1 DR. KARI CUNNINGHAM: Crossing continents and changing lives DECEMBER 2023 CODING TIPS TO SPEED UP YOUR CLAIMS PROCESS CE MADE EASY best practice DENTISTRY, BUSINESS & POLICY IS VALUE-BASED REIMBURSEMENT THE FUTURE OF HEALTH CARE? A publication of Delta Dental of Michigan, Ohio, and Indiana
1 Jeffery W. Johnston, DDS, MS Editor | Diplomate, American Board of Periodontology and Dental Implant Surgery | Senior Vice President of Professional Services and Chief Science Officer Delta Dental of Michigan, Ohio, and Indiana Supporting access, excellence and success PHOTO: STEVE MCCLELLAN
2 The practice of dentistry has never been more promising. People are finally becoming aware of the connection between oral and overall health. Providers are using new sophisticated technology to personalize care, reduce discomfort and improve outcomes. And the vast majority of Americans now have private or government dental insurance. At the same time the business of dentistry has never been more vexing. Whether you are trying to run a robust private dental practice or advocate for yourself and your patients in a dental service organization (DSO), the rapid pace of change, the cost of new technologies, inflation and staffing shortages keep a lot of us up at night. To help you maximize opportunities and minimize risks and aggravations, Delta Dental of Michigan, Ohio, and Indiana is launching Best Practice: Dentistry, Business and Policy. This publication, which will be mailed to you three times a year, and the digital content available between issues is designed to help you bridge the gap between dentistry and business so you can make a good living while also providing the best, most expansive care possible in your community. Best Practice will offer concise, actionable content on the latest dental trends and research, emerging technologies, and business strategies to give you a competitive edge. Helping you be more effective means making sure you are aware of the many resources and programs available to you as a Delta Dental provider, such as the rich selection of continuing education (CE) courses we offer at no cost to you. It also means showing you how to get paid quickly and correctly by avoiding common mistakes made in coding and submitting claims. Beyond the printed publication, we hope to build a community of dental professionals dedicated to our shared mission of increasing access to oral health care and building healthier communities one smile at a time. This work is best done together. I welcome your comments and ideas. You may email me at [email protected]. EDITOR’S NOTE
3 Thank you. We appreciate you being a part of Delta Dental’s network and for being a force for good health in your communities. We are passionate about our company’s mission to increase access to oral health care, and we believe our more than 12,500 dentists in Michigan, Ohio and Indiana are essential to fulfilling that purpose. We need your expertise, dedication and commitment to your patients, our members. We know it’s challenging. It’s hard to be a dentist and an entrepreneur. It’s equally difficult to be an advocate for patients and an employee of a large dental service organization (DSO). It’s taxing to do it all with chronic staffing shortages. Welcome to the first issue of Best Practice: Dentistry, Business and Policy, created exclusively for Delta Dental participating dentists. Our hope is that this timely, reader-friendly publication will make it a little easier for you to balance the many things you have to do to serve your patients, stay on top of your credentials and keep the lights on. Dentists are our primary audience, but we hope you will share this resource with office managers, hygienists and others with whom you work. All our content will be reviewed by a team of dentists before publication. Email us at bestpractice@deltadentalmi. com and let us know if you are interested in publishing articles, being a source of information, participating in a focus group or being part of an editorial advisory board to guide the content of Best Practice. Thank you for being our partner. Margaret Trimer | Managing Editor | Vice President of Strategic Partnerships Delta Dental of Michigan, Ohio, and Indiana
4 DECEMBER 2023 5 Examining the link between gum disease and Alzheimer’s disease Links between the two have been long suspected; can new research solidify the connection? 7 CE made easy Looking for hassle-free continuing education? We’ve got you covered. 13 Spotlight on a trend: Value-based reimbursements With an emphasis on quality over quantity, the fee-for-service model holds promise. 15 Whistles while she works Going to the dentist is fun...really. Dr. Dawn Yuen Harvey is changing the way kids think about a visit to the dentist. 16 Getting youths to the dentist A program aimed at increasing participation in the Delta Dental Healthy Kids Dental program proves to be a rousing success. 17 Office efficiencies Fast-track claims, simplify credentialing and meet your Delta Dental reps. 21 Unlocking greater benefits for patients with special health care needs Delta Dental’s Special Health Care Needs Benefit removes barriers to care and provides the reimbursement and resources you need. CONTENTS 9 Dentistry as ministry Caring is a calling for Dr. Kari Cunningham, whose impact has spanned continents. 11 A dream takes root From breaking down racial barriers to providing a path for others to follow, Dr. Traci Dantzler builds bridges. 19 Advocating for screenings Senate Bill 280 is making its way through the Michigan legislature and would require kindergarten oral health assessments. To view citations and references noted throughout this publication, visit bit.ly/BP-citations-1223.
5 Examining the link between gum disease and Alzheimer’s disease by Jeffery Johnston, DDS, MS To view citations and references noted throughout this publication, visit bit.ly/BP-citations-1223.
