Drivers of Change

Change is something to be expected and oftentimes anticipated, especially in the world of health care delivery. Change drives the transformation of systems and processes that unless challenged will not evolve. The winds of change are definitely upon the field of dentistry, stirring feelings of both excitement and fear of the unknown.

There is growing interest in group practices and dental service organizations (DSOs). The changing demands of consumers coupled with a new emphasis on patient-centered care are drivers of the paradigm shift away from a longstanding model of delivering oral health services. The allocation of resources for the provision of health care is at the forefront of discussions today, as the demand and need for services increase and the understanding of oral health’s effect on overall health is solidified. The importance of a patient/provider relationship is well documented and remains at the heart of successful patient care, as well as business success. The complex and changing dental landscape will challenge the traditional delivery model. Table 1 includes some of the most significant drivers of change.

THE ROLE OF DENTAL SERVICE ORGANIZATIONS

The term “group practice” has many definitions. It sometimes refers to the number of providers in the same building or the number of providers associated through a common brand who may practice in different locations. The DSO, on the other hand, is an organization that provides dentists with a resource for dental management services. The services provided may include training, human resources, marketing, information technology, risk management, and operations and clinical support. By hiring a DSO to provide these services, the dentist reduces the amount of time spent on administrative responsibilities, enabling him or her to focus on clinical decision making and the provision of patient care.

DSOs have often faced criticism centered on the assumption that administrators direct patient care. This is not correct, as the responsibility for all clinical decisions remains solely with the dentist and never transfers to the DSO providing management services.

Many states define who can own a dental practice through state statute, and it is through a management agreement with the DSO that services are provided. The services administered by DSOs are often the same that sole proprietors typically contract another professional to provide, such as accounting, information technology, and marketing. In addition to the demands already mentioned, the growth of DSOs is also due, in part, to the increased requirements for compliance with state and federal mandates, the need for sophisticated business acumen, and the growing pace of advances in technology. The opportunity to retain clinical decision making and a level of autonomy within a DSO-supported practice, while also reaping the benefits of becoming part of a larger organization, can be very inviting. Joining a supported group provides advantages in efficiency with the provision of many centralized services. This gain in efficiency may ultimately contribute to improved profitability and more time to focus on patient care. The professional community that emerges from within supported groups can also benefit all members of the dental team. Opportunities for continued learning, relationship building, and mentoring are vast among a group of professional colleagues.

EMPLOYMENT STRUCTURE

The employment structure for dentists and team members varies by model and individual state statute requirements. Restrictions may exist in states that limit the provision of care by different workforce models. The ability to improve care and manage costs are achievable and should not be seen as independent of one another.

When considering the access-to-care problems present in the United States, it’s important to note that DSO-supported providers have played an important role in the fight against oral disease. A 2012 policy brief estimated that DSO-supported dentists provided more than one-fifth of dental care services to children covered by Medicaid in 2009.¹ The ability to provide services at a reduced operating cost enables DSOs to serve more patients. As workforce models continue to evolve, DSO-supported practices will likely be able to leverage successful operational and clinical support systems to potentially integrate new provider models to ensure the provision of comprehensive care.

DSOs provide employment opportunities for dentists, dental hygienists, dental assistants, and administrative professionals. In the organizational structure of many DSOs, clinicians support clinicians. Dental hygienists can serve within the DSO in a number of professional roles, including clinician, educator, and administrator/manager. The many aspects of management that are required in the operation of a dental practice are well supported by the DSO. Effective leadership is of the highest importance in this time of transformative change within dentistry. The need for leaders who are adept at change and can motivate and inspire others will be significant.

As the focus on reducing oral disease continues to gain importance, the individuals who make this happen must be able to practice to their fullest extent. The ability of all clinicians to serve as advocates for oral health, regardless of their practice setting, is also important. This is an exciting time in the dental hygiene profession, and the opportunities to work both collaboratively and interprofessionally will significantly impact the oral health of the public now and in the future.

From Perspectives on the Midlevel Practitioner, a supplement to Dimensions of Dental Hygiene. October 2015;12(10):36–37.