A proposal to update 80-year-old laws regulating dentistry in Washington is facing unexpected push-back from the state’s professional organization for dentists.
The dental support organizations pushing for the update say the proposed changes would better reflect the business models dentists in the state are using today and give dentists more choices.
“We need to update the laws to reflect the ways we do business now,” said Dr. Jeffrey Sulitzer, chief clinical officer for InterDent, a dental support organization with administrative offices in Vancouver.
But the Washington State Dental Association contends the changes could open the door for more dental offices to be owned or controlled by entities rather than dentists, which could lead to decisions on treatment based more on profit than the patient’s well-being.
“We fundamentally believe the treatment decisions should be made between the dentist and the patient,” said Bracken Killpack, executive director of the dental association. “When you have a non-dentist entity owning a practice, they can put a higher level of scrutiny into that decision.”
‘Practice’ defined
Under current Washington law, if someone owns, maintains or operates a dental office, they’re considered to be practicing dentistry. The Washington Coalition for Modern Oral Health, a group of dentists and support organizations, wants to see the law updated to create clear lines between the practice of dentistry and the business side of an operation.
Some dentists in the state contract with dental support organizations to provide nonclinical support services, such as billing staff or office managers, and to lease equipment. The current law could be interpreted to mean a dental support organization that is not owned by a dentist is “practicing dentistry” and violating the state law, the coalition argues.
House Bill 1514 would distinguish between clinical and business operations, according to the coalition. The bill still requires a clinical practice to be owned by a dentist and have no undue influence by a dental support organization. The bill also clarifies that services offered by dental support organizations are not considered “practicing dentistry.”
The Washington State Dental Association, however, is opposed to the bill and does not think changes to the law are necessary. The current law is clear that leasing equipment or hiring a company to help with accounting or marketing is permissible, Killpack said.
While the association supports the use of dental support organizations, it does not want the organizations owning dental offices or having a payment structure that allows the organizations to influence the level of care provided to patients. Looser language in the state law could open the door to those things, Killpack said.
“If part of my dental practice is owned by a hedge fund and their top priority is a return on investment, is that really in the best interest of the patient?” he said.
Local example
Dental support organizations, however, argue changes to the law will not allow them to own a clinical practice but rather to provide services to clinician-owned practices.
An example of such a relationship in Vancouver is Gentle Dental. Gentle Dental is the brand name for the companies Saiget PC — owned by Dr. Bill Saiget, a Clark County dentist for 30 years — and InterDent, a dental support organization.
Gentle Dental has nine offices in Vancouver — 30 in the Portland-Vancouver metro area — and another 19 in Seattle.
InterDent’s administrative building, where about 75 people work, is located in Vancouver. In addition, the companies have 67 clinicians and about 350 support staff working across the state.
InterDent’s services allow dentists to focus on treating patients, rather than trying to care for patients and run a business, said Vito Dacchille, InterDent’s chief executive officer. The arrangement can also give younger dentists an opportunity to hone their skills without opening their own practices and allows dentists to have a better work-life balance since they’re not working late hours handling the non-clinical aspects of their businesses, he said.
“We want to give the clinician the opportunity to have a choice,” Dacchille said.
Killpack said the dental association is not opposed to dentists choosing to contract with support organizations, as long as the organizations don’t own the practice and their payment structures don’t influence treatment decisions. When practices aren’t owned exclusively by dentists, accountability is diminished, he said.
“It’s not the way we want to see heath care done in Washington state,” Killpack said. “We believe it’s in the best interest of the patient.”