6 The connection between oral health and brain health just got a little stronger. A recent publication in the journal Frontiers in Aging Neuroscience by Tufts University has spurred much interest in Alzheimer’s disease. The paper suggests a link between Fusobacterium nucleatum (F. nucleatum) and Alzheimer’s disease. The relationship between gum disease and Alzheimer’s disease has been studied for years; however, this latest paper suggests a different mechanism proposed by previous investigators. In 1907, Dr. Alois Alzheimer, a German physician, first described the disorder as an idiopathic, irreversible, progressive neurological condition that slowly destroys memory, language and thinking skills. Small abnormalities called amyloid plaques and tau tangles in specific locations in the brain are pathopneumonic for Alzheimer’s disease. It is marked histologically by the degeneration of brain neurons in the cerebral cortex and by the presence of neurofibrillary plaques of beta-amyloid. It is the most common cause of dementia in adults older than 65 and is among the top 10 leading causes of death in the United States. Interest in the link between periodontitis and Alzheimer’s disease is not new. In previous studies, researchers analyzed brain tissue, spinal fluid and saliva from Alzheimer’s patients and found evidence of P. gingivalis. Gingipains, the toxic enzyme secreted by P. gingivalis, was found in 96 percent of the 53 brain tissue samples examined, with higher levels detected in those with Alzheimer’s disease. P. gingivalis increased the production of beta-amyloid. Studies confirmed that P. gingivalis can travel from the oral cavity to the brain and that the related gingipains can destroy brain neurons. This suggests a biological mechanism for how putative periodontal bacteria may play a role in the development and progression of Alzheimer’s disease. A recent study involved mice and Fusobacterium nucleatum. F. nucleatum, a bacteria commonly found in gum disease, generates systemic inflammatory mediators and infiltrates nervous system tissues to exacerbate the signs and symptoms of Alzheimer’s disease. F. nucleatum has also been linked to conditions such as colorectal cancer. F. nucleatum results in an abnormal proliferation of microglial cells, which are the immune cells in the brain that function to remove damaged neurons and infections to help maintain the overall health of the central nervous system. This oversupply of microglial cells also creates an increased inflammatory response. Chronic inflammation is believed to be a key determinant in the cognitive decline that occurs as Alzheimer’s disease progresses. F. nucleatum can reduce the memory and thinking skills in mice through certain signal pathways. Although the study adds to the evidence supporting a link between periodontitis and Alzheimer’s disease, additional research is needed to further understand the etiology of Alzheimer’s disease and how periodontitis-related bacteria can exacerbate progression. The research also underscores the concept of oral health being related to systemic health and that oral health should be considered a component of overall health.
7 Your state requires you to complete continuing education courses. We make them convenient and relevant. Delta Dental of Michigan, Ohio and Indiana’s online continuing education (CE) courses are offered at no cost to you through your state-specific website. Any dentist, hygienist, dental assistant or office staff member who is a Delta Dental of Michigan, Ohio and Indiana participating provider or works for a Delta Dental participating provider may take these courses. “Our CE courses are developed for dental professionals by dental professionals,” said Dr. Jeffery Johnston, senior vice president of professional services and chief science officer. “They provide a science-based response to what can seem like increasingly unwieldy government requirements.” These courses are available 24/7 to help you conveniently and costeffectively comply with ongoing regulatory demands so you can quickly get back to what you would rather do—serve patients. Courses include an informational video on each topic and an assessment. Complete them at your own pace. Upon completion, you will receive a certificate. What’s required? Each state issues their own guidelines for continuing education compliance. Delta Dental Plan of Michigan Inc. is an ADA CERP recognized provider. Our Delta Dental courses are worth up to 1 CE credit and each take about one hour to complete. Required CE hours by state: Michigan (every 3 years) Ohio (every 2 years) Indiana (every 2 years) Dentists (Half of hours must be in person) 60 30 20 Hygienists (Half of hours must be in person) 36 20 19 CE MAD
8 E EASY COURSE OFFERINGS: Dental Care for Children with Special Health Care Needs | This course covers general information about an oral health visit for infants and toddlers with special health care needs. Ethics and Jurisprudence | Gain important knowledge about dental ethics, professional definitions (RDA, RDH, dental therapist, dentist, specialist), delegation, supervision, assignment, dental record requirements and jurisprudence. (Though the content applies only to Michigan, those in Ohio and Indiana are invited to participate.) Fluoride | Learn about current concepts on the clinical use of fluorides. How to Complete an Age 1 Dental Visit | Understand and review the importance of a dental visit at age 1. A technique will be introduced to help dentists complete the visit in an efficient and effective manner. HPV and Head and Neck Cancer | Learn more about how changing lifestyle behaviors have changed the demographics and clinical presentations of oral squamous cell carcinoma. Human Trafficking—Modern Day Slavery | This course discusses the scope of current issues surrounding human trafficking and how you can be more aware at your dental office. Infant and Toddler Oral Health Care | Review general information about an oral health visit for infants and toddlers. Infection Control | This course reviews the CDC guidelines on infection control in the dental office. Nutrition for Health and Disease Prevention | Learn about nutrition for health and disease prevention, identify dietary patterns, specific foods and food components that have shown promise in health promotion. Nutrition for Oral and Overall Health | Expand your nutritional oral health knowledge by reviewing nutrition and oral health interrelationships. Opioids, The Opioid Epidemic, and Opioid Use Disorder | This course will introduce you to the opioid epidemic, opioid use disorder, medications for OUD (MOUD) and treating patients on MOUD. (Course only available for Michigan and Indiana.) Periodontal and Peri-Implant Diseases and Conditions | Gain insight on the proceedings from the American Academy of Periodontology world workshop, as well as the diagnostic classifications, staging and grading of the periodontal diseases. Safe Opioid Prescribing Practices, New Laws and Regulations | This course is a general awareness training surrounding opioids and other controlled substances for prescribers. The Proper Handling of Amalgam and its Wastes—Complying with the New EPA Rules | Review best practices and legal requirements for the handling and disposal of dental amalgam. The Seal is the Deal | Examine the current evidence-based thinking on sealants. MICHIGAN OHIO INDIANA
