Appendix A: Survey Questions

Background Questions 1. In which state is your primary practice located?  [INSERT DROP‐DOWN MENU FOR ALL 50 STATES + DC]

2. Which of the following categories describe your race? Select all that apply:  White / Caucasian  Black / African American  American Indian/ Alaska Native  Asian / Pacific Islander  Other; please specify: _______  Prefer not to answer

3. Ethnicity  Hispanic  Non‐Hispanic  Prefer not to respond

4. Which of the below most closely align with your gender identification?  Female  Male  Other; please specify: _________  Prefer not to respond

5. How many years of experience do you have practicing dentistry?  0‐5  6‐10  11‐20  21‐30  31+

6. In what setting is your primary practice located?  Rural  Urban  Suburban

7. Which of the following best describes your current work environment as a dentist?  Solo practice (operated by one dentist)  Small group practice (operated by multiple dentists at one location)  Large group practice (operated by multiple dentists at multiple locations)  Multispecialty group practice  Other; please specify: _________________

8. Does your dental practice fall under any of the following categories? Select all that apply:  Integrated Delivery Network/ System  Federally Qualified Health Center (FQHC)  Accountable Care Organization (ACO)  Patient Centered Medical Home (PCMH)  Dental safety net provider  Other; please specify: _________________

9. Which of the following age groups accounts for the largest proportion of patients you serve as a dentist?  Older adults (ages 65+)  Adults (ages 18‐64)  Children and/or adolescents (ages <18)

VBOHC Awareness and Acceptance

The dental profession is moving toward value‐based care (VBC), an approach to care that ties reimbursement to the quality and value of care provided (in contrast to traditional approaches to reimbursement based on the quantity of services provided). A key component of VBC is use of quality measures, which capture the quality of care provided and patient outcomes achieved. For example, the Dental Quality Alliance (DQA) has developed quality measures, including measures that evaluate preventive care processes (e.g., “Oral

Evaluation”), access to care (e.g., “Usual Source of Services), and care outcomes (e.g.,

“Ambulatory Care Sensitive Emergency Department Visits for Dental Caries in Children”).

1. Does your dental practice utilize quality measures? Select all that apply:  Yes, to track and monitor quality improvement efforts  Yes, for public reporting purposes  Yes, for alternative payment model arrangements that tie quality of care to provider reimbursement (e.g., pay‐for‐performance)  Yes, to identify variations in care  Yes, for provider comparison purposes  Yes, to establish and track progress toward performance benchmarks  Yes, for other reasons; please specify: ______  No, my practice doesn’t utilize quality measures

2. If yes, which quality measure(s) does your practice utilize? Select all that apply:  Dental Quality Alliance (DQA) measures  Measures developed by my practice  Measures required by payers  Measures required by my state

 I use other quality measures; please specify: ______  My practice does not utilize quality measures

3. If you do not utilize quality measures, on a scale from 0‐10, how interested are you in using quality measures in your dental practice?

0 1 2 3 4

Not at all interested in using quality measures 5

Neither interested nor disinterested 6 7 8 9 10 Very interested and planning to use quality measures in the future

Another component of VBC is use of alternative payment models (APMs). APMs tie provider reimbursement to quality of care provided, as opposed to fee‐for‐service reimbursement based on volume of services. The following are examples of APMs that can be used by oral health providers or provider organizations: a) Shared savings: Providers receive a percentage of the total cost savings for a defined patient population b) Pay‐for‐performance (P4P): Financial rewards or penalties based on quality measure performance benchmarks c) Pay‐for‐reporting: Financial bonuses for reporting data or penalties for not reporting data d) Bundled payments: Prospective or retrospective payments based on an entire episode of care (e.g., a specific procedure, a time‐limited condition, or condition‐specific care management); Payment adjustments are based on quality measure performance e) Capitated payment models: Prospective payments to providers (per‐member and per‐month) covering health services that are based on quality measure performance measured against quality benchmarks

4. Does your practice participate in any alternative payment models (APMs)? Select all that apply:  Shared savings  Pay‐for‐performance or Pay‐for‐reporting  Bundled or Capitated payment models  My practice does not participate in an APM  Other; please specify: ________

Another important component for value‐based oral health care is the integration of medical and dental care. Medical‐dental integration refers to an approach to care that integrates and coordinates dental medicine into primary care and behavioral health.

5. Indicate how you learned about the following; select all that apply:

a. I learned about quality measures…  During my education for my DDS/DMD degree  Through continuing dental education  Through a specialty/professional society/ study club  I do not have any education in this area  Other, please specify: _________ b. I learned about alternative payment models (APMs)…  During my education for my DDS/DMD degree  Through continuing dental education  Through a specialty/professional society/ study club  I do not have any education in this area  Other, please specify: _________ c. I learned about medical‐dental integration…  During my education for my DDS/DMD degree  Through continuing dental education  Through a specialty/professional society/ study club  I do not have any education in this area  Other, please specify: _________

As a reminder, value‐based care (VBC) rewards dental providers based on the quality and value of care provided. This is in contrast to the traditional model of payment in which dentists are paid based on volume of services performed.

6. Do you currently participate in a value‐based care arrangement?  Yes  No

7. If no, indicate your level of agreement with the following statement: I am interested in participating in value‐based care arrangements.

1 2 3 4 5 6

Strongly disagree Disagree Slightly Disagree Slightly Agree Agree Strongly Agree

8. Specify your level of agreement with the following statements: a. Value‐based care has the potential to improve oral health care for my patients.

1 2 3 4 5 6

Strongly disagree Disagree Slightly Disagree Slightly Agree Agree Strongly Agree

b. My practice understands how oral health care fits into value‐based care.

1 2 3 4 5 6

Strongly disagree Disagree Slightly Disagree Slightly Agree Agree Strongly Agree

1

c. My practice is incentivized to participate in value‐based care.

2 3 4 5 6

Strongly disagree Disagree Slightly Disagree Slightly Agree Agree Strongly Agree

Integrated Care, Coding, and Interoperability

9. What are the top 3 challenges that your dental practice faces in providing integrated dental and medical care?  Lack of collaboration between medical and dental practitioners  Separation of medical and dental electronic record systems  Interoperability issues stemming from different medical and dental coding conventions  Low utilization of diagnostic codes among dentists  Unclear benefits for my patients  Lack of established models or guidelines  Variations in medical and dental payer requirements  Lack of performance metrics to monitor, evaluate, and improve integration efforts  Other; please specify: ________  This question is not applicable to my dental practice

10. Indicate functions for which you use diagnostic codes (e.g., ICD‐10 codes). Select all that apply:  Record clinical data in non‐electronic record systems  Record clinical data in the electronic health record  Facilitate communication/ collaboration with external providers  Dental insurance claims  Medical insurance claims  Quality measure reporting  Quality improvement initiatives  I do not use diagnostic codes  Other; please specify: ________

11. Which of the following would be most helpful to increase utilization of diagnostic codes in your dental practice? Select the top 3 options:  Education on the use and value of diagnostic codes  Increased payer requirements to include diagnostic codes on claim submissions  Improved information systems that capture diagnostic codes within the dentist’s workflow  Increased dental coverage

 Financial incentives for quality patient outcomes that are tracked using diagnostic codes  N/A  Other; please specify: ________

Additional Opportunities

12. Are there any additional considerations related to the transition to VBC and/ or your ability to participate in VBC arrangements that are important to mention?