the state of dentistry what data tell us about your future practice environment cassie yarbrough,...
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The State of DentistryWhat Data Tell Us About Your Future Practice Environment
Cassie Yarbrough, MPPHealth Policy ResearcherADA Health Policy Institute
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Overview
• Introduction• The Dental Environment• Changes Impacting the Dental
Profession• Looking Forward and Points of
Strategic Action
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The Dental Environment
• What does the world look like today?
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A Major Transition
Dentistry
Shifts in Source of Dental Care
Financing
The Economy
New Dental Care Delivery
Models
Rising Student
Debt
Affordable Care Act
Change in Oral Health
Status
Shifts in Dental Care Utilization
Patterns
New Dental Schools
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Total Dental Spending ($ millions)
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
$0
$50,000
$100,000
$150,000
$9
2,3
24
$1
09
,93
4$
10
9,2
14
$1
10
,95
7$
11
1,1
59
$1
11
,61
3$
11
0,9
70
Nominal Inflation Adjusted
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Total Dental Spending
1990 1995 2000 2005 2010 2011 2012 20130%
20%
40%
60%
80%
100%
48% 51% 50% 49% 49% 48% 48% 47%
48% 43% 44% 44% 42% 42% 42% 42%
2% 4% 4% 5% 8% 8% 8% 9%
Private insurance Out of pocket CMS programs Other
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Dentist Earnings
1981
1983
1985
1987
1989
1991
1993
1995
1997
1999
2001
2003
2005
2007
2009
2011
2013
$100,000
$120,000
$140,000
$160,000
$180,000
$200,000
$220,000
$240,000
$260,000
$280,000
$300,000
$10,000
$15,000
$20,000
$25,000
$30,000
$35,000
$40,000
$45,000
$50,000
$55,000
130,
782
130,
970
133,
451
135,
074
143,
456
144,
591
147,
789
148,
488
151,
217
152,
843
157,
574
166,
858
177,
637
179,
782
177,
658
186,
540
204,
298
212,
642
210,
568
206,
623
215,
618
211,
788
210,
093
215,
876
214,
399
208,
684
200,
169
190,
492
197,
161
190,
735
186,
705
180,
950
1304
1019
2400
All GPs Non-owner GPs Owner GPs GDP
Mea
n Re
al A
nnua
l Net
Inco
me
Real GDP per Capita
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Dental Care Utilization, 2000-2012
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 201230%
35%
40%
45%
50%
42.4%43.1%
44.2%
46.1% 46.1% 46.2%
47.5%47.2%
44.4%
46.4%46.2%45.4%
47.6%
38.9%
40.3%40.9%41.0%
40.6%
39.6%39.3%
39.8%
38.4%37.9%36.8%
36.1%35.4%
38.3%38.2%
39.6% 40.0%40.4%
42.5%41.4%
42.3%41.3%41.7%
40.2%
42.4%42.0%
Children 2-18 Adults 19-64 Adults 65 and older
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Dental Benefits: Children
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120%
20%
40%
60%
80%
100%
57
.8%
57
.3%
55
.2%
55
.6%
54
.7%
53
.9%
54
.5%
52
.0%
52
.1%
52
.0%
48
.7%
49
.0%
49
.7%
20
.5%
23
.0%
25
.8%
27
.1%
28
.3%
29
.9%
29
.8%
30
.9%
30
.6%
32
.5%
35
.5%
36
.8%
37
.2%
21
.7%
19
.7%
18
.9%
17
.3%
17
.0%
16
.2%
15
.6%
17
.1%
17
.3%
15
.4%
15
.8%
14
.2%
13
.1%
Private Medicaid or CHIP Uninsured
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Dental Benefits: Adults
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 20120%
20%
40%
60%
80%
100%
61
.0%
61
.5%
60
.8%
59
.6%
60
.2%
60
.1%
59
.5%
59
.1%
57
.6%
56
.9%
56
.1%
56
.2%
55
.9%
6.5
%
6.5
%
7.4
%
7.7
%
8.0
%
7.9
%
7.8
%
7.9
%
8.4
%
8.6
%
9.3
%
10
.0%
10
.1%
32
.5%
32
.0%
31
.8%
32
.8%
31
.8%
32
.0%
32
.7%
33
.0%
34
.0%
34
.5%
34
.6%
33
.7%
34
.0%
Private Medicaid Uninsured
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Reasons Why Adults Do Not Plan to Visit a Dentist
All Private Insurance Medicaid Medicare Uninsured
-10%
0%
10%
20%
30%
40%
50%
60%
40
.2%
35
.1%
49
.9%
38
.3% 43
.8%
32
.7%
34
.8%
13
.7%
23
.8%
38
.9%
14
.1% 19
.7%
18
.4%
19
.9%
16
.6%
35
.8%
25
.6%
1. Cost
2. My mouth is healthy and I do not need dental care
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Reasons why High Income Adults Do Not Plan to Visit a Dentist
-20%
0%
20%
40%
60%
53.2%
21.9%17.5%
13.5%10.8%
2.9% 2.0% 1.1%
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Financial Barriers to Dental Care
Prescription Drugs
Dental Care Mental Health Services
Eyeglasses Medical0%
2%
4%
6%
8%
10%
12%
14%
16%
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
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Changes
• The Affordable Care Act
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Uninsured Rate as of December 2014
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Dependent Coverage Policy
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Marketplace Dental Benefits, 2014 and 2015
2014 Medical Plans 2015 Medical Plans 2014 Stand-Alone Dental Plans
2015 Stand-Alone Dental Plans
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
72.8%63.8%
0.7%1.3%
58.0%70.4%
26.1%34.4% 42.0%
29.6%
0.4% 0.5%
None Family Child Adult
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Marketplace Questions
• Are consumers buying dental benefits?
