Practice and malpractice expenses in maxillofacial prosthetics.

Recent changes in Medicare reimbursement methods have made the estimation of specific practice and malpractice expenses in maxillofacial prosthetics more important. New reimbursement models such as the resource-based relative value scale used by Medicare and an increasing number of private carriers require accurate and specialty-specific values for these parameters. The Health Care Financing Administration's estimates of practice expense values in all specialties of medicine are significantly lower than those suspected in maxillofacial prosthetics. There is concern that the assignment of erroneous values in maxillofacial prosthetics could lead to inadequate reimbursement. Because the American Dental Association provides only aggregate specialty values, a survey of the general membership of the Academy of Maxillofacial Prosthetics was undertaken to determine these values more accurately. Practice expense values were found to be significantly higher than those in medicine, whereas malpractice expense values were lower. In addition, practice expense values in the survey were found to be greater than the ADA's aggregate specialty calculations.

Maxillofacial prosthetics: a preliminary analysis of Resource Based Relative Value Scale.

A study done by the American Academy of Maxillofacial Prosthetics to evaluate the Medicare Resource Based Relative Value Scale (RBRVS) as it relates to maxillofacial prosthetics. The method of RBRVS formulation is described. The degree of difficulty and treatment time were determined for nine Physicians' Current Procedural Terminology-edition 4 (CPT-4) codified maxillofacial procedures. A preliminary survey indicates that practice expense and malpractice expense ratios were 66% and 1%, respectively. Correlation of maxillofacial procedures to other medical procedures was not performed because an additional study with a greater sample size is needed.

Maxillofacial prosthetics: vital signs.

A maxillofacial prosthetics survey was designed to record the response rate of prosthodontists regarding the frequency of maxillofacial procedures and insurance coverage in 1991. The survey explored variability with respect to membership in professional organizations, region, education, primary activity, and age of the prosthodontist. A total of 342 survey instruments were received from a total of 690 mailed. A total of 18,410 maxillofacial procedures were performed by the survey population. Members of the American Academy of Maxillofacial Prosthetics performed procedures at a significantly higher rate than did the members of the American College of Prosthodontists. A greater procedure rate was observed for prosthodontists in the South Midwest and Southwestern regions; the hospital setting; with 2 plus 1 year additional postgraduate maxillofacial training; and the 45- to 54-year age group. Insurance covered most maxillofacial procedures, but was not uniformly distributed within predictor variables nor between procedures.

The use of osseointegrated implants in the treatment of patients with trauma.

The replacement of missing anatomic structures may become more demanding when the etiology is trauma. Patients with traumatic injuries will likely have increased forces placed upon their prostheses because of the altered support from the loss of normal anatomy. Successful treatment for these patients may include preprosthetic surgery using osseointegrated implants to augment prosthesis support and stability.

Acquired maxillofacial defects from motor vehicle accidents: statistics and prosthodontic considerations.

Trauma from motor vehicle accidents is one of the leading causes of death in the United States; moreover, the costs related to personal harm are only second to cancer. Head and neck injuries predominate and involve contact with the vehicle's interior (80%), contact with the vehicle's exterior (12%), or noncontact with the vehicle (8%). The patient with maxillofacial defects resulting from motor vehicle accident will have numerous soft tissue and hard tissue injuries ranging from neurologic involvement to fractures and/or avulsions of the temporomandibular joint, maxillae, mandible, teeth, and supporting structures. Tooth avulsions, pulpitis, and fractures without pulpitis have been found in a 4:2:1 ratio. The prosthodontist plays an important team role by anticipating the increased functional demands that may be placed on the required prostheses and by anticipating the preprosthetic procedures and counseling that may be necessary to assist in the total treatment.