Two factors are forcing the dental industry to re-evaluate itself. First, millions of Americans lack access to dental care. Second, the dental sector is experiencing a slowdown in spending and predicting sluggish growth for decades to come. Combined, these market forces are producing a philosophical shift, according to a top official at the American Dental Association (ADA).
Speaking about the the tectonic forces bringing long-term change to the profession At a dental trade alliance meeting earlier this year, Dr. Marko Vujicic, managing vice president for the ADA’s Health Policy Resources Center, detailed how demographic realities and market forces are culminating in “a watershed moment for the dental sector.”
Dr. Vujicic notes that total dental care spending per capita began to slow in 2002 before flattening in 2008 . It’s not expected to pick up any time soon. As a result, providers are under growing pressure to increase their efficiency and improve profitability.
The system’s current inefficiencies are making dental care unaffordable for millions of Americans. In order to suervive, dentists must learn to adapt because dental care is the second most expensive out-of-pocket cost for consumers, causing many people to skip visits to the dentist. The ADA estimates 181 million Americans went without dental care in 2010. With more adults bypassing routine dentist visits they are turning to the emergency room for care when problems arise, which is costing states and taxpayers. A Pew Center on the States report, A Costly Destination, estimated that 830,590 Americans, an 16% increase from 2006, visited the emergency room for preventable dental care.
To compensate for the falling number of visits from people who can no longer afford care, dentists are seeing more Medicaid patients. While this is a positive development, it’s likely unsustainable because most dental practices are challenged to serve Medicaid enrollees under current reimbursement rates.
Those rates are unlikely to increase, given budget constraints in most states, and ultimately, raising Medicaid rates would not solve the dental access crisis. An independent study found that “the behavioral impact of raising Medicaid reimbursement rates is disappointingly small.”
Due to the spending slowdown and the high out-of-pocket costs for dental care, providers are under growing pressure to increase their efficiency and improve profitability. The dental industry needs to find innovative ways to improve efficiency and deliver more cost-effective care. A very promising and evidence-based innovation would allow dental therapists to join the dental team. Dental therapists are mid-level dental providers in underserved communities. They are rigorously trained to provide culturally competent routine and preventive care in community settings.
As detailed in our recent report, dental therapists practicing in Alaska and Minnesota are showing how to do more with less. They provide cost-effective, routine and preventive dental care to traditionally underserved Medicaid, rural, and tribal populations.
According to the report:
- Eighty-five percent of the care dental therapists provide is routine and preventive.
- Dental therapists cost their employers less than 30 cents for every dollar of revenue they generate.
- Seventy-eight percent of dental therapists’ patients in Minnesota were publicly insured and most were under 21. In Alaska, 66 percent of patients served by dental therapists were under 21.
Dental therapists offer a solution to the industry’s need to deliver cost-effective care to underserved communities. Expanding this model will allow dentists across the country to bring a new, financially viable provider to their businesses and generate additional revenue by expanding care to populations that currently aren’t getting it.
Changing the status quo and overcoming misguided opposition to dental therapists from within the dental industry will be difficult, but market forces inevitably will prevail. Although Dr. Vujicic was not speaking about dental therapists specifically, he understands that new approaches are needed:
“Getting out of the status quo mentality is essential for this profession to survive,” he said. “We don’t have time for turf wars. We’ve got to get on the same page, get an advocacy agenda everyone can agree on and we have to push it through.”
As advocates for better oral health care access, our job is to elevate awareness of the access to oral health care crisis and educate policymakers and dentists alike that dental therapists are a common-sense, evidence-based approach to making the dental delivery system more efficient and cost-effective. More importantly, they can help increase access to care for the millions of Americans who are suffering from untreated oral disease.
Our voices are being heard. Today, Senator Sanders and Senate HELP Committee will be holding a hearing on the escalating cost of care to and growing access problems in the country. You can view the hearing at 10am online and continue promote the need for more affordable oral health care.