Dental Regulation Bill Drawing National Attention | Eastern North Carolina Now

   Publisher's note: The author of this fine report is Barry Smith, who is a contributor for the Carolina Journal, John Hood Publisher.

Measure limiting outside investors pits established practices against newcomers

    RALEIGH     Arthur Smith of Durham hopes Senate Bill 655, a measure placing tighter restrictions on dental service organizations, doesn't become law.

    Smith on Tuesday told his wife's story of successful treatment she received at DentalWorks across from Durham's Southpoint Mall. If the bill, which has passed the Senate and now resides in the House Health and Human Services Committee, passes, he fears that dental prices will increase.

    Supporters of the bill, including the N.C. Dental Society, say that its aim is to make sure licensed dentists, not corporations, make dental health care decisions.

    Opponents of the bill say the bill is an attempt to keep competition for dental services from coming into North Carolina.

    The bill has raised considerable attention from out of state. Grover Norquist of Americans for Tax Reform has urged legislators to reject the bill. The Federal Trade Commission has even weighed in on the legislation, suggesting that it could reduce anticompetitive benefits for consumers.

    Smith, however, is just pleased with both the services and cost of the services he received at the DSO. But he expects costs to increase if the bill becomes law.

    Smith said his wife continuously was having headaches and ringing in her ears. She wasn't eating well, and she wasn't sleeping well.

    "For almost two years, she kept going back and forth," Smith said, noting that she went to various specialists. Finally, she learned the cause of her illness. "Her sickness was coming from her teeth," Smith said.

    One of the doctors asked her if she'd had any trouble with her teeth. Smith said that his wife didn't want to go to her previous dentists because of the cost. When one of her wife's co-workers told her about the new dental office that recently had opened across from Southpoint, she went, Smith said.

    He said his wife had root canals and crowns put in.

    "Within 30 days, she was starting to feel better," Smith said.

    The N.C. Dental Society says that the measure is needed to ensure that the N.C. Dental Board has the authority to enforce current laws and that decisions regarding patient care are made by licensed dentists, not by the DSO.

    "I would rather have patient care decisions made by a dentist who has been educated to put the patient's needs first rather than by a corporation who by law has to put the benefit of their shareholders first," said Alec Parker, executive director of the N.C. Dental Society.

    The dental society put out a statement Tuesday afternoon reaffirming its support for the bill, saying that DSOs are putting up a smokescreen.

    "Are these corporations truly concerned about poor people's access to dental care -- or their own profits?" the statement asks.

    The statement goes on to outline problems that investigations and reports of DSOs operating in other states have unveiled: "Medicaid fraud, assembly-line dentistry, unnecessary and expensive treatments and even mistreatment of children as young as 4 years old - all in the pursuit of profits."

    Doug Brown, CEO of Affordable Care Inc, one of the DSOs currently operating in North Carolina, responded. "There are bad actors in dental service organizations; there are bad actors in private practice," Brown said. "It's a convenient way to vilify our model."

    He said that if the bill becomes law, it likely would stop the growth of DSOs and put some out of business.

    "It's protectionist legislation by dentists to really stop our model," Brown said.

    Both supporters and opponents agree that dentists don't get a lot of training operating the business end of a practice in dental school.

    Brown said that the dental service model helps out in that aspect as well as providing dentists coming out of dental school with flexibility. They could be saddled with debt and not be able to obtain the capital necessary to start their own practice, he said.

    Winn Maddrey, a spokesman for the Alliance to Dental Care, which opposes the bill, said that start-up costs for a practice with three chairs and no laboratory could run around $300,000. Larger practices would cost more.

    Other dentists who don't want to be tied down to one location for decades might find the DSO model attractive, Brown said.

    State Rep. Bill Current, R-Gaston, who is a dentist, said he is concerned that corporate interests don't get involved in treatment decisions.

    He said that stakeholders are meeting to try to hash out a compromise on the bill. "It's an ongoing situation," Current said.

    Parker said that the dental society has no problem with dental service organizations that play by the rules. The aim of the bill, he said, is to keep what he refers to as "egregious examples" of what such organizations have done in other states from happening in North Carolina.

    Such practices include dental service organizations telling dentists that they have to see more patients or over-diagnose problems with patients' teeth. Other problems include requiring dentists working for a DSO to send their work to a particular lab, where the DSO has negotiated a particular fee, Parker said.

    Mark Sisak, business and marketing analytics director at Affordable Care, said that there are 36 DSOs in North Carolina serving 226,000 patient visits from all of the state's 100 counties. There are 625 people employed by DSOs in the state, according to industry statistics.

    DSO officials say that traditional private practices charge an average of about 11 percent more for services than DSOs. The DSOs also help get dental services to many of North Carolina's rural counties.

    Barry Smith is an associate editor of Carolina Journal.