Would you work with small smiles if given opportunity?

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Hello folks,

Would you work with small smiles as a fresh graduate if given opportunity?
- $500 a day (5 days a week) with 17% production limit (includes all X-ray, hygiene, operative)
- nearly 100% medicaid
- 17-20 patients a day

please, give your inputs.

Originally Posted by Jobless

Hello folks,

Would you work with small smiles as a fresh graduate if given opportunity?
- $500 a day (5 days a week) with 17% production limit (includes all X-ray, hygiene, operative)
- nearly 100% medicaid
- 17-20 patients a day

please, give your inputs.

Small Smiles is probably not long lived given several lawsuits currently against it. But if you were to make a generalization, no I wouldn't work at a place like that. The compensation is actually not very good. 17% production is on the low end and $500 daily minimum is also rather bare minimum. If you had a fair %, then a daily minimum isn't necessary in a medicaid practice. I'd require 23-25% of production as my minimum.

But besides that, I think Small Smiles pushes doctors to treat a bit too aggressively and I don't like papoosing as a general way to treat all children.

Originally Posted by Jobless

- 17-20 patients a day

I would guess that this number is drastically underestimated.

Originally Posted by mike3kgt

I would guess that this number is drastically underestimated.

Not necessarily. Places like Small Smiles are heavy Pulp and SSC treatment planners, sometimes, depends who the doc is really. Depending on the state, a PSSC on a primary can produce about $200 for the practice. So let's assume they see 20 patients, and half are new patients because places like these usually don't retain patients like a private practice and thus have a much higher percentage of new patients, so that's 10 new patients. We can also maybe assume that 20-30% of those new patients have been to other places that treatment plan kids relatively aggressively and have most of their molars either PSSCed already, which leaves about 7-8 kids with work to do. Kids on medicaid tend to have more decay than other kids, so if say, 6 of those kids have decay on their molars and the practice thus treatment plans, lets say 6 PSSCs and 2 fillings each, on average, which along with exam, radiographs and cleaning is like $1400 of production.

Let's say only 3 of the 6 kids get treated cause the other 3 have parents who say no or decide for some other reason to wait. That is then:

$4200 of treatment from these three kids

Then factor in 10 recall, radiographs, and cleanings ($1000), 4 New patient exams, radiographs, and cleanings ($500 cause they didn't have decay or had all molars already PSSCed) and 3 New patient exams and radiographs but no treatment or cleaning ($200)

Grand total: $5,900 production for the day. Not bad.
Production for the month working 20 days: $118,000
Production for the year (2 weeks of vacation): $1,361,538.46
17% of production: $231,461 a year

These are all just estimate #s of course, but you can see how even off 17-20 patients a day, a place like this can do more than well enough to survive and thrive.

Originally Posted by djeffreyt

Not necessarily. Places like Small Smiles are heavy Pulp and SSC treatment planners, sometimes, depends who the doc is really. Depending on the state, a PSSC on a primary can produce about $200 for the practice. So let's assume they see 20 patients, and half are new patients because places like these usually don't retain patients like a private practice and thus have a much higher percentage of new patients, so that's 10 new patients. We can also maybe assume that 20-30% of those new patients have been to other places that treatment plan kids relatively aggressively and have most of their molars either PSSCed already, which leaves about 7-8 kids with work to do. Kids on medicaid tend to have more decay than other kids, so if say, 6 of those kids have decay on their molars and the practice thus treatment plans, lets say 6 PSSCs and 2 fillings each, on average, which along with exam, radiographs and cleaning is like $1400 of production.

Let's say only 3 of the 6 kids get treated cause the other 3 have parents who say no or decide for some other reason to wait. That is then:

$4200 of treatment from these three kids

Then factor in 10 recall, radiographs, and cleanings ($1000), 4 New patient exams, radiographs, and cleanings ($500 cause they didn't have decay or had all molars already PSSCed) and 3 New patient exams and radiographs but no treatment or cleaning ($200)

Grand total: $5,900 production for the day. Not bad.
Production for the month working 20 days: $118,000
Production for the year (2 weeks of vacation): $1,361,538.46
17% of production: $231,461 a year

These are all just estimate #s of course, but you can see how even off 17-20 patients a day, a place like this can do more than well enough to survive and thrive.

Time to start your own practice, lol.

Originally Posted by djeffreyt

Not necessarily. Places like Small Smiles are heavy Pulp and SSC treatment planners, sometimes, depends who the doc is really. Depending on the state, a PSSC on a primary can produce about $200 for the practice. So let's assume they see 20 patients, and half are new patients because places like these usually don't retain patients like a private practice and thus have a much higher percentage of new patients, so that's 10 new patients. We can also maybe assume that 20-30% of those new patients have been to other places that treatment plan kids relatively aggressively and have most of their molars either PSSCed already, which leaves about 7-8 kids with work to do. Kids on medicaid tend to have more decay than other kids, so if say, 6 of those kids have decay on their molars and the practice thus treatment plans, lets say 6 PSSCs and 2 fillings each, on average, which along with exam, radiographs and cleaning is like $1400 of production.

