Second Opinion: Wash. lawmakers should regulate dental chains

A debate in Olympia, WA, about the operation of corporate dental chains might seem the type of issue that matters only to those directly involved, with little impact on the public at large.

Nothing could be further from the truth. The outcome will have a dramatic impact on the quality of care received by dental patients in Washington state.

Bernard Larson, DDS, is the president of the Washington State Dental Association.

Corporate dental chains, known as dental service organizations (DSOs), already operate in Washington state under names such as Modern Dental, Bright Now, Half Dental, and Gentle Dental. But they do so in a gray area outside of the oversight of the state regulators at the Department of Health or the Dental Quality Assurance Commission.

Legislation (SB 5158) heard in the Senate Health Care Committee on January 19 would give these corporations virtually unlimited authority to continue operating with no regulatory oversight.

As a practicing dentist, this concerns me greatly. Not because these chains represent new competition. And not because dentists should be denied the option to contract for back-office, administrative support so they can concentrate on patient care. As a profession, dentistry welcomes innovation in both clinical care delivery and administrative support when it improves treatment outcomes for Washingtonians.

Decisions left to dentists

My concern is rooted in knowledge that the best dental care results when decisions are left solely to the patient and his or her dentist. Interference in the doctor-patient relationship by third-party, for-profit corporations can lead to inferior care, overtreatment, or both, and it should not be allowed.

Experience has shown that, left unchecked, nondentist corporate managers routinely hire, supervise, and evaluate licensed dentists; choose equipment and materials; review and challenge treatment plans; and develop unrealistic production schedules that treat patients like widgets moving through a factory. Incentives in DSO employment contracts often have nothing to do with patient need or the quality of care provided and everything to do with revenue generation and profit maximization.

Government studies at the federal and state level concur. Washington's Dental Quality Assurance Commission reported in 2015 that "growth in new business models has raised concerns about the quality of dental care and the treating dentists' ability to meet their professional responsibility to patients. These concerns arise in connection with nondentists gaining influence over issues related to dental treatment."

A June 2013, a U.S. Senate report stated that "profits are being placed ahead of patient care" in these offices.

The legislation heard by the senators ignores all this. It would confirm the authority of corporations to own and operate dental practices in Washington but provide no protections for patients. The DSOs could operate outside the auspices of the Department of Health; regulatory oversight would be limited to individual dentists operating within the clinic, who often have little or no control over decisions that directly impact patient care or cost.

Fortunately, there is an alternative proposal (SB 5322) that would eliminate these problems and provide strong protections for patients. Sen. Curtis King (R-Yakima) has a bill that would confirm dentists can contract with third parties for support services, but it expressly prohibits DSOs from interfering with the dentist's judgment on what is right for patients.

The bill would prohibit corporations from compensating dentists based on volume, revenue generation, or referrals to affiliated specialists -- arrangements used to exert control over dentists' decisions. It would also provide clear authority for the state to monitor DSOs and whistleblower protections for those who report violations.

No patient should have to endure unnecessary costs or treatment. If they do, there should be oversight by the state to ensure bad actors are held accountable. Patient care decisions must remain separate from those pertaining to corporate profit.

Bernard Larson, DDS, is president of the Washington State Dental Association.

A version of this first ran in the Puget Sound Business Journal. DrBicuspid.com appreciates permission to print an edited version.

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