MESSAGE FROM THE EDITOR
SEA CHANGE Dr. Richard F. Roadcap
Much of the world’s crude oil is transported by oil tankers, sometimes called “supertankers”, huge ships that measure up to 1,500 feet long, and capable of carrying 550,000 metric tons. These vessels carry over two billion barrels of oil each year, and are second only to pipelines in terms of efficiency. Less than $0.03 per gallon of gasoline is assigned to the cost of this method of transport. It can take up to 30 minutes and 5 miles to bring one to a halt from an average cruising speed of 20 knots. Navigating its way through Congress is a $3.5 trillion Budget Reconciliation Bill which includes, for the first time, a dental Medicare benefit. Medicare provision of dental benefits is hardly a new idea – several times a year for the last 40 years I’ve been asked if my office accepts Medicare, only to reply that it does not pay for routine dental care. The ADA has its own Medicare policy statement, adopted by the 2020 House of Delegates, that advocates benefits for lower income seniors. The ADA standard recommends enrolling beneficiaries whose income does not exceed 300% of the Federal Poverty Level. If adopted, nearly half (47%) of Medicare enrollees would qualify. Democrats now control the White House and both houses of Congress. Two features of the proposed legislation should alarm practicing dentists: 1) the benefit is not means-tested; i.e., our patients with a seven figure net worth would qualify and 2) the program would be rolled into Medicare Part B, a program which has been fine-tuned for decades to meet the needs of physicians. The formulas are complicated, but MDs are reimbursed by Medicare for their time and not for procedures. Dentists know, and physicians know, but policy makers often
don’t know that the economics of dentistry and medicine are different. Medical insurance companies employ actuaries to calculate risks and set premiums; dental insurance is a form of prepayment, or savings account, that does not endanger the fiscal health of the carrier.
“ If you’ve assumed we’re headed for lower reimbursements, you are correct.”
If you’ve assumed we’re headed for lower reimbursements, you are correct: the ADA estimates the current proposal provides, over a 10-year period, only two-thirds ($24 billion a year versus $32 billion) of the amount needed to achieve the “median” fee for most dental procedures. Provider enrollment can be described in one word: burdensome. Most of us remember the effort to enroll dentists in Medicare in order for their patients with the drug benefit (Part D) to have their prescriptions filled. In other words, if we didn’t sign up, our patients had to pay out of pocket for clindamycin, acyclovir, chlorhexidine, or any medication we felt necessary. Those who elected to “opt out” later found that patients with Medicare Advantage (Part C) dental benefits could not be treated in their offices, based on a ruling from the Centers for Medicare and Medicaid Services (CMS). Thankfully, the prescription enrollment requirement was later rescinded. The infrastructure needed to develop a program of this magnitude will delay
the program beyond next year, the year after that, and perhaps up to five years, based on estimates from CMS. Most of us now treat patients enrolled in Medicare Advantage, and no decision has been made on those patients’ status. It’s possible they could be required to join Part B, eliminating an escape route for many of the seniors in our practices. We ignore this behemoth at our own peril. Five years is not far off, and with the rapid expansion of group practices and DSOs, not participating may not be an option. If you haven’t already done so, please let Senators Kaine and Warner, as well as the congressman in your district, know that enrolling all seniors, regardless of income, in Medicare Part B dental plans is a mistake. Both our patients and the profession will suffer. The ADA’s Legislative Action Center https://actioncenter.ada.org/opposemedicare-dental-benefit-part-b/ can make your voice heard. Also, there’s an excellent webinar https://www.ada.org/ en/advocacy/congress-considers-amedicare-dental-benefit on the ADA’s website, which every reader should watch in order to make sense of the alphabet soup of agencies and programs involved. Remaining on the sidelines is not one of our options. I hope I’m proven wrong and this juggernaut making its way through Congress runs aground. Rescinding legislation can be nearly impossible. The McCarran-Ferguson Act, enacted in the 1940s, survived until 2020 despite having little or no support from legislators. Opposition with no alternative will tarnish our image as a profession. We need to take action now on behalf of our patients before we find that our ship has sailed.
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