General dentist limiting scope to 3rds?

[toofdoc]

If a GP is proficient and experienced with a variety of impacted wisdom tooth extractions, for example from doing an OMS internship, would it be practical for them to limit their practice to 3rds under LA? It seems that the more affluent prefer IV sedation while lower SES don’t mind anything under local. So if the GP was to accept Medicaid/HMO and keep fees low, 150-200/3rd, could they run a successful practice doing 2 sets/hr at about $600-800 each? Would they simply tell insurance companies that they only provide extractions?

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[HupHolland]

I don't see why not.

 

[omaralt]

I don't see why not.

And I don't see why. Why limit yourself to that? Why not do everything and do the impacted molars when they come to your office?

 

[charlestweed]

If a GP is proficient and experienced with a variety of impacted wisdom tooth extractions, for example from doing an OMS internship, would it be practical for them to limit their practice to 3rds under LA?

No, because none of the GPs in the area would refer the patients to his/her office. The GP would rather refer the patient to an OMFS who charges $2000 for 4 wisdom teeth extraction than to his rival GP down the street who only charges $500 for all 4.

. So if the GP was to accept Medicaid/HMO and keep fees low, 150-200/3rd, could they run a successful practice doing 2 sets/hr at about $600-800 each? Would they simply tell insurance companies that they only provide extractions?

As a GP and a medicaid/HMO provider, you cannot deny dental care to patients who have medicaid and HMO. This means that you cannot just do 3rd molar extractions on them and deny other types of tx. You are also obligated to do a lot of amalgam fillings and cleanings for $0 (for HMO patients) or $35-50 (for medicaid patients). Because of the low reimbursement, most private practice GPs I know don’t accept HMO…only big corporate offices like Western Dental, SmileCare, BrightNow accept HMO.

Would they simply tell insurance companies that they only provide extractions?

No, if you are a specialist, you have to submit the specialty certificate to the insurance companies when you apply. HMO pay the specialists more than they pay the GPs. For example, HMO pays the periodontists $500 for a quadrant of osseous surgery. HMOs pays the GPs $0 for the same type of surgery.

 

[Demeter]

If a GP is proficient and experienced with a variety of impacted wisdom tooth extractions, for example from doing an OMS internship, would it be practical for them to limit their practice to 3rds under LA? It seems that the more affluent prefer IV sedation while lower SES don’t mind anything under local. So if the GP was to accept Medicaid/HMO and keep fees low, 150-200/3rd, could they run a successful practice doing 2 sets/hr at about $600-800 each? Would they simply tell insurance companies that they only provide extractions?

I know a GP who works as an independant contractor and goes to to multiple office. He limits his service to IV sedations and extractions of 3rd molars. The owner and the IC split the fee 50-50. Owners will rather refer to OMFS then to a GP, but may would prefer to have a GP come to their office offer the same service In House and make a profit off the procedure.

 

[gryffindor]

I think like Demeter said, you could find a niche in a full-service GP office. I see tons of patients at one GP office who could benefit from taking out their thirds, but don't want to go to the surgeon due to the expense. Since none of the GPs in the office feel it is worth the hassle and risk to chase partically erupted thirds, the patients don't get them out. If you market yourself right, I don't see why you couldn't even set up your own shop. I also don't see why you have to tell insurance companies anything about your limited scope of general practice. Just do the procedure and submit for whatever procedure you did. Maybe your malpractice carrier would be interested to know.

However, the flaw I see is that a patient from a lower income group might not have the $600 - $800 to hand over to get out their thirds in once shot. From what I've seen, a lot of these patients never pursue extraction of their thirds unless the pain and swelling is REALLY bad. Instead of the patient paying $200 to get the recommended extraction done last week when it hurt a little and the swelling was small, they end up in the ER and we (the taxpayers) get to pay for a surgical extraction in the OR because the swelling is now so bad it is impeding the airway.

 

[charlestweed]

I know a GP who works as an independant contractor and goes to to multiple office. He limits his service to IV sedations and extractions of 3rd molars. The owner and the IC split the fee 50-50. Owners will rather refer to OMFS then to a GP, but may would prefer to have a GP come to their office offer the same service In House and make a profit off the procedure.

The difference here is this GP doesn’t have his own office. He is an independent contractor who travels from office to office to do extraction so there is no conflict of interest. However, this GP can only perform extractions on patients who pay cash or have good insurance plans. My wife’s boss (a general dentist) has to hire an OS to do 3rd molar extraction for his patients because there are certain insurance plans (all HMO and a few PPO plans) that only pay the OS. And since many of the insurance plans don’t pay the GPs for doing crown-lengthening and perio surgeries, my wife’s boss has to hire a periodontist (my wife) to do these procedures for his patients.

