I read with interest a recent article passed on by a Sullivan/Schein sales rep. In it, the management consultant wrote at length about math and demographic exercises you should apply to decide whether to join or stay in a PPO. What interested me the most and I found glaringly lacking was that there was no mention whatsoever of the need to eveluate the past practices of the PPO - has this PPO been improving the offers either to the patients or to the provider? Let me call this “track record”. It should be viewed as a forecast of what’s in store. If you discern a postitive trend, then perhaps you can take the numbers generated from following the advice of the consultant at face value, but if the track record is negative, you will be wise to introduce a modifier for this effect. Maybe 10% cut in your income projections would be wise for a PPO that has a mild negative track record and for one that has a moderate negative track record it might be better to apply 25% or greater cut in future income. Probably you would do well to increase your modifier significantly for situations where the track record is severely negative.
If you could rely upon your numbers generated from today’s decree from the PPO, the consultant’s advice might be relevant. If history tells you this would be risky and foolish, it probably is.
I’ve heard and seen advice from other consultants in addition to the one mentioned. This includes those commissioned by our WSDA recently for a webinar. Some of these I have known and admired over the years and in some cases decades. I have not seen any of them introduce or mention this concept or factor, if you will. It tells me we have our collective heads buried in the sand. We need to wake up!
-John Barrett, DDS
Port Hadlock, WA
I’m wondering if any other dental practices are having problems with WDS approving, allowing and stating an amount they will pay for a procedure, on the Predetermination, then denying final payment based on a history violation that was not stated on the Predetermination. Patients are making what they believe are educated decisions to proceed with treatment based on these documents. What’s next?
On April 4th, Washington Dental Service announced they were lowering the fees for all Premier and PPO programs. As many WDS member dentists have reported, the fee decrease is an average of 15 percent of their existing filed fees. WDS explains in a letter to members that the decision was necessary due to the challenges they are experiencing with increased competition from their competitors, particularly “low cost insurers.” In order to reduce the cost of their premiums, they had to reduce the fees paid to providers. On their web page, in the frequently asked questions section for providers, they state it is unlikely that provider compensation will go up again.
Click here to find out
Click on the link below for “A primer of “DOs, DON’Ts and HOW TOs” . This resource lives in the ADA’s Member’s Only section so you will be required to login.
As a reminder of why collective action should be avoided, please read “FTC Settlement Order Bars Texas Doctors’ Group from Joint Price Negotiations” at http://www.ftc.gov/opa/2011/05/southwest.shtm
Quality, Comprehensive, Conservative, Beautiful…this is the kind of dentistry that I would want for my family, my friends, my patients, my self. These are the things I would like to emphasize to my valued patients. I truly believe that if you care for people and take the time to listen to patients, they will place their trust in your care and not the care of a third party insurance company. The problem in the last few years has been the volume of patients that need to be seen for sufficient reimbursement to occur. When the volume is high, the relationship between the doctor and patient is sacrificed and the trust quickly declines. Patients begin to question treatment, dentists begin to work on strangers and the quality of dentistry and communication goes down. I am embracing the changes that WDS is making as an opportunity to spend more time with my health centered patients and less time trying to get reimbursed from insurance.
-Kelley Fisher DDS
Copy of letter, dated May 6, from WDS to patients, announcing reduction in remibursment rates to dentists.
In other posts I have said that I think dental insurance is becoming irrelevant but I have not said what I think that means for the future. I don’t think dental insurance should or will go away completely. I believe in the future, the value of dental insurance will be to make it easy for people to get preventive care thus providing for fundamental hygiene and diagnostic procedures. Most care beyond that will be purchased out of pocket by the patients. Getting them in the chair provides them with the opportunity to learn what is happening in their mouths and what ought to and can be done about it.
The handwriting is on the wall as I see it. By lowering their standards, WDS, up until now THE pre-eminent leader in dental prepayment is affirming this concept, but by trying to force all dentists to deliver expensive care without adequate compensation it is bringing about a paradigm shift among patients, dentists, and following that, employers who must realize that there is not enough will or incentive for group plans to provide coverage for comprehensive dental care in the face of other rising costs.
April 15th, 2011
To Mr. James Dwyer and the WDS Board of Directors,
This is a letter in response to the recent letter I received from the WDS board of directors dated April 4th 2011. The letter states that WDS is considering restructuring its dental fees effective June 15th by lowering fees for most providers because employers are demanding lower premium rates from WDS. I contend that not only is this unnecessary but that it is not in the best interest of WDS.
As hard working dentists, we have labored over the years to provide quality dental care in our wonderful state of Washington. It is on the backs of our labor that that WDS has become the company that it is today. In return, WDS has helped dentists in Washington State prosper and provide excellent dentistry for its subscribers. In fact, I feel that our state offers its citizens the best dental care available any where in the world partly because of the partnership that the dentists have with WDS. The relationship that Washington State dentists have with WDS is symbiotic and has resulted in benefits to the providers, WDS, and all of our wonderful patients. Brewing from this is a unique and wonderful benefit to employers, as well as their employees. I have always been appreciative of this excellent relationship and have conveyed that often to my patients and other dentists who have talked poorly of WDS. Now, I am shocked and hurt that WDS is choosing to be quite short sighted and is back stabbing us, the providers, who have made them the great organization that they have become.
