FRONTLINE: Dollars and Dentists

[Cold Front]

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It's about time.

Dental care can be a matter of life and death. Yet millions of Americans can't afford a visit to the dentist. An investigation by FRONTLINE and the Center for Public Integrity reveals the shocking consequences of a broken safety net. Poor children, entitled by law to dental care, often cannot find a dentist willing to see them. Others kids receive excessive care billed to Medicaid, or major surgery for preventable tooth infections. For adults with dental disease, the situation can be as dire — and bankrupting. While millions of Americans use emergency rooms for dental care, at a cost of more than half a billion dollars, corporate dental chains are filling the gaps in care, in some cases allegedly overcharging patients or loading them with high priced credit card debt. Correspondent Miles O'Brien investigates the flaws in our dental system and nascent proposals to fix them.

http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists

Coming June 26, 2012

 

[AwesomeTeeth]

So it begins....

 

[yappy]

People go bankrupt from a couple of thousand of dollars? For most people who have been working full time for 2 years or greater - if they don't have a 5-10k emergency fund - it was a choice.

I don't think anything good can come from trying to fix problems for people who are not that invested in fixing or trying to fix it on their own.

 

[Bereno]

Interesting. I hope this doesn't demonize dentists though...

 

[TheClutch]

Interesting. I hope this doesn't demonize dentists though...

it will def.
I just hate that media portrays us as bad buys all the times. I wonder if the show talks about why dentists don't take HMO and debt dentists accumulate over years. I doubt it.
On a positive note, if we show to patients that we are honest, ethical and compassionate, that will set us apart from other dentists

 

[Bereno]

it will def.
I just hate that media portrays us as bad buys all the times. I wonder if the show talks about why dentists don't take HMO and debt dentists accumulate over years. I doubt it.
On a positive note, if we show to patients that we are honest, ethical and compassionate, that will set us apart from other dentists

I think you could very well be right. However, if the message of the video/article is that dental care is important to your overall health there could be some benefit here as well. However like you said, I think that it might place dentists in poor light as if we are preying on those in need. We will see I guess.

 

[Daurang]

People go bankrupt from a couple of thousand of dollars? For most people who have been working full time for 2 years or greater - if they don't have a 5-10k emergency fund - it was a choice.

I don't think anything good can come from trying to fix problems for people who are not that invested in fixing or trying to fix it on their own.

Unfortunately, half of Americans really and simply do not have $2000 in emergency fund if something should come up tomorrow. The only reason our economy keeps humming along is the $5 TRILLION in freshly printed money the last three years.

 

[Cold Front]

Unfortunately, half of Americans really and simply do not have $2000 in emergency fund if something should come up tomorrow. The only reason our economy keeps humming along is the $5 TRILLION in freshly printed money the last three years.

👍

 

[Firm]

Dental decay is very predictable. It's causes are well known and it doesn't occur overnight. It's caused by not removing highly refined sugars from tooth surfaces. The decay's first symptom is sharp pain that lasts 3-5 seconds. 6 months after that, the pain will become a dull throbbing pain that may last 15 minutes to days. 6 months after that an abscess will form. The abscess will go away. Then some time after that generalized swelling to the face and around that tooth will occur. At this point the airway can be compromised. This is the point at which most people go to the hospital. There are years of warning signs and they are ignored. Many times these patients have seen a dentist and know that there is a problem. There is time to save the money. It's just not a priority. People would rather buy cell phones, clothes, and tvs rather than have dental work done. Yet the greedy dentists are the ones to blame for not doing it for free.

 

[Cold Front]

Anyone else notice Aspen Dental on the Frontline clip? 🙄

 

[Bereno]

Anyone else notice Aspen Dental on the Frontline clip? 🙄

+1 that noticed lol. I laughed when I saw it haha

 

[yappy]

Maybe. But most everyone I personally know is employed and earns greater than 50k/yr (I do not live in a high cost of living city). They have 2k/yr invested in cell phone plans. Once you factor in things like vacations and cable internet most people, despite what is causing the "humming" economy, could save a couple K a year if they chose to.

I dont want to give you the idea I'm judging them for spending money on those things. I think the companies that provide those things are great services and entertainment is a lot of fun. But flip side of enjoying those things on a limited budget is the opportunity cost of not having an emergency fund. Indeed, it was so important to me that I lived in a 400 sq foot apartment and worked 60hrs/wk. It kind of sucked but that's what we do for our goals. I maintain that for most people not having an emergency fund is a choice and not having one may be detrimental to your health or a serious financial hardship.

Unfortunately, half of Americans really and simply do not have $2000 in emergency fund if something should come up tomorrow. The only reason our economy keeps humming along is the $5 TRILLION in freshly printed money the last three years.

 

[Daurang]

Maybe. But most everyone I personally know is employed and earns greater than 50k/yr (I do not live in a high cost of living city). They have 2k/yr invested in cell phone plans. Once you factor in things like vacations and cable internet most people, despite what is causing the "humming" economy, could save a couple K a year if they chose to.

I didn't make it up. According to a study published by the National Bureau of Economic Research, 28% of respondents said they "certainly" wouldn't be able to put together the $2,000 in 30 days, while 22% said they "probably" would be unable to do so. These respondents were in households making between $100,000 and $150,000 annually!!!

 

[yappy]

No doubt. But it sounds like a household spending, not a household revenue problem. What's the opportunity cost of living so close to the red line? One little bump along the road sends you into financial trouble. That was all I was trying to say in my posts. I'm not against it as I think peoples finances should be their own. But to suggest that the consequences should be mitigated by the government to a large degree... I dont agree with that.

EDIT: looks like this study measured 2k in 30 days. A emergency fund is best done made over the course of a couple of years prior to an emergency. For example - I have had mine for 3 years but have not had to use it yet. I would not wait till the month of an emergency then try to catch up in one month.

