February 2023

Along Comes the Medical Loss Ratio for Dentistry

Patients and consumers are fed up with the rising cost of just about everything - and this includes dental care.  Across the country, state legislators are listening to  consumers and finally taking steps to hold dental insurance companies accountable.  Laws involving something called the medical loss ratio ensure a level of financial transparency and guarantee a certain percentage of your premium dollars go directly to your patient care or you get your money back.   Medical loss ratio legislation is coming to Rhode Island and it’s vital you understand how it affects you as a patient and you as a provider.  Let’s explore…..

What is the Medical Loss Ratio?

Medical Loss Ratio (MLR) is the proportion of medical or dental insurance premium revenues spent on medical or dental services.  In the simplest of terms, it’s the ratio of the dollars the insurance company receives from patients in monthly premium dollars to what is actually spent on patient care. The Affordable Care Act (ACA) mandates that 85% of premium dollars for health insurance be spent on patient care. The ACA also requires health insurance providers to submit data regarding MLR for analysis. Unfortunately, the ACA exempts dental insurers from complying with MLR, leading dental practices and advocacy groups like RIDA to speak out for a standard for acceptable Dental Loss Ratios.  Well, why is dental insurance exempt?

Is dental insurance really insurance?

When most people think of insurance, they think of medical insurance that pays for tests and procedures.  Sometimes the medical insurance company is on the hook for a catastrophic illness or hospitalization that produces significant payouts. Dental insurance is different from medical insurance in one fundamental way: the maximum payout for patient care is capped.   Dental insurance company losses for payout of patient care are far easier to predict because they set the maximum annual payout.  Most dental insurance companies impose yearly maximum payouts limited to only $1,200 to $1,500.  

The American Dental Association agrees, “Dental benefit plans are not really insurance in the traditional sense. They are designed to provide you with assistance in paying for your dental care.” Those drafting the Affordable Care Act considered this and exempted dental insurance companies from meeting the same standard of return demanded by medical insurance carriers. 

Why is the Medical Loss Ratio for Dental Care Important?

Dental care providers in Rhode Island need to be proactive in supporting an acceptable MLR for “dental insurance”. Protecting their patients from dental insurance providers is crucial to protecting their patients’ best interests. When patients discover that the procedures they need are not covered or are reimbursed at an absurdly low level, they are more likely to delay or forego dental care. Unfortunately, this leads to more severe health problems. 

Another result of exempting dental care from Medical Loss Ratio requirements is that dentists and other dental care professionals are less likely to practice in states where MLR rates for dental insurance providers are egregious.  Patient access and care suffers when there are fewer providers.  Across the nation, research has shown that some dental insurance companies operate with a Medical Loss Ratio as low as 4%, meaning just 4% of premiums go to paying for dental care. The remaining premiums cover inflated administrative costs and profits.

According to Michael Davis, DDS, an expert witness in dental fraud and malpractice legal cases, “Operational costs in the dental insurance industry are far more predictable and much less expensive than they are in the medical insurance business. The public and the dental profession have every reasonable right to assume the DLRs will be much higher and far less varied than MLRs. Unfortunately, that hasn’t always been the case.”

The Massachusetts Dental Loss Ratio Revolution

Dental practitioners in many states, including Rhode Island, are now looking toward Massachusetts, where recent legislation implemented a Medical Loss Ratio for dental insurers of 83%. Excess premiums are required to be refunded to covered groups and individuals. The kinks haven't been worked out regarding how this new standard will be implemented or the oversight needed to enforce such provisions. Still, it's a step toward accountability for dental insurance companies that may become the standard other states will follow in efforts to reform dental insurance coverage. 

Advantages of Dental Loss Ratio Legislation for Rhode Island

Successfully extending consumer protection to include dental insurance companies in addition to medical insurance companies would offer several advantages, including:

  • Financial transparency- who is getting premium dollars?  