Let's say only 3 of the 6 kids get treated cause the other 3 have parents who say no or decide for some other reason to wait. That is then:

$4200 of treatment from these three kids

Then factor in 10 recall, radiographs, and cleanings ($1000), 4 New patient exams, radiographs, and cleanings ($500 cause they didn't have decay or had all molars already PSSCed) and 3 New patient exams and radiographs but no treatment or cleaning ($200)

Grand total: $5,900 production for the day. Not bad.
Production for the month working 20 days: $118,000
Production for the year (2 weeks of vacation): $1,361,538.46
17% of production: $231,461 a year

These are all just estimate #s of course, but you can see how even off 17-20 patients a day, a place like this can do more than well enough to survive and thrive.

Excellent, well thought out analysis. I always stayed away from pedo at the office I worked at that participated with medicaid. It's amazing how much these guys can produce.

There just seems like something is going to give, I just can't imagine that the public will tolerate practices like these. I know the events of a few years ago with small smiles but it seems to have gone away (relatively). It seems like the pedo phenomenon is a bubble waiting to pop.

Thanks everyone!!

Well, those numbers looks amazing and scary at same time. Being aggressive may lead in overtreatment and overcharge, if those numbers are true - there's a good possibility of you being over-pressurized for over-production. Medicaid is state/federal funded, so indirectly, that potentially could be at the risk of your license. What's your thoughts on it? - http://www.youtube.com/watch?v=nF3re1ciRck

Originally Posted by Jobless

What's your thoughts on it? - http://www.youtube.com/watch?v=nF3re1ciRck

Just curious, is this a commercial corporation? When you mix commercial scumbags and healthcare this seems to be the result. Same thing in optometry if you sell your soul to Walmart or other commercial venues you have to give an RX even if it would be unnecessary so they sell as many glasses as possible.

Originally Posted by Jobless

Thanks everyone!!

Well, those numbers looks amazing and scary at same time. Being aggressive may lead in overtreatment and overcharge, if those numbers are true - there's a good possibility of you being over-pressurized for over-production. Medicaid is state/federal funded, so indirectly, that potentially could be at the risk of your license. What's your thoughts on it? - http://www.youtube.com/watch?v=nF3re1ciRck

I don't know, you tell me if it's worth losing everything and going to prison like Dr. Shelburne. I wouldn't touch Medicaid with a mile long pole if I was a dentist. Even if you code the wrong thing and accidentally upcode for $1 more than you're supposed to, they can send to you jail, do not pass go, do not collect $200.

Originally Posted by SexyMariGal

I don't know, you tell me if it's worth losing everything and going to prison like Dr. Shelburne. I wouldn't touch Medicaid with a mile long pole if I was a dentist. Even if you code the wrong thing and accidentally upcode for $1 more than you're supposed to, they can send to you jail, do not pass go, do not collect $200.

You will not go to prison for simple honest mistakes even if they are repeated over time. Don't let what you hear shy you from taking Medicaid patients. We all know the reimbursement is low but you are not at risk for felony conviction if you treat them. DP

Originally Posted by Dr. Dai Phan

You will not go to prison for simple honest mistakes even if they are repeated over time. Don't let what you hear shy you from taking Medicaid patients. We all know the reimbursement is low but you are not at risk for felony conviction if you treat them. DP

I most certainly wouldn't want to go in front into a federal or state deposition with the onus of responsibility of proving to them that years of upcoding or overcharging mistakes were "simple and honest". That is a scary thought.

Originally Posted by Shnurek

Just curious, is this a commercial corporation? When you mix commercial scumbags and healthcare this seems to be the result. Same thing in optometry if you sell your soul to Walmart or other commercial venues you have to give an RX even if it would be unnecessary so they sell as many glasses as possible.

Small Smiles, like most dental offices, began as a dentist owned office and grew. It was eventually sold off to FORBA who runs and owns it now, though each individual office is still managed by a dentist. But just cause a corporation manages practices doesn't make it bad, just as not all dentist owned practices are necessarily great either.

Originally Posted by Dr. Dai Phan

You will not go to prison for simple honest mistakes even if they are repeated over time. Don't let what you hear shy you from taking Medicaid patients. We all know the reimbursement is low but you are not at risk for felony conviction if you treat them. DP

I agree. my analysis of a usual 20 patient day practice is actually on the low side...if most medicaid practices saw 20 patients and only produced $5-6000, they probably aren't very aggressive. It's actually pretty easy to do the right thing for medicaid patients and still make plenty.

The medicaid system in several states however was broken and lacked oversight. Some greedy dentists took advantage of this and made a butt load while doing things that might not have been in the truly best interests of their patients. Some of those dentists have since been caught, like the Small Smiles group. Others have dropped out of the medicaid race. Silll others made so much money that they have essentially retired and sit on their money. Some have reformed, and many others still do it and just will never get caught. That's the way it goes...but honestly, I see lots of medicaid and I don't do anything I think most dentists would say is unethical and I do perfectly fine. There's plenty of decay out there that is real and needs to be treated.

17% production limit isn't on the low end, I think that's the lowest that I've ever heard actually. Lots of the Medicaid clinics here in Texas pay ~20-25% production, which is significant considering the volume you are doing. Regular associateships pay 27-33% on avg. in PPO/FFS offices.