I didn't make it up. According to a study published by the National Bureau of Economic Research, 28% of respondents said they "certainly" wouldn't be able to put together the $2,000 in 30 days, while 22% said they "probably" would be unable to do so. These respondents were in households making between $100,000 and $150,000 annually!!!

 

[jr8047]

It's about time.

Dental care can be a matter of life and death. Yet millions of Americans can’t afford a visit to the dentist. An investigation by FRONTLINE and the Center for Public Integrity reveals the shocking consequences of a broken safety net. Poor children, entitled by law to dental care, often cannot find a dentist willing to see them. Others kids receive excessive care billed to Medicaid, or major surgery for preventable tooth infections. For adults with dental disease, the situation can be as dire — and bankrupting. While millions of Americans use emergency rooms for dental care, at a cost of more than half a billion dollars, corporate dental chains are filling the gaps in care, in some cases allegedly overcharging patients or loading them with high priced credit card debt. Correspondent Miles O’Brien investigates the flaws in our dental system and nascent proposals to fix them.

http://www.pbs.org/wgbh/pages/frontline/dollars-and-dentists

Coming June 26, 2012

This is a valid point people!! It is a problem that we can't ignore or dismiss. But the solution begins with curving the outrageous price of dental school.

 

[HopeforDMD]

Ah here we go. Do you guys think people will think one degree or the other, DMD or DDS, will be confused with dental therapists more? I feel like the gen pop is going to think ones a therapist and the others a dentist.

 

[TheClutch]

No doubt. But it sounds like a household spending, not a household revenue problem. What's the opportunity cost of living so close to the red line? One little bump along the road sends you into financial trouble. That was all I was trying to say in my posts. I'm not against it as I think peoples finances should be their own. But to suggest that the consequences should be mitigated by the government to a large degree... I dont agree with that.

EDIT: looks like this study measured 2k in 30 days. A emergency fund is best done made over the course of a couple of years prior to an emergency. For example - I have had mine for 3 years but have not had to use it yet. I would not wait till the month of an emergency then try to catch up in one month.

obviously we are educated and have common sense to understand why emergency fund is needed. Unfortunately, a lot of people are dumb and stupid. I've worked for a little bit as a junior high after school tutor for underprivileged kids. Its program manager told me that she is so surprised to see families having hard time providing necessities for their family but their kids managed to have a xbox and stuffs like that. smh

 

[yappy]

Lets hope it gets better. My friend, who works in banking (not investment), donates some of his time going to talk to and set up financial-common-sense mini series at local Jr highs and high schools. He is trying to cover all the basics with them. They look at case studies and talk about the short term and long term effects of financial decisions. I think it would be great if these programs were national and helped kids who dont get instruction at home to realize the importance of emergency savings, opportunity cost, bad consumer debt, and secure retirement stratigies like roth IRA. Nothing fancy because without the basics none of that matters.

obviously we are educated and have common sense to understand why emergency fund is needed. Unfortunately, a lot of people are dumb and stupid. I've worked for a little bit as a junior high after school tutor for underprivileged kids. Its program manager told me that she is so surprised to see families who having hard time providing necessities for their family but their kids managed to have a xbox and stuffs like that. smh

 

[DrJeff]

This is a valid point people!! It is a problem that we can't ignore or dismiss. But the solution begins with curving the outrageous price of dental school.

There is some validity to the point for sure. However, basically expecting us, as not just dentists, but also as business owners to see such a large volume, as some would have it, of patients, who 99% of the time have dental needs as a result of actions of their own doing, and see them either at a loss or totally free is also a ridiculous concept. The concept that a midlevel provider will have basic business operational costs that are less than a dentists, without any government subsidies, is just plain false.

You've got a situation where there's this huge chunk of the population that feels that they're entitled to EVERYTHING for basically nothing, and that's a core problem that needs to be addressed in an adult fashion, rather than continually glanced over. Until the idea that there are some people who will finish 1st, some that will finish 2nd, some 10th, some 100th, etc, but that they can all finish, but with different overall results, this problem is going to just continue.

And once again, as for people's views of dental fees, 99.9% of patients, reguardless of their income level and cost of the procedure(s) they're currently receiving will always on some level feel that your fees are too high and that they're just paying for your "brand new Mercedes, or 3rd vacation home, etc" Personally I gave up really caring what people thought about my fees probably 10 years ago, and since the vast majority of my patients keep coming back, and referring their friends/coworkers to my practice, even though my practice has some of the higher fees in my town, I think that my patients feel that the value they get for the fees that they pay are quite fair, and that's the bottomline!

Dentistry IS a business, and the sooner you realize that it's OK to make a profit, and that profit allows you as a business owner to do things for others, the better things will be

 

[DrJeff]

Interesting. I hope this doesn't demonize dentists though...

My guess that that with so many different businesses being the subject of some "investigative reporting" that casts a negative light on them these days, that the general population has become so used to stories like this that if anything they'll just nod their heads yes a few times, and the forget about it and carry on with their lives as usual right after.

Personally i'm just waiting for the investigative report about investigative reporters that says that they really don't know much of anything they're talking about and are all about shock factor for ratings vs. actual substance, or even a report that actually casts blame of people for making poor choices about their health and daily actions! 😉

 

[yappy]

+1. I feel you and I are cut from the same cloth.

There is some validity to the point for sure. However, basically expecting us, as not just dentists, but also as business owners to see such a large volume, as some would have it, of patients, who 99% of the time have dental needs as a result of actions of their own doing, and see them either at a loss or totally free is also a ridiculous concept. The concept that a midlevel provider will have basic business operational costs that are less than a dentists, without any government subsidies, is just plain false.

