Partnership Building

In the landscape of health care delivery, numerous changes have occurred in the past decade. The current state of public oral health, accessibility of oral health care services, and changing dynamics within the dental profession are just a few of the factors driving these changes. The provision of dental care is a unique and important health care service, especially now that research has demonstrated that oral health is an integral part of overall health. Within the dental practice—which is similar to other licensed health care settings, such as physician offices—both clinical and nonclinical activities take place on a daily basis. The challenges associated with running a business are a part of dental practice management—an area that is often outsourced to those with business and management expertise. Dental service organizations (DSO) can support dental practices by providing these critical management services, enabling clinicians to focus their valuable time on treating patients.

DENTAL PRACTICE OWNERSHIP

Every state’s dental practice laws provide clear distinction on what services are within the scope of practice for each licensed professional. As such, dental professionals practicing within a DSO model maintain personal responsibility for clinical decisions and practicing within the accepted professional and ethical standards, as well as within the laws of their individual states. While DSOs are often criticized due to the assumption that they are directing patient care, the ultimate responsibility for clinical decision making does not transfer to the DSO as a result of providing management services.

The ownership aspect of DSOs is often questioned, but many states specify what entities are allowed to own dental practices in their state laws. Professional corporations (PC) or other professional entities owned by a licensed dentist generally own dental practices. This is similar to the sole-practitioner model, in which a licensed dentist owns the entity. When a PC owns a practice, the PC employs the dentist and staff unless otherwise defined in the individual state statutes. The dentist’s contract clearly outlines his or her aspects of employment and likely includes additional language consistent with state statutes to define his or her responsibility for clinical decision making related to patient care. The PC then employs or contracts providers for practice management services, or it may hire a DSO to fulfill all administrative duties. One distinct difference is that in a sole-proprietor model, the licensed dentist may contract several different providers, such as accountants, consultants, and marketing and billing services. When contracting with a DSO, the scope of services is provided within one partnership. There are also a variety of DSO models relating to ownership, financial reward, and profitsharing at the office level, with the dentist(s) and employees within different group practices. This is often the case with sole proprietorships, as well. 

With few exceptions, the DSO does not employ dentists or contract for dental services—the DSO is the provider of management services. As such, the often heard complaint of “corporate practice of dentistry” is not applicable, as the provision of clinical services remains the responsibility of the clinician—not the DSO. Even in the few states where dental practices can be owned by someone other than a licensed dentist, there are clear distinctions between clinical aspects of care (which are regulated by state dental boards or a similar body, and individual state laws), and nonclinical services (which are not viewed the same way as professional services overseen by state dental boards). Licensed oral health professionals must provide the clinical services defined within their scope of practice, and maintain direction over the patient’s diagnosis and treatment plan.

MODELS OF ORGANIZATION

Many models and variations exist within the group practice environment. For this reason, it is difficult to categorize group practices. The growth of group practices and DSOs is due to several factors, some of which include: rising supply and technology costs; increasing demands for business acumen; liability and risk management concerns; increasing requirements for compliance with state and federal mandates; and rising education costs. The DSO model also offers support in areas that are important to today’s workforce, such as: flexible schedules leading to opportunity for enhanced work-life balance; guaranteed salary; strong benefits package, including health insurance, retirement planning options, and continuing education; implementation of current technologies; and proven internal systems for both practice and professional growth. There is also great opportunity for connecting with professional colleagues throughout the network. In the DSO model, clinicians are supported by other clinicians. This benefit can help build confidence in both new and experienced oral health professionals. Many DSOs also share a common philanthropic view of giving back to the communities they serve, and often support local, state, national, and international charitable causes.

ACCESS TO CARE

As workforce models evolve and the opportunities to fully utilize all dental team members—including dental hygienists, dental assistants, and dental therapists (where allowed by state statutes)—abound, the ability to expand access to care should also increase. DSOs can provide quality services with an efficient delivery model to all populations. The unique ability of DSOs to offer services to group practices in both rural and underserved areas enables the continued provision of dental services in a community when challenging economic times may have limited or eliminated the viability of the sole-proprietor dental practice.

The DSO model offers a number of services, including business operations, clinical support, dental supply management, orientation and training, marketing and communication, human resource management, and billing and claims processing, as well as providing a centralized location for other support services. 

As key stakeholders continue to address the oral health care crisis, fewer employers are offering dental insurance for their employees, dental hygienists’ scope of practice continues to evolve, and alternative delivery models are becoming commonplace. These factors, as well as new challenges, will continue to impact the dental profession. DSOs play a critical role in the changing landscape by providing support services for clinicians so they can focus on the area where their skills and training are best utilized—delivery of patient care. This shift provides the opportunity for dental professionals to increase their impact on the fight against oral disease. The ability for all providers who deliver oral care to be seen as equal partners in reducing the oral disease burden in the United States should not be defined by the practice model in which they work. A shared vision among dental professionals to provide high-quality, accessible care is the key to improving oral health today and in the future for all populations.

From Perspectives on Dental Hygiene, a supplement to Dimensions of Dental Hygiene. November 2014;12(11):32–35.