Paul R. Amato, DDS, FAGD, LeCuyer & Amato Dentistry (Seattle): From the general dentist’s perspective, the PPACA hasn’t affected us positively or negatively thus far. There have been a few patient inquires, mainly patients with children. Pediatric dentists would most likey see the biggest change. It is very strange that teeth are not included in overall healthcare, but eventually I think this will come down the pipeline.
Dental insurance benefits are different than general healthcare coverage. Patients get a set amount of coverage, say $1,000, for a year and then everything else is out-of-pocket. How is $1,000 for any adult with dental needs sufficient? Hopefully patients will be able to get more coverage.
Michael W. Davis, DDS, Smiles of Santa Fe (N.M.): Generally, the PPACA is an expansion of Medicaid, with basic Medicaid fees and Medicaid oversight mechanisms. Thus, it’s an expansion of an already failed and dysfunctional program. Most private practices decline to accept Medicaid, because the fee schedules encourage gross over-treatment of disadvantaged patients, to make it fiscally viable. See reports from PBS Frontline, Bloomberg Business News, July 2013 Report on Corporate Dentistry by bipartisan committees of U.S. Senate. Most dental Medicaid in the private sector is pretty abysmal.
We have interstate corporate-managed Medicaid dental clinics, which are primarily run by the private equity banking industry. They front “ownership” by enlisting nominee owners (generally dentists), when they are the true beneficial owners. This is to circumvent tax consequences and potential malpractice & fraud liabilities.
[There is] no impact on most dentists, because it’s primarily an expansion of Medicaid. Although numbers of patients were hoping for a reasonably viable program, they’re usually disappointed. The programs focused on adults are particularly disappointing.
Alan Gurman, DDS, PC, Alpine Dental Center (Denver): Unfortunately there is no dental coverage as part of [the PPACA], unless a 
person qualifies for Medicaid. With Medicaid this applies to children, up to the age of 19. The problem I see is the funding, or the lack thereof, to provide adequate care. Medicaid promises coverage to the most needy, but there has always been a lack of funding to meet this promise. With the anticipated millions of new patients on the Medicaid rolls, where is the money coming from?
The independent dentist will probably not benefit from the increase patient load due to the inadequate reimbursement of services provided. The one-man dental office will be a dinosaur. In its place there will be large corporations with large staffs that can handle the increased volume of patients and will be able to absorb the lower reimbursements from insurance companies through sheer numbers.
With lower reimbursements an office will need to see more people to take up the slack. This probably will not happen, but the government needs to rebuild the public health infrastructure and hire dentists with incentives for them to stay in public health. This can be noble and rewarding career for the practitioner. With enough publicly funded clinics that provide essential dental services, improvement in oral health for Americans can be made.
Edita Outericka, DMD, Dynamic Dental (Mansfield, Mass.): With the launch of the Patient Protection and Affordable Care Act has come numerous, noticeable changes in the field of dentistry. The expansion of dental benefits for children is the biggest of these changes. With expanded, mandated dental coverage more children are now visiting dental offices. This is great news! An important part of oral and overall health is biannual visits to the dentist — especially for children. The PPACA has included expanded coverage for Medicaid recipients as well. Adults with personal individual coverage or coverage through an employer now have access to coverage as well.
An uptick in patients’ dental office visits is a direct result of having coverage that was not available to them prior to the PPACA. The PPACA has created problems for dental offices and insurance companies. The new plans are plentiful for sure, but there is no standardization. Treatment coverage is difficult to understand and varies so greatly that dental insurance carriers themselves are confused. Patients rarely take the time to understand their coverage so it falls on the dental office workers to sort through a multitude of convoluted plans in order to provide the patient with their coverage information. Each plan comes with its own set of deductibles, coverage percentages, covered treatment and fees.
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