What does quality in dentistry mean to you?

The Dental Quality Alliance starts a new ‘quality movement’

As our country watches the unfolding drama of healthcare reform that promises to provide health insurance for millions of Americans, significant changes lie ahead. Medicare (for those over 65) and Medicaid (for low income) insurance plans are leading the way by linking improved health with physician and hospital reimbursement. This is pay-for-performance healthcare. And it’s coming to dentistry.

The Dental Quality Alliance

Recently, I attended the first Dental Quality Alliance conference where 125 dentists, faculty, public health and other professionals gathered to discuss ‘What is quality in dentistry?’ and become ambassadors to bring up this topic throughout the nation. Our speakers shared ideas from physician practices, displayed statistics from numerous journals and gave examples from existing dental practices and insurance companies that are trying to measure improved health in dentistry.

So, what is quality in dentistry? In the past, quality dentistry focused on a per tooth level – Does the margin on the crown fit properly? Was all the decay removed? Is the occlusion correct? Now, the definition is evolving to mean improved health for a population, increased affordability and enhanced patient experience. In fact, these three areas are called the Triple Aim in healthcare – population health, per capita cost and patient experience. Now, we have the opportunity to define what that means for dentistry.

Why Care?

If you’re a practicing dentist, you know it still matters that you provide quality dentistry on each tooth for your patients. The challenge now is that this type of quality is expected, even assumed – and dentists will be asked to meet this new, broader definition of quality. In the future, dentists will be paid based on their performance – just like physicians and hospitals are beginning to be paid this way now. How far in the future? Here’s a story I heard at the conference that makes it sound closer than one might think.

Wal-Mart is headquartered in Arkansas and as the 2nd largest employer in the country, they approached Delta Dental of AR saying that they expected Delta to create a pay-for-performance dental plan just as they already are receiving a pay-for-performance health insurance plan. Wal-mart intends to offer this new dental plan through its employee wellness program. Once this program pilots in AR, Wal-Mart plans to roll it out across the country. Do you have any patients that work at Wal-Mart?

So, what do we do?

Luckily, our physician counterparts are the trailblazers with pay-for-performance healthcare and we will watch and learn. The more dentistry can steal and adapt successful methods of tracking and reimbursement from medicine, the easier our transition to this new definition of quality will be. At this conference, everyone in the room seemed to acknowledge that we are just at the beginning of this conversation. The need for agreed-upon standards – starting with the documentation of diagnosis, completing a risk assessment and advancing the field of evidence-based dentistry was made clear throughout this meeting.

Dentists can think about the triple aim in their practice. Look at the community you serve.

  • How are you doing at improving the health of all the people that live within your range?
  • Do you accept Medicaid to include this group?
  • How are you doing at improving the dental health of people that are not your patients – people that don’t go to any dentist at all?
  • How are you doing with affordability?
  • Do you offer payment plans to help lower income families afford your care?
  • How are you doing at providing a quality patient experience – taking patient & family preferences into account for treatment decisions?

This is the first in a series of articles on quality in dentistry. As a practicing dental office manager, my perspective is focused on implementation. Listening to the many PhD speakers at this conference, I was often left thinking, ‘Okay, that makes sense. Now, how do we do it?’ – and I will share my thoughts on first steps in that regard. I believe dentists that are interested in this new definition of quality dentistry can help to create the future by beginning to craft our own pay-for-performance criteria. If you’re interested in tackling these challenges in your own practice, please comment and/or email me. I welcome the opportunity to create a group of dental practices that want to begin to measure their own performance and perhaps exchange data – and the Dental Quality Alliance welcomes you to join the conversation as well.

AUTHOR: Jill Nesbitt
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