NAVAPD President Engages with GAO on VA Dentistry Initiatives
Dr. Abate, President of the National Association of VA Physicians and Dentists (NAVAPD), accompanied by several organizational members, recently convened with Senior Policy Analysts from the Government Accountability Office (GAO) to discuss matters stemming from the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act (PL118-210).
This legislation directs the GAO to assess user experiences with DRM+ and eDRM (the Dental Record Manager platform integrated with CPRS and its corresponding version in Oracle’s electronic health record system), as well as veterans’ and providers’ interactions with programs such as VetSmile and VADIP (VA Dental Insurance Plan). The meeting also covered VA’s implementation of Teledentistry, Dental Community Care, and considerations regarding the proposed expansion of VA dental eligibility for all veterans with ischemic heart disease.
Dr. Abate presented a comprehensive overview of VA Dental clinicians’ utilization of DRM+ for diagnostic charting, treatment planning, care documentation, and EHR recordkeeping. He emphasized that consistent application of standardized software protocols is essential to ensure thorough documentation across facilities, thereby promoting safe and coordinated care for veterans served at multiple clinical sites. Workflow standardization through exam templates was discussed as an important mechanism for facilitating continuity of care.
While acknowledging the comparable functions of DRM+ and eDRM, Dr. Abate highlighted notable distinctions in user experience between CPRS and Oracle platforms, voicing concerns about the escalating costs associated with Oracle. He advocated for elimination of funding and development of Oracle, and continued investment in the modernization of CPRS, citing cost efficiency, established IT infrastructure, and provider familiarity as key benefits. NAVAPD members reported usability challenges with Oracle—including its non-intuitive interface, its frequent errors in pulling in the correct patient data leading to patient safety issues, and cumbersome processes—as well as technical drawbacks of DRM+, such as slow response times, “hidden” windows, and occasional glitches.
The community care portion addressed how eligible veterans receive services outside the VA when internal capacity or timeliness standards cannot be met. Nevertheless, NAVAPD identified barriers in referral management, approval protocols, scheduling logistics, and retrieval of external records. These inefficiencies contribute to longer wait times and increased administrative burdens for VA dentists. The group reviewed the post-pandemic surge in community care, noting fluctuations in external provider engagement due to reimbursement rates and expressing concern over the incidence of overdiagnosis and overtreatment, sometimes resulting in high-cost treatment plans per veteran.
Dr. Abate further asserted the cost-effectiveness and superior quality of in-house VA dental services versus community-based alternatives. He advocated for greater investment in dental clinic infrastructure and dental workforce expansion to address current constraints, particularly in light of expanded eligibility following the PACT Act.
Additional concerns were noted regarding low reimbursement rates that potentially deter provider participation and administrative fees charged by third-party administrators, which diminish payments to community partners. These factors may contribute to both excessive billing and limited provider availability.
Regarding Teledentistry, Dr. Abate outlined its constrained utility within VA Dentistry, given the predominance of procedures requiring direct patient interaction. He cited implementation delays linked to insufficient training and technology adoption among both patients and staff. He emphasized that teledentistry has limited applications in VA.
The discussion on VADIP and VetSmile included strategies to enhance dissemination of information about the VA dental insurance and VetSmile programs, with Dr. Abate recommending distribution of materials alongside disability decision letters and during healthcare registration, rather than exclusively within dental clinics.
Finally, the meeting addressed the implications of expanding dental benefits for veterans with ischemic heart disease. Dr. Abate underscored the necessity of enhanced capital investment in VA Dentistry, including larger clinics, increased operatory capacity, and greater staff allocations for dentists and support personnel. Dr. Abate outlined optimal staffing-to-facility ratios and called for augmented recruitment and retention incentives for VA Dentists, noting that many community providers lack the expertise required for the complex medical and psychosocial needs of veterans.
NAVAPD appreciated the opportunity to provide expert perspective to the GAO analysts, who acknowledged that the discussion had illuminated critical issues not previously recognized. NAVAPD remains steadfast in its commitment to advocate for Congressional support and robust funding to strengthen VA Dentistry.