4. Access and Delivery Systems Flashcards
Forces influencing dentistry
- DEMAND
- ____
- changes in utilization patterns
- changes in ____
- shifts in sources of financing
- SUPPLY
- rising ____
- new delivery systems
- new ____
• Red are supply
• Green are demand
• Look at projections for pop and combine with utilization rates and limit the number of schools and number of graduates so you don’t have cycle of busy/non-busy
economy
oral health status
student debt
dental schools
Total dental spending
• In great recession > \_\_\_\_ out of dental expenditures ○ Rebound in 2012 ○ Expenditures for next few years will be flat
flattening
Dentist busyness
• Mean \_\_\_\_ is indictative of dentist busyness • Has \_\_\_\_ over the years • \_\_\_\_ of the distance between two lines ○ Another indication
dentist waiting time
declined
narrowing
Dentist net income vs. GDP/capita
• Compare dentists income to GDP over 30 years • GDP has been \_\_\_\_ steadily ○ Blue bars - periods where we suffered some form of a recession § Drops in these areas • GDP drops in those areas, some times barely registered ○ Mean real income for dentists > gone up from 2000 to prior recession , but taken a \_\_\_\_ sinc ehten
rising
dive
Supply vs. Demand “Drivers”
Supply Side
1 Train more ____?
2 Do today’s students
understand changing patient ____?
Demand Side 1\_\_\_\_ 2\_\_\_\_ 3\_\_\_\_ (M/M, ACA) 4Potential \_\_\_\_ Sources
dentists mix patient employer government referral
• Supply v demand drivers
○ Supply
§ Everyone understadn the changing patient mix
§ Patients have more ____ > has changed since the past
§ Access to care - lower ____ setting
○ Demand
§ Will patient value?
§ Will they have coverage?
□ Bc of ACA > children from medicaid have increased utilization prior to that
§ Care seeking has gone up in seniors > medicare doesn’t cover dental care
§ Employers
□ Primarily pay for medical/dental care through programs; supplement to ____ (or replacing)
□ Concerned about increased cost > places more strain on the ____
§ Govt
□ Increasing utilization in some groups; but 19-60 there has been a decline in utirlization of services
health problems
socioeconomic
salary
patient
Distribution of Adults 19-64 yrs
• Increase the demand ○ Difference of people who visited and din't visit • Those who visit dentist and visit physician but have private dental benefits but not going; better develop relationship with physicians > it'll be better for both patient and dentist if these people use their \_\_\_\_ ○ Physician is a \_\_\_\_ § Can just ask if they've been going
benefits
gatekeepers
Is the Supply Side ready to adjust?
____ and inner city areas? Medicaid, low income population?
Arrangements with FQHCs?
____ positions?
Will Dental Schools provide support?
Can the Demand Trend be reversed?
vReduce ____ of care?
vIntegrate ____ into whole body care?
vInnovative ____ models
• Adaptation is important for this presentation! • FQHC ○ Programs largely to serve those without access ○ >75% have dental care now • Salaried ○ Unlike traditional dentist - operate in two modes • Current mantra: reduce the cost of care ○ Healthcare is absorbing 18% of GDP > no \_\_\_\_ health results • Making sure mouth is part of body • Interacting with other health individuals ○ \_\_\_\_s are important
rural salaried cost dental delivery positive social workers
Model of Four General Eras of Public Expectation for Oral Health
• Compares the proportion of pop that ahs expectation for oral health ○ 18th century: \_\_\_\_ § Teeth will hurt and rot > can get rid of the pain, hopeful ○ 19th: \_\_\_\_ § Materials that can make full dentures > patients wanted the teeth out ○ 20th: \_\_\_\_ ○ 21st (now): \_\_\_\_
resignation
replacement
repair
protection/prevention
What is a “Delivery System”?
“…
means by which care is provided to patients.”
