The Pay for Performance Reimbursement Model and Dentistry

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Recently, more American insurers have turned to a new reimbursement model for hospitals and physicians called Pay for Per­formance (P4P). It links the amount of the provider’s re­imbursement to the quality of care provided to treat a pa­tient. In essence, if pro­viders meet the insurer’s measurable standards for quality of care, they will be fully re­warded. If they fail to meet the quality measures, their payout will be reduced. While insurers and providers continue to debate the merits of P4P in the healthcare arena, many foresee a day when the model will be extended to reimbursement for dental services. But is the current state of the P4P science compatible with dentistry? In the Journal for Healthcare Quality, National Institute of Dental and Craniofacial Research (NIDCR) grantees take a fresh look at this question based on past experience with P4P in primary and dental care. They conclude that large-scale implementation of P4P in dentistry may not be a realistic option right now. The researchers noted that public insurance for dental services in the United States is limited, with insurance payments representing just 61.4% of dentists’ revenues compared to 86% of physicians’ in­come. They also found that existing government healthcare reimbursement programs tend to be oriented to hospitals and large provider groups. Dentists tend to operate their own individual practices and thus provide their services in outpatient settings. “Dental providers might accept P4P if they contribute to program design and see a link between P4P and quality,” the researchers added. At the present time, quality in dental care is not clearly defined and is difficult to measure. With the absence of this, along with the lack of clinical practice guidelines and evidence-based quality indicators, dentistry will continue to trail be­hind medicine in the adoption of P4P.


 (Source: NIDCR Science News in Brief, March 12, 2010)