DENTAL CARE’S NEW NORMAL:PROVIDER SURVEYREVEALS THE NEED TOADAPT AND REDESIGN
DentaQuest Partnership Continuing Education WebinarJune 30, 2020
DOI: 10.35565/DQP.2020.3013
2
Learning Objectives
By the end of this webinar, participants will be able to:• Understand the impact of COVID-19 on changes in the dental workforce and
in the practice of dentistry• Understand attitudes towards long-term changes in dental practice due to
COVID-19
3
Housekeeping
• All lines will remain muted to avoid background noise.• A copy of the slides and a link to the recording will be shared after the webinar
concludes. • In order to receive CE credit you must fill out the webinar evaluation, which
will be shared at the end of the presentation. The evaluation must be completed by EOD Friday, July 10 to receive CE credit. CE certificates will be distributed a few days after the webinar takes place.
The DentaQuest Partnership is an ADA CERP Recognized Provider. This presentation has been planned and implemented in accordance with the standards of the ADA CERP.
*Full disclosures available upon request
4
Q&A Logistics
After the presentations we hope to have some time for Q&AWe will be monitoring the chat box throughout the entire presentation and we will do our best to answer all questions.• Type your question in the chat box
and make sure you send it to allpanelist.
5
Presenter:
DENTAL CARE'S NEW NORMAL:PROVIDER SURVEY REVEALS THE NEED TO ADAPT AND REDESIGN
Eric TranbyManager, Data and [email protected]
Madhuli ThakkarBiostatistician, Analytics & [email protected]
7
Dental Care is a Barometer for Overall Economic Health
8
Dental Practices are Beginning to Recover, after Dramatic Losses
9
Dental Providers Remain at High Disease Risk
https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html
10
Patient Volumes and Revenue Continue to Lag
ADA Health Policy Institute
11
State Budgets and Medicaid are under Significant Financial Strain
Preliminary Analysis of Spending Data
12
• Survey of 37,208 DentaQuest participating providers from May 19th to June 22nd
• 2,710 Complete or partial responses
• Survey is unique because it:• Covers a range of topics not previously
covered
• Focuses primarily on Medicaid and safety-net providers
About the Survey
13
More than 3,925 dental providers from 35 statesand the District of Columbia completed the survey
Survey Responses by States
14
Type of Dental Practice
67%
16%
6%
4%
1%4%
2%Private practice in single location
Private practice with multiple locations
Practice in a federally qualified health center
Practice affiliated with a franchise, large group or dental serviceorganization
Practice at a university or other training facility
Other
Prefer not to answer/Don't know
15
Size of Dental Practice
• 6% of the providers have more than 5 dentists in their practice
54% of the providers reported being the only dentist in the dental practice
• 18% of the dental practices having at least 11 non-dentist staff members in their dental practice
80% providers reported having up to 10 non-dentist staff in their practice including hygienists, office managers, reception staff, etc.
• 21% reported seeing less than 50 patients in a typical week
65% reported seeing 50-300 patients in a typical week prior to any COVID-19 related shutdowns, similar to national averages
16
Insurance coverage among patients and location of dental practice
48%
57%
86%
59%
37%
33%
3%
12%
14%
10%
11%
29%
0% 20% 40% 60% 80% 100%
Commercial dental insurance or Medicare Advantage plans
Mediciad
Self-Pay
Managed Care Contract
Insurance coverage among patients
< 50% patients > 50% patients Don't know/Prefer not to answer
74%
18%
8%
Location of Dental Practice
Urban/Suburban Rural Prefer not to answer
17
Provider profiles
8%
55%
37%
0%
20%
40%
60%
80%
100%
Gender
Male
Female
Other/Prefer not to answer
49%
7%
11%
14%
20%
Race
White
Black
Hispanic
Asian/American Indian/NativeHawaiian/Pacific Islander
Other/Prefer not to answer
More than 60% of the providers have been practicing dentistry for 16 years or longer
18
CHANGING FINANCIAL IMPACT
19
57% of dental practices reported being open for most services, while 8% of practices remain closed
57%31%
8%4%
Current status of dental practices
Open for most services, including routine care
Seeing patients for urgent and emergency care only
Closed and not seeing any patients
Other
20
AL, AZ, CO, FL, IN, OH, TN, and TX reported having more than 75% of dental practices open for most services
21
MA, MI, NJ, NY, PA, DC and WI reported having more than 50% of dental practices open for seeing patients for urgent and emergency care only
22
• 80% of dental practices reported changing status in response to changes in guidance or policies in the last three weeks.