____
supply of ____
means of ____
structure
personnel
payment
• Private and public side to structure
○ And ____ that address the system
QA
Private Practice (~90% of dentists)
+ Aspects
- ____
- ____
- no tax ____ required
- freedom of choice?
negative Aspects
- fixed ____
- dentist ____
- cost of care
- chronically ____
- developmental disabilities
- ____ children• Largest
• Positive
○ Don’t need to buy more equipment to get more money. Of it
○ Flexible
§ Can open more offices
• Negative
○ Dentists are not always where patients need them to be
○ Cost
§ Trying to include dental care as package of Clinton reform, frustrated bc couldn’t get admin to get feedback
§ “Costs too much to include dental care”; but didn’t have to be this way > got into the bill but not via government
○ Pre-school
§ GD don’t feel comfortable treating
flexible
efficient
$$
overhead
distribution
ill
pre-school
Distribution of Private Practice Dentists
* Majorly \_\_\_\_ * Shrinkly rapidly * Indep non solo - \_\_\_\_practice
solo
group
Other Private Practice
Franchised
- rapid growth in 1980s
- named ____
- bulk purchasing
- ____ clinic design
- rapid decline in late 80s
- lack of ____
- poor management/unprofessional image
- ____
- high costs
branded
standard
capital
overexpansion
Other private practice
Hospital-based
- 1,000 dental depts
- ____/academic
- 40,000 dentists w/ hospital privileges
- ____ children
- maxillo-facial surgery
- ____ patients
- GPR programs
federal
young
high risk
Other private practice
• Hospital-based ○ Less common in \_\_\_\_ hospitals ○ Largely set up to take care of young children, OMFS, high-risk and GPR programs • Franchised ○ Grew rapidly but flamed out ○ Rapid decline due to the reasons listed
private
Dental Management Companies
Potential Benefits:
____ support (bookkeeping, billing, payroll, supplies) Human resources
____
Training
____, purchasing power, marketing, access to capital
New ____
Team players
Possible Disadvantages:
Lack of ____ Practice decisions
* Not directly paying for these things * Better for team players - traditionally been solo-oriented
admin insurance QA programs technology ownership/control
Corporate Dental Practice
What is it?
“… frightening … no one knows exactly what
we are dealing with.” (
Separation of treatment and management
Most states ____ corporate ownership
States that allow include: ____, MS, ____, ND, ____, and Utah
prohibit
AZ
NM
OH
Dental Practice Management/Service Companies
Increasing percentage of dentists are in DPMCs Student \_\_\_\_ Two career families (flexibility/mobility) \_\_\_\_ opportunities Practice management experience More \_\_\_\_ time
● Heartland Dental: 250 practices in 14 states
● Pacific Dental Services 195 in 5 states
● Aspen Dental > 300
● Dental Care Alliance 250 in 15 states
debt
CE
family
• Buy dental practices, string them together, or build their own clinics and hire clinics as salaried employees
• Take care of the management side
• Reasons
○ Usually younger dentists
○ More flexible than a private practice if you’re moving often
• Why are DMOs growing? ○ \_\_\_\_ available ○ Increased supply of labor, and supply of practices for sale § Due to the recession and dentists hanging onto their practices \_\_\_\_ ○ Increased revenue from captured specialty svcs § Can now be provided in house ○ More efficient use of facil and staff ○ Lower facil cost ○ Higher \_\_\_\_ from mgd care plans § Result of \_\_\_\_ power - better rates ○ Aggressive marketing ○ Economies of scale for equip & supplies
venture capital
longer
reimbursement
bargaining
- Size of dental orgs
- ____% of dentals particiapate in DMO
- Greater percentage are ____, and are younger
- Many specialties involved > ____ is high
- ____ states have none involved with DMOs
- ____ have the largest % (17.5%)
- Upenn is 6.2% - below average (the national)
- Under age of ____ - a lot of dentists participate in DMO
- Compare to those not in DMO that participate in medicaid - a larger % of dentists in DSOs have ____ services
7.4 female pediatrics 6 Arizona 30 medicaid