 

[toofdoc]

Thanks for everyone’s feedback. It seems like the major obstacles to setting up shop and only providing wisdom tooth extractions would be adequate patient flow, obtaining reimbursement and providing restorative and preventive treatment, which I’m still unclear if it’s absolutely required. Doing IC would certainly be an option if the fee split was greater than what could be produced independently.

What if the GP accepts Medicaid in order to increase pt flow and not have to rely on referrals? Will this be enough to bring in >10 new pts a day on avg? This would not include pts from other insurance plans or marketing efforts.

I was under the impression that Medicaid covered wisdom tooth extractions. At my dental school Medicaid fees were about $300/full bony. Are there many Medicaid coverage restrictions on them?

To get around the possible need of providing restorative care and complete dental exams, maybe hiring an associate or two and providing them a higher commission than corporate dental offices might be an option. I wouldn’t be expecting much in the way of profits from this though unless they’re really fast. Any thoughts on how this scenario could work out?

 

[charlestweed]

What if the GP accepts Medicaid in order to increase pt flow and not have to rely on referrals? Will this be enough to bring in >10 new pts a day on avg? This would not include pts from other insurance plans or marketing efforts.

I was under the impression that Medicaid covered wisdom tooth extractions. At my dental school Medicaid fees were about $300/full bony. Are there many Medicaid coverage restrictions on them?

The problem is my state medicaid pays the GPs too little that most of them try to find excuses not to do them and refer the patients to the OS.

Is it $300 per tooth or for all 4 wisdom teeth? If it is for 1 tooth, it’s pretty high. If it is really $300 per tooth, I am sure there will be plenty of GPs in your state who will do the extractions themselves instead of referring out. Don’t assume that when you accept medicaid, your office will be busy. The OS, whom I regularly refer my patients to, accepts medicaid and he is still struggling to fill his appointment book (he has had this office for 5 years). Also keep in mind that the patients don’t just walk straight to your office for wisdom teeth extractions. It’s not like getting braces. The GPs usually have to recommend the wisdom teeth extraction and refer the patients to OS.

 

[toofdoc]

The problem is my state medicaid pays the GPs too little that most of them try to find excuses not to do them and refer the patients to the OS.

Is it $300 per tooth or for all 4 wisdom teeth? If it is for 1 tooth, it’s pretty high. If it is really $300 per tooth, I am sure there will be plenty of GPs in your state who will do the extractions themselves instead of referring out. Don’t assume that when you accept medicaid, your office will be busy. The OS, whom I regularly refer my patients to, accepts medicaid and he is still struggling to fill his appointment book (he has had this office for 5 years). Also keep in mind that the patients don’t just walk straight to your office for wisdom teeth extractions. It’s not like getting braces. The GPs usually have to recommend the wisdom teeth extraction and refer the patients to OS.

After doing some more research about Medicaid, it’s not looking so attractive anymore. So many unpredictable factors. I’ll probably only accept PPOs and start out doing broader scope dentistry and see how pt flow goes, then maybe hire some associates and open up several satellites over time. That way income is derived from several sources and internal referrals can be made to in house specialists hired to work for us. Kind of defeats the purpose though. Might have to become a full time manager, which I’m not completely against.

 

[drhobie7]

This is what some OMS residents do during their training. You go work Saturdays at a GP's office. Yeah the typical split is 50-50. Clearly you're not going to be able to set up your own shop doing this because nobody would refer to you. Many OMSs will take Medicaid because it's still halfway decent considering how fast they can take out a tooth. Fees are $160 per FBI here in California, which is crap. But if you can take out the tooth in less than 2 minutes that's pretty good. The other problem you have as a GP doing just extractions is you don't have the knowledge, skill, or operating room privileges to handle complications. Say you push a tooth into the sinus, can you access it confidently or will you flog around for 2 hours? If you fracture the jaw can you put on archbars? If you get an abscess are you comfortable doing an incision and drainage? If you transect the lingual nerve by some horrible luck can you re-anastamose it? And then let's say you decide to do IV sedations. Perhaps versed and fentanyl just isn't cutting it, the patient is flailing, and you just need another 15 minutes, so you give 50 mics of fentanyl and your patient goes apneic. Can you manage that? Ventilate him? Intubate him? What about a laryngospasm? Anyhow, there are GP exodontists. They tend to work for places like Western Dental where it's all about volume. I guess if that's your cup of tea it's a good way to go.

 

[jk5177]

The other problem you have as a GP doing just extractions is you don't have the knowledge, skill, or operating room privileges to handle complications.

I agree. Thanks for the post.