  • Increased value for patients

  • Reduction of inflated earnings and administrative costs for dental insurance providers

  • Increased ability of dental care providers to provide appropriate care for patients leading to improved oral health

  • Lower likelihood of unnecessary audits and claw backs

  • More incentive to practice in dentistry in Rhode Island leading to improved access

According to the American Dental Association, over 80% of dentists from other states are interested in grassroots efforts to enact Dental Loss Ratios similar to those legislated in Massachusetts. In the coming months,  dentists across the country will be watching Massachusetts to learn how well Medical Loss Ratio legislation will help dental care providers and their patients. 

What Can I Do to Help?

Let your voice be heard!  Talk or write to your state legislators. Let them know how important this issue is for patients and providers.  In Massachusetts the MLR was on their November ballot.  In Rhode Island, we are addressing the MLR through legislation being introduced this session.  Stay in close contact with the Rhode Island Dental Association for updates on specific ways you can become involved in passing this historic legislation.  


November 2022

How Stress and Burnout are Affecting Rhode Island Dentists – And What to Do About It

The American Dental Association’s 2021 Dentist Well-Being Survey Report indicates that the percentage of dentists diagnosed with anxiety tripled in 2021 compared to 2003. 

The dental industry continues to feel the impact in many ways, including difficulty finding employees. Healthcare professionals are experiencing stress and career burnout like never before due in part to the lingering effects of Covid-19 and its dramatic toll on healthcare workers and patients. Add in the pressure of long hours, inflation, and increasing difficulty managing the complications of running a dental practice, and you have a perfect storm for burnout. 

Numerous studies in recent years have confirmed that over 80 percent of dentists have experienced burnout at some point. It's a disturbing trend that affects mental health, relationships with family and friends, and career satisfaction. Finding ways to decompress, relieve the pressure at work, and discover new ways to handle business effectively without sacrificing your sanity is a must for Rhode Island dentists, their coworkers, and employees.

Signs of Burnout and Stress

If you are experiencing one or more of these symptoms regularly, you're under too much stress and could be heading for burnout:

  • Anxiety or panic when thinking about your work
  • Trouble focusing on your job
  • Chronic tardiness or difficulty staying on schedule
  • Snapping at coworkers or being short with patients
  • Chronic exhaustion or falling asleep at inappropriate times
  • Brain fog and losing track of your thoughts
  • No feeling of satisfaction or fulfillment from your work
  • Using alcohol, drugs, or food to soothe yourself
  • Insomnia or poor sleep habits
  • Unexplained digestive problems, chronic pain, or recurring headaches
  • Depression or feeling worthless
  • Anxiety, restlessness, and increased heart rate

What is Causing Burnout in Rhode Island Dentists?

While some of the reasons behind burnout are common in every industry, some, including rapid changes in the dental industry, seem to disproportionately affect dentists and their coworkers.

Wearing Too Many Hats

Many dentists try to juggle multiple responsibilities, but keeping all those balls in the air can be exhausting. Too much time spent on paperwork and not enough on patients leads to dissatisfaction. Understaffed offices have to ask their current employees to take on multiple roles, such as being the dental hygienist, receptionist and IT troubleshooter. Too many diverse responsibilities dilute everyone’s effectiveness.

Staffing Issues

There is a shortage of dental hygienists and dental assistants across the country. Still, the problem is particularly evident in Rhode Island. Finding ways to attract dental professionals to Rhode Island and get more people interested in dental careers is an urgent need. In the meantime, many practices are understaffed and overworked, a potent combination for burnout. We often see this shortage causing bidding wars between offices for experienced staff.

Stagnant Reimbursements vs. Rising Costs

Reimbursements from dental benefit companies have stagnated in the last few decades. At the same time, supply chain issues and rising manufacturing costs mean dentists are paying more for supplies. Without sufficient reimbursement, dentists have to find ways to cut costs, affecting staff salaries and reducing profits.  

