Terminology Talk

By Drs. Linda Vidone and Mark Jurkovich

Chairs NADP Diagnostic Terminology and Clinical SWGs

NADP Engages with DQA and SNOMED on Key Initiatives

NADP continues to represent the dental benefits industry by advancing clinical measures, coding standards, and payment practices that support improved oral health and drive business success.

Dental Quality Alliance Updates

At the Nov. 22 semi-annual meeting of the Dental Quality Alliance (DQA), NADP represented members on several key initiatives.

• Since 2022, the DQA has been working on a starter set of validated practice and clinician-level quality measures (PCM) to keep quality and patient considerations at the forefront of any provider rating system. These measures are not to create standards or be judgmental but to improve oral health. Currently PCM work is based on claims-based data and phase two will include electronic health records (EHR) or e-measure data.

The committee approved the first two starter set of measures:

1. Care Continuity in Children: The report is focused on measuring care continuity at the practice level.
2. Maintenance for Adults with Periodontitis: This measure aligns with program- and plan-level measures and supports practice- and clinician-level reporting.

The Committee has two additional interim measures under review for public comment, contingent upon validation using additional Medicaid data:

1. Interim Report: Topical Fluoride in Children and Sealant Receipt on Permanent First Molars
2. Interim Report: Sealant Receipt on Permanent First Molars

• The Measure Development Maintenance Committee is exploring potential measures including:

1. Patient reported outcome performance measure using Office of Health Insurance Programs (OHIPS) data (a patient-based survey)
2. An opioid measure
3. Oral evaluation following a problem focused episodic care procedure

There will be more to come as these develop further.

• The DQA dashboard continues refinement, which now included adult measures. It uses Transformed Medicaid Statistical Information System (T-MSIS) data, which includes Medicaid and CHIPS data from the states. If your organization is involved with or considering involvement with these programs, it may be worthwhile to review the DQA dashboard at this link:

https://www.ada.org/resources/research/dental-quality-alliance/dqa-improvement-initiatives

Diagnostic Coding and Value-Based Payments- gradual change with improving support

During the recent SNOMED International Meeting, the Dentistry Clinical Reference Group (CRG) covered three primary areas.  The first involved risk assessment development, which had substantial interest internationally.  The discussion at this meeting was limited to caries risk assessments, but there is broad interest in periodontal risk, oral cancer risk, and prioritizing treatment.  The good news is that SNOMED already has several concepts that are related and much more granular than just the low/medium/high risk seen within CDT.  Dr. Joel White from UCSF gave a presentation relative to caries risk assessment tools, their validation, and showed two implementations and their use within care systems.

The CRG is also closing in on the finalization of revisions to the General Dentistry Ref Set.  This is important to the various care systems already using it (Many dental schools as well as a few non-academic dental practices).  The General Dentistry Ref Set changes were developed using an approach that matched procedures to diagnosis and findings using several million dental encounters.  This may be one of the most validated approaches that should result in an increasingly easy-to-use set of terms that could help define whether members want to start requesting/requiring the addition of a small number of diagnostic codes that are the most frequently used.  This relates to the NADP Crosswalk project that may develop a useable manual for both plans and clinicians.

Today, there are two newer data warehouses that differ from those currently available.  “Big Mouth” is a data warehouse made up of several dental schools and one larger dental practice that contribute data from their electronic health records rather than through claims only.  This provides much broader data.

The American Dental Association has a project called DERE that also uses data primarily from the electronic records systems.  They are obtaining data from several commercial electronic data records (EDR) systems already during the early testing stages but is already approaching a million patient records.  This echoes closely the dramatic change that took place within the medical plan world a decade ago, where care systems began using the data from their electronic health records (EHRs) compared to the medical plans that were limited to claims data.  The care systems suddenly understood their patients and the costs/risks in much greater detail than the plans and has rapidly led to Value Based Payment systems.

Another issue addressed was further development of necessary “views” for effective transmission of images, both x-ray and visible using Digital Imaging and Communications in Medicine (DICOM) standards.  This has the potential for allowing easier and greater consistency of obtaining images necessary for benefit determination.

While change remains gradual, these changes continue to move the industry forward towards a better understanding of what might be the best care approaches for members/patients.