year Ahead!
Feb 25th, 2010What is a Legacy?
Dec 14th, 2009Holiday Reflections…
Dec 14th, 2009Challenging the Myth of the Suicide-Prone Dentist
Dec 14th, 2009There is Hope: Suicide Awareness and Prevention in Kentucky
Nov 6th, 2009Break your Right Arm and Suddenly You have Time to Study Economics.
Nov 6th, 2009Don’t Balance Health Care Books by Shortchanging Physicians
Jun 26th, 2009Making the World a Better Place, One Village at a Time!
Apr 13th, 2009Breaking Glass
Feb 20th, 2009At the Heart of any Worthy Project is a Committed Volunteer