Doctor-patient relationship key to success in dental care
October 16, 2017
Editor’s note: This is the second part of a conversation about issues facing dentistry with Dr. Joseph P. Crowley, ADA president-elect, who will be installed as the 154th president of the American Dental Association Oct. 23 in Atlanta. The Oct. 2 ADA News featured Part 1. ADA News Editor Judy Jakush interviewed Dr. Crowley.
Because of antitrust concerns, the Association is limited in actions it can pursue regarding third-party payer issues. However, it can take steps to protect the doctor-patient relationship. This summer, the ADA informed Delta Dental Plans Association of its objections to two specific practices by some of its plans. The practices include exhorting patients in explanation of benefits statements to abandon a dentist and find a participating provider. A second objection was to the practice of disallowing some procedures as medically unnecessary and including in EOBs unsolicited and unsupported medical opinions from insurance company dentists who were not involved in treatment. Why is it important for the Association to take this kind of action?
One of our core values in dentistry is the integrity of the doctor-patient relationship. The dentist and the patient decide on a course of treatment — not an insurance company. Last year the House of Delegates approved policy that clearly says the ADA “opposes interference in the treatment decisions made between doctor and patient.” This relationship is the key to all success in delivering dental care. Third-party interference in how care is given is inappropriate. Some of these EOBs are telling patients of nonparticipating dentists to seek a participating provider and even include names and contact information of other dentists. That is direct interference and in my opinion is immoral and unethical. Anything that implies what the doctor and patient decided is not proper is interference in the relationship. Third parties walk the line on how they do that. Our policy opposes the substitution of business decisions for treatment decisions. An insurance company dentist who has not examined or communicated with a patient is really just practicing dentistry by mail, and that’s what some of these recent EOBs have done.
This is a crucial role for the Association: We are standing for the profession, for the core value of the dentist-patient relationship. This is the same for individual practices as well as larger group practices, wherever there is unwarranted third-party interference. The ADA Council on Dental Benefit Programs keeps a constant eye on what’s happening out there, and we continuously advocate for the doctor-patient relationship.
The ADA Board of Trustees has submitted a proposal to the 2017 House to establish a new commission to oversee the process of specialty recognition. Why? What is the expected outcome?
First, I love the process we used to develop the proposal for the new specialty recognition commission. We took a deep dive and analyzed the specialty recognition process for a year, bringing all the players into the discussion.
The new agency, as proposed in Resolution 30, would be called the National Commission on Recognition for Dental Specialties and Certifying Boards. The structure is designed to keep the decision-making on specialties at the highest level. It will be a body outside of the ADA House of Delegates, with the intention of removing it from any perceived bias. We believe this move will enhance the credibility of any decisions regarding new specialties.
At the same time, the Association’s established criteria, the ADA Requirements for the Recognition of Dental Specialties and National Certifying Boards for Dental Specialists, remain the basis on which specialties are considered. These requirements will continue to be approved by the House.
How do you see the ADA’s role in advocacy?
We’ve often talked about what the ADA should be. We have a responsibility to our member dentists to be an organization from which they can get tremendous value to help them achieve their goals. That’s a membership responsibility that we have, but in the big picture as a profession, I truly believe that we have a social responsibility that’s more apparent than ever. As a profession we can change society’s view of oral health and total health and our role in that. Dentistry’s not an island that has to solve all this. We have to work with others to do it, so the people who are providing the benefits — the payers, the government — have responsibility, too. We can’t own it by ourselves, and sometimes I think we beat ourselves up thinking we have to.
I’m proud of us as we advocate, not just what we do regarding social responsibility, but the way we chip away at regulations and laws that impede the ability of our members to deliver care to their patients. We do this at the state and national level, and we’re winning some of those battles.
The ADA’s Action for Dental Health initiative has put us at the highest level of a conversation that shows where our profession fits in with making better places for people to get care. That includes nursing home residents and senior citizens who are lacking care and the diversion of people out of emergency rooms and into dental homes, and with fluoridation efforts. Fluoridation in itself is an amazing accomplishment because there are very few professions who create something so good that really works against the job they do every day.
The important thing to remember is that science is behind the positions we take in advocacy.