Combating Stress in the Office

Dental health professionals' stress and burnout affect their coworkers, families, and patients. It is a danger to patients and providers. It often results in compassion fatigue – the loss of empathy for patients due to stress. As a business owner, it is crucial to put safeguards in place to protect your and your employees' mental health and welfare. Ways you can do this include:

  • Remind employees to take their breaks, even when the office is busy. Just ten to fifteen minutes each morning and afternoon to decompress brings employees back refreshed and feeling less overwhelmed.
  • Offer mental health support through local organizations and ensure your employees know these resources.
  • Create an office plan to cover absences due to mental health issues.
  • Offer health and wellness incentives to your employees, such as gym memberships.
  • Consider outsourcing administrative work to lighten the burden on your employees and allow them to focus on their primary responsibilities.

Self-Care for Mental Wellness

Self-care for those in healthcare is often neglected, contributing to stress and burnout. As medical professionals, our natural instinct is to focus on the needs of others. However, self-care must be addressed to prevent compassion fatigue and burnout that could lead to errors in judgment or an inability to focus on the tasks at hand. 

Commune with Nature

The stress hormone cortisol is responsible for many of the symptoms of burnout outlined above. Whether you take a walk, relax in a hammock, or lie on the grass and watch the clouds drift by, being surrounded by nature eases away stress. A recent study published in Neuroscience News indicates that just 20 minutes spent in natural surroundings causes cortisol levels to drop dramatically. Instead of scrolling your social feed, take a stroll outside!


Our society is addicted to electronics. We use them every day at work, piling on the electronic "noise" that can lead to overstimulation that contributes to anxiety. At the end of the day or the end of your work shift, shut off your phone, disconnect from social media, and allow yourself time to engage in conversations, read (not using a tablet), or relax. 


Physical activity stimulates your body’s release of endorphins, the feel-good neurotransmitters in the brain. Exercising regularly also improves your overall health, which can reduce feelings of stress. The key is finding exercise you enjoy. It could be swimming, hiking, dancing, resistance training, or a spin class. Activity should be sustained and temporarily elevate your heart rate. At least three sessions of 20-30 minutes each week is sufficient, but slowly building up helps.

Retrain Your Brain

Cognitive therapy, meditation, and practicing mindfulness reduce stress and anxiety when adhered to regularly. Each retrains your brain to think and reflect in calmer, more rational, and positive ways. Dedicating a few evenings a week to helping your brain refocus and refresh is an investment in long-term mental health.

Consider Professional Help

Finding time for counseling in an already busy schedule can be challenging, but it's worth the effort. In addition to traditional office visits, you can now seek mental health services online. You can log on to your appointments from anywhere, making it convenient for those with very little time on their hands. Your treatment options include talk therapy, counseling, and medication for anxiety or depression. 

Ignoring stress will not make it go away. The longer you neglect addressing anxiety and mental overload, the more likely it will flare into full-blown burnout. If you’re feeling stressed and overwhelmed, the time to do something about it is now. 


The ADA offers a directory of peer-to-peer support services for dental professionals coping with personal or professional challenges: ADA Dentist Wellbeing Program. 


On the ADA’s Health and Wellness page, you’ll find videos, podcasts, and brochures to download on topics such as mindfulness tips, how to support colleagues with depression, and avoiding burnout.


If you or someone you know is contemplating suicide, contact the National Suicide Prevention Hotline immediately at 988.


___________________________________________________________________________________ August 2022

Rhode Island Dentists + Staff Share their Favorite Summer Recipes

For such a small state, Rhode Island is surprisingly big on food. Given that we are known as the Ocean State, some of our favorite summer fare centers around life near the water, be it at the beach, floating out on Narragansett Bay or hanging out poolside. From dishes that feature fresh seafood like clam cakes, stuffies and calamari (remember we are the only state with an official appetizer!) to sweet treats like Doughboys and those that keep us cool like Del’s Frozen Lemonade. 

In this edition of the RIDA blog, we asked RIDA members to share their favorite summer recipes. We still have one full month of summer to go so get out there, get cooking and enjoy! Just be sure to brush afterwards.

