Many factors are likely to slow the adoption of pay for performance in dentistry
Linking the quality of medical care to reimbursement by payers, an incentive system termed "pay for performance," is likely to be adopted more slowly in dentistry than in medicine, a new paper concludes. The authors note that insurance for dental care and the use of evidence-based prevention and treatment lag in the dental profession. The United States does not have public dental insurance equivalent to Medicare or Medicaid, and an estimated 44 percent of adults have no dental coverage at all. This lack of widespread insurance reduces the possible leverage of payers on dentists, note the authors.
At the same time, few dental organizations, including the American Dental Association, issue evidence-based practice guidelines or define care-outcome indicators. The lack of guidelines results in much variation in dental treatment that cannot be attributed to the types of patients cared for. Further, little of the published dental research uses randomized, controlled trials, considered the basis for developing good evidence in medicine. Finally, the authors note that most dental practices still keep paper records and collect data electronically only for billing purposes. This makes it difficult to collect diagnostic information to explain why a particular procedure was done by the dentist.
The authors suggest that broad adoption of pay for performance requires the dental profession to expand its evidence base, create evidence-based clinical guidelines, and create evidence-based performance measures tied to existing practice guidelines. The authors were funded in part by the Agency for Healthcare Research and Quality (HS16956).
More details are in "Pay for performance: Will dentistry follow?" by Andrea Voinea-Griffin, D.D.S., M.B.A., M.S.H.A., Jeffrey L. Fellows, Ph.D., Donald B. Rindal, D.D.S., and others in BMC [BioMed Central] Oral Health, which was published online April 28, 2010.
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