Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Model Assumption
2.3. Data Sources
2.4. Cost and Revenue Estimates from Dental–Medical Integration
2.5. Primary and Secondary Outcome Metrics
2.6. Sensitivity Analyses
3. Results
3.1. Base-Case Analyses
3.2. Sensitivity Analyses
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Conflicts of Interest
References
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Parameters | Value | Source |
---|---|---|
Practice/patient characteristics | ||
Number of patient visits per dentist (including hygienist appointment) per year | 3415 (347) | ADA HPI [21] |
Number of patient visits per dentist (excluding hygienist appointment) per year | 1831 (127) | ADA HPI [21] |
Number of patient visits per hour | 2.3 | ADA HPI [21] |
Number of hours spent on patient visits per day | 6.1 | ADA HP I[21] |
Health insurance payer distribution of overall population (proportion with dental insurance in each group) | MEPS [22] | |
Private | 0.66 (0.01) [0.69 (0.01)] | |
Public | 0.25 (0.01) [0.02 (0.01)] | |
Uninsured | 0.08 (0.01) [0.04 (0.01)] | |
Dental insurance payer distribution | MEPS [22] | |
Private | 0.52 (0.05) | |
Public | 0.19 (0.03) | |
Uninsured | 0.29 (0.01) | |
Utilization rates | ||
CDT procedure level utilization rate (privately insured) | Supplementary Table S1 | Aetna Warehouse |
Relative scales of utilization rates (public and uninsured) | Supplementary Table S1 | MEPS [22] |
Costs of dental procedures | ||
CDT procedure level costs (privately insured) | Supplementary Table S2 | Aetna Warehouse |
Reimbursement rates relative to private insurance | Supplementary Table S3 | MEPS [22] |
Expenses | ||
Dentist salary | 152,210 (20,830) | ADA HPI [21] |
Hygienist | 74,070 (12,680) | Bureau of Labor Statistics [23] |
Chairside assistant | 37,630 (6870) | Bureau of Labor Statistics [23] |
Primary care physician (hourly) | $98 (7) | MGMA [24] |
Medical Assistant (hourly) | $15.1(2) | Bureau of Labor Statistics [23] |
Recurring costs | ||
Clinical space | $1014 (290) | MGMA [24] |
Dental supplies | 6.4% of gross billing | ADA [25] |
Drugs | 0.3% of gross billing | ADA [25] |
Dental lab charges | 6.4% of gross billing | ADA [25] |
Repairs of dental equipment | 0.7% of gross billing | ADA [25] |
Annual depreciation cost on dental equipment | 2.2% of gross billing | ADA [25] |
EHR software monthly fee | $135 (25) | Delta Dental [26] |
Transition Costs (applied to the first year) | ||
Equipment, computers, software | $195,000 (2000) | ADA [27] |
Integrated EHR development | $5000 | Delta Dental [26] |
Planning, coordination, informatics and workflow revision, and quality improvement during setup period | $1411 (73) | Prior pilot projects in other disciplines [28,29] |
Cost, Year 1 (USD) | Cost, after Year 1 (USD) | Gross Revenue (USD) | Net Revenue, Year 1 (USD) | Net Revenue, After Year 1 (USD) | |
---|---|---|---|---|---|
Base case | 585,927 (585,335, 586,519) | 389,514 (388,923, 390,104) | 493,830 (492,831, 494,828) | −92,053 (−93,054, −91,052) | 104,316 (103,315, 105,316) |
Overall utilization (patient visit volume) change | |||||
50% | 546,758 (546,184, 547,331) | 350,372 (349,799, 350,944) | 247,654 (247,148, 248,160) | −299,227 (−299,929, −298,526) | −102,717 (−103,416, −102,019) |
60% | 554,582 (554,006, 555,158) | 358,180 (357,604, 358,755) | 296,759 (296,157, 297,362) | −257,842 (−258,595, −257,089) | −61,420 (−62,170, −60,669) |
70% | 562,408 (562,408, 561,829) | 366,018 (365,439, 366,596) | 346,057 (345,354, 346,760) | −216,448 (−217,256, −215,639) | −19,960 (−20,768, −19,152) |
80% | 570,238 (569,655, 570,821) | 373,822 (373,240, 374,404) | 395,141 (394,341, 395,940) | −175,034 (−175,904, −174,164) | 21,318 (20,450, 22,186) |
90% | 578,076 (577,489, 578,663) | 381,689 (381,103, 382,275) | 444,617 (443,719, 445,516) | −133,575 (−134,507, −132,644) | 62,928 (61,994, 63,862) |
110% | 593,784 (593,188, 594,381) | 397,350 (396,777, 397,966) | 543,252 (542,160, 544,344) | −50,490 (−51,557, −49,421) | 145,880 (144,812, 146,948) |
120% | 601,601 (601,000, 602,202) | 405,067 (404,582, 405,782) | 592,374 (591,183, 593,564) | −9145 (−10,287, −8004) | 187,191 (186,052, 188,330) |
Preventive service utilization change with additional dental hygienist | |||||
50% increase | 673,080 (672,304, 673,857) | 476,603 (475,843, 477,363) | 576,377 (575,362, 577,391) | −96,703 (−97,787, −95,620) | 99,774 (98,657, 100,889) |
60% increase | 675,706 (674,927, 676,484) | 479,228 (478,469, 479,988) | 592,887 (591,868, 593,907) | −82,818 (−83,897, −81,738) | 113,659 (112,539, 114,778) |
70% increase | 678,331 (677,550, 679,112) | 481,854 (481,094, 482,613) | 609,399 (608,373, 610,425) | −68,932 (−70,008, −67,856) | 127,545 (126,421, 128,669) |
80% increase | 680,955 (680,171, 681,738) | 484,477 (483,717, 485,237) | 625,899 (624,868, 626,931) | −55,055 (−56,127, −53,982) | 141,422 (140,294, 142,550) |
90% increase | 683,580 (682,795, 684,366) | 487,103 (486,343, 487,863) | 642,413 (64,1374, 643,452) | −41,167 (−42,236, −40,097) | 155,310 (154,178, 156,442) |
100% increase(full capacity) | 686,208 (685,420, 686,995) | 489,730 (488,970, 490,491) | 658,939 (657,894, 659,985) | −27,268 (−28,335, −26,201) | 169,208 (168,071, 170,345) |
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Choi, S.E.; Simon, L.; Barrow, J.R.; Palmer, N.; Basu, S.; Phillips, R.S. Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices. Int. J. Environ. Res. Public Health 2020, 17, 2154. https://doi.org/10.3390/ijerph17062154
Choi SE, Simon L, Barrow JR, Palmer N, Basu S, Phillips RS. Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices. International Journal of Environmental Research and Public Health. 2020; 17(6):2154. https://doi.org/10.3390/ijerph17062154
Chicago/Turabian StyleChoi, Sung Eun, Lisa Simon, Jane R. Barrow, Nathan Palmer, Sanjay Basu, and Russell S. Phillips. 2020. "Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices" International Journal of Environmental Research and Public Health 17, no. 6: 2154. https://doi.org/10.3390/ijerph17062154
APA StyleChoi, S. E., Simon, L., Barrow, J. R., Palmer, N., Basu, S., & Phillips, R. S. (2020). Dental Practice Integration into Primary Care: A Microsimulation of Financial Implications for Practices. International Journal of Environmental Research and Public Health, 17(6), 2154. https://doi.org/10.3390/ijerph17062154