Chain businesses are good at selling hamburgers and other retail goods, but state lawmakers should be careful with proposed legislation that would open Washington state to chains that offer dental care.
The chains, also known as corporate dental practices or dental service organizations, are not currently legal in Washington state. Corporations are prohibited from practicing dentistry or soliciting customers for dentists employed by a corporation; only licensed dentists are allowed to own dental practices.
One such corporate dentist practice, Half Dental, was shut down in Vancouver, Wash., in 2014, after patient complaints led to an investigation that discovered the business was violating the state prohibition against corporate ownership. Although closed in Washington state, Half Dental locations remain throughout the West in Idaho, California, Nevada, Arizona and Utah.
But legislation now in the Legislature, Senate Bill 5158, would loosen restrictions on corporate dentistry and would allow chains, including Half Dental, into the state, with the intent of increasing access to licensed dentists and promising lower prices by consolidating office costs, such as billing and scheduling, for dentists.
Speaking at a Senate Health Care Committee hearing earlier this month, however, several dentists as well as representatives of the Washington State Dental Association, warned of problems seen in other states with corporate dentistry when it is not properly regulated.
Dentists testifying or sharing written testimony, told the Senate committee that turning over ownership of practices and hiring dentists as employees of the company threatens the doctor-patient relationship because the company’s motive for controlling costs and generating profits carried more weight than what a doctor believes was the best care for the patient.
Dentists, who had worked for corporate practices elsewhere, reported being required under their contracts to treat as many patients as possible in the least amount of time. One dentist told of being required to care for as many as three patients each hour. The result, another dentist, said was “patchwork” care that didn’t allow time for proper preventive treatment.
Other dentists reported being required to “up sell” services or treatments that weren’t necessary, such as unneeded X-rays and sealants or refer patients to specialists within the company rather than to ones known and trusted by the dentist.
Representatives with the state dental association reported that young dentists, recently out of medical school and carrying heavy student loan debt, are especially susceptible to signing restrictive contracts with dental service organizations. The contracts, often unregulated by the states that allow corporate dentistry, can tie dentists to onerous requirements but can be damaging to walk away from because dentists often have to forfeit their offices and even equipment.
Similar concerns regarding companies’ financial motives for over-treatment, poor continuity of care and potential abandonment of patients were voiced in a 2015 report by the state Dental Quality Assurance Commission’s committee on corporate practices.
Supporters of the legislation counter that the bill is based on law that was passed in Oregon several years ago, but it’s not clear that the proposed bill offers the same protections as Oregon’s law.
It might make sense, however, to flip the relationship here, and instead allow dentists to contract with businesses that could offer billing and other services related to running a practice.
That’s what alternative legislation proposed by the state dental association would do. Senate Bill 5322 would allow a dentist or a group practice to contract for support services, with some protections attached.
Contracts would be limited to five years or less, would have to be disclosed to patients, couldn’t interfere with patient care or a doctor’s independent judgment or limit a dentist’s referrals to specialists, limit acceptance of a patient’s dental benefits or interfere with a dentists’s supervision of staff. As added protection, the contracts could be subpoenaed by the state’s Dental Quality Assurance Commission to investigate potential violations.
The commission also is backing the alternative bill.
Lawmakers need to do more to improve access to affordable dental care. Increasing reimbursement rates for Medicaid coverage — currently less than 29 percent of commercial dental insurance reimbursement rates — would improve access for the state’s Medicaid patients, for example.
The alternative legislation could improve access and help make dental care more affordable but without sacrificing patient care and placing a corporate profit mandate between dentists and their patients.