Even if they could not, or would not, offer their services more cheaply than dentists, their presence in the market would generate increased competition. This competition would theoretically drive more dentists to accept PPOs and Medicare. It may very well also drive dentists into undeserved areas.
You do realize that the main reason why there currently is, and has been such a low participation rate amongst dentsts with Medicaid and PPO's is that what they're reimbursing you under most circumstances doesn't cover your overhead for that procedure. And as a result, there's only so many patients that you can take that have those types of insurance plans and still be able to cover your operating expenses(often at the increased expense to those who have "regular insurance" and/or are self pay with more financial resources - and the "fairness" of that is an entirely different issue) and pay yourself. The bottomline is that it is economics DOES come into play with this issue, and reguardless of who is rendering the care, there is a certain minimum amount that you have to generate to enable you to sustain the operations of your business. The fees that most PPO's and medicaid plans currently reimburse at leave little/no room for reducing the reimbursement rates any more and still actually be able to provide care. And if you can't stay in business to provide care are you actually increasing access to care or are you decreasing it and/or making it less cost efficient to deliver care??
This is also the reason why you see many cases of medicaid fraud. If the insurance company is going to "squeeze" the provider by cutting back fees so much that the provider can't cover their expenses, then the provider may be more likely to try and bill for more procedures in an effort to generate more income to allow them to operate at a profitable level. Some folks, if they choose to practice that way may try and push the boundries further and further too see how much they "can get away with". This can be exacerbated by the simple fact that the billing software that many a state medicaid system uses is often quite antiquated and may not even pick up on the fact that tooth #20 had an MO restoration in January and then a DO in October of the same year (under most situations it's 1 filling per tooth every 1-2 years minimum or else if a 2nd filling is done within that time frame, that mentioned DO would only be reimbursed to the provider at the difference between what an initial MOD rembursement rate would have been and the already paid MO)
Regardless, because the government and insurance providers (and I would assume corporate dental chains) seem to be on the same page of this issue, it is likely that we will see mid-levels in the future. So, I feel it makes more sense that we try to shape this emerging professional into something that will be safe, effective, and industry friendly.
Nope, all that the chains will look at it as is a chance to hire a midlevel, at a rate lower than a dentist, that is of course until the midlevel realizes that the rate that they're getting paid may not be enough to cover their educational loans and living expenses. Also, you need to add in "cost effective" to your desired outcomes for a midlevel provider. Since the reality is that the government, who will more than likely be footing the bill for the majority of patients that a midlevel would be treating, only has a finite pool of resources, and if some of that pool is needed to offset the operational losses that a midlevel may very well incur, then that's less money available to actually render care, and again, how would that increase access??
I personally like to see pilot programs that seek to examine the potential for advanced hygienists rather than autonomous dental therapists, because I feel the patient could benefit from direct, rather than indirect, supervision by the doctor. It seems to me that this could still have the intended effect of increasing competition and forcing dentists to provide for less profitable populations, without sacrificing quality of care by eliminating the benefit of medically-oriented training from treatment planning.
There is nothing preventing any dentist currently from providing care to "less profitable populations", except the simple basic concept of how a business operates. If you bring in more money than you pay out in expenses, chances are you'll stay open. But if your not bringing in enough to meet your expenses, its not like the electric company, or the amalgam manufacturer, or the dental chair manufacturer, or the handpiece manufacturer, or even the cotton roll manufacturer, or heck, even the property tax assessor in the town you practice in, will lower the amount that you owe them, just simply because you're treating someone from a "less profitable population". That's real life. And as much as most everyone loves a story with a fairytale ending, there are times when the simple truth is that facts win out over fiction in the end.