You've got a situation where there's this huge chunk of the population that feels that they're entitled to EVERYTHING for basically nothing, and that's a core problem that needs to be addressed in an adult fashion, rather than continually glanced over. Until the idea that there are some people who will finish 1st, some that will finish 2nd, some 10th, some 100th, etc, but that they can all finish, but with different overall results, this problem is going to just continue.

And once again, as for people's views of dental fees, 99.9% of patients, reguardless of their income level and cost of the procedure(s) they're currently receiving will always on some level feel that your fees are too high and that they're just paying for your "brand new Mercedes, or 3rd vacation home, etc" Personally I gave up really caring what people thought about my fees probably 10 years ago, and since the vast majority of my patients keep coming back, and referring their friends/coworkers to my practice, even though my practice has some of the higher fees in my town, I think that my patients feel that the value they get for the fees that they pay are quite fair, and that's the bottomline!

Dentistry IS a business, and the sooner you realize that it's OK to make a profit, and that profit allows you as a business owner to do things for others, the better things will be

 

[Bereno]

Personally i'm just waiting for the investigative report about investigative reporters that says that they really don't know much of anything they're talking about and are all about shock factor for ratings vs. actual substance, or even a report that actually casts blame of people for making poor choices about their health and daily actions! 😉

Genius!

 

[Cold Front]

My guess that that with so many different businesses being the subject of some "investigative reporting" that casts a negative light on them these days, that the general population has become so used to stories like this that if anything they'll just nod their heads yes a few times, and the forget about it and carry on with their lives as usual right after.

Personally i'm just waiting for the investigative report about investigative reporters that says that they really don't know much of anything they're talking about and are all about shock factor for ratings vs. actual substance, or even a report that actually casts blame of people for making poor choices about their health and daily actions! 😉

I think dentistry is going through a big transition that will cater to two groups. The upper-middle class (and above) and the low-income. Middle-income serving dentists will soon be rare.

Look at corporate dentistry, there are two kinds. Aspen Dental and the likes are targeting baby boomers who have the means to afford their dental needs, whether they have the cash or the ability to finance it through services like CareCredit. On the other hand, you have Small Smiles, Kool Smiles who are dedicated to pediatric medicaid patients, and Comfort Dental who don't take medicaid but have ultra low discounted rates (pretty much similar to medicaid fees) who see all ages patients who are at or below poverty lines. The average dentist will soon fall to one of those categories, and I think that will be the main theme of the FRONTLINE investigation, exploring how these corporations are exploiting the field to maximize their goals.

 

[DrRobert]

It's about time Dentistry gets pulled into the Medicare/Medicaid quagmire. Welcome to the party. 👍

 

[yappy]

One thing I've noticed about dentistry is that it is much more price sensitive than medicine. Imagine how much a pano would "cost" if it were done in a hospital VS a private practice dental office. I imagine the technology fee + radiology fee would be as least 500+ vs the 50-100 you pay in a dental office.

In this way the financials of dentistry seem much less on a bubble than that $1000 IV lock + 2 labs you get when you visit the ER. I believe even seeing a triage RN results in a $100 dollar bill for a 10 min convo lol. In contrast, with little financing, most non-elective dental procedures are within a patients reach.. save for the homeless, drug addicted, etc. population.

For this reason I do not see dentistry being pulled into the quagmire. Though, programming like this may try to paint dentists as bad people.

It's about time Dentistry gets pulled into the Medicare/Medicaid quagmire. Welcome to the party. 👍

 

[Bereno]

One thing I've noticed about dentistry is that it is much more price sensitive than medicine. Imagine how much a pano would "cost" if it were done in a hospital VS a private practice dental office. I imagine the technology fee + radiology fee would be as least 500+ vs the 50-100 you pay in a dental office.

In this way the financials of dentistry seem much less on a bubble than that $1000 IV lock + 2 labs you get when you visit the ER. I believe even seeing a triage RN results in a $100 dollar bill for a 10 min convo lol. In contrast, with little financing, most non-elective dental procedures are within a patients reach.. save for the homeless, drug addicted, etc. population.

For this reason I do not see dentistry being pulled into the quagmire. Though, programming like this may try to paint dentists as bad people.

Dentistry is still fairly independent of the hospital... This is what is seemingly keeping us in control of pricing lol.

 

[Firm]

One thing I've noticed about dentistry is that it is much more price sensitive than medicine. Imagine how much a pano would "cost" if it were done in a hospital VS a private practice dental office. I imagine the technology fee + radiology fee would be as least 500+ vs the 50-100 you pay in a dental office.

In this way the financials of dentistry seem much less on a bubble than that $1000 IV lock + 2 labs you get when you visit the ER. I believe even seeing a triage RN results in a $100 dollar bill for a 10 min convo lol. In contrast, with little financing, most non-elective dental procedures are within a patients reach.. save for the homeless, drug addicted, etc. population.

For this reason I do not see dentistry being pulled into the quagmire. Though, programming like this may try to paint dentists as bad people.

Most hospitals are backed by local, state, and federal governements. They are much less sensitive to making a profit. If your local hospital goes $500,000 in the red this year, the local muncipalities will bail them out. If I go $500,000 in the hole, I go out of business.

 

[doubledizzle13]

Dental decay is very predictable. It's causes are well known and it doesn't occur overnight. It's caused by not removing highly refined sugars from tooth surfaces. The decay's first symptom is sharp pain that lasts 3-5 seconds. 6 months after that, the pain will become a dull throbbing pain that may last 15 minutes to days. 6 months after that an abscess will form. The abscess will go away. Then some time after that generalized swelling to the face and around that tooth will occur. At this point the airway can be compromised. This is the point at which most people go to the hospital. There are years of warning signs and they are ignored. Many times these patients have seen a dentist and know that there is a problem. There is time to save the money. It's just not a priority. People would rather buy cell phones, clothes, and tvs rather than have dental work done. Yet the greedy dentists are the ones to blame for not doing it for free.

well said !!

