The Oral Health Workforce Research Center (OHWRC) at the Center for
Health Workforce Studies (CHWS) at the University at Albany School of Public
Health published a report analyzing the development
of dental support organizations (DSOs) in the United States. Described below
are some key findings in the August 2017 report:
were mainly for-profit organizations (96.8%), and a majority were privately
were operating in 48 states and the District of Columbia. There was no DSO
presence among respondent groups in Alaska and Montana.
were affiliated with DSOs in various ways, including as associates (66.7%),
owners (66.7%) and employees (53.7%).
mean number of full-time dentists affiliated with a DSO was 213; the number of full-time
dentists in DSOs ranged from a minimum of six to a maximum of 1,500. The median
number of full-time dentists was 60.
recruited some new dental school graduates annually, but many of the
organizations mainly recruited experienced dentists. Sixty percent of survey
respondents indicated that between 51% and 100% of new recruits annually were
DSOs (100.0%) provided similar business and management services. However, fewer
than three-quarters (71.9%) had a common electronic dental record, and fewer
than half (46.9%) provided clinical care protocols to affiliates.
varied in the number of patients served by practice affiliates in 2016. The
range was 6,000 to 1.6 million patients.
number of patients served by a DSO was not necessarily an indicator of the
number of states in which that DSO operated. Some DSOs with large numbers of
patients operated in only one state, while other DSOs with smaller numbers of
patients operated in multiple states.
The National Association of State Budget Officers
(NASBO) has released a report which indicates that most
states enacted budgets with slow spending growth in FY18 in response to
concerns of an uncertain economic outlook in the states, based in part on
uncertainty at the federal level, considering Affordable Care Act (ACA) repeal
and replace efforts, potential changes to Medicaid funding and the possibility
of tax reform as well as contending with slow gains in state tax collections.
In addition, states are yet again trying to address certain program areas, such
as state spending on Medicaid, which is continuing to grow faster than the
budget as a whole.
However, despite a challenging revenue environment,
states still identified specific areas to receive increased funding or emphasis
in FY18, including:
- Initiatives to reduce Medicaid spending growth.
- Initiatives to provide increased tuition assistance at two or four-year institutions.
- Efforts to address the opioid epidemic.
The NASBO report details state-by-state, in
alphabetical order, each state governor’s proposed budget for FY18 and what was
actually enacted with regard to Medicaid program changes, higher education
policy initiatives, and new policies to address the opioid epidemic.
The Henry J. Kaiser Family Foundation and the National Association of Medicaid Directors have released a report providing an in-depth
examination of the changes taking place in Medicaid programs across the country
during this time of uncertainty with regard to potential changes in federal policy
Medicaid covers one in five
Americans, accounts for one in six dollars spent on health care in the United
States and more than half of all spending for long-term services and supports,
and it is a state budget driver as well as the largest source of federal
revenues to states. Medicaid is constantly evolving, as state and federal policymakers
strive to improve program value and outcomes through delivery system reforms, respond
to economic conditions or public health concerns (such as the opioid epidemic) and
implement federal policy changes, including those in the ACA or other
regulatory changes (like the recent Medicaid-managed care rule).
Key findings from the
report show that despite uncertainty about federal legislative changes, many
states were continuing efforts to expand managed care, move ahead with payment
and delivery system reforms, increase provider payment rates and expand
benefits as well as community-based long-term services and supports. Emerging trends
include proposals to restrict eligibility (e.g., work requirements) and impose
premiums through Section 1115 waivers, movement to include
value-based purchasing requirements in managed-care organization contracts and
efforts to combat the growing opioid epidemic. Key areas to watch for in 2018
and beyond include federal legislative efforts to restructure and limit federal
Medicaid financing as well as Section 1115 waiver activity.
In the spring and early summer of 2017, the OHWRC conducted a short survey of a
convenience sample of 47 DSOs in the US.