State's Dental Organizations Endorse New Uniform, Quality Audit Tool.

Business Editors & Health/Medical Writers

SACRAMENTO, Calif.--(BW HealthWire)--Aug. 15, 2002

California Dental Association, California Association of Dental

Plans and Delta Dental agree to common audit tool for

more consistent regulation

Officials representing organized dentistry, the state's leading dental plan trade group and California's largest dental plan announced today their adoption and endorsement of a new uniform, onsite dental audit tool for evaluating patient care.

The tool consists of four spreadsheets with several check-off items and a range of possible findings on common dental office practices and procedures. Dental plan auditors use the tool for inspecting dental offices under contract to provide care to dental plan enrollees. The Department of Managed Health Care (DMHC) requires Knox Keene-licensed health and dental plans to conduct random and targeted onsite office audits as a condition of licensure, and reviews the audit findings as part of a larger survey process to ensure regulatory compliance.

The new uniform audit tool was co-developed by the California Association of Dental Plans (CADP), with assistance and input from Delta Dental Plan of California, the state's largest dental plan. The California Dental Association provided additional input, helping refine the tool before all three organizations jointly presented it to the DMHC.

Already, CADP has secured voluntary agreements from nearly all the dental directors of its dental plan members to use the new audit instrument. The dental trade group will host workshops throughout the year to "calibrate" individual plan auditors and train them on consistent use of the tool. CDA, meanwhile, has pledged to work collaboratively with CADP to promote awareness of the audit tool to its members, which includes more than 90 percent of all licensed dentists in California. The organization will play a prominent role in helping its members understand the tool and earn passing grades.

"For years, California dental plans managed their onsite audits differently, with varying definitions and procedures for determining what constitutes quality patient care," said D.E. FitzGerald, DDS, chair of CADP's Quality Management committee. "The problem was a lack of consistency -- not only in how plans were auditing dentists, but in how the DMHC determined which dental plans were in compliance with requirements to conduct the audits. This new audit tool is a collaborative solution to all these issues and has been more than 10 years in the making."

Adoption of the uniform audit tool means offices selected for audits by any dental plan will be subject to a single, more meaningful process, according to Scott Jacks, DDS, a practicing dentist out of South Gate, Calif., and chair of CDA's Council on Dental Care.

"The new audit tool promises a more simplified and standardized audit process," said Dr. Jacks. "It also provides dentists with a single, consistent, and predictable tool for assessing quality of care. It represents the potential for fewer audits being performed each year in dental offices. The audit tool will assure quality of care, which is a benefit to patients, while reducing the burden of audits on dental offices."

Delta Dental's chief dental executive, Marilynn Belek, DMD, said the new audit tool should also make possible some significant new efficiencies in the future.

"Ultimately, the dental plans would like to be able to share audit results so that the same dentist need never be audited more than once in the same year by different plan auditors," said Dr. Belek. "We want to minimize disruption to our member dental offices, especially once we've already made findings that they are in full compliance, providing quality care to insured patients."

Dr. Belek noted, however, that details regarding confidentiality, cost sharing and technical challenges remain to be worked out before multiple audits can averted. "There are plenty of short term benefits for all concerned, but some of the longer term benefits may require some time and cooperation between competitors. The bottom line is that our three organizations have produced something that immediately benefits consumers, eases administrative burdens and which even helps the regulators."

The California Dental Association is a nonprofit organization representing organized dentistry in California. Founded in 1870, CDA is the largest constituent of the American Dental Association, with membership consisting of more than 18,000 dentists. CDA is online at www.cda.org.

The California Association of Dental Plans represents 32 member dental benefit companies, providing dental benefits to more than 17 million Californians. CADP's mission is to provide leadership in the dental benefits industry and promote quality dental care through legislative, regulatory and educational advocacy. CADP is online at www.caldentalplans.org.

Delta Dental Plan of California is California's largest dental plan and part of a larger holding company system with 18.7 million enrollees in 16 states and the District of Columbia. Delta Dental is based in San Francisco and maintains a government operations center in Rancho Cordova. The company can be reached online at www.deltadentalca.org.