The Supreme Court has spoken and the Patient Protection and Affordability Care Act has passed the scrutiny of America’s highest court. However, the debate continues along partisan lines as this landmark legislation is adopted and integrated into the world’s largest healthcare system. The process to reform America’s healthcare Industry has begun but we should expect more political theater from both sides of the political isle and compromise while these reforms are administered.
The reforms slatted for 2012 will swiftly be incorporated as the current administration enjoys the recent Supreme Court victory and their momentum on this issue. The health care fight will be front and center as the Republican Party and their presidential candidate aim at repealing the law. The repeal measure is doomed in the Senate where the democrats hold a majority but it will create additional uncertainty and divisiveness amongst the electorate.
The Patient Protection and Affordability Care Act, otherwise known as “ObamaCare” is unpopular with many groups (across party lines) but elements of the program appeal to Americans across the board. The roll out of this transformational healthcare act will begin immediately and will be in full force by the end of 2014. The three most popular provisions under the Affordable Healthcare Care Act are: (1) No lifetime and annual limits on benefits for the elderly and sick, (2) No denial of benefits for those with pre-existing conditions and (3) Dependent coverage up to age 26.
Little is known how this legislation will ultimately affect the dental community but one thing is certain, the debate over this issue has put healthcare and insurance benefits in the spotlight for many Americans. Questions on annual limits, what are excepted and essential benefits are still unclear in the dental and vision benefit category. Pediatric dentistry will operate under a different set of guidelines than adult dentistry and orthodontic services will be administered differently based on age and population and insurance type. The rules for self administered insurance, private insurance, group insurance and federal insurance programs will vary.
Regardless of your offices insurance participation, most Americans will have questions about their benefits and how they will be affected by the new legislation.
You and your team are expected to be knowledgeable about the legislation and will need to bring clarity to your patients who have questions.
Over the next few months, I will address this legislation and share more critical information with you. In the mean time, please meet with your accountant and look for information and guidance from the American Dental Association and other credible agencies on the changes and opportunities this bill will create.
Thirty million uninsured Americans will receive health care coverage so the ranks of the insured will grow exponentially. While it is true that millions of underprivileged children and the elderly will have better access to care, it is unclear how this breaks down in the dental and other healthcare specialties. Below are two excerpts from a Q&A article I came across while studying the new healthcare act. Here is the site information so you can review the entire article: http://www.benefitmall.com/News-and-Events/Legislative-Updates/Health-Insurance-Reform-What-Does-It-Mean-for-Dental-and-Vision-Plans.
What are some of the PPACA provisions that will apply to dental and vision plans?
If the dental and vision plans are covered, most of PPACA’s normal requirements will apply, including:
• No annual and lifetime dollar limits on benefits
• Employees’ children remain eligible until age 26
• Mandatory coverage of preventive services with no cost sharing
• Mandatory external review of adverse claims decisions
• No preexisting condition exclusions
• No waiting periods exceeding 90 days
If the limited benefit plan is not excluded, the lifetime benefits that limited scope benefit plans often have must be deleted. Consequently, this will likely increase the cost of the limited benefit plan to the employer.
In relation to specialty benefits, what happens after January 1, 2014 when all qualified health plans must offer the essential benefit package through the exchange?
Regarding dental coverage, the National Association of Dental Plans, makes the following observations:
By January 1, 2014, all health insurance issuers offering health insurance coverage in the Individual or small group market (with the exception of grandfathered plans) must ensure that the coverage includes the essential health benefits package, including pediatric dental benefits.
Outside of the new health insurance exchanges: Although stand alone dental plans are specifically exempt from the requirement to offer all essential benefits, for health plans to be recognized as meeting the essential benefits package in the individual and small group market, they must offer pediatric dental benefits.
Inside of the new health insurance exchanges: By 2014, states are to establish health insurance exchanges to provide access to affordable health insurance options for individuals and small employers. (By 2017, states can allow large employers to obtain coverage through an exchange.) Plans must include all essential benefits to be offered in the exchange. However, stand alone dental plans are allowed to offer the required pediatric dental benefits. If a standalone dental plan offering required pediatric dental benefits is available in an exchange, a health plan without these benefits that offers all other essential benefits can be treated as a qualified health plan to offer coverage in the exchange.7
American’s are split on this legislation, so try to avoid political discussions in and around the office. Spend time with your dental team and discuss this landmark legislation and give them talking points. Your office should be sensitive to the value a patient puts on their healthcare benefit.
Regardless of your insurance participation, the PPACA will dramatically affect the way healthcare is implemented, delivered and paid for. Independent dentist/owners will still dictate how they run their shop but the competitive nature of the market, compounded by greater insurance involvement will still be a consideration when determining equipment and technology acquisition (differentiation and better care) facility and location (socio economic considerations and their impact) and what type of environment and amenities you offer. All dental practices (including fee for service facilities) would do well by evaluating critical systems such as scheduling, account receivables, dental and medical billing, room utilization, inventory control, marketing and services offered. I would also look into wellness models that promote prevention and modern day dentistry.
In my opinion, there will be an expansion in the geriatric and pedo patient population over the next decade. The boomers are here for the next 30-40 years and the new healthcare act will open the gates for the uninsured and millions of children. All practices must consider expanded duties for key clinical and administrative staff. This will allow the doctors more time to see more patients and perform higher paid procedures.
Mitch Cutler – “Legend of the Road”
October 22, 1956 – June 2nd, 2012
I just lost a dear friend of twenty years after he had a six year bout with cancer. This friend of mine was no ordinary man and was a fixture in our dental community. Mitch Cutler was an over achiever with incredible talent and a work ethic rarely seen these days. He motivated people with his enthusiasm, comforted them with his amazing smile and led them by example. Mitch was a sales representative, a valued consultant, a remarkable marketer and the ultimate optimist. Mitch’s spirit, energy and passion will be missed by hundreds of people who saw Mitch as their advisor and friend. The dental community has lost one of its shinning stars who pioneered consultative selling and provided value added services before it was in vogue.
I will miss Mitch because he made me a better man. He challenged me and supported me. And while we did not always agree, we always respected each other.
Mitch and I hugged every time we saw each other like long lost friends. Mitch was and remains one of the best friends I’ve had in my entire adult life. We were so different and yet so similar in many ways.
Mitch did not see the glass half full; he saw the glass as overflowing.
On behalf of Mitch, I ask you a question that was notoriously Mitch
“What are you doing to grow your business?”
R.I. P. Mitch.
Did you know that the A.D.A. and the F.D.A. radiography guidelines changed in 2006?
Panoramic Exam with Posterior BWX recommended for:
• Child with Mixed Dentition
• Adolescent with Permanent Dentition
• Adult, Dentate or Partially Edentulous
This protocol is utilized at all 4 U.S. OMFR Programs:
(U of Connecticut, U of North Carolina, U of Iowa, U Texas – San Antonio)
*Information provided by J. Morita.
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