Characteristics of dentists participating in capitation and Preferred Provider Organization dental plans

BACKGROUND: In 1998, the American Dental Association Survey Center conducted a telephone and mail survey of U.S. dentists in private practice in an effort to determine the extent of dentists' participation in capitation and preferred provider organization, or PPO, dental plans and the characteristics of dentists who participate in those plans. METHODS: An initial telephone screening survey of a random sample of 11,550 dentists in private practice was conducted to identify dentists who participated in PPO or capitation dental plans. Dentists who participated in either of these plan types then were asked to complete a mail survey on their plan participation. RESULTS: The majority of dentists participating in either type of dental plan reported having never left a dental plan. Dentists who belonged to more than one PPO or capitation plan reported that a larger percentage of their patients were enrolled in these plans and that more of their practice's gross income came from the plans. Participation in PPO and capitation plans has had a positive impact on the practices of many of the responding dentists, particularly with regard to expanding their patient base. CONCLUSIONS: The authors found that the majority of dentists participating in PPO dental plans found it to be a positive experience overall. Dentists participating in capitation plans were less satisfied; more than 50 percent of capitation plan participants reported some level of dissatisfaction with the plans. The majority of dentists participating in a PPO plan expected to renew participation when their current contract expired; a much smaller percentage (though still a majority) of responding capitation-plan participants indicated the same. PRACTICE IMPLICATIONS: Responding dentists' overall indication of satisfaction with their current PPO plan participation probably indicates further growth for these dental plans. On the other hand, capitation plan participants seem much less satisfied with their plans. PPO plans, therefore, seem much more likely to be the type of plan that dentists will choose in the future.     

Determinants of general dentists' decisions to accept capitation payment: a conceptual model and empirical estimates

Abstract – Background: Shifts in payment options for dental care over several decades have resulted in more dental expenditures being paid through health maintenance organizations (HMOs), preferred provider organizations (PPOs), and capitation arrangements. Patients’ and employers’ choices to participate in these arrangements is determined in part by dentists’ willingness to participate in plans, and plan choices may be influenced by patient satisfaction, self‐reported oral health, and/or quality or cost of care. Objectives: This study examined determinants of dentists’ decisions to accept capitation payment for services. Research Design: Cross‐sectional mail survey in December 2006. Subjects: 1605 general dentists in Oregon. Measures: Questions addressed dentists’ perceptions of the importance of control over various practice parameters, willingness to accept capitation payment, employment or ownership status within the practice, and practice characteristics. Results: Capitation was accepted by 22.6% of the respondent dentists (n = 729). Reported average fees (2007 dollars) ranged from $60 (initial oral examination) to approximately $800 (porcelain crowns). The likelihood of accepting capitation payment was related to the number of dentists in the practice, but surprisingly owner‐dentists were no less likely than employee‐dentists (associates) to accept capitation. As expected, dentists’ usual and customary fees were negatively associated with accepting capitation. In contrast, measures of dentists’ importance of control were not related to decisions about capitation. Longer average appointment delays were related to acceptance of capitation, but the effects were small. Conclusions: Dentists’ behavior regarding payment acceptance is generally consistent with microeconomic theory of provider behavior. Study findings should inform practitioners, plan managers, and researchers in examining dentist payment decisions.     

The case for dental preferred provider organizations

The dental PPO market is the fastest growing segment of the dental benefits business. As with traditional indemnity plans, dentists are reimbursed on a fee-for-service basis. Members can refer themselves to dentists of choice, including specialists, inside and outside the network. Employers' interest in DPPOs is expected to continue as they seek to control or reduce expenses associated with dental benefits plans. Dentist participation in managed care programs significantly lags medical, and fewer than half of practicing dentists participate in DPPOs. Negotiated discounts vary across carriers and geographic regions, generally ranging 15% to 30% off average fees. The American Dental Association predicts that dentists' participation in DPPOs will continue to increase, indicating further growth for these dental plans. There are financial incentives for members to stay in network.     

Dental case management: increasing access to oral health care for families and children with low incomes