 

[JcRoughriders]

just watched the report... really good investigation... brings awareness to both the dentists and the patients. the access problem is a huge issue for dental care and there's really no easy fix. but raising awareness is a good start though...

 

[Quattro DMD]

just watched the report... really good investigation... brings awareness to both the dentists and the patients. the access problem is a huge issue for dental care and there's really no easy fix. but raising awareness is a good start though...

So basically corporate dentistry is horrible (already knew that but maybe the public will now be aware). And that dentists are just greedy monsters opposed to mid-level providers. I almost laughed out loud when the dental health therapist said (with a straight face) that they get the same level of training of a dentist just with fewer procedures. I guess the hundreds of thousands of dollars I paid for dental school was overkill.

 

[JcRoughriders]

yeah i've never heard of a dental therapist... lol
but the guy from florida dental school did said that its not wise to have dental therapist treating underserved populations who mostly likely have no access to medical treatment in general and may have other health problems.

 

[DDGDDS]

There were a lot of reports on corporate dentistry today. Here is a list and eye opening documents to match. I'm in shock, but not...

Dentistry News http://dentistthemenace.com

 

[TheClutch]

very well produced. fairly accurate and unbiased in my opinion.

I'm wondering how the medicare/medicaid clinic in AL is successful? I've heard dentists arguing that the reimbursement rates not enough to stay afloat. After all, we are the liars?!

After watching this, I feel like Corp. Dentistry is not as a big threat as I thought it was. It targets low income family and the care is awful. A lot of us will be in private practices where ppl (household income above 50k? maybe?) earn significantly more and want care and quality.

On the other hands, Dental Therapy seems like a good program for the underprivileged and states. And definitely bad news for us. I feel like DT will crawl into the private dentistry and will create a bigger impact than Corp. Dentistry.
Does anyone know how PAs and nurse practitioners affect primary care physicians in medicine??? It may be an excellent case study

 

[Mackchops]

I thought it was a good report. A little over the top in some areas but there were some interesting points.

I work in Virginia and have volunteered at two of the free clinics (MOM projects) like the one where the 31 year old got dentures. It's amazing how many people show up to these things. Long lines by 4am usually. And every single person with dental pain. Usually a long day of pulling teeth and certainly some people who feel "entitled" but the vast majority are extremely and tearfully grateful. So whoever's to blame - patients with backwards priorities, dentists with outrageous fees, dental schools charging too much, or federal reimbursements too low - something needs to be done. Dental therapists are NOT the answer...

 

[diasIItema]

If this country would stop throwing public health under the bus and better finance it, we could halve those emergency room numbers b/c most dental procedures are simply PREVENTABLE. Same goes for all behavioral, obesity and smoking-related health issues. If we spent more than 1-2% of our national health budget on preventative public health, rather than medical costs, we wouldn't be in this problem.

Are individuals entitled to health care? Yes, to an extent they are. But they are also expected to take care of themselves.

C'est la vie.

 

[DrJeff]

very well produced. fairly accurate and unbiased in my opinion.

I'm wondering how the medicare/medicaid clinic in AL is successful? I've heard dentists arguing that the reimbursement rates not enough to stay afloat. After all, we are the liars?!

After watching this, I feel like Corp. Dentistry is not as a big threat as I thought it was. It targets low income family and the care is awful. A lot of us will be in private practices where ppl (household income above 50k? maybe?) earn significantly more and want care and quality.

On the other hands, Dental Therapy seems like a good program for the underprivileged and states. And definitely bad news for us. I feel like DT will crawl into the private dentistry and will create a bigger impact than Corp. Dentistry.
Does anyone know how PAs and nurse practitioners affect primary care physicians in medicine??? It may be an excellent case study

Dental therapists are not the answer as some would have us believe, the facts back this up, but so many either don't want to pay attention to them and/or think that "just because this is the US, it will be different here 🙄 ) In New Zeland (not exactly a 3rd world country by any means), which has roughly the population of CT, they've had dental therapists in one form or another for almost a century. Last year the NZ government subsidized their dental therapist to the tune of over 400 million dollars, and the rate of decay amongst the targeted population is HIGHER than it is in the similar population in the US now. One could easily deduce that if a therapist was the answer that after almost a century of use in a civilized country that you'd see results

I have the benefit of a business partner who is on the ADA Access to Care Task force and a recognized national leader on Access to Care, and the amount of data that i'm fed on this is mind boggling. The underlying theme amongst all the data, is that therapists can do competent work. They very often if they stay in the public sector need government subsidation to function, many of them end up in private practice, the work that they do is at best done at medicaid rates (why they often need subsidation to remain in business) and often done at a dentists "regular" rates. The various advocates that want to believe that somehow a therapist will fill the void for the portion of the population that for multiple reasons is "underserved" need to look at things more from a scientific standpoint (as we are trained where facts are facts, and dreams/wants are trumped by facts) as opposed to the somewhat utopian dream world viewpoint that many seem to posses.

 

[DrJeff]

If this country would stop throwing public health under the bus and better finance it, we could halve those emergency room numbers b/c most dental procedures are simply PREVENTABLE. Same goes for all behavioral, obesity and smoking-related health issues. If we spent more than 1-2% of our national health budget on preventative public health, rather than medical costs, we wouldn't be in this problem.

Are individuals entitled to health care? Yes, to an extent they are. But they are also expected to take care of themselves.

C'est la vie.

