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ADA HPRC recommends classification system for dental group practices

April 07, 2014

By Kelly Soderlund, ADA News staff

Dr. Torbush
The meaning of the term "group practice" has evolved.

The number of dental group practices in the United States is increasing; the existing ones are expanding, new ones are being added and many are changing in character and structure. The term "group practice" isn't a one-size-fits all classification.

The ADA Health Policy Resources Center published a brief suggesting group practices be categorized based on their commonalities. In "A Proposed Classification of Dental Group Practices," authors Dr. Albert Guay, ADA chief policy advisor, Matthew Warren, senior manager of health policy and analytics at the ADA, Rebecca Starkel, HPRC research analyst, and Marko Vujicic, Ph.D., managing vice president of HPRC, identify and describe six basic types of group practices.

"Group practices have existed in the profession for many years," said Dr. Douglas Torbush, chair of the ADA Council on Dental Practice Subcommittee on Practice Patterns and the Economy and chair of the ADA's Interagency Workgroup on Dental Practice. "This classification system is needed as the first step in understanding the differences between groups, and the differences between each type of group and solo dentists."

HPRC proposes classifying dental group practices into six categories:

• Dentist owned and operated group practice: Dentists in a single practice that may be located at one or multiple sites. The group practice is completely owned and operated by dentists, usually organized as a partnership or professional corporation.

• Dental management organization affiliated group practice: A group practice that has contracted with a dental management organization to conduct all the business activities of the practice that do not involve the statutory practice of dentistry, sometimes including the ownership of the physical assets of the practice.

• Insurer-provider group practice: A group practice that is part of an organization that both insures the health care of an enrolled population and provides their health care services.

• Not-for-profit group practice: A group practice that is operated by a charitable, educational or quasi-governmental organization that often focuses on providing treatment for disadvantaged populations or training health care professionals.

• Government agency group practice: A group practice that is part of a government agency, which organizes and manages it. All dentists are government employees or contractors and operate according to agency policies.

• Hybrid group practice: A group practice that does not clearly fit into any of the above categories and can exhibit some characteristics of several of them.

According to the 2012 HPRC survey "Distribution of Dentists," the percentage of dentists who were owners decreased from 91 percent in 1991 to 84.8 percent in 2012 and the proportion of dentists who were solo practitioners decreased from 67 percent to 57.5 percent. Data from the U.S. Census Bureau from 2007 show the number of office sites controlled by multi-unit dental companies increased by 49 percent to 8,442 in 2007. For dental firms with more than 10 offices, the number of offices they controlled increased from 157 in 1992 to 3,009 in 2007.

"As the dental marketplace and dental group practices evolve, it will be interesting to observe which types expand and which types do not," the authors wrote in the brief. "It seems unlikely that any one form of dental practice will overwhelm the market. More likely, a variety of practices will evolve to satisfy the varied demands of patients and other stakeholders in the dental care system. Changes will inevitably occur; key factors for successful innovation are the changes that will enhance the quality of care, efficiency of care delivery and availability of care for all who seek it."

To read the full research brief, visit the website.