Purpose of Review
To examine the literature on dental reimbursement methods, with emphasis on paying for value (e.g., health care outcomes) rather than procedure. To make recommendations that would facilitate the expansion of access to dental care for those most in need and improve the oral health of the US population.
Although the health care system is moving toward paying for performance and outcomes, dentistry lags behind. We review publications that identify obstacles to payment for outcomes in oral health as well as moving away from traditional fee-for-service reimbursement.
Payment for value in dentistry is a long way from becoming a reality; however, the testing of models within Medicaid that set aside a small percentage of the fee for a procedure to be reimbursed based on the improved oral health of the patient and/or the population of the practice may facilitate its adoption. A similar set aside in capitation-based programs could ensure the delivery of essential services and avoid the underutilization traditionally associated with this type of reimbursement system. Similar incentives could be tested in group practices and perhaps even community health centers. Widespread adoption of diagnostics code, missing in dental records, would enable better tracking of met needs. Educational systems that foster intra- and interprofessional teamwork and the appropriate use of personnel operating at the top of their competency would increase efficiency while adding value at the same or lower cost.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
Papers of particular interest, published recently, have been highlighted as: • Of importance
Institute of Medicine. Crossing the quality chasm. 2001.
Corrigan J, McNeill D. Building organizational capacity: a cornerstone of health system reform. Health Aff. 2009;28(2):205–15.
Garcia-Caban IA. Pay-for-performance: quality programs at the crossroads. J Healthc Qual. 2010;31(1):3–7.
Squires D, Anderson C. U.S. Health care from a global perspective: spending, use of services, prices, and health in 13 countries. The Commonwealth Fund. 2015.
Schroeder SA, Frist W. Phasing out fee-for-service payment. N Engl J Med. 2013;368(21):2029–32.
National Commission on Physician Payment Reform. 2013. http://physicianpaymentcommission.org/report/. Accessed 30 April 2018.
Center for Medicare and Medicaid Services. https://innovation.cms.gov/Files/slides/CMSInnovCtrUpdateOne.pdf Accessed April 1, 2018.
Porter ME, Pabo EA, Lee TH. Redesigning primary care: a strategic vision to improve value by organizing around patients’ needs. Health Aff. 2013;32(3):516–25.
Porter ME and Lee TH. The strategy that will fix health care. Harv Bus Rev 2013. Available at: https://hbr.org/2013/10/the-strategy-that-will-fix-health-care. Accessed 20 Apr 2018.
Perry M. Doing business in the current dental benefits marketplace. CDA J. 2013;41(12):907–8.
Andäs CA, Ostberg AL, Beggren P, Hakeberg M. A new dental insurance scheme-effect on the treatment provided and costs. Swed Dent J. 2014;38(2):57–66.
Woods N. The role of payments systems in influencing oral health care provision. OA Dentistry. 2013;1(1):2.
• Vujicic M. Our dental care system is stuck. J Am Dent Assoc. 2018;149(3):167–9. An excellent summary of major structural changes needed in dentistry and a way forward.
American Dental Association. Code on dental procedures and nomenclature. https://www.ada.org/en/publications/cdt (2018). Accessed 1 May 2018.
Friedman JW. Bringing oral health to school-aged children. Editorial. J Public Health Dent. 2008;68(4):187.
Friedman JW. Development of criteria and standards for dental care In Symposium on quality assurance. Dent Clin N Am. 1985;29(3):465–75.
Friedman JW, Atchison KA. The standard of care: an ethical responsibility of public health dentistry. J Public Health Dent. 1993;53(3):165–9.
Bader JD. Challenges in quality assessment of dental care. J Am Dent Assoc. 2009;140(12):1456–64.
Miller CS. Where are the diagnostic codes in dentistry? Oral Surg Oral Med Oral Path Oral Radiol Endod. 2011;111(2):131–2.
American Dental Association. SNODENT value and benefits. Available at: https://www.ada.org/en/member-center/member-benefits/practice-resources/dental-informatics/snodent/snodent-value-and-benefits Accessed 20 Apr 2018.
Miller CS. Op cit. p.132.
Ramoni R, Walji MF, Kim S, et al. Attitudes toward and beliefs about the use of a dental diagnostic terminology. JADA. 2015;146(6):390–7.
• Shimpi N, Ye Z, Koralkar R, et al. Need for diagnostic-centric care in dentistry. JADA. 2018;149(2):122–31. This paper describes the value of integrated and easy-to-use medical-dental electronic health records to enhance clinic workflow and patient care.
Lotzkar S, Johnson DW, Thompson MB. Experimental program in expanded functions for dental assistants: phase 3 experiment with dental teams. J Amer Dent Assoc. 1971;82(5):1067–81.
Abramowitz J, Berg LE. A four-year study of the utilization of dental assistants with expanded functions. J Amer Dent Assoc. 1973;87(9):623–35.
Wright JT, Graham F, Hayes C, Ismail AI, Noraian KW, Weyant RJ, et al. A systematic review of outcomes produced by dental teams incorporating midlevel providers. J Amer Dent Assoc. 2013;144(1):75–91.