BACKGROUND: Medicaid beneficiaries have lower rates of dental visits and higher rates of dental disease compared with the rest of the population. Beneficiaries ascribe their low use of services to difficulties finding dentists who treat patients with Medicaid. Dentists cite low reimbursement rates, excessive paperwork, and patients' not keeping appointments and poor oral health literacy as reasons for not accepting patients with Medicaid. The authors pilot-tested the effectiveness of a dental case management program (DCMP) in increasing dentists' participation in Medicaid and Medicaid beneficiaries' use of services. METHODS: A dental case manager recruits dentists to participate in the Medicaid program, arranges training in billing procedures, resolves billing and payment problems, educates clients about the use of dental services and keeping appointments, links clients to dental offices, identifies potential barriers to care and helps clients obtain transportation to appointments. The authors evaluated the levels of participation of dentists in the DCMP in Medicaid and Medicaid beneficiaries' use of services. RESULTS: Dentists accepting new Medicaid patients increased from two to 28, with 145 dental visits a month provided to Medicaid beneficiaries. The percentage of Medicaid beneficiaries receiving dental services increased from 9 to 41 percent after the DCMP was implemented. CONCLUSIONS: The authors found that the DCMP was effective in increasing Medicaid beneficiaries' use of services, increasing dentists' participation in Medicaid, minimizing administrative burdens related to Medicaid participation, and increasing oral health literacy and treatment compliance among clients with low incomes.     

The Use of Dental Sealants by Ohio Dentists

Objectives : To assess the extent to which Ohio dentists report using pit and fissure sealants and factors associated with sealant use. Methods : A mail survey of a random sample of Ohio dentists was conducted in 1989 and repeated in 1992 with a newly drawn sample. Only responses from general dentists were analyzed using univariate analyses and multiple regression. Results : Dentists who reported using sealants increased from 79.4 percent in 1989 to 91.8 percent in 1992. In 1992, 42.9 percent were low-level users (<15% of school-aged patients), 41.7 percent were moderate-level users (15–39%), and 15.3 percent were high-level users (>39%). Over three-fourths of sealant-using dentists expressed some degree of willingness to seal incipient caries. The level of sealant use was associated with dentists' knowledge about sealants, conservative management of dental caries, number of children seen in the practice, and influence of insurance coverage for sealants. The regression model explained 22.0 percent of the variance. Clinical factors associated with the level of use were: dentists' willingness to seal premolars; caries-free teeth; teeth with deep, narrow pits and fissures; teeth with small, frank occlusal caries; and patients 18 years of age or older. This regression model explained only 15.1 percent of the variance. Conclusion : The great majority of Ohio dentists report using sealants. The percent of reported sealant users increased between 1989 and 1992. Ohio dentists are not consistent with regard to the percent of their child patients for whom they apply sealants or their willingness to seal incipient caries. Dentists continue to identify lack of insurance coverage for sealant application as a major barrier to patients receiving the service.     

Retirement savings of dentists in private practice.

BACKGROUND: Retirement planning is an issue that concerns all working people. In this article, the authors present their analysis of the results of a 1995 American Dental Association survey that asked dentists questions about their plans to finance their retirement. METHODS: The ADA's Survey Center conducts a periodic "Survey of Current Issues in Dentistry," which gauges dentists' opinions about a variety of topics of interest to dentistry. The authors analyzed the results of the 1995 survey in which retirement savings was one of the topics. RESULTS: The majority of responding owner/dentists whose primary occupation was private practice (40.7 percent) indicated that they were relying only "a little" on the sales of their practices to finance their retirements. Overall, dentists whose primary occupation was private practice reported saving an average of 10.5 percent of their income specifically for retirement. The average total amount of money dentists invested in various retirement plans increased with age and was highest for the 55 to 59 and the 60 to 64 years of age cohorts. The only exception was the 401(k) plan, in which the peak occurred in the 65 years of age and older cohort. CONCLUSIONS: Fifteen years ago most dentists retired between the ages of 60 and 69 years. Recent trends show that dentists are retiring at younger ages. This means that while in practice, dentists must save enough to support themselves for 20 or more years of retirement. PRACTICE IMPLICATIONS: The transition from private practice to retirement can be difficult. Therefore, planning for the future is important. Dentists can benefit from making appropriate decisions based on age, investment goals, risk tolerance, monetary constraints and time until retirement.     

Dentists' experience with low-income patients benefiting from a public insurance program

France has a system of public coverage that guarantees low-income earners full payment of basic dental health costs. In spite of this coverage and major needs for care, deprived populations have lower access to dental care. The aim of this qualitative study was to explore dentists' experience with low-income patients benefiting from the French universal healthcare coverage system. This study is based on 17 one-on-one semistructured interviews carried out with French private dentists. Dentists distinguished two categories of low-income patients: 'good patients', described as being regular attenders; and 'bad patients', whose main characteristic is irregular attendance. Dentists explained that they have difficulties in dealing with patients who do not keep their appointments. First, dentists feel that they fail in conducting their mission of being a care provider (therapeutic failure). The absence of the patient is also seen as a lack of recognition (relationship failure). Furthermore, dentists do not earn money when patients miss their appointments (financial failure). In this context, many dentists feel discouraged and powerless (personal failure). Moreover, dentists do not understand why patients renounce the dental-care opportunities offered under the system of public coverage (failure of the system). Dentists who repeatedly experience failures related to irregular attendance tend to adopt exclusion strategies.     