The real problem is that far too many people feel that they DON'T have to make the proper decisions about their own health, and as such, even with a public health system that for many DOES work, inspite of providing a miriad of education to those that receive their dental and medical healthcare through the public health system, very few actually make the changes that you have instructed them to make to avoid future occurrance/reoccurrances of the problem(s) that brought them there in the 1st place. I STRONGLY feel that much of this isn't because of a lack of knowledge on the part of the patient, but a lack of ownership and/or appreciation for what has been done for the patient, since rarely do they have any monetary responsibility for the care they receive. Think of it this way, if you receive a free t-shirt from someone/something and soon thereafter it rips on something its no big deal since it "was free" now if you bought a t-shirt for say $20 and it soon thereafter rips on something, its a bigger deal since you just recently paid out of your own pocket $20 for it, and as such your likely to take better care of it. Same thing with healthcare. Generally speaking if its "free" the value of it isn't as profound to the patient

 

[DDGDDS]

One thing is clear, I understand why these companies are spending millions to get the regulations in North Carolina relaxed to get at our residences. It is not about getting them affordable care. I see where we as student dentists better be paying closer attention to what is really happening and not drinking the kool aide we are being served. I almost fell into to this black hole. I'm glad I listened to my instincts and not my student loan.

 

[diasIItema]

The real problem is that far too many people feel that they DON'T have to make the proper decisions about their own health, and as such, even with a public health system that for many DOES work, inspite of providing a miriad of education to those that receive their dental and medical healthcare through the public health system, very few actually make the changes that you have instructed them to make to avoid future occurrance/reoccurrances of the problem(s) that brought them there in the 1st place. I STRONGLY feel that much of this isn't because of a lack of knowledge on the part of the patient, but a lack of ownership and/or appreciation for what has been done for the patient, since rarely do they have any monetary responsibility for the care they receive. Think of it this way, if you receive a free t-shirt from someone/something and soon thereafter it rips on something its no big deal since it "was free" now if you bought a t-shirt for say $20 and it soon thereafter rips on something, its a bigger deal since you just recently paid out of your own pocket $20 for it, and as such your likely to take better care of it. Same thing with healthcare. Generally speaking if its "free" the value of it isn't as profound to the patient

I do agree with you. However, public health has time and time again proven effective if given the resources it needs; it's especially been proven effective on the international level, where different programs have succeeded in all types of economies, cultures, and markets. And it ALL begins with education. Do people know smoking is bad for them? Of course. Do people realize the actual effects, the true morbidity and mortality rates, and the financial burden they are bringing upon themselves? Hardly. If people had accurate knowledge and access to preventative resources at an EARLY age at which to establish good health care HABITS, we can effectively prevent most behavioral causes of morbidity, especially poor oral health, tobacco-related disease, and obesity, no matter the socio-economic status. Teach people how much money not smoking and brushing your teeth/flossing will save you over the course of your life ($$$), and they'll listen.

People never give public health the credit it's due until it's either too late, or 50 years down the road. It's only the reason our life expectancy has risen 35 years in the past century...

 

[yappy]

Strongly doubt it.

People never give public health the credit it's due until it's either too late, or 50 years down the road. It's only the reason our life expectancy has risen 35 years in the past century...

I agree with most of what Dr. Jeff has said. The financials for a mid level dentist are difficult because of the cost of delivering health care. Could you imagine the government actively supporting the DT by subsidizing their practice which is in direct competition with you? That seems illegal and a huge conflict of interest.

 

[diasIItema]

Strongly doubt it.

Um, it's pretty common knowledge that the reason life expectancy has increased by three decades in a century is due to the effective elimination of infectious and communicable disease in this country (including the eradication of smallpox and soon to be eradicated polio). Where medicine has made strides is in the treatment of chronic illness (i.e. heart disease, AIDS, cancer) and injuries. The adage remains the same: an ounce of prevention is worth a pound of cure.

Your other points are somewhat valid and I won't argue them.

 

[HopeforDMD]

Sorry for the repost. I'm like 90% sure I'm just being crazy about this. But... with the knowledge that non-doctor practitioners are coming into the picture, I'm concerned about the otherwise irrelevant fact that my school offers the DDS rather than DMD degree.

Can't you see a member of the gen pop falling under the impression that DDS = dental therapist, while DMD = dentist? They will have no conception as to why the h**l we have two different sets of letters after our names. I can see them thinking to them selves that MD=real doctor

Please make me see this more sensibly 🙂

 

[88845]

Source: http://www.aspendental.com/news/201...-joint-pbscenter-for-public-integrity-report/

Aspen Dental Management, Inc. Response to Joint PBS/Center for Public Integrity Online Report
June 26, 2012
We are very disappointed with the biased approach that PBS and the Center for Public Integrity employed in their scurrilous attack on our company and on the dental services industry in general.

We participated in this story because we were led to believe it would be a serious and balanced story that could contribute to an important discussion of the challenges facing people who desperately need dental care.

As it turns out, this was not the objective.

Instead of taking advantage of an opportunity to discuss the national problem of obtaining quality dental care, PBS and the Center for Public Integrity ignored what we shared during the past few months and instead decided to cast private enterprise as the villain in their crusade.

The story also overlooked what we believe is a fundamental issue – the growing disparity for a large, forgotten middle portion of the population, hard-working Americans who need dental care that is more affordable and more accessible. Aspen Dental offers them a real solution.

We have no interest in going point by point through this example of the worst kind of journalism. However, we challenge the central and most offensive assertion made in this story that dentists supported by Aspen Dental make decisions to bolster their offices’ bottom lines.

Nothing is further from the truth. Let us be clear: the dentists who own and operate Aspen Dental practices make their diagnoses and treatment recommendations to patients based on what is best for the patient’s medical needs. Dental care can be expensive – especially when it is pushed off for years or decades – and Aspen Dental practices provide affordable, easily accessible options for patients that would otherwise not be available to them.