9 Dr. Kari Cunningham has been captivated by smiles for as long as she can remember. They move her like works of art. The variety, the emotion, the shades of white against the diversity of skin tones. “I was always known to look at teeth and smiles,” said Cunningham, a Cleveland native who had dreamed of becoming an orthodontist. She wanted to make it easier for people to perfect their smiles and feel good about themselves after she watched her older sister, Ada, cope with the discomfort of braces. Then during a semester at sea in 2004 her idea of a perfect smile changed—and so did she. Cunningham was among almost 700 students who spent 100 days on a floating college campus, visiting a dozen countries including Tanzania. She experienced different kinds of smiles in that developing nation— ones that signaled disease, poverty and desperation. She saw the tell-tale brown, mottled teeth of fluorosis, the thick calculus build-up on teeth that have been neglected, and she smelled the overwhelming pungent odor of periodontal disease in the crowded markets. That was the moment that Cunningham, owner of Panther Pediatric Dentistry in Euclid, Ohio, near Cleveland, felt what she can only describe as a calling to improve oral health. Dentistry would be her ministry. Meeting the need Cunningham is a board-certified pediatric dentist. She focuses her practice on teaching and treating underserved children not far from where she grew up. She learned from her travels and her education that so-called dental deserts are not just a problem in faraway countries. That realization brought her back home. “There is need everywhere, but I believe I can have a greater impact serving those in my backyard,” said Cunningham. “I’m immersed in the community that I’m treating. We’re all facing this together.” Cunningham completed her undergraduate work at the University of Pittsburgh, and after her semester at sea she earned several scholarships from the DENTISTRY asMINISTRY by Margaret Trimer PHOTOS: WETZLER STUDIOS
10 YYNational Health Service Corps and returned home to Case Western Reserve University (CWRU) School of Dental Medicine. She thrived in the experiential and community-based learning approach that balanced the classroom and textbook learning. She earned her doctor of dental medicine degree in 2010 and completed her residency at Rainbow Babies & Children’s Hospital (RB&C) in 2012. That summer she began working at a community health center in Cleveland to pay back her scholarships through service. She was shocked to learn how many patients didn’t show up for their appointments. Some days five or fewer showed up out of 50 or more who were scheduled. She worried her skills would deteriorate due to lack of practice, and she stayed just over two years. “I knew we could serve more than five a day,” said Cunningham, who has also been an adjunct faculty member at CWRU and RB&C since 2012. “There was no penalty for no-shows, and there was no training. From a business standpoint, it wasn’t smart.” Then, with no administrative experience but a lot of ideas and inspiration, she took the position of dental director at The Community Health Center of Lorain, Ohio. There, she developed a full pediatric dental practice seeing 35–40 children a day and implemented strategies for reducing no-shows, including frequent reminder phone calls, signed treatment agreements, advance scheduling privileges and penalties, and more. Cunningham returned to Africa as a volunteer pediatric dentist a decade after she first visited. She spent two weeks in Kenya at the PCEA Kikuyu Hospital Dental Clinic with the nonprofit Global Dental Relief. She was once again struck by the number of children lacking dental care. Only this time, she could help. She took seriously the words of a South African tour guide from her semester at sea who said that when someone in their community does well, they reinvest so that someone else can have a chance to succeed. Cunningham visits Africa regularly and has treated more than 2,000 children in Kenya. She also met her husband, Vincent Otieno, in the clinic in Kenya where he was working as an oral health officer and dental hygienist. He now works as a dental assistant and massage therapist on the Panther Pediatric Dentistry team. Doing good is good business Cunningham has a robust practice serving a mostly low-income demographic. She recruits patients through school-based contracts and community outreach activities including back-to-school bashes, trunk or treats, health fairs and Give Kids a Smile Day events. Since opening in 2018, she has structured Panther Pediatric Dentistry, named and designed after her high school and undergraduate college mascots, to encourage respect and inclusion for patients and her staff, reduce no-shows and provide a stable dental home to families, many of whom have never had one. Metrics matter to Cunningham, and she keeps a close eye on her practice management software to learn such things as where new patients are coming from, what no-show rates are, and what the payor mix is among private insurance, Medicaid and self-pay/fee-forservice. Like many health professionals in underserved communities, Cunningham has learned to strategically overbook to meet goals. She also has firm policies and expects patients to honor their appointments. Dental care is not always the top priority for her patients because they are often consumed by meeting their basic needs. She knows it’s not personal when a patient doesn’t return for followup appointments. “It’s not a reflection on me. It’s just their reality,” she said. “If I can get someone to understand being proactive and not reactive, then I have really done my job. I’ve converted them, and that’s the best part of my job.” That and the chance to give them a smile that is not just a work of art, but also a tool to improve their health and quality of life.