Nash DA, Friedman JW, Kardos TB, Kardos RL, Schwarz E, Satur J, et al. Dental therapists: a global perspective. Int Dent J. 2008;58(2):61–70.
Phillips E, Shaefer HL. Dental therapists: evidence of technical competence. JDR Clin Res Supplement. 2013;92(Suppl 1):11–5.
Minnesota department of Health. Health Policy Division. Early impacts of dental therapists. A report to the Minnesota Legislature. 2014. http://www.health.state.mn.us/divs/orhpc/workforce/dt/dtlegisrpt.pdf. Accessed 23 Apr 2018.
Blue CM, Rockwood T, Riggs S. Minnesota dentists’ attitudes toward the dental therapist workforce model. Healthcare. 2015;3:108–13. https://doi.org/10.1016/j.hjdsi.2014.07.002. Accessed 18 Apr 2018
Harris NO. A career-ladder for educating dental personnel. J Public Health Dent. 1972;32(3):169–74.
Yoder K, DePaola D. Navigating career pathways-dental therapists in the workforce: a report of the career path subcommittee. J Public Health Dent. 2011;71:S38–41.
Guyton B, LeBeau J, Sorci R, Doneen A. Commentary on an innovative interprofessional dental practice for 2026. J Evid Base Dent Pract. 2016;16(Suppl):11–9. https://doi.org/10.1016/j.jebdp.2016.01.014. Accessed 2 May 2018
Institute of Medicine. Measuring the impact of interprofessional education on collaborative practice and patient outcomes. 2015. http://iom.nationalacademies.org/reports/2015/impact-of-ipe.aspx Accessed 24 Apr 2018.
Nash DA. Envisioning an oral healthcare workforce for the future. Community Dent Oral Epidemiol. 2012;40(Suppl 2):141–7.
Voinea-Griffin A, Fellows JL, Rindal DB, et al. Pay for performance: will dentistry follow? BioMed Central. 2010;10:9. http://www.biomedcentral.com/1472-6831/10/9. Accessed 2 May 2018
Nash DA. Money in tension with ethics: a commentary. Pediatr Dent. 2017;39(7):431–3.
Vujicic M. Our dental care system is stuck. J Amer Dent Assoc. 2018;149(3):167–9.
Guay AH, Wall TP, Petersen BC, Lazar VF. Evolving trends in size and structure of group dental practices in the US. J De Educ. 2012;76(8):1036–44.
Guay AH. The evolution of dental group practices. J Calif Dent Assoc. 2013;41(12):899–904.
Manos PA, Bramson JB. Potential future elements of dental care financing—a third-party payer’s perspective. J Calif Dent Assoc. 2013;41(12):887–94.
Sparer MH. Health care reform and dentistry. J Calif Dent Assoc. 2013;41(12):883–6.
Pauly M and Field R. Is CVS-Aetna merger a game changer for health care? http://knowledge.wharton.upenn.edu/article/potential-impact-cvsaetna-merger/ (2017) Accessed 1 May 2018.
• Hinde W, Irving K, and Baenen B. Turning point: the fate of standalone dental. West Monroe Partners. 4 January 2018. https://www.westmonroepartners.com/en/Insights/White-Papers/Standalone-Dental. Accessed 2 May 2018. This survey summarizes the perspective of health insurance executives in regard to the future of dental insurance as a standalone entity.
Willard M. The Alaska Native Tribal Health System Dental Health Aide Therapist as a dentist-centric model. J Am Coll Dent. 2012;79(1):24–8.
Pew Charitable Trusts. http://www.pewtrusts.org/en/projects/dental-campaign/about/dental-therapy. Accessed 2 May 2018.
Rydrych D and Khanal P. Minnesota Dept Health. 31 January 2018. Memorandum to selected state legislators clarifying comments of the Wisconsin Dental Association on dental therapy in MN.
Smith BJ, Shay K. What predicts oral health stability in a long-term care population? Spec Care Dentist. 2005;25(3):150–7.
Jacobi D, Hegelson MJ. Apple Tree Dental: an innovative oral health solution. J Calif Dent Assoc. 2015;43(8):453–8.
Hegelson M. Economic models for prevention: making a system work for patients. BMC Oral Health. 2015;15(Suppl 1):1–11. https://doi.org/10.1186/1472-6831-15-S1-S11.
http://www.sarrelldental.org/wp-content/uploads/2013/05/Sarrell-Dental-EA-Summary-Report.pdf. Accessed 2 May 2018.
• Centers for Medicaid and Medicare services. https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/iap-downloads/functional-areas/ohi-program-overview.pdf Accessed 4-24-18. Describes various models of VBP being tested.
Woods N. The role of payments systems in influencing oral health care provision. OA DEntistry. 2013;1(1):2.
Conflict of Interest
The authors declare that they have no conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
This article is part of the Topical Collection on Dental Public Health
Rights and permissions
About this article
Cite this article
Collins, R.J., Friedman, J.W. The Future of Payment for Dental Care. Curr Oral Health Rep 5, 147–153 (2018). https://doi.org/10.1007/s40496-018-0190-2
- Dental insurance
- Diagnostic codes
- Pay for performance (P4P)
- Value-based payment
- Health care outcomes