The Climbing Trend of Dental-Related ER Visits – Especially Among Young Adults

By Dr. John Luther, DentaQuest Chief Dental Officer

A record number of people are heading to hospital emergency rooms (ERs) when they have an urgent dental need, straining the nation’s health care system and increasing health care costs.

While ERs are equipped to provide pain relief and treat dental infection, few hospitals have dentists available to provide definitive dental care. Most of the time, ER staff are only able to provide a temporary fix, providing patients with prescriptions for pain or antibiotics for infection without diagnosing or resolving the underlying dental issue. This leaves the individual vulnerable to returning to the ER with the same problem or perhaps a more severe problem, which ultimately becomes more costly and painful to treat.

This month, the American Dental Association Health Policy Resources Center (HPRC) released findings which conclude that the number of dental-related ER visits in the United States jumped from 1.1 million in 2000 to 2.1 million in 2010.

According to HPRC’s research, dental ER visits cost the health care system up to $2 billion annually. HPRC found that the increase in cost is primarily driven by young adults, aged 21 to 34 years old, with inadequate dental coverage. During the last decade, decreases in private dental insurance combined with major reductions in adult dental Medicaid coverage have caused young adult dental-related ER visits to skyrocket from 1.5 percent to 3 percent--higher than any other age group.

The Affordable Care Act (ACA), as the HPRC points out, lacks the power to address this rising trend because it does not mandate dental benefits for adults. And, adult dental benefits are not be included in the essential benefit packages that insurance plans will sell through states’ exchanges under the law.

HPRC is calling on policy makers to look at other ways to improve access to dental care for adults, including innovative programs aimed at diverting dental patients from the ERs to community health centers (CHCs) or private dental practices, where they can receive preventive, continuous dental care.

Driven by our mission to improve the oral health of all, DentaQuest supports this approach. We believe that access to prevention-focused dental care is a cost-effective, valuable way to keep health care costs down. Our programs, such as the Strengthening the Oral Health Safety Net Initiative, the National Interprofessional Initiative on Oral Health, and Oral Health 2014, invest in national and community-based actions that engage communities across the country to create conditions for optimal oral health through prevention support and access to oral health care.

In the next decade, I am hopeful that our collaboration with policy makers and other key stakeholders will result in the reversal of this climbing negative trend.

Check Out Our New Infographic

DentaQuest is driven by our mission to improve the oral health of all, to achieve a nation free of dental disease. We strive for a nation where no child suffers from the pain of tooth decay, where adults keep all their teeth for their entire lives and where every person has access to quality dental care.

Although we have seen tremendous improvement in the oral health of Americans, the journey to solving the oral health crisis is far from over. Part of achieving this mission is educating the public about the state of oral health care and access in our nation. As a small part of our efforts, we have created this infographic to spread awareness around oral health.

Did you know:

• Dental disease (cavities) is the most common chronic disease in children. It is five times more common than asthma.

• Every year across the United States, children miss 51 million school hours due to dental problems and visits, and adults lose close to 164 million work hours.

• More than a quarter of all Americans 60 years of age or older have lost all of their teeth.

• It is estimated that in 2010, Americans spent $106 billion dollars on oral care.

• About 1 in 4 non-elderly adults have untreated tooth decay. The rate among low-income adults is twice that for adults with more income (41% versus 19%).

• An estimated 17 million low-income children in America go without dental care each year. This represents about 1 out of every 5 children.

• More than 64 million Americans have moderate to severe forms of periodontal disease.

• Dental disease is nearly 100% preventable.

Any of these facts surprise you? Help us spread the word by sharing this infographic on social media. Feel free to give us a shoutout on Twitter using our handle, @DentaQuest, to join and encourage others to join the oral health online conversation.

Partial Caries Removal is Alternative to Traditional Dental Practices

By Dr. John Luther, DentaQuest Chief Dental Officer

Nicknamed the “father of operative dentistry” in the 1990s, Greene Vardiman Black (more commonly known as GV Black) advocated that all dentin, or the tissue that surrounds a tooth, where decay is present should be removed.
 
However, recently new evidence published in a study in the Journal of Esthetic and Restorative Dentistry contradicts this dental tradition. This recent study reveals evidence that partial caries removal may be more beneficial for both the patient and practitioner.

