Government Relations Update:
Medical Loss Ratio (MLR)
Similar to how the Affordable Care Act requires insurance carriers to report the ratio of premium dollars spent on patient care versus administrative costs, loss ratio for dental plans will establish a reporting requirement on the portion of revenue from premiums spent on patient care and will ensure that dental plans are more transparent to the patients they serve.
Why is this important? It is estimated that unused dental premium dollars, constituting 40 percent or more of premiums, are kept by insurance companies to cover administrative costs rather than the actual cost of care. That means less reimbursement to dental practices.
Enacting MLR will increase revenue to your practices from insurance companies and will hold insurance companies accountable for their use of premium dollars.
The MLR win in Massachusetts created a groundswell of enthusiasm to pursue similar legislation across the country. ADSO will work in collaboration with state dental associations in more than 10 states to advance this issue.
Assignment of Benefits (AOB)
AOB laws require insurers to honor a patient’s request to pay their dentist directly for services rendered. Already passed in more than 20 states, AOB laws let patients choose whether they want insurance companies to directly pay the dental practice, or whether they wish to receive the payment.
Why is this important? In states where these laws don’t exist, insurers often pay the patient instead of the dentist, creating confusion and additional hurdles for dental practices and patients. Not allowing assignment of benefits has two negative effects: the dental practice must wait for payment, sometimes resulting in cash flow issues, and the dental practice may have to use staff resources following up with patients to chase payment for services rendered.
The ADSO will work in partnership with state dental associations to pursue AOB legislation in Arkansas, , Wisconsin, and Pennsylvania.
The ADSO also is working to enact additional insurance reform efforts such as network leasing and virtual credit card payment and other issues important to our members including licensure portability, and reform of outdated and burdensome regulatory issues. We will detail these efforts in upcoming issues of the ADSO Advocate.
In the meantime, please feel free to contact our government relations team for more information or to become involved in ADSO’s government relations committee.
DSOs are Leading on Address Dentistry Staffing Shortage
Staffing woes are impacting businesses across America, and the dental industry is not immune to these issues. The Health Policy Institute (HPI) recently spotlighted these challenges, finding lack of adequate staff to be a significant reason why dentists reported not having a full appointment calendar. The dental workforce shortage is a complex problem, making it difficult to find and retain skilled talent to keep practices at full capacity and provide critical healthcare services for their patients.
“Workforce shortages were initially attributed to the COVID-19 pandemic. We now know that is just part of the story,” wrote HPI in its report. The reality is that there are a multitude of factors driving the staffing shortage, most important among them the growing trend of current dental hygienists and assistants leaving the profession, as well as dental auxiliary training faculty shortages, state-to-state inconsistencies in scope of practice for these professions, and lack of license portability.
Dental support organizations recognize that the workforce shortage is a critical one for its members and the patients they serve and are committed to finding solutions. Among the most important – taking deliberate steps to attract, win and retain top talent. “We’re looking for ways to elevate the entire dental team – emphasizing the importance of their roles in improving health through dental care,” said Andrew Smith, executive director of the Association of Dental Support Organizations (ADSO). That means ensuring competitive compensation, quality benefit packages, and the support, community and professional development team members expect and need.
Establishing a broad-based task force to identify real solutions to address these workforce shortages is a key priority of the ADSO, according to Smith. This will include identifying policy changes to address inconsistencies in educational programs and state regulations around licensure and certification, license portability for dental professionals, and exploring public-private partnerships to help expand training programs and increase DA and DH faculty.
“There’s no one-size-fits-all solution to this problem. It will require a multi-faceted, individualized approach that considers the unique needs, strengths and challenges facing each DSO as an organization. Commonsense solutions are out there, and ADSO and its members are well-positioned to find and implement them,” Smith said.
HPI: Dental Practice Ownership Drops Significantly
Private practice ownership rates for dentists have declined across all age groups since 2005, but particularly among younger dentists, according to a survey from the ADA Health Policy Institute (HPI).
A little over one-third of dentists ages 30 to 34 were owners of their practice in 2021 compared with more than half of surveyed dentists in 2005, according to the HPI. And less than 10% of dentists under the age of 30 in 2021 were practice owners. Read More >
Aspen Group’s Oral Care Center of Excellence has provided $370k in free dental care since opening
The Aspen Group’s Oral Care Center of Excellence in Chicago has provided $370,000 worth of free care to patients since opening in July. The 25,000-square-foot center provides dental care to underserved Illinois residents, including those eligible for Medicaid or who are uninsured with a household income that does not exceed 200 percent of the federal poverty line. Read More >
American Dental Hygienists’ Association Teams Up with Heartland Dental for Student and Professional Education and Events
The American Dental Hygienists’ Association (ADHA®) is proud to announce its partnership with Heartland Dental, the nation’s largest dental support organization, to launch student and professional education programs and events.
ADHA and Heartland Dental share a passion for professional development and empowering dental professionals to achieve their goals. The purpose of this partnership is to support and connect dental hygienists, and in particular dental hygiene students, with information and opportunities that enable them to further their clinical skills, self-advocate, and address the non-clinical aspects of their professional environment to grow as leaders and professionals. Read More >
How the Massachusetts ballot measure could spark dental payer reform nationwide
Several states could begin efforts to implement medical loss ratios for dental payers after Massachusetts signed its own into law in December. Read More >
Dental industry continues to grapple with workforce shortages: 4 updates
The dental industry is still dealing with a shortage of providers exacerbated by the COVID-19 pandemic, particularly dental assistants and hygienists. A recent poll from the American Dental Association found that 34.9 percent of dentists were recruiting hygienists and 35.8 percent were recruiting dental assistants. About 80 percent of dentists described recruiting dental hygienists as “extremely challenging,” while 57 percent described hiring dental assistants as “extremely challenging.” Read More >
New partnership puts physicians and dentists under one roof
A regional health care provider and a national dental support organization are forming a partnership to put physicians and dentists under one roof, allowing practitioners to seamlessly share information on patients and giving patients access to their primary and dental health records all in one place. Barry Arbuckle, president and CEO of MemorialCare, and Pacific Dental Services founder and CEO Stephen Thorne recently announced the joint venture at Pacific Dental Services headquarters in Irvine. Read More >
6 DSO exec insights in 2022
Several DSO executives spoke with Becker’s this year to discuss their organizations’ growth and challenges in the industry. Read More >