Corridor dentists deal with industry changes

The dental industry may be more insulated from the significant changes the health care industry is facing with the implementation of the Affordable Care Act — but it still is an industry in transition.

Here in Iowa, dentists are dealing with an influx of new patients, many of whom rarely have had regular dental care.

This is the direct result of the Iowa Health and Wellness Plan, Iowa's Medicaid expansion created in 2013. The plan includes a dental benefit, which Jeff Russell, president and CEO of Delta Dental, said is unusual.

'Iowa is one of only a handful of states to do that,' he said.

The program began on May 1 and since then about 110,000 Iowans have signed up for the coverage, surpassing Delta Dentals projections of 85,000.

As with the health and wellness plan, the Dental Wellness Program offers coverage for those with an income of 0 to 133 percent of the federal poverty level and are not eligible for Medicaid or Medicare.

Those insured in the program have access to core services, including exams and cleaning as well as emergency services. But the plan incentivizes more complex work, such as restorative services, root canal care and gum treatment.

Those on the plan can earn these services by completing a recall exam within six to 12 months of their initial exam.

'We want to build an ecosystem to improve oral health,' Russell said.

About 700 of the state's more than 1,400 dentists accept this insurance plan, according to Delta Dental.

Dr. Chris Tyler, who has a practice in Hiawatha, said the expansion has helped with accessibility issues.

'It bridged the gap between Medicaid and the general public,' he said. 'More people are eligible.'

Dr. Thomas Grimes, a dentist in Marion, said the Dental Wellness Plan also has a higher reimbursement rate than Medicaid — 70 cents for every dollar spent compared with about 40 cents.

Because of the low reimbursement rate, Grimes said that few dentists will take Medicaid patients, which means people slip through the cracks.

Corporate Dentistry

In addition to new patients, Iowa is seeing an influx of corporate, or franchise, dental practices.

Businesses such as Syracuse, N.Y.-based Aspen Dental — which has more than 450 practices in 28 states across the country — are popping up more frequently around the state.

The business model means that the owner is not the primary care provider.

'We're going to start paying more attention to the corporate arena,' said Grimes, who also sits on the committee that overseas the Iowa Dentist Tracking System.

That tracking system, unique to Iowa, looks at the demographics, geographic distribution and makeup of the state's dentists each year. It is funded by Iowa Dental Association and the University of Iowa's Carver School of Medicine, and a new survey will be released in September.

According to the 2012 report, there are 80 dentists, or 5.7 percent, in the state who practice at a corporate dental office. This is up significantly from 55 in 2011.

Grimes said one reason for the increase could be that selling a practice to a corporation is more appealing as there is more money up front.

'If you sell your practice to another dentist, you would have to be financed by a bank,' he said.

An Aging Work force

After a push by the federal government in the 1970s to increase dental school enrollments, many of the states dentists soon will be retiring.

About 49 percent of the state's dentists are 50 years old or older, according to 2012 data. But Dr. Doug Horton, who has a practice in Cedar Rapids and teaches at the University of Iowa's College of Dentistry, said he's not concerned about the future work force.

'The College of Dentistry recently expanded its (enrollment)' he said. There also is a better mix of men and women than in past years, he said.

The number of female dentists has increased from 141 in 1997 to 331 to 2012.

The vast majority of Iowa's dentists come from UI, which supplies about 1,078 of the state's 1,402 dentists, according to the 2012 tracking report.

The distribution of dentists is more a concern than the number of dentists, Grimes said. Only about 1.4 percent of the state's dentists, or 20 of the state's more than 1,400, practice in the 723 communities with 1,000 people or fewer.

Meanwhile more than 41 percent of dentists — or 577 — work in the 10 communities with populations of 50,000 or more.

To help deal with this problem, Delta Dental offers a loan repayment program to dentists who practice in state-designated dental shortage areas. The program has attracted 23 private-practice dentists since 2002, according to the insurance company.

'It's a challenge and opportunity to have dentists in the right place,' Delta Dental's Russell said. 'There will be a lot of transition in the coming years.'