Co-authors Daniel Chan, DMD, a professor and the associate dean of clinical services at the University of Washington School of Dentistry, and William Browning, DDS, a professor in the department of restorative dentistry at the Indiana School of Dentistry, cited several studies that support the belief that the complete removal of all the affected dentin in deep carious lesions leads to pulp exposure, complex and higher-cost treatment, and, possibly, extraction. It also suggests that creating a sealant barrier is just as effective as total removal, but with more advantages. The approach is supported by numerous clinical trials and systematic reviews, which is decidedly rare for operative dental procedures.

This study provides great insight for dentists nationwide. At DentaQuest, we support new innovative research, like the study mentioned above, that challenges and improves overall dental care. We want to help oral health care providers improve their practice to emphasize prevention and disease management. We identify promising strategies for quality improvement and, working with clinical partners, provide technical assistance to accomplish the goal.

We look forward to new research that helps transform the dental industry and ultimately how dental care is delivered.

Dentists Adapt to Healthcare Reforms

By: Dr. Rob Compton, DDS, Director of the DentaQuest Institute

I had the opportunity to represent the DentaQuest Institute at the Massachusetts Dental Society’s New England Oral Health Summit recently.

Attended by hundreds of dentists across New England, the Summit focused on upcoming changes to oral health as a result of the Affordable Care Act (ACA) and significant cultural shifts in the way health care is delivered. I spoke about the emerging and important role of data analytics in dentistry. 

Among the many questions about changes in the profession, what struck me most were the concerns about the transition from volume-based care to value-based care. In the medical world, this transition began long ago and the ACA is only speeding things up. However, the dental profession is just beginning the transition and without fully understanding what it means, it can be overwhelming.

Healthcare professionals go into the medical field to help patients and the goal is always, first and foremost, to keep patients healthy. But they also need to make a living and run a business. Value-based care is about focusing on costs, quality and, most importantly, outcomes. The goal is to reduce cost strains and reliance on the health care system by keeping patients healthier. The challenge is that under the current system (referred to as fee-for-service), medical professionals are paid each time they provide care to a patient, so if a patient is cared for in a way to prevent further illness, it reduces the need for additional treatment, and doctors and dentists make less money. 

In the new health care delivery model - data analytics is king. A number of models are emerging to help organizations remain financially viable while providing better outcomes for patients. We are seeing hospitals merge into larger coordinated care systems like accountable care organizations and patient-centered medical homes. Physicians are moving away from private practices and are trending towards employment in a larger system. Global payments are no longer a buzzword or a theory. They are actually happening.

But in dental, this trend is just starting and it needs to move fast. Dentists have every reason to feel uneasy about a transition in payment models that could affect their livelihood. The focus is now on outcomes, rather than easily countable treatments, which requires measurement. Organizations like DentaQuest are developing models to measure preventive treatments and ensure that patients are receiving the high-quality care they deserve – and that dentists are being paid for it. For example, when patients leave the hospital and then are readmitted within 30 days for the same illness, hospitals will now be penalized for not keeping the patient well. The ultimate goal is to encourage hospitals to keep the patient healthy and out of the hospital.

Dentists don’t have the time to sit idly by. Instead, they have a unique opportunity to learn about health care reform and make their voices heard by actively participating in the transition.  Change is coming and as one of the panelists said at the Summit “if you aren’t at the table, you may be on the menu.”

Highlights from the Massachusetts Dental Society’s New England Oral Health Summit

By Ralph Fuccillo, DentaQuest Chief Mission Officer and DentaQuest Foundation President

Earlier this month, we had the opportunity to participate in the Massachusetts Dental Society’s (MDS) New England Oral Health Summit to educate oral health professionals about the upcoming changes to oral health care delivery as a result of the Affordable Care Act (ACA).  I was joined by my colleague, Dr. Robert Compton, DDS, DentaQuest Institute Executive Director.  We were pleased to represent the DentaQuest Foundation and the DentaQuest Institute at the Summit and to collaborate with the MDS Foundation on this important issue.