11 Dr. Traci Dantzler’s summer after high school set the course for the rest of her life. While her friends were scooping ice cream and babysitting, she spent three transformative months working at her uncle’s dental office in Flint, Michigan. “Even as a child, I was always motivated by a desire to heal and to alleviate pain,” Dantzler said. She watched her uncle Dr. Raymond Gist—who would later become the first Black president of the American Dental Association—treat patients who were in tremendous physical and emotional pain. After witnessing a patient of Dr. Gist tear up with joy at seeing their brand new smile, Dantzler headed to the University of Michigan (a first-generation student) knowing that dentistry was her calling. Fast forward to dental school at Northwestern University, where she found herself as the only Black student in her class, nearly a century after Dr. Ida Rollins, the first Black woman to become a dentist, graduated in 1890 from the University of Michigan. “It felt intimidating,” Dantzler reflected, “when you are ‘different,’ you expect people to treat you differently.” Her first year and a half were marked by a sense of isolation and long hours of studying alone. That changed when two of her classmates invited her to join their study group. Soon, she and her peers were collaborating and having candid discussions about race, mindsets and culture. “It became evident that our similarities and shared goals were greater than our differences,” she said. Like her uncle before her, Dantzler has been a trailblazer in her own right. Her passion for dentistry has led her from breaking racial barriers at school to serving as a mentor and role model so others can follow in her footsteps. While a practicing dentist in Flint, she provided future dentists, many of whom were Black, with shadowing opportunities and guidance. Dantzler advised her mentees to keep their passion for dentistry at the forefront, especially when they face difficult days spent performing surgeries and working with anxious patients. Although Black students comprise less than 7 percent of first-year dental school students,1 all the students she has mentored have enrolled in dental school. A DREAM TAKES ROOT by Faith Ureel To view citations and references noted throughout this publication, visit bit.ly/BP-citations-1223. PHOTO: STEVE MCCLELLAN
Passion in practice Dantzler was recently inducted into the Pierre Fauchard Academy for her contributions to the field of dentistry. She practiced dentistry for 23 years, providing care to patients in Chicago and Flint. She has worked alongside her uncle and also owned an independent practice. Her advocacy work began with her involvement in the Genesee District Dental Society (GDDS), where she served for eight years, eventually being elected secretary and then president. During this time, she helped GDDS influence legislation and shape policies to improve oral health in the community. A key moment in Dantzler’s advocacy came during the Flint Water Crisis. As a practitioner in Flint, she witnessed firsthand the increased prevalence of cavities during the crisis. She met with the U.S. surgeon general and alerted him of the need to study the impact of lead on oral health, and the role of dentists in responding to the public health emergency. “Remember dentistry,” she told him, “Oral health and overall health are connected.” Her advice to dentists looking to get involved in the community? “You can start small. Your time is valuable and limited, but no matter how busy you are, make time for a cause you are passionate about.” Bridging gaps In February, Dantzler took on a new role at Delta Dental to expand her impact on oral health. As director of utilization management, she leads a team of licensed dentists that reviews and adjudicates claims. Recently, she arranged for a presentation by Delta Dental to the GDDS on claims review. Her practicing colleagues appreciated the insights offered into the process. Dantzler said proactive communication and addressing dentist concerns is of paramount importance to her. As a practitioner, she bridged the gap between patients and dentistry. Now, she bridges the gap between dentists and insurance. Breaking barriers in dentistry Black dentists have championed oral health for more than 150 years. In fact, Black dentists are more likely to treat patients with Medicaid and those from underserved communities. And yet, there is still work to be done to achieve racial equity in the dental profession. Take a look at the following numbers: Only 3.8% of American dentists identify as Black 86% of Black dentists have experienced racial discrimination Delta Dental recognizes the importance of celebrating the achievements of Black dentists and supporting inclusion in dentistry. This year, the Delta Dental Plans Association announced a $1 million campaign to promote racial diversity in the dental workforce. In conjunction with the national initiative, Delta Dental of Ohio sponsored a feature in the Real Times Media publication Who’s Who in Black that detailed the accomplishments of Black dentists. Dr. Terrence Poole of Cincinnati ensures each of his patients is treated with care and has demonstrated strong commitments to education, community service, and diversity and inclusion. Dr. Traci Dantzler of Flint, director of utilization management at Delta Dental of Michigan, Ohio, and Indiana, is known for her dedication to bridging the gap between society and dentistry through oral health advocacy and community outreach. Dr. Dale Kates of Cleveland takes pride in providing top-quality, affordable care to patients of all ages at Premier Smiles Orthodontics, helping them to achieve the self-confidence that comes with beautiful smiles. Dr. Kari A. Cunningham of Cleveland, owner of Panther Pediatric Dentistry, is a leader in the diversity and inclusion space, advocate for oral health care and mentor for up-andcoming dentists. Dr. Mark E. Bronson of Cincinnati, first vice president of the American Dental Association, contributes to the advancement of dentistry through his private practice, extensive involvement in professional organizations and faculty role at The Ohio State University College of Dentistry. Dr. Monica L. Newby of Cincinnati, the first African American woman to practice dentistry and orthodontics in Cincinnati, has been providing healthy smiles to her patients for more than 26 years, owning successful solo private practices and engaging with the community through professional and philanthropic organizations.
