Is Value Based Dentistry Right Around the Corner?
There’s a need more than ever for value-based dentistry. Simply put, this type of care focuses on being proactive with prevention versus reactive. When patients are motivated to be healthier and providers are incentivized for keeping them healthier, then dental care can begin to tie back to its bottom line — to keep patients healthy. Not to mention, less money spent on chronic care could mean a significantly reduced overall cost of healthcare for society as a whole.
What is value-based care, you ask? It’s a healthcare delivery model where providers are paid based on patient outcomes.
Yet the question remains for me: What's the incentive for the dental community to get the patients to be healthier when providers, DSOs, hospitals technically financially benefit from them being unhealthy? Is it nothing other than morals and ethics? This conversation has been going on in the dental industry for quite some time and I’d love to discuss it.
Dental Care and Healthcare are Changing
Reimbursement in medicine is changing and it’s time to start looking at value-based healthcare as a viable option to keep Americans healthy and happy. As my good friend Dr. Marko Vujicic, Chief Economist for the American Dental Association, said in his article appropriately titled, Our Dental Care System is Stuck, “The current dental care delivery and financing model will not drive significant, sustained improvements in oral health going forward like it did in the past, particularly for key segments of the population. We are stuck. And the changes needed to get unstuck are not tweaks, but major reforms.”
When a dentist graduates from dental school they pledge that they’ll do the best they can to treat their patients with their overall well-being in mind. They vow to make their patients healthier, which educating them along the way. After all, in Latin, "doctor" evolved from the Latin word "docere," which literally means to teach. Yet, there is no incentive in the current healthcare system that financially incents practitioners to actually do this. Instead, dental providers that are paid on a percentage of their overall collections are compensated more when their patients are unhealthy and, progressively get unhealthier. There is no clear incentive (other than ethics) for providers for keeping their patients healthy.
From a DSO perspective, there’s even less money to be made when patients don’t constantly need restorative care. Even the most morally sound dentist can’t seem to easily escape this conundrum. Eventually, it’s going to come back to bite them because the DSO leadership is going to say, “Look, your practice is performing ok, but you’re at the bottom third of the performance dashboard in comparison to other providers, how can we change things and make you better?” That’s when it comes down to making patients who are slightly unhealthy but working to get healthy, even more unhealthy — because the reality is, the providers in healthcare who make a lot of money perform a lot of procedures.
For example, say a newly graduated college student goes to the dentist after not going for a few years and discovers they have gingival inflammation. The altruistic side of a dentist wants to call that an anecdotal situation and empathize with them. They’d do a “bloody prophy” or a D4346, see them back in three to four months, help the patient re-discover flossing, and then if all goes well, put them back on a six-month recall cycle. In reality, what more frequently happens is that the patient is diagnosed with early stages of periodontal disease, quoted $1000 for a deep cleaning, and is shamed into starting treatment.
We need to go back to why we got into medicine and dentistry in the first place, to help patients get (and stay) healthy!
Aligning with Value-Based Healthcare
The real question is: How do you align the payment model, incentives of providers and insurance companies with value-based healthcare?
Right now insurance companies, in a non-value based model, pay for procedures when they need them. What if, for example, providers were able to provide care as needed and insurance would reimburse them over the next few years as they provided supplemental care, assuming that the patient stays healthy? The focus then shifts to overall well-being and not just selling a patient a procedure because it puts more money in someone’s pocket.
The NEJM Catalyst has mentioned this value-based model can help align patients and providers as well. When the focus shifts from chronic disease management to prevention-based services it also shifts the amount of care needed from volume to value. Overall, this can improve care quality and patient satisfaction.
Is value-based dental care far fetched?
The value-based system has already made its way to medicine, but can it work for dental care too? The dental industry is resistant to the idea because it deviates away from the traditional reimbursement models and what dentists have grown to find “comfortable.”
As things stand, I believe that what the dental industry needs is disruption in order to see improvement in things like the percentage of adults with periodontal disease, caries incidence, etc. I’d love to promote some healthy discussion here and get your thoughts on this.