Advocating for Quality Endodontics and Fair Payment Policy

by Helen Jameson, J.D.

Insurance-bridge_blogAn important component of the AAE's advocacy for members and the specialty focuses on dental benefit plans. It is "quiet" advocacy because it happens through sustained relationship development with individual dentists who work as dental directors for dental benefit plans.

Dental directors are members of the plan senior management team, and they are responsible for claims processing and payment policy. They have real influence,
but it is limited by cost containment pressures from plan purchasers and the financial goals of the company.

The AAE strategy is to influence through education and ongoing dialogue. We advocate for excellence in endodontic care and the proper course of treatment. A good example is the use of cone beam computed tomography in endodontics. In discussions with dental directors, they acknowledge that CBCT has a role but the plans are concerned with the cost/benefit analysis and the potential for overuse if CBCT is routinely covered.

The influence of the AAE, or any other dental association, is limited by the realities of the landscape. Dental plans have wide latitude to set payment policy and payment rate based on the needs of the purchasers of their plans. Further, the AAE is viewed under the antitrust laws as "an association of competitors," and must ensure that any advocacy with dental plans is not perceived as anticompetitive. Our dental plan advocacy occurs at several critical points in the year.

In May, the AAE attended the American Association of Dental Consultants Workshop. Dr.
Kenneth B. Wiltbank, AAE Practice Affairs Committee chair and AAE representative to the ADA's Code Maintenance Committee presented "Carrying the Standard: Endodontics Expectations." The workshop was attended by more than 200 dental directors and independent dental consultants who review claims for plans. The AAE sends PAC members each year, and most of the dental specialties and the ADA have representation as well.

Dr. Wiltbank set the stage by reviewing different systemic aspects to establishing standards, starting with the AAE's-and our members'-role as the experts in the field of endodontics. He pointed out that the breadth of CODA's undergraduate curricula requirement and the grading criteria for licensing exams (e.g., WREB, ADEX, CRDTS) results in many programs "teaching to the test." Once a person is licensed by the state, he/she can practice the full scope of dentistry practice (with the exception of states that require a certificate to perform dental anesthesia) with little, if any, experience in the complexity of endodontics. Dr. Wiltbank illustrated the "real world" consequences of this by sharing radiographs from root canal treatments performed by general dentists that would constitute a "fail" under any of the licensing exams.

"There's a saying that if you're not at the table, you're on the menu," said Dr. Wiltbank. "Showing up and engaging is critical. We can't tell the dental plans how to run their business but we can take opportunities like the AADC workshop as a conduit to get our message out to important stakeholders. This is an important part of being the leaders in endodontics."

Did You Know?

The AAE has resources to help you and your staff navigate the complexities of dental benefit plans and claims navigation.

Dr. Elizabeth S. Perry, a member of the PAC, also attended the AADC workshop and agreed that it is important for the AAE to be present and visible. "The AAE is clearly held in high esteem by the dental directors. Dr. Wiltbank's excellent presentation was attended with great interest and stimulated informal follow-up discussion on current standards in endodontic care," explained Dr.
Perry. "The dental directors look to the AAE for guidance in what is appropriate in the endodontic management of their patients. In Massachusetts we struggle with a lot of dental plan issues. The AADC Workshop reinforced to me that there aren't easy answers to a complex dynamic. It is important that we keep the conversation going."

The next AAE leadership meeting with dental directors takes place in May 2018 and will build on this momentum. As that agenda takes shape, look to AAE Connection for opportunities to provide input on your practice's biggest challenges with payers.

 

Helen Jameson is the assistant executive director of professional affairs for the AAE. She oversees advocacy related to policy, government affairs, dental insurance, and other professional and clinical issues. Helen can be reached at hjameson@aae.org.