The Summit encouraged oral health professionals and dentists to work together to ensure that everyone is involved in shaping the future of health care delivery and reform.  An estimated 1 in 5 (about 17 million) children go without dental care each year, but beginning in 2014, individual and small group health plans will offer essential pediatric dental benefits giving access to nearly 27 million children. 

More than 200 oral health professionals from across New England attended the summit to discuss what the oral health community can accomplish together. Participants spent the morning hearing from speakers about the current health care delivery environment and changes due to the ACA. In the afternoon, attendees interacted through panel and group sessions to talk more specifically about changes in how oral health care will be delivered, evaluated and reimbursed.  Participants worked together to develop messages for dental care providers across New England about the future impact of the new health care environment on dental care delivery and how we  must all  be involved.  The more of us that are at the table, the better.

View the video below or click here to learn more.

Say Hello at AHIP Institute2013 and Exchange Conference

Guest post by Michael Enright, National Director of Sales, DentaQuest

Next week, DentaQuest will attend America’s Health Insurance Plans (AHIP) Institute 2013 and Exchange Conference. The conference, which will gather health plans from across the country in Las Vegas, is an opportunity to connect, and collaborate with thousands of health care stakeholders. 

At the AHIP Exchange Conference on June 12, DentaQuest Chief Analytics Officer Shaju Puthussery and DentaQuest Institute Executive Director Dr. Rob Compton will join me in leading a breakfast session called “Aligning Business Strategy and Dental Benefits to Meet the Needs of Today’s Healthcare Consumer.”

This time of healthcare reform has been a challenge for many organizations.  There are critical decisions to be made for 2014, 2015, and beyond.  Their focus is to provide increased value to their members and ensure they are making the necessary adjustments to stay relevant in the changing market.  Our session will set the stage for the opportunities ahead regarding dental and vision benefits. Participants of our session will:

• Learn how the right dental partner can help grow membership, control costs, and improve health through dental management, data analytics, and preventive programs; 
• Gain insight into how integrated dental benefits create value for health plans and how data analytics go hand-in-hand with value-based healthcare; and 
• Leave with a better understanding of why collaborative, patient-centric dental care is vital within the context of the Affordable Care Act. 

We encourage you to stop by our breakfast session and say hello. For attendees also attending the AHIP Institute 2013, please visit us at Booth #458 on June 13.

For specific details about the AHIP Institute2013 and Exchange Conference, visit http://www.ahip.org/Conferences/Institute2013/.

Preventive Visits Matter—A Lot

By Dr. John Luther, DentaQuest Chief Dental Officer

This week, a study featured in the June issue of Pediatrics, conducted by the Department of Health Care Organization and Policy and Lister Hill Center for Health Policy of the University of Alabama at Birmingham School of Public Health, raised a few eyebrows within the dental care community.  The study reported more preventive visits for children do not reduce overall dental or medical (inclusive of dental) expenditures.

Study researcher Bisakha Sen, PhD, and colleagues analyzed data from Alabama's Children's Health Insurance Program (CHIP) between 1998 and 2010. The database included 14,972 children younger than 8 years and 21,833 children aged 8 years or older. 

The study concluded that more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures for both groups. However, the study also concluded preventive visits did not reduce overall dental or medical (inclusive of dental) expenditures. 

The American Academy of Pediatric Dentistry (AAPD) responded to these conclusions by providing some important contextual considerations for the results, including the family’s ability to access care and preventive services, the levels of health literacy of the family, and social, cultural and economic pressures. 

As a dental administrator for many state health plans, DentaQuest understands that CHIP programs are the vehicle for many at-risk children to get dental care.  These children often start at a deficit, with multiple unaddressed dental needs, some more pressing than others, and therefore they need an ongoing treatment plan.  And, as the AAPD response points out, there are other costs not counted as dental, such as dental emergency room visits and services that must be performed under general anesthesia.

Preventive care is important for everyone, but especially for children. Dental disease is caused by a bacterial infection. It is the most common disease of childhood. Children with untreated dental disease have difficulties eating, learning to speak, and even stay focused in school. The impact of untreated dental disease stays with the child as he or she grows into an adult.

My key takeaway from this study is: “more preventive visits were associated with fewer subsequent non-preventive dental visits and lower non-preventive dental expenditures.” And that’s a good thing.

Prevention is a long term investment in improving lives.