13 SPOTLIGHT ON A TREND: value-based reimbursement In recent years, there has been a significant shift in health care reimbursement models, with a growing emphasis on value-based care. This approach prioritizes quality outcomes and patient satisfaction. Value-based reimbursements were initially associated with primary care and hospitals, and now dentistry is starting to adopt them. Delta Dental has participated in value-based reimbursement as required by the state of Michigan in the Healthy Kids Dental Medicaid program for low-income children. The company currently has no plans to implement it in commercial business by Greig Davis, CPA, CVA, MST
14 What is value-based reimbursement, and can it benefit dentists? The goal of the value-based reimbursement model is to improve both patient care and the financial stability of dental practices. Only a few value-based systems are in place and, while promising, there is debate over what quality measures should be used and what impact they will have. Value-based reimbursements incentivize dentists to focus on delivering high-quality, versus highquantity service to their patients. Of course, most dentists aspire to deliver the best care possible as efficiently as possible. This model adds additional discipline and focus on preventive measures, oral health education and evidence-based treatment plans. A successful value-based program should result in more comprehensive care, and improved oral health and overall well-being. The fee-for-service model should not encourage dentists to perform more procedures to generate higher revenue, but it can skew in that direction and still not guarantee financial stability. Value-based reimbursements, on the other hand, can provide a more predictable and sustainable revenue stream. By aligning reimbursements with quality outcomes, dentists can reduce unnecessary treatments and focus on preventive care. This shift can lead to better patient retention, increased referrals and long-term growth for dental practices. Value-based reimbursements encourage dentists to engage patients actively in their treatment plans. This collaborative approach fosters a stronger patientdentist relationship, where patients are involved in decisions regarding their oral health. Dentists can spend more time educating patients about preventive measures, oral hygiene practices and lifestyle modifications, leading to better oral health outcomes. Additionally, when patients experience improved outcomes and enhanced satisfaction, they may be more likely to stay loyal to their dental provider. Under the fee-for-service model, patients often visit multiple dental providers for different treatments, which can hinder continuity of care. Value-based reimbursements promote a team-based approach and coordinated care, ensuring that patients receive comprehensive treatment plans from a single dental provider or a closely coordinated group of specialists. This approach facilitates seamless communication, better treatment coordination and improved patient outcomes. Value-based care encourages the integration of technology, such as electronic health records (EHRs) and data analytics, to enhance patient care and practice efficiency. Dentists can leverage these tools to collect and analyze data on patient outcomes, treatment effectiveness and costefficiency. This data-driven approach allows dentists to make informed decisions, identify areas for improvement, and provide evidence-based care that optimizes patient outcomes and reduces costs. Value-based reimbursements offer numerous benefits to dentists, including a focus on quality care, financial stability, patient engagement, continuity of care and the integration of technology. By shifting the reimbursement model toward value, dental practices can prioritize patient outcomes and satisfaction, leading to improved oral health and long-term success. Embracing value-based care represents a promising path forward for dentists as they strive to provide the highest quality of care for their patients. Greig Davis is a dental CPA, serving dentists nationwide for more than 25 years. He is the founder of Dental ROI Associates in Farmington Hills, Michigan, and Nashville, Tennessee. For more information on value-based reimbursements, Davis can be reached at [email protected]. By shifting the reimbursement model toward value, dental practices can prioritize patient outcomes and satisfaction, leading to improved oral health and long-term success. Delta Dental of Michigan, Ohio and Indiana does not currently have a value-based payment program in its commercial offerings but understands that VBP is a trending topic of conversation for dental providers. In 2022, Delta Dental, at the request of the Michigan Department of Health and Human Services implemented a trial VBP program for dentists in an effort to boost utilization of Michigan’s Healthy Kids Dental program. (See article on page 16). We will continue to consider how VBP programs could be structured to improve oral health.
