Ed Schooley, DDS, MHA
I first heard the noise in Detroit some five years ago. I was involved in a sales presentation of dental-insurance benefits to a group of insurance brokers and employers of large companies. No, it has nothing to do with the "big sucking sound from Mexico" that Ross Perot referenced in his campaign rhetoric, but it definitely was a foreshadowing event.
The noise surfaced in a single query from a General Motors representative. He stated, "General Motors is only interested in paying for dental benefits that increase the company employees` state of health." That statement has stuck with me and, over the years, has been wordsmithed to a singular noisy word-accountability.
Industry and government want to know what they are getting for their health-care dollar. The "what" primarily refers to all the dental-treatment procedures of dental benefit-plan members. Their dollars are purchasing treatment procedures, but what is the correlation of these procedures to the dentist`s cost of rendering the same? What effect do they have on the patient`s state of health? What level of customer satisfaction was delivered and perceived by the patient? That`s the noise, and the decibel level is increasing.
From a dental-benefit perspective, the answers to these questions are the key challenges to the dental profession in the future.
You`ve seen it, and so have I, in professional journals: "The United States has the best dental care in the world!" We may and we may not. We really don`t know. Such a statement implies that we can and we have measured it, and that we have a yardstick. The dental profession, to its credit, is just embarking in this endeavor. Dental diagnostic codes, which will serve as a patient`s starting point in the delivery system, are under development and forthcoming. With these, treatment procedures will be linked to a "why" we as dentists are rendering them. The necessity and preconditions for dental care will be more defined. Parameters of care development have been rejuvenated. Hopefully, these will not be a regurgitation of textbook language, but will be a decision-support tool used to determine the appropriateness of procedures in relation to a specific diagnosis. As such, the procedures will provide treatment-decision guidelines to a specific clinical condition.
Dental-outcome studies have commenced, but much work is required in this area. These studies would help the General Motors representative as he/she would correlate the starting point for a dentist, i.e., diagnosis, with the treatment procedures available (eg., CDT-2)-and measures whether the patient`s oral-health status has ben elevated or not. A correlation of required resources for treatment-to-efficacy will yield an outcome measure of cost-effectiveness. The patient-satisfaction surveys will incorporate an evaluation of the quality of "service."
A purchaser of dental benefits will be able to relate the dental-care dollars contributed to a dental-benefit plan with the fees, efficacy and customer-service level of benefits provided to plan members.
Why all this? A demand for explicit accountability for treatment decisions and actions is the main reason. Gone are the days of automatic, implied trust in the care-giver.
There are a multiple of reasons for this erosion of trust, all of which are beyond the scope of this Viewpoint article. But, just as you demand good customer service or functionality in the services and products you purchase, business and government will increasingly do the same. Some managed dental-care plans already are relating customer satisfaction and treatment costs to dental benefits provided at the care-giver level. It may be an unpleasant thought, but a provider report card with outcome measurements (grades) already is surfacing in many managed medical circles.
The "noise" is, indeed, getting louder. One option of confronting it is to put headphones on, pretend not to hear it and hope it will go away. I am afraid you will be left behind. I would encourage you to start to lay the groundwork for this increased demand for accountability. Here is a place to start:
Accountability for fees:
- Know your operating costs (fixed and variable) and what a unit of service (procedure, time) costs in your practice;
- Analyze the dental services you provide to time, costs, complexity and risk;
- Set your fees so there is a logical correlation.
Accountability for treatment:
- Keep abreast of proven and questionable procedures, techniques and materials;
- Know the indication and contraindications for all treatment procedures, (eg., sealants, posts, crowns on endodontically-treated teeth);
- Refine your recordkeeping system to substantiate diagnosis, treatment options and treatment decisions at all times.
Accountability for patient satisfaction:
- Acknowledge there are different perceptions to dental care;
- Listen to what patients are saying, why patients are coming/ leaving your practice;
- Define your practice philosophy and values and integrate them in your office policies, staff selection/training and marketing.
The author is a national dental director of CIGNA Dental Health, with responsibilities that include sales training, dental policy and product development. He has 15 years of experience in the dental-insurance field and is a certified consultant of the American Association of Dental Consultants.
