Evolving the Standard of Care

Many dentists are frustrated with the insurance industry for not keeping reimbursement amounts in line with the rate of inflation. Today, the amounts are not much higher than they were 30 years ago, and developments in technology and the science of materials continue to race far ahead. To make matters worse, as employers look to save money on benefit packages, it seems that the number of procedures that are covered in many plans has decreased. Further complicating all of this is the fact that insurance companies like to focus primarily on bacteria-related issues when paying benefits. Although treatment to arrest the activity of bacteria is important, every dentist knows that most patients who have major restorative issues also have functional issues as well. Patients who have severe wear into their dentin and a loss of functional tooth contours are usually left with few benefits from their insurance carriers. Anterior teeth commonly need to be restored despite the lack of a bacterial cause; however, this is often considered elective cosmetic treatment, even though it is functionally necessary. Claims frequently get rejected based on a lack of evidence of bacterial involvement, and in the eyes of the patient, the wording of "evidence of bacteria" claims can make it look like the care was never needed. Throughout the years, dental practices have become more and more dependent on insurance to provide them with patients and thus, have learned to operate within the boundaries of yearly benefits. As a result of this, the insurance industry has begun to dictate the standard of care based on what they are willing to cover. This leaves dentists trapped between patients and their insurance plans.

Most dentists who I speak with describe experiences that are similar to the this narrative. Many feel burned out and defeated. The reality, however, is that dental insurance is here to stay. The choice then becomes either to work with it and view it as an asset or to let it be a veil of negativity. In my view, the problem isn't with the insurance industry-it is with the profession. If we want to change the relationship that we have with our patients and change how they view oral healthcare, it is we who must change and adapt.

If dentistry is to raise its standard of care, the profession needs to move beyond seeing the issues only one tooth at a time. Dentists need to be thinking about their patients' health 10 or 20 years into the future, evaluating where patients are and where they have come from in their individual health journeys. Ultimately, the responsibility of dentists is to prevent their patients from ever needing care in the first place. Every 50-year-old with significant dental needs started as a 25-year-old showing early signs and symptoms of bigger problems. The difference is in communicating genuine concern and educating patients about what is possible.

Once concern has been expressed over a patient's condition, it is time for compassion. Patients need to take ownership of their oral health issues. Oftentimes, the cost of recommended care exceeds patients' dental benefits. They may need time to financially prepare in order to properly take care of their issues. Our job is to keep supporting and educating them until they are ready and able to choose a higher level of care.

Providing clinical care to our patients is truly an honor and a privilege, and when patients accept treatment, it is the greatest compliment that they can give us. I can say with certainty that when you express genuine concern and offer compassion, you will often be given the privilege of providing care. The keys are slowing down, communicating with and educating patients, and taking insurance out of the equation. As dentists, we are doctors of the masticatory system. When we help patients take ownership of their issues and understand how to move forward, dental insurance stops driving their decision-making, and the result is a steady increase in the standard of care that we can provide.

Leonard A. Hess, DDS, is a senior faculty member at The Dawson Academy and maintains a private practice in Monroe, North Carolina.