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Dental organizations to lawmakers: Current Medicare Part B structure won’t work for dentistry

Low reimbursement rates, compliance issues among reasons cited

September 03, 2021

By Jennifer Garvin

Washington — The ADA and 10 other dental organizations are committed to providing oral health care to vulnerable seniors and all Americans but say they believe legislative proposals to expand the current Part B structure of Medicare won’t “adequately meet the needs of our dentists and Medicare patients,” according to a Sept. 1 letter the groups sent to Congress.

Congress is currently considering legislative proposals to expand Medicare benefits. Those proposals include expanding benefits within the current Part B structure of Medicare to include dental.

In the letter, sent to leaders of the House, Senate and key congressional committees, the organizations explained that the current Medicare program includes “distinct parts that recognize the variability in delivery of health care services such as hospital care, physician services and prescription drugs,” and said the dental care system is “significantly different” from the medical care delivery system. They also told lawmakers that dentists are unlikely to join a network based on the current Medicare Part B structure for a number of reasons, including:

Low reimbursement rates. The rates “fail to address overhead costs associated with delivering dental care [and] will strongly influence dentists’ ability to participate.”
Compliance issues. Medicare Part B will put “undue burden on dentists by requiring compliance with regulations designed for the medical delivery system, such as those for electronic health records, quality ratings, auditing/compliance, documentation, and more, further dissuading dentist participation.”

The coalition also said the overall administrative burden of participating in Part B of Medicare will likely impact access to care for Medicare beneficiaries.

“Given that dental offices are vastly different than physician offices, applying the physician fee schedule system to fee schedules for dental care will not ensure sustainability of the dental delivery system,” the letter concluded. “This is a system that has high costs of maintaining and running an office, including dental equipment, supplies, lab costs, staffing needs, anesthesia and personal protective equipment.”

Follow all of the ADA’s advocacy efforts at ADA.org/Advocacy.