Pew Study: New Types of Dental Providers Can Improve Access to Care and Dentists' Profits

Most private-practice dentists who hire new types of dental providers can serve more patients, including more Medicaid enrollees, while maintaining or improving their financial bottom line, according to a new report from the Pew Center on the States. New types of providers play a role in delivering dental care similar to that performed by nurse practitioners in the medical system. 

Pew's report is the first to examine the impact that hiring new types of providers — dental therapists and hygienist-therapists — would have on the productivity and profits of a private dental practice, where more than 90 percent of the nation's dentists work. The study also assesses the impact of dental hygienists, who are currently employed by most dental practices.  Dental therapists and hygienist-therapists are trained to perform a broader range of services — including filling cavities — than hygienists.   

It Takes A Team: How New Dental Providers Can Benefit Patients and Practices applies an economic tool that Pew commissioned, the Productivity and Profit Calculator, to evaluate the impact on dental practices that hire one of these three "allied providers." The report, calculator and related materials are accessible at www.pewcenteronthestates.org/ittakesateam, and individual dentists can use the calculator to evaluate the impact of allied providers on their own practices. 

"This report is good news for dentists who work in private practices, patients who aren't getting care and policy makers who are eager to find cost-effective solutions to access problems," said Shelly Gehshan, director of the Pew Children's Dental Campaign. 

Nationwide, 17 million low-income children go without dental care each year. Multiple factors fuel this problem, including a shortage of dentists serving rural and poor communities. As a number of states consider authorizing new types of dental providers to fill this unmet need, dentists in private practice are looking at the effects of this potential change on their businesses. 

Children without access to care are more likely than their peers to suffer tooth decay, miss school days and face broader health problems that end up costing their families and taxpayers much more money than basic dental care. 

The health care reform law enacted this year guarantees medical and dental insurance for nearly all children.  This means an estimated 5.3 million more kids will secure dental coverage by the year 2014. States will be hard pressed to ensure that the supply of dental providers meets this greater need for care. It Takes a Team shows that new types of providers offer policy makers a sound strategy to significantly improve access for low-income and rural children.   

The calculator commissioned by Pew tested multiple private-practice scenarios, and most showed that hiring new types of providers can enable a practice to expand services and see more low-income patients without experiencing a drop in the practice's profits. Pew's report found that:   

• In solo dental practices devoted to serving the privately insured, adding any allied provider increased productivity and pre-tax profits. In every scenario tested, solo dental practices — where most dentists work — increased their earnings by a range of 17 to 54 percent when hiring a new provider.
  
• In a state with an average Medicaid reimbursement rate (60 percent of dentists' standard fees), solo-practice dentists serving only the privately insured could hire a dental therapist, shift their patient mix to 80 percent privately insured and 20 percent Medicaid patients, and still see their pre-tax profits increase between 6 and 7 percent.
  
• In states with Medicaid reimbursement rates that are 30 percent, dental practices see reduced profits when they serve Medicaid enrollees. Yet even in these instances, Pew's study found that dentists fared better financially serving low-income patients with an allied provider rather than without one.

Although these scenarios represent typical dental practices, the specific impact of allied providers will differ from state to state and practice to practice. For this reason, Pew has made the Productivity and Profit Calculator accessible online to dentists and policy makers. Users can assess the potential impact of new providers by inserting data from their own dental practice to reflect the costs and market conditions in their area, as well as test the effect of providers with different scopes of service. The calculator is not intended as a business-planning tool to forecast actual profit and loss.   

"We want to replace guesswork with data by giving dentists and policy makers a tool to help them understand the impact of new types of providers in their states," Gehshan said. "This report shows that hiring allied providers can produce a win-win outcome. Dentists can serve more low-income children without seeing their earnings decline." 

Dr. Wayne Cottam, Associate Dean of Community Partnerships at the Arizona School of Dentistry and Oral Health, welcomed Pew's report. "Coupled with other emerging studies on new providers, this report should encourage an honest dialogue around what is best for the patient, the community and the larger public," he said. "More importantly, this report brings much-needed evidence to help guide the vigorous policy discussions on this topic." 

Allied providers have offered quality care for decades in Great Britain, Canada, New Zealand and other countries. In addition, dental health aide therapists have been deployed in Native Alaskan communities since 2005, and last year Minnesota enacted the first state law authorizing similar allied providers.