Reimbursing Dentists for Smoking Cessation Treatment: Views From Dental Insurers

Abstract

Introduction: Screening and delivery of evidence-based interventions by dentists is an effective way to reduce tobacco use. However, dental visits remain an underutilized opportunity for the treatment of tobacco dependence. This is, in part, because the current reimbursement structure does not support expansion of dental providers ' role in this arena. The purpose of this study was to interview dental insurers to assess attitudes toward tobacco use treatment in dental practice, pros and cons of offering dental provider reimbursement, and barriers to instituting a tobacco use treatment-related payment policy for dental providers.Methods: Semi-structured interviews were conducted with 11 dental insurance company executives. Participants were identifi ed using a targeted sampling method and represented viewpoints from a signifi cant share of companies within the dental insurance industry.Results: All insurers believed that screening and intervention for tobacco use was an appropriate part of routine care during a dental visit. Several indicated a need for more evidence of clinical and cost-effectiveness before reimbursement for these services could be actualized. Lack of purchaser demand, questionable returns on investment, and segregation of the medical and dental insurance markets were cited as additional barriers to coverage. Conclusions:Dissemination of fi ndings on effi cacy and additional research on fi nancial returns could help to promote uptake of coverage by insurers. Wider issues of integration between dental and medical care and payment systems must be addressed in order to expand opportunities for preventive services in dental care settings.

Treating nicotine dependence and preventing smoking relapse in cancer patients

“…Various factors such as inadequate time and resources dedicated to smoking cessation in cancer patients, low provider reimbursement for cessation treatment, a lack of expertise and training prevent clinicians from addressing smoking cessation [Shields, 2015; Warren, 2015; Morgan, 2011; Toll, 2013; Warren, 2013; Shelley, 2012; Frazier, 2001]. Although the provider reimbursement for offering smoking cessation have improved over the past decade largely for the medical settings [McMenamin, 2008], it is still perceived to be low and inadequate especially for providers running a busy practice.…”

Tobacco screening and cessation efforts by dental providers: A quality measure evaluation

“…The lack of financial reimbursement is often claimed as a barrier by dental professionals for providing cessation treatment. Donna Shelly et al noted that “lack of data on intervention efficacy” is a main reason why tobacco cessation insurance reimbursement increased for medical offices but not dental clinics, even though the relevance of providing tobacco cessation in dental offices was well recognized . Therefore, results from quality measures research evaluations such as this project, can be a valuable contribution toward providing data to inform decision‐makers.…”

Challenges to be overcome: Current situation involving smoking cessation in Dental setting

“…Shelley et al [61] in a study involving 11 American insurance company executives addressed this fact. The study showed that research and interventions for tobacco cessation are appropriate for routine dental practice.…”

“…Important aspects such awareness, attitude, practices, willingness and barriers were evaluated using hand-delivered, self-administered or via electronic contact were searched. Studies were conducted in many different clusters like dental universities [62], dental health professionals [7,9,12,13,17,32,46,48,[50][51][52]55,56,[63][64][65], dental insurance companies [61], students [1 5,21,28,31,32,38,39,45,47,49,51,53,55,66], dental patients who use tobacco [30,67,68] and dental teachers [44].…”