Latest / The Word of Mouth Podcast / Big Legislative Changes in Dentistry?! - WoM Ep 005
Transcript
- speaker-0: Welcome to the Word of Mouth Podcast, the podcast where we discuss how to grow your dental practice as a business. I'm your host, Jeff, and this is my co-host, Sarah. Hey. speaker-1: Jeff, I'm excited to talk about what we have planned today. It's some really interesting stuff we're gonna talk about. speaker-0: For those of you who are new here or those of you who are coming back, we're changing up the format a little bit from just a podcast with me, kind of talking about the business of dentistry, to now kind of a round table with Sarah and other dentists and other experts about the trends, the news, the things that are affecting the business of dentistry. So today we're gonna talk a little bit about the ADA and the CMS arguing over adult dental being included as an essential health benefit on Affordable Care Act. Healthcare plans. speaker-1: Yeah, exactly. So kind of to break it down, what this ⁓ is talking about is that the ADA is urging the CMS or the government to finalize a rule making routine adult dental ⁓ and essential health benefit by twenty twenty seven. And the CMS or the government, they're trying to push it back, delay it to twenty twenty nine. So they're kind of going head to head, the ADA and the CMS. on when to to finalize this this new change in insurance, in health insurance. speaker-0: So the inclusion of adult dental on Affordable Care Act plans and as an essential health benefit is something that's been coming down the road for the last couple of years. the plan was to roll it out January 1st, 2027. Now the CMS is balking and trying to push that back to 2029. And I think on the one hand, there's a lot of benefits if they don't have how it's going to be structured, figured out yet. ⁓ on the other hand, I think There may be some downsides. So we're gonna talk through a little bit of what that means for dentistry as a business, for your practice, and for how to handle and prepare for that eventual coming. speaker-1: Yeah, and I think it's kind of it's interesting that the the ADA seems to be taking the approach of ⁓ wanting dental to be a part of overall health, right? For the longest time they've been very separated. You have the health insurance and the dental insurance. And I think the ADA kind of their argument with with wanting to get this out sooner is they want that dental to be ⁓ included in the realm of overall health. They think, you know. Since teeth are part of our body, they're included in our health. And and I think that's part of their their push to get this out sooner. I think two, they they want to make dentistry kind of recession proof almost. I think the ADA kind of thinks that this will help ⁓ level the playing field a little bit for dentistry. I definitely think there's a lot of ways that this affects dentistry as a business, the way it interacts with insurance. I think there's a lot of factors that play into these new changes and I think it's important to to understand it from some different angles. speaker-0: Yeah, so let's start by talking about some of those different angles. The ADA's approach for sure is the more people who are covered by dental insurance or that insurance covers dentistry, it may not be dental insurance. In this case, it might be medical insurance, but the more people who are covered, the more people who will go to the dentist, the better off the dentists are because now they are seeing more patients and more people are it it like you said, it makes it a little more recession proof. But The counter to that is that medical insurance works way differently than dental insurance. Dental insurance has deduct basically no deductibles. And so the insurance is covered, or the insurance covers treatment up to a certain amount, that annual maximum. And so, on the one hand, yes, now it's covered on all medical insurance. So everyone has effectively dental insurance, but on the other hand, Having a deductible with medical insurance now means that patients are spending more out of pocket for preventative dental care. Unless it's covered, and in that case, then medical premiums go up. And so it's kind of this mess of trying to include it. The National Association of Dental Plans t wrote an article that we'll link to in the description about kind of how this affects. Dental coverage and insurance benefits for patients. That there are some of these things that may be illusory benefits, but that in practice actually end up costing the patients more, which may ultimately have the opposite effect on getting people into the dental chair, not necessarily from a business perspective, because people obviously then may have more restorative ⁓ requirements from their dentist, but it does affect. the type of coverage, the premiums, how people interact with the dentist quite a bit. And anytime you're disrupting a giant industry like dentistry, ⁓ there are some downstream effects that I'm not a hundred percent confident people are thinking about in these discussions. Obviously people are thinking about them, but they're ⁓ maybe not being fully taken into account from either the dentist perspective or the patient's perspective. speaker-1: Yeah, absolutely. I think it'll be really interesting to see kind of the patient psychology with this change of how this affects their decision making when it comes to routine cleanings or even higher-end ⁓ services that dentists offer. I think with getting rid of the maximums that we currently see with ⁓ with the dental insurance setup, I think it'll be ⁓ interesting or it'd be interesting to see how many people will stop. Delaying those bigger procedures. I think a lot of people have already kind of hit their maximum. They don't have enough ⁓ insurance to cover some, you know, root canals or bridges or implants. And so I think a lot of times those are getting put off. So it might be interesting to see those more premium cases ⁓ being or people taking more advantage of insurance with those premium cases. But like you mentioned, with the ⁓ deductible, they'll they'll have to pay, you know, out of pocket for for a lot more with dentistry, which might lower the amount of of patients going in for some of those smaller procedures. I don't know, it'll be interesting to see kind of what the that psychology looks like. I think it's like you said, we gotta take into account the the dentists as well as the patients. And I I don't know how much ⁓ the ADA and the CMS is taking really all those perspectives into account for this this change. speaker-0: Yeah, definitely there is other incentives to move legislation along. And so you never know exactly ⁓ what those things mean. Another couple of points, ⁓ to to your point of case acceptance. There's a study that just came out in the Journal of General Internal Medicine, and they talk about medical debt and its effect on patients seeking dental care. And what they found is that. Dental care is often the first thing deferred when patients have medical debt. And there's as many as 10% of the population across different population groups, that's uninsured, Medicaid, Medicare, ⁓ and insured patients have existing medical debt. And with inflation rising, that only gets worse. The first thing to go is dental care. On the other hand, we see that with inflation rising. Dental reimbursements are not keeping pace with inflation. And so you have these kind of two competing pressures on dentistry right now that ⁓ patients view dental dentistry as a somewhat optional service. And then similarly, the patients who are covered by insurance right now have such low reimbursement rates relative to inflation that a lot of dentists aren't making any money on general cleanings. So These are kind of some interesting pressures on dentistry that exist already that I think medical reimbursements are much more stingy than I think a lot of dental insurance reimbursements would be. So that's some pressure. I think, like you said, if you're having to now pay out of pocket for some of these preventative cleanings and things, now that may move the pressure of like I have medical debt. Now even more patients are deferring dental care. So There definitely are some pressures on both sides because obviously, like you say, if my full mouth restoration is covered by insurance, well, that's great because as a dentist, you're getting reimbursed for a lot of that work. And as a patient, you're paying less out of pocket. You're paying the the your deductible effectively. And so there are certainly two sides of that coin, but A lot of things are going to change in dentistry. speaker-1: And speaking of changes in dentistry, something really interesting is has happened here in our home state of Utah where dental hygienists can now work in hospitals without dental supervision, which is kind of an interesting change because while it does open up some opportunity for these dental hygienists, I think it's also interesting because dentists are having a really hard time finding dental hygienists right now. So I think there's a little bit of Like the the law that we just talked about, there's a little bit of push and pull and there's lots of different perspectives on how this can affect dentistry, especially if it does spread to to other states. speaker-0: Yeah, I think this is a super innovative law. It makes a lot of sense here in Utah where we have a lot of rural areas. I think getting dentists out into these rural areas is not always the easiest. These are people who still need dental care, though. And so allowing hygienists to work in these environments where they can help in these rural areas or ⁓ in care facilities, ⁓ in hospitals, some of these places where There may not be as much access to a dentist. ⁓ it certainly opens the doors for hygienists. It does put some there are labor shortages, ⁓ and that's I think part of the reason for this law, but it does put more pressure on the dentists with regard to those layer labor shortages. speaker-1: It'll be interesting to see too if this kind of becomes the new norm, like it has in other areas of medicine, you know, with nurse practitioners and and things like that. I wonder if this will become the new norm in dentistry with with these hygienists kind of taking taking on more more work. speaker-0: Yeah, I think it opens up some interesting business models. I wonder if we'll see kind of like the salon, the hair salon model where you get dental hygienists who are just renting a chair effectively from the dentist. it obviously makes a ton of sense. We spoke with one of our clients about this, and they're super excited about the opportunities to have the hygiene and that kind of preventative dental work taken off their plate. Have that outsourced to a hygienist that's in their practice. And then when there are higher value cases, just get automatic referrals straight to the dentist. And so there's certainly some interesting ⁓ business model applications of this new change. There are certainly, I think, ⁓ the most obvious thing though to consider is does this work like a nurse practitioner with a in comparison to a physician, or are you better off ⁓ having that dental oversight where the dentist has a little bit more education and experience ⁓ overseeing some of these hygienists? And and maybe it evolves to kind of a middle ground where you get a instead of a nurse practitioner, you get a master's or a doctorate of dental hygiene where they're effectively getting a little more education and more of that practice knowledge in order