House committee considers dental bill

The House Committee on Health and Human Service heard testimony Monday on a bill to overhaul a 71-year-old law that prevents dentists from owning more than three practice locations.

“This bill would make it easier for dentists who are interested in expanding into underserved areas to do so,” said Dr. Brett Roufs, a Newton dentist and chair of a Kansas Dental Association task force that helped draft the bill.

Since 1943, Kansas law has required dentists with satellite practices to be “physically present” for at least half of the time that “dentistry is performed” at each location.

Typically, dentists have complied with the law by spending three days at a mid-size office that is open four or five days a week, and one day each at one or two small-town offices open two days a week.

‘Curbs the entrepreneurial spirit’

The law, Roufs said, effectively prevents dentists from owning or being partners in practices that have more than three locations.

House Bill 2611 would reduce the on-site time requirement from 50 percent to 20 percent of each location’s operating hours.

“It is time for this present law to be changed because it curbs the entrepreneurial spirit and limits our profession’s ability to grow our businesses here in Kansas,” said Dr. Daniel Thomas, a Leawood periodontist with five practices in the Kansas City metropolitan area, only two of which are in Kansas. The other three are in Missouri.

“The 50 percent-ownership rule hinders our ability to expand to areas of Kansas that are desperately in need of our services.” Thomas said, noting that surveys have shown that 93 of the state’s 105 counties have dental workforce shortages.

Kevin Robertson, executive director of the Kansas Dental Association, said lowering the on-site requirement to 20 percent would allow established dentists to hire recent dental-school graduates who are interested in locating in rural areas but who can’t afford to buy or start a practice on their own.

“The average debt for a dental school student who graduated in 2012 was a staggering $212,000,” Robertson said.

The ability of recent graduates to borrow enough money to buy a soon-to-retire dentist’s practice, he said, now rarely survives as an option.

“The reality is that students coming out of dental school these days are much more interested in being employee-dentists,” Robertson said. “They’re simply not in a position to assume the higher financial burden that comes with ownership.”

Owner oversight

Rep. Kevin Jones, a Wellsville Republican, asked why the dental association hadn’t proposed eliminating the on-site requirement altogether.

“We still believe that it’s important to tie the owner-dentist to the oversight of a satellite practice and for them to be held accountable for the work that’s being done by an employee-dentist at that location,” Robertson responded.

That level of oversight, he said, could be achieved by owner-dentists being on-site with patients at satellite locations at least one day out of a five-day work week.

HB 2611 would not alter the state laws that prohibit for-profit corporations from owning and operating dental clinics in Kansas.

Everything from dogs to death

B. Lane Hemsley, an attorney and executive director of the Kansas Dental Board, said his office fields about 150 complaints a year:

“Everything from dogs in the (dentist’s) office to the death of an anesthetized patient,” he said.

Since 2005, Hemsley said, the 50-percent rule had generated 14 complaints from dentists who said it prevented them expanding their practices.

The state dental board, he said, was neutral on the bill. No one testified or submitted written testimony against the measure.

The committee chair, Rep. David Crum, an Augusta Republican, said he planned to have the panel work the bill by Feb. 25.

Crum said he would oppose doing away with the on-site requirement entirely but could see merit in reducing the time requirement.

“For me, this comes down a quality-of-care issue between a dentist being able to own an unlimited number of offices versus one who could manage five,” he said. “I think if an owner-dentist was in an office 20 percent of the time treating patients, they’d have a vested interest in making sure there wasn’t a reduction in patient care. I’m not so sure about the other.”