Dentists nationwide are struggling to provide dental services with low reimbursements from insurers, including public programs such as Medicaid and Medicare.
CMS is proposing to pay for more dental services under Medicare as part of its proposed Calendar Year 2023 Physician Fee Schedule. The proposal includes payment for additional services such as dental exams and treatment preceding an organ transplant. The proposed physician fee schedule conversion factor for CY 2023 is $33.08, a decrease of $1.53 from 2022.
Here, four dentists react to the proposal and discuss how CMS reimbursements affect the dental industry:
Editor's note: Responses were lightly edited for clarity and length.
Charles Rim, DDS. Oregon State Hospital (Salem): The Centers for Medicare & Medicaid Services proposed physician fee schedule for dental services can be discussed from the provider, consumer and policy level.
Amid COVID-19 pandemic, the healthcare system is facing increased costs due to heightened standards for infection control and prevention measures, supply chain and staffing issues. The dental industry is also greatly affected. If the reimbursement does not appropriately meet the financial cost of running a dental facility, the dental clinic is not sustainable to provide essential dental services in the community. Another sustainability factor for the dental industry is the high cost of dental education that impacts the bottom line. The CMS proposal to increase access to high-quality care and payment for dental services must consider the provider-level expenditures.
At the consumer level, the CMS proposal to increase access to high-quality care and payment is good news, as more people will need geriatric care in the future. An integrated healthcare system including essential oral health services may address the complexity of care for the aging population and unmet healthcare needs.
The practice of healthcare must be a comprehensive and multifaceted system to address a healthier population with prevention and support of improved quality of life while better managing available resources. As the country is recovering from the pandemic, the healthcare system must evaluate opportunities for improvement balancing the provider and consumer level of care effectively for the complex patient population. The CMS proposal for dental services can improve access, coordination and quality while reducing overall cost of care through appropriate structure, strategy and substantial policy changes.
C. Bradford Rand, DDS. Watermark Dental (Brewer, Maine): The Center for Medicare & Medicaid Services' proposal to increase dental benefits represents a significant step forward for patients with Medicare. Previously, Medicare coverage for dental treatments was very limited, such as prior to reconstruction of the jaw. This new proposal broadens the types of surgeries where dental procedures may be covered. Since there are correlations between good oral health and improved healing after surgery, patients undergoing organ transplants and specific heart surgeries may soon have some dental benefits under Medicare. Dental and medical colleagues will have the opportunity to partner in improving outcomes for these patients.
Michael Davis, DDS. Smiles of Santa Fe (N.M.): Our Medicaid program is disgustingly rife with waste, fraud and various abuses. A patch here and an interim quick-fix there is not a viable solution.
The entire program is so toxic that it must be scrapped and restructured from the ground up.
Unfortunately, government policymakers in public health are largely clueless and generally exhibit little to no financial or clinical experience. Too often "stakeholders" in the Medicaid program are the same parties which "game" the system.
There are wonderful viable solutions. Both taxpayers and disadvantaged citizens can benefit. Persons such as myself and numerous other clinicians have offered these changes publicly and in writing.
Unfortunately, nothing meaningful will be addressed until or unless certain stakeholders are excused from the table of decision making.
Marshall Bonnie, DDS. Bonnie & Simone (Norfolk, Va.): The fee schedule is only one of several issues affecting participation in the CMS program. Participation in the Medicare program by dentists is a very minor factor in their practices. Participation by oral and maxillofacial surgeons is only marginally more prevalent. According to the referenced article, it appears that the conversion factor will result in a decrease in reimbursement for fiscal year2023 — certainly not a compelling reason to participate.
The article states that certain services are presently covered … namely, "extractions in preparation for radiation therapy in cancer patients." I have been providing that service for over a decade. The potential reimbursement is hardly sufficient to cover the cost of the service. This reimbursement is further reduced if the practitioner is a non-participant with Medicare. The real dilemma is the inability to easily have the claims accepted and processed. It has been difficult to get CMS to provide a clear and consistent protocol for approval of the service and adjudication of the claim.
Admittedly I have not pursued this problem in many years. It was just too time consuming and frustrating. Perhaps the process has been streamlined and become more straightforward.
The implication is that preventive exams and care would result in early detection and early treatment of "medically necessary dental procedures" and save billions. This would require a profound increase in the number of participating dentists and surgeons, a clear decision pathway for determining which procedures and medical conditions are eligible for reimbursement, and a user friendly, seamless claims submission and payment process.