• Are the dental benefits “good”?• Are consumers using the dental
benefits they purchase?
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Are Consumers Buying Dental Benefits?
Under 18
18-25 26-34 35-44 45-54 55-64 65+0%
10%
20%
30%
20.1% 21.7%26.7%
23.5%19.5%
16.1%10.8%
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Are Dental Benefits “Good”?
First Dollar Coverage for Preventive Pediatric Services?
Medical Plans with Embedded Pediatric Dental Benefits
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Click icon to add picture
Are Consumers Using These Benefits?
?
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Medicaid Expansion15% of
general dentists
50% of
pediatric dentists
are accepting new Medicaid patients
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Medicaid Expansion
IN*NE*SC*LA*VT
WY*VA*SD*DC
MT*MNMI
PA+NJKYAR
NC*MACTNY
WI*AK*CAIAIL
NMOHORRI
WAND+COLi
mite
d A
dult
Den
tal B
enef
its in
Med
icai
dE
xten
sive
Adu
lt D
enta
l Ben
efits
in M
edic
aid
0% 50% 100% 150% 200% 250%11.1%12.2%14.2%15.0%15.3%15.4%15.6%
21.7%25.8%
30.4%45.9%
66.9%93.2%
156.0%198.0%
205.2%9.2%9.6%
27.9%30.4%30.6%
38.2%43.7%
60.8%77.5%
91.1%93.2%
101.4%102.3%
119.5%127.8%
152.5%
9.2% to 205.2% Potential Increase in Medicaid Adults Seeking Dental Services
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Total ACA Benefits Expansion
IL
OH PA MI
NJ AR NM IA ND WI
NC LA VA IN AK MT NE SD WY0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
Estimated 2014 Medicaid Increase 2014 Adult Federal SADP Enrollment
States Not Expanding Medicaid under the ACA
States Expanding Med-icaid under the ACA
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Let’s Assume Demand Goes Up…
• Are there enough dentists to keep up?
• Will they want to treat these new patients?
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Dentists per 100,000 Population
2003 2008 2013 2018 2023 2028 203350
52
54
56
58
60
62
64
66
59.160.0
61.762.6 63.1 63.2 63.3
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Percent of Dentists “Not Busy Enough”
Nor
th D
akot
aRh
ode
Isla
ndVe
rmon
tVi
rgin
iaM
inne
sota
Mas
sach
usett
sAr
kans
asW
isco
nsin
Tenn
esse
ePe
nnsy
lvan
iaTe
xas
Mar
ylan
dIn
dian
aN
ew M
exic
oIo
wa
New
Yor
kO
rego
nN
orth
Car
olin
aCo
lora
doN
ew Je
rsey
U.S
. Ave
rage
Ohi
o Ca
lifor
nia
Mic
higa
nSo
uth
Caro
lina
Geo
rgia
Alab
ama
Conn
ectic
utW
ashi
ngto
nIll
inoi
sM
isso
uri
Flor
ida
Ariz
ona
Uta
hKe
ntuc
ky
0%
10%
20%
30%
40%
50%
60%
6%
36%
55%
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Child Medicaid Reimbursement, 2014
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Adult Medicaid Reimbursement, 2014
IL NJ MI MN WA CA RI WI OR CT CO NY KY OH PA IA VA MA NC IN NM SD DC WY VT MT AK ND AR
0%
10%
20%
30%
40%
50%
60%
70%
13
.8%
60
.5%
Pe
rce
nta
ge
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Opportunities and Strategies
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Emphasis on Value
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Leveraging the Value Agenda
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Increased Care Coordination
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Consumerism
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Increase Dental Care Utilization
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Rethink the Role of the Dental Practice
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Practice Consolidation
The trend toward larger, consolidated multi-site practices is expected to continue, driven by changes in practice patterns of new dentists, a drive for efficiency, and increased competition for patients.
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Career Choices – Group Practice
Dentists in large group practices… – reported lower satisfaction levels associated with work hours,
scheduling, and overall work-life balance– reported less ability to influence the organization or to advance within
it– reported higher satisfaction levels with income and benefits– were less likely to report feeling stressed in their jobs– were less likely to be satisfied with the care delivered in their practice– were less likely to report satisfaction with their careers in dentistry
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Student DebtWhat are the trends in dental student debt? How does this compare to higher education in general?What is the impact of dental student debt on career choices?
– Pursue advanced education – Work in private practice or public health, government, faculty
position– Own a practice– Hours worked per year– Accept uninsured and Medicaid patients
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Student Debt
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Student Debt
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Student Debt
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Thank You!
For more information visit the ADA Health Policy Institute at:
www.ada.org/hpi