NADP Urges Limit on Texas Dental Board’s Rulemaking Keep Reading

Houston Chronicle: Proposed rule has some Texas dentists worried

Texas State Board of Dental Examiners may regulate companies that provide them administrative services

Tyler Green has owned a dental practice in Conroe for nearly 20 years, but recently has begun contemplating other lines of work.

“The business sector is always looking for people with a medical background,” said the 48-year-old dentist, thinking aloud. “Universities are always looking for instructors.”

The reason for Green’s newfound career interests is not restlessness or a desire for more money. It is a little-known rule change under consideration by the Texas State Board of Dental Examiners that he said could put him out of business.

The change would regulate the use of dental support organizations, which some dentists and dental chains use for accounting, scheduling, marketing and other administrative services. The proposal is aimed at ensuring medical decisions are not made by the profit-driven support organizations, which do not have clinical expertise but have been found to impose quotas or otherwise influence work.

To Green and others, including the strange bedfellows of the Texas Association of Business to the Federal Trade Commission, the board is overreaching by seeking to impose strict rules that would all but deny dentists access to a service that saves them money and allows them to focus on patients instead of paperwork. The worst practices already were illegal, they say.

“We understand the idea and the desire that dentists are the ones making health care decisions, and we actually support that. But we do feel that there has been some unfair criticism,” said Keith Newton, president of Dental One, which runs 42 dental practices in Texas, as well as some in other states, and is leading a coalition opposing the rule change.

Support organizations contract in large part with chains, such as Dental One, but also with individual dentists. They have been around for decades but have become more common recently, doubling the number of dental offices they work with over the last four years, to 371.

Those dental offices employ 644 dentists and 2,127 clinical support staff and have more than 1.1 million active patients, according to the Texas Coalition of Dental Support Organizations.

A 2012 study by conservative economist Arthur Laffer found dental procedures in Texas cost 20 percent less when performed by dentists with support organizations.

The push for regulation began in earnest that same year, when the Center for Public Integrity and public television’s “Frontline” program reported that two large dental chains were owned by private-equity firms and put pressure on dentists to meet production goals, leading to unnecessary procedures. One of the chains, Kool Smiles, worked extensively in Texas and used support organizations.

State Sen. Jane Nelson, a Flower Mound Republican who then chaired the chamber’s Health and Human Services Committee, called the findings “outrageous” and introduced Senate Bill 151 to address the issue. It did not pass.

The dental board took up the issue afterward, proposing rules that would clarify that quotas and improper influence were wrong, but also would prohibit dentists from contracting with unlicensed people with control over billing, advertising, staffing, legal services or several other areas.

The board’s executive director, Julie Hildebrand, said the proposal would “ensure the protection of public health and safety” without any economic costs or job loss.

Nelson, in a recent statement, said she was “reviewing the proposed rules, which take a different approach, but may be helpful in solving the overall problem.”

A Democrat who co-sponsored Nelson’s bill, Jose Rodriguez of El Paso, sent a letter to the board saying he was concerned about corporate influence in dental practices, but also worried the initial rule proposal may be too broad and lead some dentists to go out of business.

An early version of the rule recently was pulled at the last minute, but the board is planning to release a new proposal by the end of the year. The details have not been finalized.

Dentists such as Green remain worried.Green said he opened his practice after obtaining a license in 1996, but only started working with a support organization five years ago on the recommendation of a friend.

The support organization does not affect his patient decisions, but controls administrative duties such as accounting and human resources, Green said.

“I really don’t know what to expect,” he said. “If those rules were enacted tomorrow, I would have to re-organize my entire practice, so I really don’t know what’s going to happen. I just want to help my patients.”

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