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We like to think each New Year presents an opportunity for a fresh beginning. But, for dental business owners, who’s to say whether the road ahead will be easy to negotiate, or one filled with obstacles? Insurance models, payor-provider relationships and reimbursement rates may change drastically as the year progresses. By educating themselves about the politics driving the industry, and actively recruiting talented team members, providers can help prepare themselves to address (almost) every issue that comes their way.
Efficiency in Group Practice polled the experts for their thoughts regarding the evolving healthcare landscape, the impact it will have on dental providers and how best to address these changes.
Aligned incentives
The coming year very well may open the door for a “closer partnership between payors and providers to better align incentives,” says Tom Nance, CEO, Benevis. “These innovative payment models – common in the medical arena for years – will become more prevalent in dentistry. This evolution will move us away from the traditional fee-for-service model and toward pay-for-performance, such as value based purchasing (an approach by which payors reward providers with increased incentives and patient steerage for superior patient outcomes and cost performance).
“We are also seeing this closer payor-partner relationship leading to vertical integration, where payors and providers merge into one organization, with fully aligned incentives and a goal of efficiently providing improved outcomes to patients,” he continues.
Navigating these changes will require some work on the part of providers, Nance points out. “More comprehensive data and insight on patient outcomes and costs will be required, as practices adapt to an evolving payment model,” he says. “We will see this first in Medicaid-focused DSOs, where there is a much greater concentration of payors; but, eventually the need to improve outcomes and lower costs will drive this change throughout the entire dental industry. Those practices that have focused on providing high-quality, clinically appropriate care, leading to better patient outcomes and lower costs, will be the ones who benefit the most initially. In the long term, the winners will be of improved patient outcomes are, [and can use this knowledge to] create a culture that is focused on these drivers.”
DSOs, such as Benevis, will be available to support their practices through the transition, says Nance. “DSOs can add value by investing in the systems and processes that provide visibility into the measures that efficiently deliver improved patient outcomes. Furthermore, they can work with providers to create the desired culture based on what is measured, recognized and rewarded.”
Dental practices that have invested in their infrastructure will be more prepared to embrace change and “emerge stronger in 2017,” he adds. A key move will be to “expand the dental office to a dental home, which offers a full range of services. Dental practices will be tasked with offering a range of services in addition to general dentistry, including oral surgery, endodontics and orthodontics, in order to attract and retain patients, he notes. “Effective scheduling and support to ensure efficient utilization of those specialists will be key to running an expanded dental home efficiently.”
Dwindling Medicaid reimbursement
“Whether the new presidential administration repeals or drastically alters the Affordable Care Act, at a minimum, we should expect changes in the Medicaid program, with the possibility of further reductions in reimbursement rates,” says Quinn Dufurrena, DDS, JD, president and CEO, Avitus Dental Management Solutions. “We also can expect to see drastic changes in the way providers interact with – and patients utilize – insurance.”
These changes – which could likely impact the whole dental practice, including dentists, hygienists, assistants and receptionists – could be significant, particularly for dental groups whose “business model is geared toward acceptance of Medicaid, or [for those] in PPO relationships,” he continues. “With the margins already historically low, further reduction could put a financial strain on their practice. To compensate for these decreased reimbursement rates, the practice will need to increase efficiencies (productivity), while maintaining quality and improving the patient’s experience.”
To prepare themselves for the transition, group practices need to “streamline their workflow to create more efficient systems,” he continues. In fact, “even if dental insurance policies don’t change and Medicaid benefits don’t reduce reimbursement rates, it still benefits every practice to take a cold hard look at streamlining and simplifying their systems (e.g., marketing, scheduling, recall, hygiene etc.).”
That said, it’s not only important to improve productivity,
but to do it in a way that creates a culture of support for the dental staff, notes Dufurrena. A more productive practice does more dental procedures, which can place additional stress on the dentists and their support staff, he points out. “Providers and their support staff need a culture that supports them.
“Analytics, and understanding what [the data] means,
are the first two steps in creating a culture of productivity and resultant profitability,” Dufurrena continues. “You need to understand the problems and potential before you can make appropriate changes. If you make the conscious decision to position your practice to take advantage of the uncertainty and opportunities that change creates, then 2017 could be the start of a stronger, more successful practice.”
Top-level talent
As dental practices continue to expand, and the market becomes increasingly competitive, “providers will need to focus on team member recruitment and development,” says Stephen James, CFO, Mortenson Dental Partners. “The emergence of DSOs lowers the barriers for team members to move between organizations, so it will be critical to recruit top-level talent, and then to invest in that talent to lower turnover.”