• Of the practices that made changes recently, 55% reported reopening to see patients for routine dental care
Recent changes to dental practice
No20%
55%
19%6%
Yes80%
Changes in status of dental practice in the last three weeks
Reopened to see patients for routine dental care
Reopened to see patients for urgent and emergency care
Other
23
• 90% of dental practices reported having less volume of patient visits.
• More than 82% reported having 25% or more reduction in patient visit volumes.
• Average: 51% reduction
Patient Visit Volumes
More volume3.8%
No change in volume6.7%
17%
35%
21%
17%
Less volume89.5%
Patient visit volume this past week as compared to a typical week
<25% fewer patients as compared to a typical week
25-50% fewer patients as compared to a typical week
50-75% fewer patients as compared to a typical week
>75% fewer patients as compared to a typical week
24
• 86% of dental practices reported having lesser payments and collections as compared to a typical week.
• More than 86% reported having 25% or more reduction in payments and collection volumes.
• Average reduction: 56%
Payments and Collection Volumes
More volume3%
No change in volume11%
12%
31%
21%
22%
Less volume86%
Payments and collections volume this past week as compared to a typical week
<25% fewer payments/collections as compared to a typical week
25-50% fewer payments/collections as compared to a typical week
50-75% fewer payments/collections as compared to a typical week
>75% fewer payments/collections as compared to a typical week
25
Significant financial burden on practices and staff and increased concerns about the future
• 38% are operating at full staffing
• 17% have less than 15 days cash on hand
22% cannot afford to be
closed again
72% have laid off or
furloughed staff
72% anticipate reduced patient
volumes
93% anticipate long-term
changes in dentistry
26
• The Dental Provider Return to Work Survey was emailed to providers on May 19, 2020 and closed on June 22, 2020.
• We created quartiles of this time period to examine variations over time
Variations in Current Status of Dental Practices over Time
52%
69%
36%
23%
9%5%
4% 4%0%
20%
40%
60%
80%
1st quartile 2nd quartile 3rd quartile 4th quartile
Current Status of Dental Practice Over Time
Open for most services, including routine careSeeing patients for urgent and emergency care onlyClosed and not seeing any patientsOther
27
Variations in Current Status of Dental Practices over Time and By Regions
6%
49%
77% 75%69%
40%
16% 18% 19%
9%4% 2%
31%
75%
85%
77%
54%
16%
9%
18%12%
4% 3% 0%0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Northeast Midwest South West Northeast Midwest South West Northeast Midwest South West
Open for most services, including routine care Seeing patients for urgent and emergency care only Closed and not seeing any patients
Current Status of Dental Practice Over Time By Region
1st quartile 2nd quartile 3rd quartile 4th quartile
28
CHANGES TO THE PRACTICE OF DENTISTRY
29
46% of dental practices are seeing more emergency visits and 28% reporting more severe dental emergencies in the last week
than typical
More emergency visits46%
No change in emergency visits36%
11%
8%
Fewer emergency visits19%
Emergency visits this past week as compared to a typical week
<50% fewer visits as compared to a typical week>50% fewer visits as compared to a typical week
66%2%
4%
4%
24%
Severity of dental emergencies this past week as compared to a typical week
About the same as typical
Much less severe than typical
Much more severe than typical
Somewhat less severe than typical
Somewhat more severe than typical
30
• Compilation of Resources from:
• Occupational Safety and Health Administration (OSHA)
• Centers for Disease Control (CDC) -https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
• American Dental Association (ADA)/ American Dental Hygiene Association (ADHA)
• PDF fillable Checklist
• Resources/Tools
Substantial Changes to Dental Practice due to Infection Control Procedures
https://www.dentaquestpartnership.org/osap-best-practices
31
Substantial Changes to Dental Practice due to Infection Control Procedures
32
Sources of Information and Guidance used by Dental practices to inform protocols
16%
22%
39%
52%
56%
92%
0% 20% 40% 60% 80% 100%
Sources used to obtain information on the practice of dentistry in the current COVID-19 environment
Governmental or organizational websites
Dental journals
News articles
Dentistry magazines
Blogs
Other
81%86%
71% 74%
29%
0%
20%
40%
60%
80%
100%
Protocol Guidance used by Dental Office
CDC ADA
OSHA Governor’s Executive Orders
Mayor’s Executive Orders
33
Changes made to patient treatment protocol to address issues related to the coronavirus crisis
Type of change %Calling patients prior to them come into the office to screen for COVID-19 symptoms 76%Asking patients about their recent travel or social distancing behaviors 81%Taking patients temperatures when they come to the office 78%Wearing additional PPE when treating patients 83%Enhanced disinfection procedures 82%
34
There is gap between what providers know they SHOULD do and what they CAN do to reduce infection risk
87% 84%
94% 94% 95%
65% 65%
78%83%
59%
86%90%
54%50%
0%
20%
40%
60%
80%
100%
120%
Screen patients forCOVID-19 risk factors
Screen staff for COVID-19 risk factors
Secure proper PPE Properly use PPE Clean and disinfectoperatories
Reduce the use ofaerosol generating
procedures
Reduce spread ofaerosols through the air
Factors to Reduce the Risk of COVID-19 Infection
Important to Do Confident Can Do
TELEDENTISTRY
36
• Most states expanded telehealth coverage and loosened regulations during the pandemic.