Classic Clam Boil

It’s easy to add a personal touch to this New England favorite. The classic version features littleneck clams, whole ears of corn, onions, garlic, lemons, Old Bay seasoning, small red potatoes, grilled sausage, crushed red pepper, salt and pepper boiled together until the clams open up and the potatoes are tender.

Jamie Montgomery, an oral surgery assistant from Tiverton, RI, adds Narragansett Beer to her clam boil for a bit of extra flavor. Interestingly, chef Emeril Lagasse (a native of nearby Fall River, MA) has been quoted as saying that some of the best clams in New England are from Tiverton! For a bit of added flavor, Sarah Eager, DDS from East Providence adds Portuguese chourico sausage to her clam boils.

If you love the oversized, hard-shell clams known as quahogs (challenge your non-New England residing dental school classmates to spell that one!), check out this recipe for Rhode Island Stuffed Quahogs or “stuffies”. It’s one of the most iconic offerings found in restaurants across our state but is easy enough to make at home for family and friends.

Black Sea Bass Ceviche

Fred Hartman, DMD, a Rhode Island oral surgeon, recommends a simple ceviche for summer entertaining without having to turn on the oven. Just fill a Ziploc bag with fresh lemon and lime juice, add chopped red onion and some chopped jalapenos. Cube the filets and add into the Ziploc bags. Toss the bags in the fridge or, better yet, right into the cooler should you be out fishing. After several hours, the sea bass is cooked. Add chopped cilantro, cubed avocado, and chopped tomatoes for a refreshing and delicious evening meal.

Block Island Mudslide

Dr. Jonathan Enright from Bristol, RI thinks the MudSlide served aboard the Block Island ferry as it heads out of Point Judith is a classic Rhody summertime fun starter. If you don’t have sea legs that enjoy drinking on the ferry, then it's a must to visit The Oar once on island and order one of their famous versions of this drink. 

Even better, you don’t have to leave home to try this summertime staple. It’s as easy as adding equal parts vodka, Bailey’s Irish Cream, and Kahlua to a blender, fill with ice and blend. Swirl some Hershey’s chocolate syrup around in your glass before pouring in the frozen concoction. Top it off with some whipped cream and a chocolate-syrup drizzle and you’re ready to put your feet up, blast the AC and enjoy this cold and creamy summertime treat.

Rhubarb Coffee Cake

Erin Kelly, RDH, cherishes summertime walks through the fields surrounding her home to harvest the red rhubarb planted by her great-grandmother! She uses it for delicious coffee cakes she shares with coworkers and neighbors. There are many versions of rhubarb coffee cake, but the food.com Rhubarb Coffee Cake Recipe is simple and flavorful. If you don’t grow your own rhubarb, be sure to check out one of the many farmers’ markets in Rhode Island, where fresh produce abounds.

Local Sweet Corn

Dr. Nick Barone, an orthodontist in North Providence, tells us local sweet corn stands alone as the best part of the Rhode Island summer harvest. Brine it. Grill it. Boil it. You can’t go wrong – unless you buy the corn too early in the summer!  

Dr. Barone’s orthodontic assistant Sandra knows nothing is better in the summer than carne asada on the grill. In fact, no summer meal is truly complete without throwing something on the grill. Of course, carne asada gets its deep flavor from a proper and patient marinade so do the prep work in advance in the air conditioning by following a recipe like this one for Simple Carne Asada and then relax and wait for things to cool down in the evening before firing up your grill to do the relatively quick cook. 

Blueberry Margaritas

Of course, what goes better with the spiciness of carne asada than this refreshing margarita recipe that came to us from Michelle, a dental assistant at Samuel Dental Center.

Start with local, fresh blueberries and a bottle of Natalie's margarita mix from Dave's Market. 

Make blueberry simple syrup  by blending 1 cup water, 1 cup berries, 1/2 cup sugar in a small pan. Boil until berries open and smash a bit. Cool and strain.


1.5 oz tequila 

1 oz Cointreau 

3oz Natalie’s Margarita Mix

1oz blueberry simple (more or less to taste) 

Shake and serve over ice, adding a blueberry and lime wedge garnish! 

