DENTAL CARE’S NEW NORMAL: PROVIDER SURVEY ......DENTAL CARE’S NEW NORMAL: PROVIDER SURVEY REVEALS THE NEED TO ADAPT AND REDESIGN DentaQuest Partnership Continuing Education Webinar

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

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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

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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

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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.

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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]

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Dental Care is a Barometer for Overall Economic Health

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Dental Practices are Beginning to Recover, after Dramatic Losses

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Dental Providers Remain at High Disease Risk

https://www.nytimes.com/interactive/2020/03/15/business/economy/coronavirus-worker-risk.html

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Patient Volumes and Revenue Continue to Lag

ADA Health Policy Institute

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State Budgets and Medicaid are under Significant Financial Strain

Preliminary Analysis of Spending Data

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• 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

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More than 3,925 dental providers from 35 statesand the District of Columbia completed the survey

Survey Responses by States

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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

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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

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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

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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

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CHANGING FINANCIAL IMPACT

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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

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AL, AZ, CO, FL, IN, OH, TN, and TX reported having more than 75% of dental practices open for most services

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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

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• 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

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• 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

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• 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

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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

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• 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

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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

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CHANGES TO THE PRACTICE OF DENTISTRY

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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

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• 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

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Substantial Changes to Dental Practice due to Infection Control Procedures

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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

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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%

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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

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• 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

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• 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

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• 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

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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

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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.

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• 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

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Teledentistry Resources

• https://www.dentaquestpartnership.org/care-improvement/teledentistry-in-practice

DENTAL CARE’S NEW NORMAL

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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

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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

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• 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?

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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

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