U.S. stimulus bill a tease for dentistry

With President Barack Obama's hotly debated stimulus package now a done deal, attention is quickly turning to what it all means. For the healthcare community, much of the focus is on the promise of $20 billion to develop a nationwide health information network and motivate medical professionals to adopt electronic health records (EHRs).

Unfortunately, this part of the stimulus package doesn't extend to dentists.

Officially known as the American Recovery and Reinvestment Act (H.R. 1), the new legislation proposes to give those healthcare providers who install EHR systems Medicare incentive payments -- $18,000 in the first year of certified EHR implementation (2011 or 2012), $15,000 if implementation occurs in 2013, and $12,000 if it occurs in 2014. There are also incentive payments for the following four years -- $12,000, $8,000, $4,000, and $2,000, respectively.

While dentists are not explicitly named in the section of the act that defines a healthcare provider, there is some vagueness in the wording (see page 114 of the 407-page document). But that point is moot, said John Morrissey, communication manager for the Certification Commission for Healthcare Information Technology (CCHIT), the organization responsible for certifying all EHR products in the U.S.

The key word, he said, is "certified." If healthcare providers -- including dentists -- aren't using a CCHIT-certified EHR product, they will not qualify for any of the EHR incentive funds. And so far there are no CCHIT-certified EHR products for dentists -- nor will there be any anytime soon, according to Morrissey. (To see a list of the criteria an EHR must meet in order to be CCHIT-certified, click here.)

"The basis for qualifying for the incentives and discretionary money in the act is dependent on a product being certified," he said, adding that CCHIT is the only nationally recognized EHR certification body. "We've only been at this less than five years, and we've come a long way. But we have not gotten into dental yet, and it is not on the horizon."

Part of the reason is that the dental community has not been as vocal as other medical disciplines in making its presence known to CCHIT, Morrissey said.

"Some of this has to do with the people responding to our requests for suggestions," he said. "We got a handful [from dentists] during the most recent public comment period but no groundswell, versus clinical research, dermatology, and oncology." As a result, Morrissey added, CCHIT will focus its next certification development efforts on those three disciplines, plus behavioral health, long-term care, eye care, and obstetrics/gynecology. (To learn more about the CCHIT certification process, click here.)

Matthew Messina, D.D.S., a national spokesperson for the ADA, said he would be "very surprised" if Congress was even thinking about dentistry when the bill was crafted. For dentists, he added, when it comes to EHR adoption, the issue isn't so much one of resistance or indifference -- it is more "wait and see."

"If I work for a hospital, it is easier to get on board with electronic medical records because I have an IT department to handle it. But 80% of dentists are solo practitioners and have to be their own IT department," he told DrBicuspid.com. "The benefits to my office of having the ability to access patients' medical records in an organized way are huge. But we are not there yet. The systems are not in place to make this happen."

One section of the stimulus package that does directly affect dentistry sets aside $600 million to provide incentives, through the National Health Service Corps, for physicians, dentists, and nurses to practice in communities with limited access to healthcare. Some funds may also be made available to dental schools interested in developing curricula that include EHRs and EHR integration.

In the meantime, Dr. Messina believes the new legislation should have a positive impact on the dental profession in a more indirect way: by boosting consumer confidence.

"Dentistry is very tied into how people feel about themselves," he said. "The good news for dentistry is its message of prevention. Doing routine things now and saving money later is a message that has been heard for years, and the American people understand this and have shown their willingness to stick with their current practice of dental care."

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