Dental support organizations are typically not owned by dentists, so historically they use creative methods to operate in Washington. Until recently, state law required any entity providing dental services to be owned and controlled by licensed dentists. A new law opens that door, while placing clear restrictions and patient protections.
Effective July 23, 2017, the new law resolves many long-running conflicts between licensed dentists and dental support organizations and brings clarity to a number of issues.
To get around practice ownership restrictions, support organizations took payment through management or franchise contracts with dental practices. Those contracts often gave support organizations extensive control over dental practices. The state’s enforcement agency stepped in when it saw a support organization taking too much control and thereby improperly engaging in the unlicensed practice of dentistry. Objectionable contract terms included setting support organization fees based on dental practice receipts; prohibiting use of alternative vendors for supplies, lab work, and services; and non-competes on dentists, restricting transferability of practice ownership.
By defining what does and does not constitute the practice of dentistry, the new law specifically authorizes or prohibits a number of these contracting practices. Dental support organizations (or any unlicensed provider) may now:
- Own or lease assets used by a dental practice
- Employ or contract for the services of personnel other than dental professionals (i.e., other than licensed dentists, licensed dental hygienists, licensed dental auxiliaries, certified dental anesthesia assistants, and registered dental assistants)
- Provide business support and management services to a dental practice
- Receive fees for any of the above services as agreed to by the dental practice owner or owners
The law restricts dental support organizations from interfering with a dentist’s independent clinical judgment and limiting dentists’ patient services or treatment decisions. It also adds a number of patient protections. An attending dentist, without reasonable cause, may not neglect, ignore, abandon, or refuse to complete the current procedure for a patient. An attending dentist who withdraws responsibility for a patient must advise the patient that they are considering termination of treatment and they should seek another dentist. And that dentist must be reasonably available for up to 15 days to render emergency care.
Generally, under the new law, in the case of employed dentists, owners of the dental practice are responsible for these requirements rather than the employed dentist.