by By Laura Thill
New – and often more complex – payor models are driving change in the dental industry.
The dental industry has grown significantly in the last 10 years, and with that expansion comes the challenge of creating a sustainable practice model. “Recent growth in the industry and the growth in dental service organizations (DSOs) have driven the demand for dentists, resulting in a 99.8 percent employment rate in 2015,” says Lisa Mikkelsen, chief operating officer, Benevis Practice Services. “In addition, the payor model was simpler a decade ago, with fewer payors and fewer multistate or large group practices.” As a result, the dental industry is transitioning from fee-for-service to pay-for-performance, which is changing the way providers are reimbursed for patient care, she points out. It also impacts the way DSOs support their practices. “Multistate dental practices and dental service organizations now must provide data and information on patient outcomes and costs, as practices adapt to an evolving reimbursement model.
“Ten years ago, multisite practices faced the challenge of how best to create a growing, sustainable DSO-supported practice model, including educating doctors about the unique opportunities available within a DSO-supported practice,” Mikkelsen continues. “In 2008, about 4 percent of dentists were affiliated with a DSO. In 2016, this number has risen to nearly 15 percent. Today, more doctor candidates recognize the benefits of working for a DSO-supported practice. At Kool Smiles, doctors are able to focus on their clinical skills versus the administrative burden of running a practice; they can experience work-life balance through flexible schedules, and take advantage of multiple long-term career path options, all while earning a great living.”
DSOs support their members and affiliates through a wide array of non-clinical support functions, says Mikkelsen. For example, Benevis’ support enables Kool Smiles doctors to focus on “the mission of improving lives in their communities by providing high-quality dental care in a fun, compassionate environment,” she points out. “Benevis utilizes scale to efficiently provide a wide range of practice support services, including marketing, IT, supplies, payroll and benefits administration, HR support, finance support and facility management. Benevis is able to provide a significantly higher level of support through our proprietary Boomerang Practice Management (electronic health records) system. With the help of this advanced technology, we offer industry-leading compliance and auditing programs to ensure quality care and transparency, integrated patient relationship management and end-to-end revenue cycle support.”
Solo vs. group
While solo practices continue to face traditional challenges, such as recruiting and retaining new staff, they are not feeling the impact of the change in payor systems as immediately as do their group dental counterparts. “The payor industry change will first impact those that participate with government-funded insurance programs,” says Mikkelsen. “Ultimately, this will impact solo practices, but they might not feel the impact as quickly or as strongly, particularly for those with mature practices serving predominately self-pay and traditional commercial insurance patients. However, as the Affordable Care Act (ACA) has shifted cost sharing for medical and dental costs to consumers, promoting more consumerism in dental, it is projected that patients will seek savings through discounts or by favoring in-network providers, thus impacting solo practices.
“Kool Smiles’ dentist owners view the payor model change as an opportunity to better partner with payors, as they lead the way in creating dental access, improving patient satisfaction and outcomes, and lowering costs,” she continues. “It’s because of the support that we [at Benevis] provide Kool Smiles that they are prepared to be a leader in this changing environment. For example, through our integrated practice management system, Benevis provides data and information that helps Kool Smiles’ dental leaders better understand patient outcomes and costs versus other providers. We also provide Kool Smiles’ leaders unique insight into patient experiences based on data analysis of millions of patient visits and thousands of patient surveys.”
Granted, the dental industry is in the early stages of the reimbursement model transition, notes Mikkelsen. But, as the transition continues to play out, she believes it will drive the growth of DSOs. “DSOs are projected to grow rapidly due to the non-clinical benefits they currently provide their clients,” she explains. “DSOs are best-positioned to support dental practices as they navigate these changes.”
Consistency vs. individuality
In recent years, the dental office has become increasingly complex, notes Mikkelsen. DSO-supported dental practices have expanded their services beyond general dentistry to include such specialty services as oral surgery and orthodontics, she points out, making it more important than ever to develop office protocols that enable staff – particularly office managers – “to lead through the increased complexity of supporting multiple specialties, including additional staff support, patient scheduling, patient flow and patient experience.
“In many cases, consistency throughout a group practice has become “essential to achieve sustained results,” she explains. “For example, when facing increased billing and collections complexities, offices need to have a clear process and resources to ensure payment. That said, there are times when office teams need to be empowered and take responsibility to address the challenge in the way that is best for the office. The key with the latter is ensuring the office teams are aligned on the issue at hand and understand what success means.”
When consistency throughout a group practice is the best direction, “it is best achieved through creating a culture that aligns teams to focus on what is most important for the success of the office,” says Mikkelsen. “In a recent initiative, Benevis supported Kool Smiles’ leaders to align with what is most important for the success of their offices; they developed key performance indicator measures and provided tools and resources for office teams to better perform their roles. Kool Smiles’ doctors, office managers and above-office leaders are now able to create a desired culture based on what is measured, recognized and rewarded. When office teams understand – and are aligned with – what is most important, and when they understand and have visibility into the key performance indicator measures of success, and have the tools and resources to perform their roles, consistency in results can be achieved.”
Moving forward, Mikkelsen anticipates that DSOs will continue to provide key support for their providers as they navigate changes and evolving complexities in the industry.