Our world is different and will never be the same. Faced with a 15 percent cut in reimbursement by WDS, many practices must make a choice: Accept the reduction in reimbursement or drop off as a contracted provider. Which will you choose?
Change is difficult
Good leaders, however, gather information, analyze the possibilities and then make the hard decision. The decision you make is personal; the factors that influence your decision are based upon your practice demographics, overhead and personal philosophy.
To answer the question, “Should I stay or should I go?”, you need accurate reports about your patients on the plan and the comparative fee schedule. What part of your income is derived from this patient population? You may need support from your software management company to obtain accurate information; then rank the plans from best to worst.
Look at the ramifications of eliminating plans. If you’re looking at elimination, consider eliminating the plan that affects the fewest number of patients and pays the poorest. Don’t be hasty — before elimination, you may need to consider ramping up your marketing efforts to replace these patients. Depending upon your practice style, most general dentists need 10-20 new patients/month to maintain their patient base. You will have patients leave based upon insurance reimbursement. If you would like to grow your practice, you’ll need at least 25-40 or more new patients/month per doctor. The need for new patients varies by specialty provider.
The uprising in our dental community regarding WDS is warranted. In my opinion the solutions are doomed to failure. Our best solution, I believe is our patients. We all need to be square with our patients about the upcoming risks to both of us. We all have patients who are employees, managers and decision makers with companies throughout Washington State. They need to hear from us!
Dentists have been supportive advocates of dental plans written by WDS for the simple reason that the essence of the company was to encourage and support dental health while supporting the concepts of freedom of choice and the economics of private practice. WDS has abandoned this commitment to both of us.
Dental insurance is an employee benefit that is under fire. Employee centric companies have seen their generous commitment to a health care package undermined by economic pressures and run away medical premium costs. We understand. Small businesses like dentistry have all been impacted (we must pay the medical premiums too!). Employees (patients) have been impacted. We understand; and have held the line on increases in fees. This in turn has impacted our employee’s income and our investments in patient care. The cost of doing business does not go down. We understand that too.
The following is text of a letter I intended to send to WDS as a resignation statement. After some thought, I decided it would be better to post these comments in open forums such as this and restrict the resignation itself to the first line.
Open letter to Washington Dental Service:
I hereby submit my resignation as a member dentist effective June 13, 2011.
Washington Dental Service was once the leader in dental prepayment promoting better dental health and relationships among patients, purchasers and dentists in a way that insured the best dental care could be offered to patients throughout the State of Washington. When WDS was created in 1954, it was the very first dental prepayment company anywhere. Who could have predicted the amazing access to care that this organization would have created for so many people over the next three or four decades.
That leadership role has been abdicated apparently in the desire for WDS to grow financially and to become a bigger player in the game or perhaps just to save its existence. It appears that WDS will sell any scheme to any purchaser in order to hang on to or grow its book of business and it is very apparent in our offices that the patients’ and purchasers’ premiums, however cheap or expensive they may be, buy them very little in the way of dental health. Annual maximums are so low that they go almost nowhere for the patient who needs significant dental care whether the need is brought on by accident, genetic predisposition, neglect or other cause. The plans we see from WDS continue to shock us in the ways they have been degraded from the standards we used to expect. They have become strikingly similar to competitors’ schemes that member dentists, WDS board members and staff have always viewed as shoddy and uncaring about whether better dental health resulted from their activities.
I just now realized why WDS is called a “not-for-profit” — it’s a “not-for-profit-for dentists.” Finally, the shoe has dropped, and we should all realize that WDS is just another PPO driven insurance company whose customer is big business, Boeing and others. Its insured are an incidental nuisance, and dentists merely a necessary evil.
When the ballots came out for the vote regarding making the board “more independent,” did anyone have any doubts that the result would not be good for either dentists or their patients?
Ed. note: The Kodak economic study projects the calculated effects of fee increases and decreases. It is based on assuming fixed percentages of cost and profit, so it presents a mathematical outcome rather than an accurate economic assessment.
Executives at Eastman Kodak were concerned about increasing competition in their industry. They decided to conduct a study to determine the effects of price increases and price decreases on their profitability. The Kodak study assumed a 25% profit percentage (75% overhead) which is rather convenient for our purposes because it is fairly close to the 30% net income the ADA reports as the average dentist’s net income today. Using this 25% profit assumption and the corresponding 75% cost assumption, here’s what the study determined:
Don’t forget to tune into the WDS webcast tomorrow, Thursday, May 5th at 6:00pm.
Register here http://www.deltadentalwa.com/Home/Guest/Public/DentistWebEx.aspx