One-third of dentists say they aren’t busy enough. The 2016 House of Delegates voted to address that challenge, and to promote the value of ADA member dentists to consumers, by authorizing the Find-a-Dentist consumer advertising campaign. What should members know about the campaign? Also, the success of the campaign is tied to member involvement. How can members get involved in helping the campaign be successful?
I am a big advocate for this. We have walked outside our comfort zone. We’ve engaged in a digital campaign with the aim of increasing dental utilization, and we’ve already reached millions of consumers with our ad campaign, which points them to Find-a-Dentist. We are reaching out to our members to add their photos to Find-a-Dentist and we’ve got more than 30,000 now. When compared to the traffic from last year to the old Find-a-Dentist tool (the new version launched in April 2017), site visits jumped 1,846 percent from April-September 2016 to April–September 2017.
The overall message is: See an ADA dentist. Am I a better dentist than somebody who’s not an ADA dentist? That’s an unfair question really, because there are plenty of nonmembers who are tremendous dentists. But who is advocating for the profession, for dental research, for access to dental care? The ADA. Who has a Code of Ethics? The ADA.
The Find-a-Dentist campaign also needs participation from our members. I urge everyone to fill out a profile and find out what it can do for you.
We are taking a risk with our digital campaign, but I’m proud that we are. Our early outcomes are very encouraging and we are monitoring the results closely. The 2016 House authorized spending $18 million for the three-year campaign, and the first year was financed through reserves. The Board is forwarding a resolution to the 2017 House for a special assessment of $30 in 2018 and 2019 be used to pay for part of the next two years’ campaign. The remainder would come from reserves.
Why is a tripartite system of membership relevant in 2017?
I know this question has been asked: If you could belong only to one leg of the tripartite, which one would you choose? It’s a loaded question because there’s value to each one of them. We spend a large portion of our budget at the ADA doing things that nobody else can do, such as advocacy. It filters back down to our states and our components, and we couldn’t exist without them. But then there are things that the states do for their people that engage all their communities, with their components, so each state is essential.
Keeping communication going among all parts of the tripartite is key. Through communication we have a shared knowledge base that can serve all members. From the national point of view, the states are our clients, and to keep a client happy, you have to have a value proposition for them. I think states serve as a pathway to spread knowledge. They’re sitting in the middle so they’ve got the up and the down covered. The states are a major conduit for keeping this organization working from top to bottom, from bottom to top. Our job here at the national level to be able to provide resources to help them do that.
What’s your favorite Association service, product or benefit?
Wow, I use an awful lot of ADA services and products. If I pick one, I have to say it’s a comfort having our insurance programs. It’s a product that I know is truly a bargain relative to other choices I could make. Plus, I know it’s backed by a group that stands strongly behind it for the members. That is a good thing. The insurance program is something I’ve been a part of since my early years as a dentist.
How can ADA members get involved in shaping policy for the Association? Is the path different for different practice
demographics, new dentists, research dentists, those from under-represented groups? What advice do you give? Is there a way to enable a faster track to leadership in the organization?
We haven’t stuck our head in the sand. We’ve been reminded that at many places our leadership does not necessarily represent the demographics of our membership, which has changed rapidly in the last 15 years. I’ve had the privilege of working with the American Student Dental Association and the new dentists at a very active level. For people starting out, it’s tough to build a practice, pay off debts, start a family and also have time and resources that are required to take on a leadership role. We also have the Institute for Diversity in Leadership, which is doing essential work. We know we have some strengths in diversity, and we also have weaknesses.
We’ve had two recent past presidents who are women (Dr. Maxine Feinberg, 2014-15, and Dr. Carol Summerhays, 2015-16) and who are spectacular role models. Both of them have been sounding boards for me. Yet, women’s numbers in dentistry are not currently reflected proportionately in leadership.
Sometimes it’s a matter of asking someone to step forward and participate. If we can see more diversity on our leadership path, we hope that will inspire someone new to participate. We are not there yet, but we are doing outreach on the local, state and national level and seeing results. Some of our societies are doing an outstanding job of recruiting younger leaders. The neatest thing about that story is that some more mature, seasoned people are stepping aside and letting that happen. It’s a challenge for the current leadership and challenge to the new people stepping into leadership roles.