Our employees receive extensive training to help patients make some of the most serious financial decisions they will ever face. We are proud of the business we run, the jobs we have created, and the care that the dental offices we support provide to millions of people who would otherwise receive no dental care in this country.

The baseless claims in this story fly in the face of a recent opinion letter on the dental service organization (DSO) business model from the Federal Trade Commission, which just a few weeks ago noted that not only was the FTC unaware of any safety or quality issues arising from the use of DSOs, but that “DSOs appear to increase efficiency and support entry by new dental practices, which may lead to lower prices, expanded access to dental services, and greater choice for dental consumers.”

To validate their thesis, PBS and Frontline opted to dig back into Aspen’s history to find anything they could use to prove their point. But the numbers just do not back up their claim.

Last year, more than 760,000 patients visited Aspen Dental practices across the country, and the vast, vast majority of those patients are highly satisfied. While even one complaint is too many, the rate of complaints that Aspen Dental practices receive is less than one-tenth of one percent of all patients.

Even when presented with contradictory facts and figures about their assertions, the journalists involved in this project opted to quote only disgruntled former employees and other sources unwilling to give their names. Their accounts misrepresent our company and mischaracterize the 4,000 Aspen team members across the country who make up our organization.

We are stunned that Frontline seems to have decided to move from its long history of balanced reporting in favor of this brand of irresponsible sensationalism. Most importantly, though, we view this as a missed opportunity to advance the discussion of dental care in America and begin to identify solutions.

 

[NileBDS]

Source: http://www.aspendental.com/news/201...-joint-pbscenter-for-public-integrity-report/


The Latest News
From Aspen Dental


Aspen Dental Management, Inc. Response to Joint PBS/Center for Public Integrity Online Report

June 26, 2012 by Kasey P.

...


We have no interest in going point by point through this example of the worst kind of journalism. However, we challenge the central and most offensive assertion made in this story that dentists supported by Aspen Dental make decisions to bolster their offices' bottom lines.
Nothing is further from the truth. Let us be clear: the dentists who own and operate Aspen Dental practices make their diagnoses and treatment recommendations to patients based on what is best for the patient's medical needs. Dental care can be expensive – especially when it is pushed off for years or decades – and Aspen Dental practices provide affordable, easily accessible options for patients that would otherwise not be available to them.

Why are they denying facts that are clear as day? That's an argument they will never win. It's just bad publicity, and just really stoking the fire.


It is a pretty well established fact that Aspen, Kool Smiles and the likes (Dental Corporate Chains) operate on quotas, production goals and bonuses for whoever treatment plans the most. That's how corporations gauge success. That's what makes shareholders grin. Not patient satisfaction, not the health of their patients ... certainly not the quality of the product/service. Doctors/hygienists are merely a means to an end. They don't care what you think ... your license and clinical skills rest at their discretion.


I've interviewed several ex-Aspen assistants and hygienists for positions at the offices I have worked at so far, and they have voluntarily and disgustingly explained to me in detail how those operations run. Office managers with no dental training, dictating treatment to younger, student-loan strapped, gullible dentists. If you treatment plan a 3 surface filling, the office manager changes that to a core buildup and crown. If the office manager sees as much as an isolated 5 mm pocket, you're getting 4 quads + Arestin. Office managers have even been reported to fudge perio probing results in order to submit to insurance, falsifying the perio diagnosis of any particular patient and obtaining better insurance coverage. If you treatment plan a scaling and root planing, the office manager will likely change that as well to a 4 quad osseous surgery + Arestin + Peridex + Prophy + whatever the heck they need to do to meet their daily production targets. And so forth. If you so much as disagree with the office manager or voice objections (get in the way of their production goals), you are out the door, and the next one is signed on.


This is a chain operation. They are not there to cater to the undeserved. They are not there to solve an "access to care" problem. They are not there to provide a better quality of care to patients who otherwise would have no means. Most patients who frequent Aspen dental have perfectly fine dental insurance.


This and other corporate chain models of Dental care delivery hurt patients in many ways ... financially, emotionally and Medically. Most ex-Aspen patients that I examine at my office exhibit evidence of poor Dental treatment, being over charged, and are just desperate and left with little faith left in the Dental profession. How damaging is that?


This must change.





On the access to care issue. I feel like it is a problem very easily solved by

• Increasing Medicaid reimbursement rates
• Easing the amount of red tape necessary to join Medicaid programs
• Lower the boundaries to becoming a dental provider

In my state of Connecticut, Dental provider Medicaid participation for young adults and children has skyrocketed since the state agreed to reform it's reimbursement schedules (I believe 2010). 2 of the very successful private practices I have worked at (one million+ in revenues per year) were Medicaid providers (Husky in Connecticut). The state was able provide Dentists with a true incentive to be able to see and treat medicaid kids, and not loose money or go out of business. Yes, there will be the occasional provider trying to play the system, or defraud the tax payers, but that does not mean the system did not work, it just means you need to implement it in a way that deters most from doing that.


Most Dentists are willing to contribute to solving the access to care issue, just not for free or not if that means loosing the shirt on their back and going out of business.


And it's about time that they recognize our society's Dental care needs as medically "essential", and not "discretionary". Until then, they can throw all the solutions they can think of at it -mid-level providers, therapists, whatever- and hope one sticks.


Off my soapbox.

.

 

[Cold Front]

Why are they denying facts that are clear as day? That's an argument they will never win. It's just bad publicity, and just really stoking the fire.