Dentists' views on fearful patients. Problems and promises

A large number of patients treated in the general dental health service in Western countries report dental fear to some degree. Dentists' views of treating these fearful patients are not well described in the literature.Therefore, the aims of the study were to explore dentists' attitudes towards, experience of, and feelings about treating fearful patients. The sample consisted of 1293 members of the Association of Public Health Dentists in Sweden who were asked to respond to a web survey concerning dental fear. The response rate was 69% (n = 889).The majority of the responding dentists stated that dental fear is a problem in routine dental care,treating patients with dental fear is a positive challenge and they felt they were making a contribution.They also reported that treating patients with dental fear is associated with hard work, poor revenues, and little appreciation by employers. Female dentists reported a greater proportion of patients with dental fear and greater self-efficacy regarding the treatment of these patients, compared with their male colleagues. Dentists trained in other EU countries reported stress more often and less perceived contribution when treating fearful patients, compared with colleagues trained in Sweden. CONCLUSION: Dentists' views of treating fearful patients are mainly positive; however, it is problematic that dentists feel stress and that dentists who treat many fearful patients feel their employers do not appreciate their efforts.     

A new concept in a dental plan

The Dentwell Plan provides dental coverage by private dentists to individuals without access to dental plans. The plan fosters a close patient-dentist relationship with a mutual motivation to perform preventive dentistry and to maintain long-term continued dental health. This concept bolsters private dentists' incomes through an innovative and cost-effective program that attracts cost-conscious patients and provides financial incentives for high-quality preventive dental care.     

Network capitation practices: a new concept

The percentage of consumers in the U. S. covered by dental insurance has increased dramatically over the last 10 years. As dental insurance grows, it is becoming increasingly important to examine the context of dental care payment systems. At present, almost all insurance programs are geared toward the fee-for-service system, which reimburses dentists a fixed sum for each type of procedure. The exceptions to fee-for-service dental insurance plans are few. A capitation program for dental care, which reimburses dentists a fixed amount per enrolled patient regardless of services rendered, offers many advantages for both consumers and providers and should be available as an option. Network capitation represents a new approach to the payment of dental care. A network capitation program is being developed in the United States and will use an approach involving two contracts, one which will be used with an insurance company, and the second with a network of private practitioners. The insurance company will supply dental practices with dental patients and funds on a capitation basis. Patients will be given the choice of fee-for-service or capitation. Network capitation allows fee-for-service solo or group practitioners to incorporate capitation patients into their practice.     

Opinions on the provision of dental care in Iowa nursing homes

Using a stratified random sample, a questionnaire was mailed to 400 practicing dentists and 200 directors of nursing (DONs). Response rates were 58.3% for dentists and 50% for DONs. Dentists were representative of Iowa dentists, with 85% male, mean age 49.1 years, and 22.4 years in practice. All DONs were female, with mean age of 44.9 years. Of the participating dentists, 86% had provided dental care for nursing home residents, but the majority of care was completed in dental offices. Three‐quarters of dentists were somewhat/not interested in nursing home dentistry. Dentists and DONs held common perceptions of the most frequent problems related to care provision at nursing homes: low financial reimbursement, especially for Medicaid patients; no portable dental equipment; no suitable area for dentistry; dentist's preference to treat patients at their dental practice; and transportation of residents to a dental practice. Dentists and DONs had some differing perceptions about oral health care (p < .01). Minimal dental care was provided on‐site at Iowa nursing homes.     

General dentists' referral of children younger than age 3 to pediatric dentists

PURPOSE: The purpose of this study was to assess which variables are associated with Iowa general dentists' referral of children younger than age 3 to pediatric dentists. METHODS: A survey was mailed to all Iowa general dentists (N=1,089). Respondents were asked how likely (never, sometimes, often, always) they were to refer children younger than age 3 to pediatric dentists in the past 12 months. Associations between referral patterns with practice, dentists,' and patients' characteristics were determined. RESULTS: The adjusted response rate was 65%. Nearly 50% of all dentists reported often or always referring children younger than age 3. Dentists who referred were more likely to be males and to have been in practice longer. Dentists who perceived that they had not received adequate exposure to preschool children younger than age 3 in dental school were more likely to refer. Dentists with smaller percentages of children within their practices were more likely to refer. Dentists most often referred children who were uncooperative, had severe decay, or had special needs. CONCLUSIONS: About one half of Iowa's general dentists refer children younger than age 3 to a pediatric dentist. Initiatives need to be undertaken to address dentists' reluctance to care for young children.     

