A firestorm erupted last month with an editorial published in the Journal of the American Dental Association titled “Value-based care in dentistry – Is the future here?” by Marko Vujicic, the chief economist and a vice president of the ADA’s Health Policy Institute and Guy David, professor of Health Care Management, The Wharton School.
Reduce healthcare costs
Under the rubric of lowering per capita healthcare costs in the US which are stated to be the highest in the world, Vujicic and David argue that dentists must bear their part of the burden of lowering these costs by eventually accepting “population-based payments” or, in other words, capitation from their insurers.
Unfortunately, of the $12,318 per person per year spent on healthcare here, Vujicic and David do not provide a percentage amount that accrues to personal dental care. So it is difficult to determine if dentistry is partially to blame for this spending.
Prevention but control patient behavior?
While value-based care tends to focus on prevention, which is a good thing, it also focuses on rewarding outcomes that obviously have much to do with patient behavior, particularly in dentistry. One can’t be there every evening to brush a patient’s teeth or stop them from drinking that Big Gulp, especially Medicaid-eligible children.
Already being done in Texas Medicaid
Bring it a step closer?
The JADA editorial ends with the wishful words:
“VBC in dentistry is an approach that prioritizes the patient’s needs and preferences, aims to achieve optimal oral and overall health outcomes, and uses evidence-based practices to deliver high-quality care. This is the future. Let us bring it a step closer.”
Do not go gently into that good night
The idea of capitation does not sit well with many dentists. This is acknowledged in the editorial.
“If you are a provider reading this and thinking “this is a terrible idea,” “we need to stop this,” “I can’t control people’s health,” or feeling really uncomfortable or angry, you are not alone. The VBC movement is disruptive, especially to providers. It is not what medical and dental schools have been training students to do. Nevertheless, although the process is slow for the reasons we mentioned, there is a consensus around its inevitability [our emphasis]. There is no turning back on this journey.”
Indeed, it is unpopular. The Dentistry in General podcast held a roundtable on June 13 on the paper. Those involved were
Raymond Cohlmia, DDS, Executive Director of the ADA
Marko Vujicic, Ph.D., ADA Chief Economist, and Vice President Health Policy Institute
David Leader, DMD, MPH, ADA member, Associate Professor Tufts University
Mouhab Rizkallah, DDS, MSD, ADA member, Author Massachusetts’ Question 2
and Bob Dee DDS, Founder Dentistry In General Dental Community, Moderator
The debate became very heated but is a long watch. Dentistry Today published an article about it. Makes for good reading.
What do you think?
Here is the editorial. The original online version.
UPDATE: Previously we had a copy here to be viewed which we had downloaded. But due to protections in the PDF file, it became corrupted once uploaded and viewed online.