Dental benefits task force hears from group practice model experts

The CDA Dental Benefits Research Task Force heard from group practice and network management experts at its December meeting.

The task force, which is identifying strategies to enhance the position of providers and patients in the dental benefits marketplace at the request of the 2011 House of Delegates, heard from Gary Pickard, director of plan relations at Pacific Dental Services; Jeffrey Parker, CEO, and Burt Arthur, CFO of Sarrell Dental Center in Alabama; and Michael Grossman, DDS, former president and CEO of First Dental Health.

“We looked at different types of group practice models and heard a lot about how they best utilize their resources and time within their practices,” said Walt Weber, DDS, chair of the task force.

Pacific Dental Services, based out of Irvine, operates under a dental support services model that handles administrative tasks such as payroll and insurance, and hiring of non-clinical staff for client dental practices. The dentist(s) in these PDS-affiliated offices own(s) the clinical practice and manages the clinical staff and the treatment of the practice’s patients.

“It’s a different model,” Pickard said. “We help the dentists focus on dentistry. They don’t have to worry about billing, claims or accounting or payroll. We say, ‘just be a dentist, focus on your patients and we’ll handle the rest.’”

Dentists join a PDS-affiliated office as an associate working under the mentorship of the owner dentist. An associate may later have the opportunity to become an owner of a PDS-supported office. The company advertises its services as giving dentists the opportunity to have other dental professionals supporting them and with whom they can confer and collaborate. The company also provides its affiliated dentists with marketing, real estate and human resources services.

“This is what large groups and DSOs are all about – efficiencies, economies of scale and support,” Pickard said.

Weber said the presentation provided a good look into this type of model.

“This is a growing approach; to partner in ways that level resources and support the business aspect of a practice,” Weber said. “It’s not for all dentists because they may have less schedule flexibility, but it does work for some dentists, particularly new dentists who may appreciate the help handling the administrative aspects of running a practice.”

Sarrell Dental, the Alabama not-for-profit, featured in the June 2012 PBS Frontline documentary, Dollars for Dentists treats Medicaid and Children's Health Insurance Program (CHIP)-eligible children ages one to 20. Sarrell Dental follows the structure of many hospitals utilizing a chief executive officer and a chief dental officer.

Sarrell's CEO, Jeffrey Parker, is a retired corporate executive. The CDO is responsible for all clinical operations and personally peer reviews the care of each Sarrell dentist. Sarrell is governed by a board of directors charged with "increasing access to care in underserved areas."

The company employs 56 dentists who are personally accountable for all treatment planning and clinical care decisions. It also employs 46 hygienists, with a total staff of about 210. Most dentists work at a different facility each day (Sarrell has 14 facilities in total) in an effort to make sure patients’ needs are met by multiple providers who are held accountable by their dental peers in the organization.

"Based on their presentation, that multiple-dentist strategy is not just encouraged, it is built into the system, so all people involved in providing care are invested in the patient outcome," Weber said.

Parker added that his offices meet the needs of the demographics of each geographic area they serve. This may mean extended hours, staying open six days a week, etc.

"It's our culture," Parker said. "It may be 7 p.m. and we are cleaned up and ready to go home. However, if a patient shows up, our team turns the lights back on and we get back to work. Eighty percent of our patients are not old enough to drive. It's not their fault they are late. What would you want done for your child?”

The Sarrell model has been highly successful in Alabama. The company has had 31 consecutive quarters of patient growth and had 105,000 patient visits in 2011, and plans to exceed 130,000 patient visits in 2012.

“We believe we have the data that proves we are the low-cost, Medicaid provider in the United States,” Parker said.

Weber said it was educational for the task force to hear about this type of model.

“This seems to be model that is showing a high level of success for treating Medicaid children,” Weber said. “It is a model that is getting increasing levels of attention nationally, so it is important that the taskforce understands how it works.”

For more insight into dentist networks and non-traditional plan offerings, the task force also heard from the Michael Grossman, DDS, former CEO of First Dental Health (FDH) in San Diego. FDH was purchased by The Principle Financial Group in October.

First Dental Health is a network management company that initially provided its network to fee-for-service (self-funded and insurance company) dental plans to be utilized as the network for their preferred provider organizations. The company also created the first licensed discount dental plan in the state. Discount health plans provide an option for cash-pay patients who otherwise lack insurance coverage.

According to Grossman, many dentists like participating in a discount dental plan because when a patient is without insurance, “the dentist may wish to offer a discounted fee but doesn’t want to negotiate with the patient regarding the cost of care. So they refer the patient to their office manager who then recommends a discount plan that the office honors.” Grossman said.

According to its website, First Dental Health networks are now available to more than 800,000 members in more than 5,500 groups through more than 60 insurance companies and third party administrators.

“There are alternatives in the market that can help a dentist retain and gain patients in the less than ideal economic times that we are living in,” Grossman said.
Weber said the companies that work under the umbrella of a “group practice model” that presented to the task force brought forth a unique look into a different side of dentistry.

“We’re seeing some advantages to being involved in a group practice such as sharing space, sharing costs and lowering overhead, all which contribute to increased margins by making practices more efficient,” Weber said.

Weber noted that the task force has learned a lot about the health and dental benefit marketplace, the Affordable Care Act, dental plan and dental practice trends over the last several months, information that will help them in the coming months as they move into the next phase of their work.

The CDA Dental Benefits Research Task Force meets again Jan. 10.

Members interested in the dental benefits research project can visit cda.org and click on the dental benefits taskforce under “Advocacy.” Additionally, further resources on dental benefits can be found on the Practice Support Center online at cda.org/compass.

For more information on this or other dental payment issues, contact the CDA Practice Support Center at 866.232.6362.