15 Joy, fun and music set the tone in the dental practice of Dr. Dawn Yuen Harvey, a pediatric dentist in Grosse Pointe Woods, Michigan. Children go home humming the latest of Dr. Harvey’s improvised songs and asking their parents when they get to return to the dentist. One young patient played dentist with her dolls and stuffed animals after a series of appointments to address serious dental issues and pain. “Everyone was overjoyed that we were able to give her the help she needed,” Harvey said. “She gave me and my assistant huge hugs, and her mom said she started playing ‘Dr. Harvey’ with her toys and asking how many sleeps until she got to visit again.” Serious business “Kids are fun, kids are spontaneous, and kids tell you exactly how they feel,” Harvey said. But for as much fun as Harvey creates chairside, it’s for a serious reason: to make her patients feel good from a young age about visiting the dentist and doctor. A large chunk of Harvey’s clientele is patients with Healthy Kids Dental (HKD) benefits—a Michigan program for children under age 21 who qualify for Medicaid. Many of these children have big needs and pain, and Harvey focuses on setting them on a healthy path forward. For instance, she remembers a 3-year-old with 15 cavities. “Why wouldn’t you want to help that child?” she muses, illustrating the obligation she feels in treating patients with HKD and Medicaid. “It’s highly rewarding for the dental practitioner who wants to serve their community,” she said. “If you want to talk about having an impact and improving the lives of children in your community, this is where you can really make a difference.” Harvey said she feels fortunate for the ability to participate in Delta Dental’s value-based payment (VBP) program, which paid dentists extra reimbursement for treating patients with Delta Dental HKD coverage. (See related story on next page.) She said the VBP program helped her grow her business, Toothworks Pediatric Dentistry, which today employs seven dentists. Answering the call Harvey grew up in Chicago, moved to Michigan after college and dental school, and started her Toothworks dental practice from scratch in an office designed by her architect parents. She has practiced dentistry for 35 years, and she’ll celebrate her 30th anniversary at Toothworks in 2024. Helping children is her calling. “You have a chance to influence and put these kids on a great path to being a great dental patient, but also a great patient for the medical field,” she said. And if they learn a new song along the way, all the better. Whistles while she works by Barbara Sutherland Chovanec PHOTO: NATALIE LONG
16 A little appreciation goes a long way, and a Delta Dental of Michigan program embraced this concept to get more children to the dentist. Dr. Michelle Kohler, director of quality improvement and population health management, and her team worked at the request of the Michigan Department of Health and Human Services in 2022 to implement a value-based payment (VBP) program for dentists. The goal was to increase utilization of Michigan’s Healthy Kids Dental (HKD) benefit, available to children with Medicaid coverage under age 21. Delta Dental of Michigan’s stateapproved program focused on Wayne, Oakland and Macomb counties, a region surrounding Detroit with a significant number of Delta Dental HKD members and low rates of dental visits. “It was an important project for us,” Kohler said. “The timing was important in 2022 because the dental profession struggled with COVID-19, with retirements and some practices not reopening. This program was a great way to reward dentists for their hard work and commitment to seeing this underserved population.” Delta Dental is one of two contractors that administer the HKD program on behalf of the state of Michigan. More than 800,000 children statewide have HKD benefits through Delta Dental. Goal: exceeded Kohler hoped the VBP program could increase access to care in the three-county region of Michigan by at least 1 percent. Dentists helped to blast past the goal. Delta Dental HKD utilization in the three-county region of Michigan increased by 4.9% over 12 months. More than 196,000 children received essential oral health care in the region, an increase of about 20,000 Delta Dental HKD members served. Dentists received 2 percent of their patients’ Delta Dental HKD claims. Delta Dental paid a total of $1.37 million in incentives. More than 1,000 dentists participated. Bonuses ranged from $25 to $84,000. “We saw this program as a win-win situation, and so did dentists,” Kohler said. “More children received essential care, which translates to better dental health and better overall health, and that’s what we all want. The incentive payments were an added bonus that, in some cases, provided a significant boost to the practice.” Now with this program done, Delta Dental leaders are considering how other VBP programs could be structured to improve oral health. “I would love to hear from providers about this program or VBP programs in general,” Kohler said. “Getting feedback is important.” Have feedback to give? Email Kohler at [email protected]. by Barbara Sutherland Chovanec
17 CREDENTIALING MADE EASY OFFICE EFFICIENOFFICE EFFICIENTake care of your credentialing and recredentialing needs in our one-stopshop: AppCentral. Delta Dental of Michigan, Ohio, and Indiana is NCQA-accredited in credentialing and recredentialing, and the electronic tool we use lets you easily complete required documentation. Other benefits include: • Forms and applications that autopopulate with existing provider information. • The ability to easily upload required documentation with your application. • Automatic electronic notifications when you are due for recredentialing. • Simplified and streamlined data gathering. • Options to set reminders and request email alerts regarding your application status. TIP: Make sure your email is accurate in AppCentral to ensure efficient credentialing and alert delivery, and update your email if it changes. Find demos and more information in the dentist section of your statespecific Delta Dental website. 99.13% The percentage of claims processed within 10 days. 95.5% The drop-to-pay percentage rate in 2022 for Michigan, Ohio and Indiana. These claims required no manual intervention! 48 10 The number of days it can take Delta Dental to process a paper claim. When Delta Dental sends claim payments via EFT, they can hit your bank account in as little as 48 hours. DOT + EFT = MAX EFFICIENCY www.dentalofficetoolkit.com
18 NCIES NCIES FAST TRACK YOUR CLAIMS: Get paid faster 7TO10 The number of days it can take to receive a paper check from claim payment. Ensure claims are processed efficiently—so you can be paid faster—with the following coding tips: Make sure you’re using the most current CDT Code Manual. Note the difference between single unit crown and bridge, and bridge retainer codes for both natural teeth and implants (example: D2750 vs. D6759 vs. D6069). Ensure that codes are consistent for the metals or materials used—check for mixed metals and/or materials (example: 6740-6240-6740). Never omit a code if you are not charging for it (example: a recently crowned tooth that was extracted). Always use the correct code to differentiate prosthetics supported by natural teeth or implants. 9999 codes (example: D6999) always require a clinical narrative (use the ADA form remarks section). Do not bundle codes and fees into one claim submission—every unit must be given an individual CDT code and fee. If you’re unsure of a code, provide a detailed clinical narrative for the procedure on the claim. Include teeth numbers, procedure(s) and material types (if applicable). For all complicated surgical/grafting procedures, include a clinical narrative and copy of the patient treatment records or surgical report. Supernumerary teeth are numbered by adding 50 to the previous tooth. When submitting documentation related to scaling and root planing services, include a periodontal diagnosis, recent radiographs of all teeth involved, a recent periodontal chart, and a copy of the patient treatment records for the service provided, including the time spent if services were provided in three or more quadrants. Submit diagnostic radiographs: • Radiograph of the entire tooth/teeth for crowns and fixed partial dentures • Radiograph of the implant(s) in place when submitting for a crown or fixed partial denture SAY HELLO TO YOUR REP If you have questions or comments about your participation in Delta Dental networks, your professional services representative is a phone call away! MICHIGAN Sue Wilson 517-899-7070 | [email protected] Rita Myers 517-896-2333 | [email protected] OHIO Elaine Ruble 614-776-2312 | [email protected] Lori Whitt 614-776-2304 | [email protected] INDIANA Jennifer Baxter 317-348-1815 | [email protected] Teresa James 317-744-1212 | [email protected]
