Nashville, Tenn.-based Marquee Dental Partners CEO Fred Ward discussed trends among dental service organizations, the rise of value-based care and strategies to keep dentists engaged with Becker’s Dental Review.
Question: What are the key strategies for DSOs and dental groups looking to expand their networks?
Fred Ward: A variety of approaches to expansion have proven effective for several successful DSOs. The key is to be clear on your approach and galvanize organizational resources to execute. Some groups took an approach to expand only by building de novos, others through acquisitions of private practices, and others, like Marquee, do both. The main thing is to know what you are solving for. What type of practice do you build or acquire? Where do you expand? Are you in primary markets, secondary or tertiary markets, urban, suburban and/or rural? What will be the size of the practice and so on? Acquisitions tend to be more capital intensive but provide more immediate cash returns than de novos.
Q: In the next 10 years, what is the biggest change dentistry will experience?
FW: We all know healthcare in the U.S. is changing rapidly. Dentistry is no exception. My opinion is that several big changes are forthcoming. Most often, I think about changes that benefit patients and/or providers. Here are three key trends:
1. Implants – The emergence of dental implants will become even more of a mainstream solution for patients who have permanently lost teeth. Dentures are a great solution for many, but implants can be forever, and patients who have them do not face the same challenges denture patients face. If your dentist does a bone graft after an extraction, then even years after that extraction, the doctor can place an implant. Dentists can make you better than you have been for years. Your smile and your bite might even be the best they’ve ever been.
2. Orthodontics – Orthodontics is going through a revolution right now. More general dentists than ever provide orthodontic services using clear retainers. Mail order clear retainers are now available too. Soon, we will begin learning the impact of this revolution on the orthodontic specialty and the prices of orthodontic services.
3. Value-based care – Healthcare in the U.S. cost $3.5 trillion in 2017. You have heard the statistics that the U.S. spends more per capita on healthcare than other wealthy countries and yet systemic health problems like diabetes, heart disease and high cholesterol are still on the rise. Better oral health can help solve many of these systemic problems.
Value-based care rewards providers for patient outcomes as opposed to services rendered. Fundamentally, this is the wheelhouse of all dentists. Their job is to prevent disease and restore patients to health. Educating patients about the value of two dental visits per year and the necessity for treating what is diagnosed, as well as the opportunity cost of not doing treatment, becomes an imperative in a value-based system. Giving or getting patients to take home dental products, like better toothbrushes, is just one way the dental field can increase prevention. Patients become more accountable between visits to maintain good oral health. We know that $1 spent on prevention today saves between $8 and $50 in restorative or emergency dental treatment down the road. Marquee Dental gives new patients electric toothbrushes; the type that most dentists and hygienists themselves use because these brushes are superior to manual brushes.
Standardization and metrics to measure patient health and outcomes will become the norm. Dentists will benefit from driving down costs, so operating efficiencies will be rewarded. DSOs are built on both standardization and operating efficiencies. So, more formalized value-based care is coming. To me, that is why DSOs are the future.
Q: Will telemedicine push over into dentistry? How will these services help or hinder the field?
FW: Telemedicine is increasingly being used within the field of dentistry. Examples include registered dental hygienists performing six-point probing, taking x-rays and intraoral photographs, and then uploading this information to a remote dentist who develops a treatment plan.
I also mentioned that patients can get clear retainers through a mail order arrangement. In this circumstance, for most state dental boards to support, a remote licensed dentist or orthodontist has to approve the case.
After-hour dental emergencies usually lead to a telemedicine approach. Patients in regular dental care can reach their dentist, describe the pain and together with the dentist determine appropriate next steps.
The first two examples are not telemedicine per se, but in these cases, a direct physician-patient interface and relationship does not exist. These are all likely cases in which telemedicine will accelerate within dentistry.
Q: Reimbursement remains an issue among the dental and medical space. What can dentists expect coming down the pipeline? Will changes be made?
FW: I mentioned value-based care previously. I think that is the future. Dentists will be compensated for outcomes. Standardization of procedures, utilization of standard labs and dental suppliers, increased analytical uses, data driven evaluations and reimbursements for outcomes will be the way.
Many of the dentists we support at Marquee Dental already render treatment based on the philosophy that a dollar of prevention spent today saves a lot more money down the road. So, I like where we are right now. A focus on prevention gives dentists the high-ground because the goal of prevention is to improve patient overall health through better oral health. Sixty-two percent of American adults over the age of 30 have untreated tooth decay or cavities and nearly 50% have untreated gum disease, so the necessity for regular dental care is unquestionable. The healthcare system, insurers and employers have to work together to get more of these adults into care, restored to health and then on a maintenance program. This will significantly reduce healthcare costs for everyone.
Q: How is Marquee Dental Partners combating burnout among dentists and staff?
FW: I have a lot of compassion and respect for dentists. Out of necessity, their work posture is not good. They work with sharp instruments around soft tissue in an environment filled with saliva and blood. They do amazing things despite all of that.
We do a few things in an effort to create a work environment that makes each day more enjoyable than functional. We recognize our dentists regularly. The staff in our support center have personal awards they give to people in the practices we support as a way to express gratitude. Physicians and staff seem to appreciate being recognized in front of their coworkers and sometimes even patients. Secondly, we confirm in front of patients how incredibly talented Marquee Dental dentists are. We have a couple of special patient events each year. On those days, we empty out the support center and each of us visits offices taking photos, bringing food and sharing in the joy of the event. So, on the one hand, we try making each day more enjoyable, and on the other, we readily express our gratitude to dentists and staff for the work they do.
Regarding burnout, we have regular dinner meetings and events with subsets of dentists, our board and private equity sponsors. We listen. We respond. Though these aren’t way to avoid burnout, these are examples of the many ways we are present and available, all of us, to hear physicians’ concerns.
We do not push dentists to work additional days. If they want a four-day work week, then we support that. We do feel the calling to provide greater patient access to care, so we recruit second physicians for many practices. In this way, we do not burn out either physician in the practice. My personal mission is to preserve the great dentists we support today, not to do things that may contribute to burnout. Having more physicians seems to help this issue. It allows each dentist to work the days that best fit his/her life, and also gives patients more options on hours and days.