Attracting and retaining top talent not only is critical to growth, but to creating “a consistent and rewarding patient experience” as well, James continues. Team turnover and underdeveloped teams impact every aspect of the patient experience, and the patient experience is a key differentiator between dental practices, he points out. “When a patient sees a different provider or team member at each visit, it sends a subtle signal about what is happening at a higher level in the organization and creates an inconsistent experience. Turnover can also create confusion for patients and lead to distrust if different providers make different treatment recommendations. [Conversely], when a team has great chemistry, there is continuity at each touch point in the patient experience, which should lead to higher patient retention, greater patient demand and, in turn, growth.
“As more and more market research comes out, we are learning that the patient experience is what creates loyalty from patients,” says James. “By focusing on the patient experience and retaining patients, the demand for the practice will change. Loyal patients are more willing to refer friends and family members, who as new patients come through the door with a higher level of trust than patients who have no prior experience with the brand or practice.”
Additionally, practices should focus on communicating the holistic value of what the office provides, he continues. Although many patients claim that cost is a big factor in selecting their dentist, “when you dig a little deeper, what they really mean is value. The ability for the practice to communicate its value to patients will be key.”
At the same time, any changes laid out by the new presidential administration will likely impact many patients’ decisions to seek dental care. And, depending on their priorities, different patients will respond differently. “There are patient segments for which dental care is a priority,” says James. Other patients seek dental care “as needed,” and some base their decisions on what benefits are available. “Depending on what the new administration’s impact is on benefits, this could influence the patient segment that is sensitive to benefits,” he explains. “However, as providers, it will be our responsibility to educate and communicate to individual patients, with regard to which segment they fall into. For patients who make care a priority, it will be important to reinforce that decision. For patients who schedule visits as needed, it will be important to educate them on preventive measures and the economics of prevention. For patients sensitive to benefit availability, the focus should be on how to maximize benefits for restorative needs, and then how to focus on preventative measures and the value of using benefits consistently. As an organization, it is – and will continue to be – our mission and model to operate productively and efficiently, so that high-quality care can be attained by all.”
James anticipates that 2017 will be a strong year for dental providers. “More resources are being dedicated to the development of DSOs and providers,” he points out. “CE opportunities not only are more abundant, but also more diverse. There is a lot of need in dentistry; we know that about half of the population is not seeking dental care. By working together, however, not only will providers come out stronger, more individuals will receive care solutions.”
Insurance barriers
Present day dental insurance plans rarely cover as much as they once did. “The structure of dental insurance – specifically the parameters of coverage, including exclusions and maximums – result in fewer people seeking needed dental care,” says Dr. Robert Brody, chief clinical officer, Great Expressions Dental Centers (GEDC). “Patients that do come to the dentist are skipping treatment because their insurance covers less. In some cases, patients elect to receive only covered services, ignoring services that are not covered. In reality all these services are needed for the patient’s overall health.”
Indeed, many people don’t recognize the importance of dental care to one’s overall health, Brody continues. “Dentists treat disease that impacts not only your mouth, but your entire body. Taking care of your health – which includes your dental health – is crucially important, but unfortunately, the public does not see it that way.” Not only do patients receive less care, dental practices – both solo and group – are losing business. “This is one reason why Great Expressions Dental Centers accepts all insurances and offers a discount dental plan, Smile Protection Plan, for those without insurance,” he says. “Our goal is to make access to dental care possible for all. We want to remove any barriers and get people the care they need.
Dental professionals should work together “to educate the public, schools, parents and children about the importance of dental care,” says Brody. And, they should do so in a way that’s relevant to their audience. Commercials and presentations at community events or schools are good channels for reaching these groups, he points out.
The dental visit, too, is an opportunity to engage patients. From the moment patients enter the front office, to the time they are seated in the dental chair, dentists and staff should ensure they have a positive, educational experience, notes Brody. This could involve something as simple as installing televisions in the waiting room and playing educational content to help patients understand the benefits of services offered at the practice, he explains. “At Great Expressions Dental Centers, we set up our offices to be a comfortable environment for our patients by communicating education to them in a way they want to be communicated to,” he says. “We design our offices with appealing and comforting art about healthy lifestyles. The televisions in our offices play entertaining content, such as news, sports and weather, and incorporate dental education videos, all with the goal of keeping patients entertained and educated.” In the end, patients will be more likely to talk about their dental needs when they are in the treatment room, he adds, noting that during the exam, dentists and their staff should communicate with patients about any oral disease they diagnose, as well as treatment plans, “in terms they can relate to.”
In addition to educating the public, Brody suggests that dental professionals contribute to the industry by:
• Working in conjunction with the American Dental Association.
• Conducting appropriate research/studies and then sharing their results with the medical community and the media.
“The goal is to help patients to live healthy, longer lives,” says Brody. “Hopefully the new presidential administration will recognize that dental health is an important aspect of the patient’s overall health, and this will lead to expansion in dental benefits from both a government and private sector prospective. If patients are not covered currently, their overall health will get worse over time. The potential of insurance creating competition would lead to favorable rates, expanded and better coverage, and more financially viable options. I hope in 2017 we will see a bigger focus on making people healthy and making means to pay easier.”