Baking Bonanza

And, while we’re talking blueberries, they are an incredibly versatile summertime favorite featured not only in cocktails but in baked goods and summer salads, all which benefit from the addition of their one of a kind sweet-tart taste. Lynne Vaudry, DDS, a general dentist in Lincoln, RI notes that her husband, Steve, is the cook in their family. Their summer entertaining features these delicious blueberry recipes.

Summer Berry Cobbler


1 pint blueberries

1 pint raspberries, red

1 pint blackberries

1 pint strawberries, hulled and sliced in half

½ cup of granulated sugar

Pinch of cinnamon

2 T Cornstarch

½ Lemon, juiced

1 recipe of Blueberry Scones

As needed – Unsalted butter, melted

As needed – Granulated sugar

Method of Preparation:

1. Preheat oven to 400 F

2. In a mixing bowl combine berries with sugar, cinnamon, cornstarch and lemon juice.  Stir gently to combine.

3. Spread mixture out on 10-inch pie dish or gratin dish.

4. Dollop spoonfuls of scone dough evenly over the top of the fruit; leave a border around the edge of the dish for spreading.

5. Drizzle the surface with melted butter and dust with sugar, as needed.

6. Set on a sheet pan lined with parchment paper, to catch any of the overflows of juices.

7. Bake in the oven for 25-35 minutes, until the top is golden brown and the juices are bubbling.

8. Cool for 15 minutes before serving.  Serve with a la mode or with whipped cream.

Yield: 6 servings

Blueberry Scones


2 cups of all-purpose flour

1 T baking powder

1 tsp salt

1/3 cup of granulated sugar

¼ cup of unsalted butter, chilled, cut into chunks

¾ cup Buttermilk or heavy cream

1 egg, whole

1 pint blueberries, fresh

Method of Preparation:

1. In a large mixing bowl, sift together flour, baking powder, salt and sugar; mix thoroughly

2. Cut in butter using 2 forks or a pastry blender.  The butter pieces should be coated with flour and resemble crumbs.

3. In another mixing bowl, mix buttermilk (or heavy cream), egg together, then add to the flour mixture.  Mix to incorporate but be careful not to overwork the dough.

4. Roll blueberries into extra flour to coat.   Fold blueberries into the dough.  Be careful not to bruise.

5. Press the dough out on a floured surface, creating a rectangle. Cut into triangles about 1-1/2 inches thick.

6. Place scones on an ungreased baking sheet and brush with a bit of milk or cream.

7. Bake for 15-20 minutes. Tops should be golden-brown.

Watermelon Feta Blueberry Salad


½ seedless watermelon, cubed (about 8-10 cups)

1 cup blueberries

¼ cup of crumbled feta

2 T mint leaves, chopped (if you love mint, use more)

2 T Honey

Juice of 1 lime

Method of Preparation:

1. Combine the fruit, mint, and cheese in a bowl.

2. Toss in the honey and lime and mix lightly.

3. Serve immediately.

Salted Cucumber Slices

Finally, we received a simple, quick side dish that takes just three ingredients from Laila Kafi, over at East Side Endodontics. She notes that her family enjoys eating meals that feature fresh produce grown right in their own their garden.

“When the weather starts to warm up, my sons love to help plant a summer vegetable garden (tomatoes, cucumbers, herbs). I should add that my husband leads this effort but we all help and definitely enjoy harvest time. It’s fun to watch the seedlings grow and tiny blossoms develop into cucumbers. We drizzle our cucumbers with olive oil and sprinkle with Maldon salt (must be Maldon!). Crunchy and refreshing. Give it a try!”

Thanks to everyone who contributed a recipe to our blog this month. If you are interested and would like to continue seeing recipes from our members, let us know. If you have a recipe you’d like to share, especially if it features traditional Rhode Island ingredients, we’d love to hear from you!

Happy Cooking! Happy Eating!

Stay tuned for our next blog about ways your RIDA colleagues are coping with stress and burnout.