MID-LEVEL DENTAL PROVIDERS AND YOU
The train has left the station. The horse is out of the barn. The soufflé cannot be put back in the oven. It's a done deal. With access to dental care now being pronounced a major public issue, dentistry will find itself painted into a corner. The profession has little power to stop the future from happening.
After years of neglect by the profession, having paid only lip-service to the issue of access, focusing primarily on practice growth through higher and more expensive utilization, the public and the Federal and State governments are declaring loudly that dental access is a major public problem. The ADA and all component dental societies are now scrambling to get ahead of this curve. As a practicing dentist in private practice, you need to get it - you can't stop it.
One outcome, which is already well in the works, is the creation of midlevel dental providers capable of doing simple extractions, fillings, sealants and giving anesthetic. Resistance by private practice dentists will be strong. The cries to "protect the integrity of the profession" will be shouted. The "death and ruination of all that is sacred" will be pleaded. Most private practitioners will perceive it as a threat to their survival. It won't matter. It's going to happen.
Already happening in Europe and now in full expression in Minnesota, with the new health care legislation in Congress, the midlevel dental provider is a "time that's come." You have a choice. You can get ahead of this curve or end up behind it. It's up to you.
Some will see this new expression as an entrepreneurial opportunity. I am beginning to work with a few select clients to carve out opportunities using this force of change. As my Native American buddy, Robert Mirabal, always tells me, "Ride the horse in the direction it is going." I see huge opportunities for dentists who know how to own, manage and lead a business and not just make money bending over the chair.
In order for these entrepreneurial dentists to win in this new future, they'll need to think about practice and practice management in a different way. They'll need to transform themselves as owners and visionary leaders. They'll need to become much more community and socially committed to make this work; larger organizational structures, much more effective management, more personnel, greater efficiencies.
For those dentists who have become accustomed to top tier fee-for-service only, high utilization, high-end of the market, they'll have to realize that their market will drastically shrink, leading to fierce competition for far fewer patients. For those entrepreneurial dentists who decide to change, it will be challenging to rethink how to deliver dentistry through others and make it work in this different context.
The healthcare reform bill introduced on the floor of the U.S. Senate proposes to extend dental care to millions of currently uninsured children, to set up new oral health surveillance programs and to train new dental professionals. Included in this category of "dental professionals" are midlevel dental providers along with their respective pilot programs. The bill also proposes to adjust and regulate many other aspects of oral healthcare in the U.S. as well, but these new regulations will be a topic for a future eNewsletter.
Contained in the Senate's 2,000+ page bill are far reaching provisions that require health insurance plans to be offered in "public exchanges" to provide dental insurance for children. These exchanges would be government run. People would be eligible to participate in the exchanges if they don't currently have health insurance through an employer or public plan such as Medicare. Employers with 50 or fewer workers could participate. For most of you, your patients are employed within these small businesses.
The shocker is the current Senate bill includes a mandate that prohibits plans in these exchanges from requiring co-payments or any other type of "cost sharing" for preventive services. Children could get services such as cleanings, exams, consultations, fluoride treatments, and sealants without their guardians having to pay anything above the exchanges (government) premiums.
Multimillion dollar grants are being proposed for midlevel dental health care providers demonstration projects. Job titles they are considering as midlevel providers include advance practice dental hygienists, independent dental hygienists, supervised dental hygienists, primary care physicians, dental therapists, dental health aides, in addition to some additional classifications. Midlevel providers would be assessed for their wherewithal to increase access to dental health care services in rural and underserved communities.
As I understand it, one of the big players in this is the CDC (U.S. Center for Disease Control and Prevention) who is being asked to formulate a five-year oral healthcare prevention campaign with an emphasis on community water fluoridation and dental sealants. The CDC would be the agency empowered to award demonstration grants to research methods of managing caries.
The current bill also includes provisions that place a tax on high-cost health insurance packages which would cause employers to strip the packages of their dental benefits. Now for many dentists who depend on 3rd parties for part or all of their revenues, this could spell real trouble.
Will the legislation pass? Who knows? Will the changes proposed in dentistry occur? Absolutely! These changes will happen and they will change the face of dentistry. Resistance, confrontation, struggle, will do little good. Did it do any good against HIPPA or OSHA?
I am clear that those dentists who are willing to change and who are willing to look beyond their past, beyond their local needs and agenda can get in front of this change and make it work as a powerful business expression. But it will take a basic transformation in how these dentists envision dental practice, how they redefine the purpose of dental practice and its mission, and stretch themselves to develop a breakthrough business model where midlevel providers fully participate.
The first step toward change is awareness. The second step is acceptance.
-Nathaniel Branden
Recommendation:
I suggest you send this blog post to your dental health care colleagues and get the word out. And as always, I am available for coaching any dental professional through the uncertanties of the future to come out on top and continute to be successful.
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