• Teledentistry can:• Help avoid care disruptions
• Increase access to care
• Help maintain revenue
COVID-19 Rapidly Increased the use of Telehealth
37
• 49% of dental practices strongly or somewhat agreed with telehealth tools being more important than before.
• 27% are seeing patients via telehealth platforms and 13% plan to be soon.
Telehealth tools and future dental practice
8%
8%
36%
26%
23%
0% 10% 20% 30% 40%
Strongly disagree
Somewhat disagree
Neither disagree nor agree
Somewhat agree
Strongly agree
Agreement with telehealth tools being more important than before for screening and evaluating
patients
38
• 51% of practices currently using telehealth or other virtual platforms anticipate increased use of non-contact dentistry
• Providers anticipating long term changes in dentistry were nearly 100% more likely to utilize telehealth or virtual platforms in their current practice
39
Probability of Telehealth Utilization
0.1
0.2
0.3
0.4
0.5
18-34 35-44 45-54 55-64 65+
Age Categories in Years
Probability of telehealth utilization by age categories
0.1
0.2
0.3
0.4
0.5
Northeast Midwest South West
US Regions
Probability of telehealth utilization by regions
40
Telehealth Utilization Over Time
30%26% 26% 27%
0%
10%
20%
30%
40%
50%
1st quartile 2nd quartile 3rd quartile 4th quartile
Survey Time Period
Telehealth Utilization Over Time • Providers’ growing readiness to use telehealth modalities to offer care is likely to be well received by patients resulting in a steady telehealth utilization trend during the survey period.
• As the pandemic continues, many patients who are at higher risk of serious COVID-19 disease because of underlying health conditions might seek telehealth options for receiving dental care.
41
• Made it easier for patient to get care
• Avoided cancellations or delays due to distance, work, or childcare
• Could get access to in-person care if needed.
“It Was Really Quick and Easy” – Patients like Teledentistry
https://www.dentaquestpartnership.org/system/files/DQP_Teledentistry_Survey_Communications_Brief_0.pdf
42
Teledentistry Resources
• https://www.dentaquestpartnership.org/care-improvement/teledentistry-in-practice
DENTAL CARE’S NEW NORMAL
44
Long term changes anticipated in the way of practicing dentistry
4%
7%
31%
50%
51%
55%
69%
71%
72%
0% 10% 20% 30% 40% 50% 60% 70% 80%
Other
I don’t expect any long-term changes
Increased use of non-contact dentistry (such as telehealth, phone calls, etc.)
Changes in patient’s trust that they will not have increased risk of COVID from dental procedures
Changes in types of procedures conducted or in the way they are conducted
Changes in your staff’s concern about occupational hazards
Changes in infection control procedures
Changes in the way that front desk and clinical staff work
Changes in number of patients seen in a typical day
Long term changes
45
Expectations for Dental Practice on or around July 1st
0%
1%
2%
5%
12%
14%
19%
46%
0% 5% 10% 15% 20% 25% 30% 35% 40% 45% 50%
Reduced patient volumes than normal
Business as normal, prior to COVID-19
Limited practice due to infection control
Still exploring options
Other
Seeing emergency patients only
Temporarily closed
Closed for good
46
• While dental practices are re-opening, there is no “going back to normal”, especially as COVID-19 threats loom.
• Multiple approaches to providing care safely and effectively will be needed for the foreseeable future.
• May help increase access to care, maintain revenue, and cut treatment costs.
Need to Adapt and Redesign Care
QUESTIONS?
49
Webinar Evaluation https://www.dentaquestpartnership.org/node/207991*Must complete by EOD Friday, July 10 in order to receive CE credit
Upcoming Webinars:• Best Practices for Re-Opening Dental Clinics: Evolving and Adapting - July
7th from 1:00PM to 2PM EST • Special Needs Dentistry - TBD
Sign up to receive our newsletter to get more information on future webinars!