Dentists' attitudes and practice regarding smoking

Dentists are a potentially valuable source of community education about the health effects surrounding tobacco use. The aims of this study were to provide Australian data on dentists' current practice regarding discussing smoking with patients, dentists' perceptions of the barriers to discussing smoking with patients and dentists' interest in discussing smoking with patients. A postal survey of all dentists who were members of the Hunter Branch of the Australian Dental Association in New South Wales was conducted. Dentists generally reported quite high levels of current activity regarding smoking. The majority of dentists reported asking at least some of their patients whether or not they smoked. Dentists reported that they discussed the possible oral effects of smoking with at least some of their smoking patients. Furthermore, they told at least some of their patients with smoking related disease that smoking may have contributed to their problems. Dentists identified a number of difficulties involved in helping patients quit smoking. These findings may be used to help guide future research and practice in involving dentists further in discussing smoking with patients.     

Training for dentists in smoking cessation intervention

BACKGROUND: Although dentists are ideally placed to deliver smoking cessation advice and assistance to their patients, smoking cessation interventions are not often incorporated as a routine part of dental care. Research is needed to identify factors that facilitate and inhibit dentists' capacities to deliver smoking cessation advice. METHODS: An initial focus group discussion was conducted in Melbourne with 10 dentists. Six Victorian country dentists were interviewed in depth by telephone. Following this qualitative data collection, a random sample of 250 dentists (response rate of 57 per cent) was interviewed by telephone. Dentists were asked about their perceived role, current practices, knowledge of resources and services and opinions on training in relation to smoking cessation. RESULTS: Dentists are willing to ask and advise patients about smoking, but are less inclined to assist patients to quit or arrange follow-up. Dentists are more likely to implement one-off, opportunistic interventions rather than take a systematic preventive approach. Dentists are interested in attending further education and say they require training to be relevant to the context of their day-to-day running of the dental practice. CONCLUSIONS: Training should aim to legitimize the dentist's role in smoking cessation and provide strategies and resources so that dentists can practise interventions as part of their day-to-day work.     

Patient participation during dental consultations: the influence of patients' characteristics and dentists' behavior

OBJECTIVE: This study examined the influence of the following variables on patients' information-seeking and participating behavior during emergency treatment: patients' preferences for information and participation, patients' coping style, patients' socio-demographic variables, and dentists' communicative behavior. METHODS: The sample consisted of 83 patients receiving emergency care from 13 different dentists. Consultations were videotaped in order to assess dentists' and patients' behavior. Dentists' communicative behavior was coded by means of the Communication in Dental Settings Scale (CDSS); scores for patients' behavior included the number and nature of questions asked during the consultation, attempts to offer diagnoses, and whether or not patients made the decision to undergo treatment themselves. At home, patients filled out a questionnaire that included scales to measure their preference for information and participation and other background variables. RESULTS: Results showed that patients' desire for information and participation, together with other variables, was not reflected in their overt behavior. Furthermore, dentists' communicative behavior was unrelated to patients' information-seeking and participating behavior. CONCLUSIONS: Scores on the CDSS show that still there is a discrepancy between the legal prerequisites of information-giving and emergency dental practice. Therefore, dentists' information-giving behavior should be improved in order to enhance the patients' right to make informed decisions.     

Impact of older adults on private dental practices, 1988-1998

BACKGROUND: A 1988 study indicated that older adults made up a substantial portion of regular patients seen in private dental practices. A follow-up study was conducted in 1998 to track changes over the decade in the participating practices. METHODS: The authors collected data from respondents to the 1988 survey again in 1998. The authors received complete data from 41.7 percent of the original respondents who still were practicing at their 1988 addresses. Dentists kept a log of all procedures provided in their practices in one day. The authors attributed values of services in both years, using a 1997 national estimate of fees. RESULTS: The authors found that the percentage of office visits, services provided and patient expenditures attributed to patients 65 years of age or older exceeded the percentage of the population in that age group. In four of the five age groups in which patients had the highest mean expenditures, patients were 60 years of age or older. Patients 60 years of age or older accounted for 28.8 percent of all patient expenditures, a 12.1 percent increase from 1988. Longitudinal analyses indicated that between 1988 and 1998, dentists 40 years of age or older experienced increases of 30.3 to 64.3 percent in the proportion of visits, services and expenditures by patients 65 years of age or older. CONCLUSIONS: The results of this investigation illustrate the importance of older adults to dental practices. Data from the practices of dentists who participated in both surveys show increases in the percentage of total dental visits, total services provided and total patient expenditures attributed to older adults. CLINICAL IMPLICATIONS: Older adults continue to have a disproportionate and positive impact on the surveyed dental practices and their financial well-being. Dentists should reevaluate the accessibility of their practices to this population. Rather than waiting for the practice to "age," dentists may want to structure their practices in ways that appeal directly to older adults and work to even better understand the needs and preferences of older patients already in their practices.