How to Get Paid for Doing EBD

Transcription

1 How to Get Paid for Doing EBD Robert D. Compton, DDS President Robert Compton, DDS Executive Director DentaQuest Institute

2 Disclosure DentaQuest Institute President DentaQuest Benefits Senior VP & CDO 25 million members 28 states Over 60,000 dentists Over 100 MCO DentaQuest Foundation DentaQuest Care Group

3 Quality of Care The degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge This prescript contains just two concepts: measurement and knowledge. Medicare: A Strategy for Quality Assurance. IOM, 1990, p.21 3

4 Value Driven Health Care Four Cornerstones 1. Reporting of quality of care measures 2. Reporting of health care price information 3. Incentives for high-quality, cost effective care 4. Interoperable health care information technology If you desire to do business with the Federal Government you need to adopt quality standards We intend to begin moving to a system where at least part of the payment structure is a reward for high quality. HHS Secretary Michael Leavitt s remarks to the ADA in

5 Triple Aim of Health Care

6 Example of Value-Based Purchasing

7 Texas Specifications for Measures

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9 Sealants Significantly Reduce Decay! Decay Rate for 1000 Teeth With & Without Sealants In a population with a 70% decay rate 511 out of 700 teeth that would have gotten decay will be saved In a population with a 40% decay rate, 338 out of 400 teeth that would have gotten decay will be saved Decayed Teeth, 700 Saved Teeth, Decayed Teeth, 400 Saved Teeth, Decayed Teeth, 189 Decayed Teeth, 63 Decayed Teeth, Total 1,000 Teeth No Sealant 40% w/ Seal No Sealant 70% w/seal Sealants for preventing dental decay in the permanent teeth (review). The Cochrane Library 2013, Issue 3.

10 Cost of Restoring Caries in Adult Teeth $500,000 $450,000 $400,000 $350,000 $300,000 $250,000 $200,000 $150,000 3rd Molar 2nd Molar 1st Molar 2nd Premolar 1st Premolar Canine Lateral Incisor Central Incisor $100,000 $50,000 $ Age of Patient

11 OR SD SC LA IN FL OK HI ND WI AL MI OH AR GA MO NY KY MN ME NJ RI NM US PA UT WV AZ VA VT IA CA NV MT WY MS TN DC NC DE CO ID TX WA AK CT IL NE KS MA 0.0% 0.0% 0.0% 0.4% 2.1% 11.4% 11.6% 11.8% 12.5% 12.8% 12.8% 13.1% 13.1% 13.3% 13.3% 13.5% 13.8% 13.8% 14.6% 14.8% 15.1% 15.2% 15.4% 15.7% 15.9% 15.9% 15.9% 16.8% 16.8% 17.0% 17.1% 17.2% 17.2% 17.3% 17.7% 18.0% 19.4% 19.7% 19.8% 20.1% 20.2% 20.6% 21.2% 21.2% 21.8% 22.0% 22.2% 22.2% 23.8% 100% Medicaid Sealant Scores for d. 6-9 Total Eligibles Receiving Sealants on Permanent Molars % 80% 70% 60% 50% 40% 30% 15.6% 20% 10% 0% CMS d

12 100% Provider Performance - Sealants Percent of 6 and 7 Year Olds Receiving Dental Sealant on First Molars % Count of Ages 5, 6 & 7 Percent 5-7 w/ Seal % % % % % % % % 100 0% 0

13 13 January 1 thru December 31,

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17 Need Diagnostic Codes Children with disease indicators and risk factors, including socio-economic factors All Children Use for sealant program in Medicaid population Elevated Risk Children Children who have had a restoration placed in the past three years. Use for fluoride measure in Commercially insured population Carious Lesions Recently Filled Teeth 17

18 Frequency for Periodontal Maintenance Many patients presenting with recurrent gingivitis without additional attachment loss after definitive periodontal therapy may be adequately maintained with PM performed semiannually. However, for most patients with a history of periodontitis, numerous clinical studies suggest that PM should be performed at intervals of less than 6 months. In general, data suggest that most patients with a previous history of periodontitis should obtain PM at least four times per year, since that interval will result in a decreased likelihood of progressive disease, compared to patients receiving PM on a less frequent basis Periodontal Maintenance (2003) J Periodontol 2003;74:

19 Perio Patients Use of Perio Maintenance 80% 75% 70% 60% 50% 40% 30% 20% 10% 25% 43% 18% 6% 0% 0 Clean 1+ Clean 2+ Clean 3+ Clean 4+ Clean 19

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21 Commercial Plan P4P Program 70% 60% 60% 61% 62% 64% 50% 40% 30% 39% 46% 43% 49% 1st 6 months 2nd 6 months 3rd 6 months 20% 4th 6 months 10% 0% Fluoride Perio Maintenance

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24 How to Get Paid for Doing EBD Robert D. Compton, DDS President Robert Compton, DDS Executive Director DentaQuest Institute