It is a pretty well established fact that Aspen, Kool Smiles and the likes (Dental Corporate Chains) operate on quotas, production goals and bonuses for whoever treatment plans the most. That's how corporations gauge success. That's what makes shareholders grin. Not patient satisfaction, not the health of their patients ... certainly not the quality of the product/service. Doctors/hygienists are merely a means to an end. They don't care what you think ... your license and clinical skills rest at their discretion.


I've interviewed several ex-Aspen assistants and hygienists for positions at the offices I have worked at so far, and they have voluntarily and disgustingly explained to me in detail how those operations run. Office managers with no dental training, dictating treatment to younger, student-loan strapped, gullible dentists. If you treatment plan a 3 surface filling, the office manager changes that to a core buildup and crown. If the office manager sees as much as an isolated 5 mm pocket, you're getting 4 quads + Arestin. Office managers have even been reported to fudge perio probing results in order to submit to insurance, falsifying the perio diagnosis of any particular patient and obtaining better insurance coverage. If you treatment plan a scaling and root planing, the office manager will likely change that as well to a 4 quad osseous surgery + Arestin + Peridex + Prophy + whatever the heck they need to do to meet their daily production targets. And so forth. If you so much as disagree with the office manager or voice objections (get in the way of their production goals), you are out the door, and the next one is signed on.


This is a chain operation. They are not there to cater to the undeserved. They are not there to solve an "access to care" problem. They are not there to provide a better quality of care to patients who otherwise would have no means. Most patients who frequent Aspen dental have perfectly fine dental insurance.


This and other corporate chain models of Dental care delivery hurt patients in many ways ... financially, emotionally and Medically. Most ex-Aspen patients that I examine at my office exhibit evidence of poor Dental treatment, being over charged, and are just desperate and left with little faith left in the Dental profession. How damaging is that?


This must change.





On the access to care issue. I feel like it is a problem very easily solved by

• Increasing Medicaid reimbursement rates
• Easing the amount of red tape necessary to join Medicaid programs
• Lower the boundaries to becoming a dental provider

In my state of Connecticut, Dental provider Medicaid participation for young adults and children has skyrocketed since the state agreed to reform it's reimbursement schedules (I believe 2010). 2 of the very successful private practices I have worked at (one million+ in revenues per year) were Medicaid providers (Husky in Connecticut). The state was able provide Dentists with a true incentive to be able to see and treat medicaid kids, and not loose money or go out of business. Yes, there will be the occasional provider trying to play the system, or defraud the tax payers, but that does not mean the system did not work, it just means you need to implement it in a way that deters most from doing that.


Most Dentists are willing to contribute to solving the access to care issue, just not for free or not if that means loosing the shirt on their back and going out of business.


And it's about time that they recognize our society's Dental care needs as medically "essential", and not "discretionary". Until then, they can throw all the solutions they can think of at it -mid-level providers, therapists, whatever- and hope one sticks.


Off my soapbox.

.

👍

The problem with corporate dentistry is that it mixes private equity goals with the standard of care.

 

[djeffreyt]

very well produced. fairly accurate and unbiased in my opinion.

I'm wondering how the medicare/medicaid clinic in AL is successful? I've heard dentists arguing that the reimbursement rates not enough to stay afloat. After all, we are the liars?!

After watching this, I feel like Corp. Dentistry is not as a big threat as I thought it was. It targets low income family and the care is awful. A lot of us will be in private practices where ppl (household income above 50k? maybe?) earn significantly more and want care and quality.

On the other hands, Dental Therapy seems like a good program for the underprivileged and states. And definitely bad news for us. I feel like DT will crawl into the private dentistry and will create a bigger impact than Corp. Dentistry.
Does anyone know how PAs and nurse practitioners affect primary care physicians in medicine??? It may be an excellent case study

I appreciate your goal, and there is definitely a place for you in the world of dentistry, but just off pure numbers...good luck with that.

The median household income in the United States is $45,000, so that means a little over 50% of the United States households take home less than 50K

There are 310,000,000 people in the United States. There are about $150,000 dentists including specialists, but I really don't feel like looking up # of general dentists only right now. That averages to roughly 2100 patients per dentist. Cut that in half since 50% live below the median income and then cut another 30% who just don't go to the dentist and you got about 750 patients.

Again, just numbers...there totally is a place for dentists who only want to treat the upper middle class of the nation. You just open in a richer area, find a Whole Foods and open near it. But if we think Chain dentists are horrible for recommending extractions and dentures, I think we'd be shocked too by how many dentists are taught by practice Gurus to convince through subtle manipulations patients to shell out $500 for bleaching teeth that are already shade A1 or to get veneers from 2nd premolar to 2nd premolar to correct their horrible esthetics.

Dentistry is a business, there's no denying that. There is crappy dentistry at every level, there are car saleman-like techniques and tricks at ALL levels.

 

[SoulPower]

The median household income in the United States is $45,000, so that means a little over 50% of the United States households take home less than 50K

There are 310,000,000 people in the United States. There are about $150,000 dentists including specialists, but I really don't feel like looking up # of general dentists only right now. That averages to roughly 2100 patients per dentist. Cut that in half since 50% live below the median income and then cut another 30% who just don't go to the dentist and you got about 750 patients.

Just want to point out that your numbers you made up are pure speculation. GPs and specialists share patients which is a huge problem in your patient count, I know you said you didn't want to look it up but that is a big variable to exclude.

And to add something, I'm sure there are private practices that are just as shady as some of these corporations seem to be. But it is ultimately up to the patient to decide what they want. That is why 2nd opinions exist, so people can shop around and get the best price or ask experts if what they are being sold is really needed. So obviously if a patient gets "suckered" into a $500 bleaching they feel that it must be either worth it or an honest price for the service.