to operate on par with a dentist, but for more of the preventative care. So it'll be really interesting to see where the dental education, the dental business models, ⁓ all the things that come out of these because they're this goes live May 6th in the state of Utah. And so we'll be keeping a close eye. I know a lot of other states are keeping an eye on how this affects the dental market and then how that continues to help progress dental care across the United States. speaker-1: Definitely crazy all the changes that are happening in in dentistry right now. In fact, in the persistent market research, they saw that the the dentistry market is projected to nearly double from $7.2 billion in 2026 to $13.7 billion by 2033. So it's interesting that we've been talking about some of these changes because a lot of these changes affect the ⁓ the smaller and you know routine cleanings with these dental hygienists and stuff where with this ⁓ with this article with this report we see that the money is in the big the high-end services the implants the invisalign the cosmetic procedures those are really becoming popular and I think we see that in all of healthcare right that these these higher end procedures are becoming very, very popular ⁓ across all fields. But I think in dentistry especially, this is really where where the money's at and where it's gonna continue to grow. speaker-0: Yeah, I think you talk about this deferred dental care that's happening across the country for people who have medical debt. Well, that's obviously for the routine maintenance, preventative dental care. And that's the stuff that's not driving growth. Obviously, if that's contracting as a market and the market is expected to double in the next seven years, it's not due to the places that are contracting, it's due to the places that are expanding. The adult Invisalign, the All on X, the veneers, the things that are cosmetic that people with money are searching for. It's the people that aren't balking at a five thousand dollar implant, but are just paying for it. Those are the people that are going to grow the dental market. And Dentists need to be ready to position themselves in order to take advantage of that. And that might be changing your current service offering mix and how you're trying to attract patients. That might be looking at different business models, like with the hygienists and kind of fill a chair, rent a chair model. ⁓ but there are different things, and a lot of these, this new legislation is going to change dentistry. And so the question is, are you keeping up with that? Or are you falling behind trying to do dentistry the way that it's been done for the last 500 years? And if you're not keeping up, the market is just gonna leave you behind. And that's not like a threat or anything. It's just that that's kind of the reality of all businesses that when the horse and boogie was really popular, it did great as a business model. But as soon as the Model T's hit the hit the factory lines, now all of a sudden being a horse and boogie owner, ⁓ Or a horse and boogie factory owner was was devastating. You now had a lot of sunk cost. And so I think dentistry is evolving. And we can see that with the legislation. We can see that with the market trends. And we're gonna be here every week trying to break down some of these market pressures and market opportunities so that dentists can take advantage of where the market's moving to. And Really grow their practices. We love the independent business model that dentistry has created. And there are huge opportunities as a result of that. ⁓ I think it's something like 75% of dentists own their own practice or are operating in a private practice. Whereas with physicians who are often cited as kind of an analog for dentists, 75% of them are working in a big hospital group. And so a lot of the flexibility, a lot of the opportunities that come from owning a small business, dentists have been able to tap into, but with the the acceleration of changes that are happening in dentistry, it's no longer good enough to just be a dentist who owns a business. You have to think like a business owner. And so that's kind of where we hope to come in and be able to help and ⁓ give our thoughts each week. We'll bring on business experts, we'll bring on other dentists. ⁓ we're also planning to do interviews with dentists about their practice. ⁓ but if you found value in this episode, we'd love it if you would subscribe below so that you'll get notified when new episodes are coming out. There will be shorts. ⁓ we're really excited about what this podcast is going to mean for dentists and and for us understanding the dental market. speaker-1: Absolutely. And just as a quick little takeaway action item for our listeners, pull your production reports from the last month and take a look at what percentage of your revenue came from routine or insurance care versus these h this high value care that we've been talking about. And think about it a little bit like this. If ten percent of your patients got hit with a $1,000 medical bill tomorrow and stopped coming for cleanings, how would this affect your practice? Would it survive? And I think if the answer is no, it's time to look at those digital workflows and kind of tap into that creative creativity that Jeff's been talking about. Something's gotta change if that's the case. speaker-0: Yeah, and let us know in the comments if you have any questions or comments or ⁓ what you guys think of the legislation. We're super interested to continue this discussion. It's not necessarily a political ⁓ thing for us, it's just kind of a business reality of where things are are moving in dentistry. So we're really excited to ⁓ chat with you each week and look forward to seeing you in the next one.