19 Vision and hearing screenings are standard for schoolchildren in Indiana, Michigan and Ohio—but dental? That’s coming soon to Michigan. Nationwide, most states have adopted mandates for school-aged vision and hearing screenings, but only a handful have passed legislation to account for dental. Below is a breakdown of states and respective screening requirements: 80% Vision 75% Hearing 28% Dental Tooth decay remains the most common chronic childhood disease despite the fact it’s fully preventable. As dental professionals, you know firsthand how tooth decay can cause distracting pain, make it difficult to eat or sleep, and prevent children from reaching their full learning potential. “I think it’s a common misperception that somehow dental care is optional or less important than other types of health care,” said Rick Lantz, vice president and chief lobbyist for Delta Dental of Michigan, Ohio, and Indiana. “As a society, we have a long way to go in ensuring that people understand that dental care is essential for overall health and well-being.” Thankfully, momentum is growing in Michigan for positive change. In the legislature: A bill that would require kindergarten oral health assessments has made its way through A WIN FOR MICHIGAN KIDS’ ORAL HEALTH What is a kindergarten oral health assessment? A dental provider looks into a child’s open mouth and notes what they see on a form. They provide a copy of the completed form with results to the parent or guardian, and let them know if the child needs to see a dentist for follow-up care. SB 280: by Kate Bartig
20 the Michigan legislative process and now awaits Gov. Gretchen Whitmer’s signature to become law. Delta Dental was a chief advocate of bills introduced in 2017 and 2019, with support from the Michigan Dental Association and other oral health stakeholders. Unfortunately, the 2019 legislation was watered down before its adoption in 2020. The changes made the screenings optional and gave the law a limited lifespan—ending the program at the conclusion of 2023. Senate Bill 280, introduced by Sen. Sam Singh, D—East Lansing, mandates kindergarten oral health assessments. The bill passed the Senate in June with a 30-6 vote and moved through the House in October by a count of 85-24. At the time of publication, the bill was moving to the governor for her signature. “This bill will promote earlier disease detection and help kids learn and succeed in school,” Lantz said. The bill includes an opt-out provision for those with a religious objection and is designed to operate the same as vision and hearing screenings—conducted by local health departments at no cost to the family. Supporters of Michigan Senate Bill These organizations advocated and/ or provided testimony in support of the bill: • Delta Dental of Michigan • Michigan Dental Association • Michigan Oral Health Coalition • Genesee Health Plan • Health Department of Northwest Michigan • Michigan Association for Local Public Health • Michigan Council for Maternal and Child Health • Michigan Dental Hygienists Association • Michigan Department of Health and Human Services • Michigan Education Association • My Community Dental Centers • Smiles on Wheels • United Way of Northwest Michigan
21 PHOTOS: RICK GUIDOTTI
UNLOCKING GREATER BENEFITS FOR PATIENTS WITH special health care needs The Delta Dental Special Health Care Needs Benefit has been a welcome change for members and providers. The benefit removes barriers to care for your patients while providing you with the reimbursement and resources you need. Delta Dental of Michigan, Ohio, and Indiana created the benefit in partnership with the Delta Dental Foundation and launched it in 2022 for eligible commercial-plan members who have a special health care need. The benefit covers: • Additional visits to the dentist’s office and/or consultations that can be helpful prior to the first treatment to help patients learn what to expect and what is needed for a successful dental appointment. (Codes D0120, D0145, D0150, D0160 and D0180) • Up to four total dental cleanings in a benefit year. (Codes D1110, D1120, D4910, D4346 and D4355) • Treatment delivery modifications, including anesthesia and nitrous oxide, necessary for dental staff to provide oral health care for patients with sensory sensitivities, behavioral challenges, severe anxiety or other barriers to treatment. (Code D9997) When creating the benefit, Delta Dental sought to address challenges dentists face when treating patients with special health care needs, and further, how additional barriers may arise when the patient has a Medicaid dental plan versus commercial plan. “The biggest part of this benefit, and the part I’m happiest about, is that this is an evergreen benefit,” said Holli Seabury, executive director of the Delta Dental Foundation. “When members turn 26 and would normally age off their parents’ benefits, they can stay on. “Dentists know patients will age out of their benefits, but families don’t always realize that. They’ll spend years working with a dentist, and when the patient ages out of the policy and goes on Medicaid, it all comes crashing down. If we can keep children with a disability on a commercial policy as adults, they will be much better served.” The benefit also recognizes the additional time these patients need in the dental chair or office, and treatment delivery modifications that can help providers ensure comfortable care. Because many individuals with special health care needs are at higher risk for developing oral diseases, the benefit also covers more cleanings per year than standard commercial plans. “If it’s recommended a patient receive four cleanings per year, that’s hard to do when the member, parent or caregiver is paying out of pocket. Now, dentists are able to do what they need to help keep their patients’ mouths healthy, and it’s covered by the benefit,” Seabury said. Help your patients take advantage of this benefit and ensure you receive the appropriate reimbursement by reviewing the Benefit FAQ section. by Kate Bartig
23 WHAT IS A SPECIAL HEALTH CARE NEED? As defined by the American Academy of Pediatric Dentistry, special health care needs include any physical, developmental, mental, sensory, behavioral, cognitive, or emotional impairment or limiting condition that requires medical management, health care intervention and/or use of specialized services or programs. The condition may be congenital, developmental, or acquired through disease, trauma or environmental factors, and may impose limitations in performing daily self-maintenance activities or substantial limitations in major life activities.
