ADA Says Dentists Need to Accept Value Based Care as “Inevitable”

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

Medicaid providers in Texas have already been started down this road back in 2018 with at least one provider agreeing to a value-based contract.

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.


3 Responses

  • Most health professionals charge hourly. Medicine and dentistry have been the exception.

    Fee for service, while long common within dentistry can be criticized for encouraging over-treatment and upcoding. While it might not be well received, an honest and open discussion of how dentists are compensated for professional services is rational.

    Would hourly fees, with lab fees added work for dentists?

    I do not pretend to know. Just asking.

  • I don’t like it when a headline does not match the content. It is not true that “ADA Says Dentists Need to Accept Value Based Care as “Inevitable””. Fake news.
    The authors wrote an opinion piece, and they do not speak for the ADA. (An employee of HPI writing an opinion is far removed from being an ADA statement.) That some reacted “as if” the ADA said it does not make it so. The headline makes it sound like this is the direction the ADA wants for dentistry. That is 100% false.
    Moreover, what it says is that it is inevitable that 3rd party payers will be offering benefit plans to employers that use the VBC model, which is a variation of the capitation model. So what? It is not inevitable that dentists have to accept those contracts. (That one provider in one state has accepted a contract first offered in 2018 speaks to the fact that there are many dental practice models and many different practice missions. It says nothing about any inevitability that “dentists” will HAVE to accept VBC/capitation contracts.)
    IMO, there has been much ado made about nothing. That was clarified in a follow-up, published by the ADA, where the authors retracted their wording that implies the point for which they had no intention to convey. That some want to latch onto certain words and certain phrases in order to make themselves upset is a waste of time and effort. (Most seem to want to prove to themselves that the ADA conspires against their interests. Fake news. Simply untrue.)

    • Thank you for your very valuable comments. There was no update to the editorial itself as that was checked before publication. The word “inevitable” comes from the authors’ use of “inevitability” in the editorial, not TDMR. An editorial written by two distinguished economists, one the chief economist and vice-president of the ADA’s Health Policy Institute, under the imprimatur of the Journal of the American Dental Association without counter veiling opinion or comment, certainly makes it seem like an ADA position. Can we be faulted for thinking so? Thank you for informing us about the authors’ followup mea culpa. The link to the online article is here. Considering the speed of the clarification, this isn’t much ado about nothing, as you state. It is their prophetic words in the editorial manifesting themselves that “if you are a provider reading this and thinking “this is a terrible idea,” “we need to stop this” coming true.

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