Innovative dental office anesthesiology program

The problem

While it’s fair to say that no one likes having dental work done, for many, the problem goes beyond cringing at the sound of a drill. Certain populations – including young children, the elderly, and individuals with intellectual or developmental disabilities or other special needs – may not be able to cooperate during dental treatment. In these circumstances, having a dental procedure – from a tooth extraction to a root canal – can be terrifying and traumatic for the patient. It can also be difficult, or even dangerous, for dental providers who are manipulating sharp tools inside the mouths of panicked individuals.

To date, the solution to this problem has been to perform dental procedures on certain patients in a hospital operating room, where they can be placed under general anesthesia. This solution enables providers to help people who need dental work, many of whom are in constant dental pain, without causing the patients distress or endangering themselves. However, changes to hospital policies resulting from profit-driven motivations have put in-hospital dental procedures out of reach for patients and dental providers alike. There are several factors at play in this shift:

• Dental procedures are reimbursed at rates significantly lower than those of other surgical procedures, which means that dental procedures are much less profitable for hospitals.
• Even in facilities that nominally allow dental procedures in the operating room, dental procedures are often “bumped” – rescheduled at the last minute – in favor of more profitable surgeries.
• Because they are less profitable, many hospitals do not allow dental procedures to be performed in their operating rooms. And many of the hospitals that did allow dental procedures in the operating room have stopped doing so in recent years.

As a result of these profit-driven decisions by hospitals, vulnerable patients are left in agonizing pain indefinitely as the treatment they need is delayed because an operating room is not available.

Moreover, because dental procedures are only performed at a few hospitals, patients face major access challenges. In California, for example, there are tens of thousands of special needs people who need general anesthesia for dental procedures – but there are only 14 centers in the state that offer operating room space for them. In Kentucky, patients and providers in some areas have to drive upwards of 100 miles each way for a hospital-based procedure. This inconveniences providers and patients alike, creating further barriers to access.

Our solution

Avēsis identified an opportunity for significant cost savings, increased access, and improved patient satisfaction by bringing general anesthesia capabilities into the dental office environment. By taking these procedures out of the operating room and into the dentist’s office, patients can get the care they need more quickly, more conveniently, safely, and at a lower cost.

Avēsis partnered with SmileMD^® beginning in 2020 to offer in-office general anesthesia services for dental procedures to managed care organizations (MCOs) across the Commonwealth of Kentucky. SmileMD^® is a medical anesthesiology group with the capability to provide full anesthesia services in dental offices, so complex dental procedures do not have to be performed in a hospital or ambulatory surgery center. Instead, dental providers can use SmileMD^® to handle their patients’ anesthesia while they perform procedures in their office, where patients are accustomed to receiving their routine dental care.

To ensure patient safety, Avēsis has a utilization management process in place to ensure that in-office anesthesia is not used for procedures with an excessively high level of complexity. SmileMD^® brings the whole suite of anesthesiology personnel, equipment, and support necessary to administer general anesthesia, including an anesthesiologist, a nurse, and a technician, as well as monitoring equipment and intervention capabilities in case of complications.

The in-office anesthesia program has several benefits. Patients are generally more comfortable receiving care at their dentist’s office, and providers can perform procedures requiring anesthesiology without having to schedule time out of the office to travel to the hospital or ambulatory surgery center. This results in patients being able to get appointments more quickly, reducing delays in treatment and improving outcomes. In-office anesthesia also results in significant cost savings as compared to hospital-based procedures by significantly reducing the associated fees.