24 CREATING A WELCOME SPACE To help provide the best possible experience to patients with special health care needs, communicate regularly with them (and/or their parents or caregivers if applicable) about their needs. This may include determining whether additional visits would be helpful to build trust, identifying and accommodating sensory preferences, discussing communications preferences, and walking through what happens during a visit in advance. Additionally, all U.S.-licensed dentists and their support personnel can enroll in free continuing education courses from Penn Dental Medicine’s Center for Persons with Disabilities Presentation Series. • Created with support from the Delta Dental Foundation, the series aims to build awareness of the barriers to equitable oral health care for individuals with disabilities and develop competency to provide oral health care to this vulnerable population. • The series includes live webinars and on-demand courses. • Dentists completing 18 or more courses within a three-year period will earn a certificate of completion from Penn Dental Medicine, an ADA CERP Provider, as a Disabilities Dentistry Clinician Expert. • Register for a free course at www.dental.upenn.edu/disabilitiescare. BENEFIT FAQ Who is eligible for this benefit? Any member of a Delta Dental group benefit plan who has a special health care need and whose group has opted in or not opted out of the benefits. The Special Health Care Needs Benefit is available to eligible members at any age. Members will maintain full dental benefits as long as they maintain eligibility via the “Special Health Care Needs” attribute in their file. How do I submit a claim for this benefit? Before rendering services, check the member’s procedure eligibility in the Dental Office Toolkit® (DOT) to verify coverage. • If the member’s record has been updated to allow for additional services under this benefit, there will be a message in DOT confirming this. • If there is not already a message but the member says their Delta Dental plan includes the Special Health Care Needs Benefit and they have a qualifying special health care need— you should include code D9997 on the first line of the initial claim for this patient. (After the first claim processes, the member’s procedure eligibility will update accordingly.) • In DOT, the “Special Health Care Needs Benefit” message is different from the “Handicap” attribute.
25 No matter the season—from football to soccer to lacrosse to hockey to volleyball and more—there’s one piece of gear that’s everyone’s favorite: The mouthguard. Okay, so maybe mouthguards aren’t the most glamorous of gear. They are, however, one of the most important pieces of protective equipment, and Delta Dental is making it easy for you to provide your patients with the only mouthguard accepted by the American Dental Association. As an exclusive to Delta Dental of Michigan, Ohio, and Indiana providers, we’re offering up to 25 free mouthguards. Featuring highperformance impact absorption, a microwavable mold for best fit, and hydrophobic materials to prevent illness with a thin design to easily breathe, speak and drink, the Delta Dental mouthguard is ideal protection for all athletes, including those with braces. Each provider can request up to 25 FREE mouthguards. To place your order, scan the QR code or visit bit.ly/DDS-free-mouthguards. OFFER GAME-CHANGING PROTECTION FOR ATHLETES PROVIDER PERK:
26 Made with a thin design ensuring it stays in the athlete’s mouth while making it easy to breathe, speak and drink Hydrophobic material prevents absorption of saliva for a longer lifespan Patented fitting material provides a comfortable custom fit and works with braces BREATHABLE AND COMFORTABLE Thank you. FOR CREATING HEALTHIER SMILES. FOR BEING VALUED, ESSENTIAL PARTNERS. FOR PROMOTING OVERALL HEALTH. FOR HELPING US BUILD HEALTHIER, SMARTER, MORE VIBRANT COMMUNITIES. For all that you do. We want you. We’re here to listen: Join Delta Dental’s oral health focus group Now recruiting passionate providers, hygienists, assistants and office managers! Delta Dental of Michigan, Ohio, and Indiana needs your input to ensure that we understand the issues that matter most to you. Virtual meetings will be led by an expert thirdparty facilitator. Participants will earn $200 per session, and we’ll conduct up to six per year. Join us to collaborate, share feedback, experiences and ideas for strengthening our partnership with you. Scan the QR code and fill out the form to indicate your interest.
27 STAY CONNECTED! This first issue of Best Practice is our introduction, and we look forward to staying in touch between issues with more on dentistry, business and policy. We’ll send between-issue updates via email, and we know that sometimes emails go to an office manager or a general office mailbox. Make sure you receive Best Practice updates by sending your preferred email address to: [email protected]. Thanks for reading! best practice DENTISTRY, BUSINESS & POLICY