 

[djeffreyt]

Just want to point out that your numbers you made up are pure speculation. GPs and specialists share patients which is a huge problem in your patient count, I know you said you didn't want to look it up but that is a big variable to exclude.

Haha, ok. So let's spend a couple seconds and look it up.

~population of USA: 300 million
~# of General Dentists: 120,000
~patient to doctor ratio: 2500:1
~% of patients HI > $50K: 1250:1

Let's not even bother to minus out the % of potential patients who don't see the dentist, so is 1250:1 a good # of patients to have in a practice...sure, if you can convince all of them to do $500 to 800 of work on average each year. Is that a little better speculation?

Regardless, that really wasn't the point. My point is that most Americans live below the $50K household income line, so to say that most dentists will work in private practice and will try to focus on this group is lofty, hopeful thinking. I'm glad the person who brought it up has goals, and I'm sure he or she will find ways to achieve them, but if we all did it, we'd ignore most of America.

And to add something, I'm sure there are private practices that are just as shady as some of these corporations seem to be. But it is ultimately up to the patient to decide what they want. That is why 2nd opinions exist, so people can shop around and get the best price or ask experts if what they are being sold is really needed. So obviously if a patient gets "suckered" into a $500 bleaching they feel that it must be either worth it or an honest price for the service.

Yup... It's pretty much the same point I made. The Frontline episode focused on the hard sale tactics of ASPEN, but hard sale tactics are a part of many dental offices. There are plenty of CE courses you can take about how to sell more aesthetic work. If Frontline wanted to do an episode looking into how dentists are trained to sell at some of these courses, it wouldn't be any less interesting.

Anyway, I really don't care too much what ASPEN or Medi mills, etc. do. I've come to expect this from the field I'm in and I just put my head down and do my work and get by just fine. When days are slow, I look at funny pics online, talk to friends and check out these forums and others. I post what I feel like but I'm not going to do any extensive research on what I say...not publishing papers here...just writing posts on an old student board I used when I was a pre-dent. Take my opinions for what their worth, sometimes relevant, usually just complete crap drummed out of boredom.

 

[SoulPower]

Wasn't attacking you DrJeffity, just saying you ignored a big variable for a point that doesn't seem to need to be made.

And after just finishing the video. A 2nd opinion is what almost all of these people should have done prior to accepting tx, especially before obtaining a credit card for said tx.

And honestly, I was quite appalled that an office manager, not dentist, would be selling the treatment plan as in Aspen's segment.

The video definitely missed how good dentistry can be for people. I've seen my dentist give free tx here and there or not charge for a certain auxiliary procedure because they didn't have insurance or was oop. But as someone stated above, it's all about sensationalism.

 

[jonmadden]

My dad has been practicing 31 years comprehensive, personally can produce 800k yr, it would be 1 mill with proper scheduling

He has paid probably 2 mill in taxes in life nearing 60

He is filing bankruptcy this year and his practice has always grossed more every year

He owes the IRS probably 100k, 200k underwater on the mortgage after being a homeowner 31 years, 300k student loans for my 2 younger sisters and younger brother. Nominal credit card debt. Didnt lose money in the stock market, all he did was not understand the impact of refinancing, even though he pays a lawyer to take care of.

And he moved to a smaller one level house better for my arthritic mother to get around. But I guess he should have assumed one year it would basically be worth 300k less.

Such careless behavior not planning for the one thing you got in equity to not be there.

He is going to have to argue to let the loans and taxes go so he can save for retirement as SS and medicare wouldnt cover theyre current healthcare costs. He pays 25k in surance premiums, other out of pocket and medicare is going to cover some drugs my moms on

Either way I guy who has more skill in his 2 hands then the entire IRS office has to beg. My little sister he wants to pay for some of college and he cant get any loan to cover. He needs to supplement SS as hes not paying a mortgage but still has to rent. He needs back surgery but cant cause he cant cover the time off work and support an underage child and chronic ill wife

If things like money of financing or investing ever interested my dad maybe he would have more but he takes good care of his employees and has raised 4 kids and he had equity in and office condo and home as a reasonable resesrve

He had to pull his ****ty little 20k 401k to pay for drugs when the insurance company decides how a patient is treated for a disorder

I guess he just doesnt get to retire? Hes funded the careers of a couple agents

End of story being a small business man is can be difficult but if you arent someone is making money of your employment. An audit theyll even do when I guess they thought 2 million plus wasnt enough

He pays that 10-12% SE tax, cover his employees part of fica, he has a soul so people get a good wage and normal hours. Insurance is insane and at least 12k avg for a family under obama. Thats probably a nice plab where you can have healthcare but not medication or treatment

Stafe income tax.

Dont have 4 kids at least I guess as it might have made his bankruptcy cheaper

Its nuts, hey can make and earn a dentists salary but then be expected to to enjoy 2 years of retirement on 38k yr

I dont think a person who doesnt care about the petty things around money should expect to be defrauded or that paying a lawyer or an accountant is enough

Why should he possibly be forced to learn the pathetic return language that preys on peoples ignorance so they pay more tax

Alternative minimun is a word you should know in this bracket

So much to financing as when he graduated inflation was huge and he just assumed that this interest is normal

Does a mortgage schedule serve a purpose besides misleading people to believe they make equal interest and principal payments? Theres a million other ways to control for risk without this. This isnt taught in schools or wasnt when I was there. My dads dad worked at the bronx zoo he wasnt money person to teach his son how these things work. And you think paying your government 2 mill plus buys you a little protection

Im in med school kissing goodbye and going to australia after

This place is getting worse

Patients dont have the disposable income they used to so set up for a low cost low overhead practice in a market you can own. Implants are drying up unless you provide s hack job and my dad spends to extra time on followup.

Dont have a partner either as my dads is worthless and definatelly took advantage of him over the years