managed care and dentists
- Thread starter futureD
- Start date
Quite simply put, because we as dentists have fought the raping of patient care by the insurance companies aggressively. I'm proud to be part of a profession that has stood up to the insurance industry and has prevented the HMO dissasters that has plagued medicine over the last decade plus. I like the fact that the decsion to do or not to do a procedure is between me and my patients, not as a result of some non dentally trained glorified temporary agency worker whose sole job it is to deny any claim request made. I think that its a great thing that a suit backed by the ADA against AETNA was just settled in favor of patients and dentists by a federal court in Florida, and eagerly look forward to a decsion being handed down against Anthem Bluecross/Blueshield filed by my state dental society here in Connecticut.
Given what has happened to our medical colleagues, I doubt that we as dentists will ever let what has happened to medicine happen to us, and with the aggressive stance that the ADA has taken on this, witht he results that they've had so far, thats every reason that you need to join the ASDA and then continue to be a member of the ADA after school, and happily pay your dues. The money you'll spend on dues, you'll make back literally hundreds of times over each year as a result of the suits the ADA is filing on our behalf!
Given what has happened to our medical colleagues, I doubt that we as dentists will ever let what has happened to medicine happen to us, and with the aggressive stance that the ADA has taken on this, witht he results that they've had so far, thats every reason that you need to join the ASDA and then continue to be a member of the ADA after school, and happily pay your dues. The money you'll spend on dues, you'll make back literally hundreds of times over each year as a result of the suits the ADA is filing on our behalf!
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PERFECT3434
what?
i don't get this. wasn't the question "In an age of managed care, how can the dentist advocate patient care first, over personal or corporate profit?"
i don't get this. wasn't the question "In an age of managed care, how can the dentist advocate patient care first, over personal or corporate profit?"
Although like Jeff I do not participate in manged care, I'll try to answer this question from things learned on Dentaltown.com and my associateships. I agree that if you can avoid HMOs do it, but if you can't here are three ways that dentists make a buck while taking HMOs:
The Patient Rapist: This is the evil HMO dentist you hear about. HMOs pay a monthly check (capitation check) per head that your office is expected to see. This "practictioner" makes money by signing up with as many HMO plans as possible and does her/his best to not see the patient. If one makes it in, the doc prescribes all sorts of unnecessary dental work that is not "covered" by the plan and is thus paid in full by the patient at the denists' normal fees.
The Costco Dentist: Hign volume, low customer service, clean but basic facility. You know the place. I get about $800 for a crown. I schedule one hour. I probably spend about 40 minutes working on the patient the rest is schmoozing. No schmoozing at the HMO! Basically if you get $350 per crown and spend an actual 30 minutes per patient, you can do two crowns at the HMO for every one crown at my office. You'll get about $100 less and may have to use a diffrent lab that may not put in occlusal stain or tertiary anatomy, but the margins will be tight occlusion sound etc. You just won't get asked if your kids like Kindergarten! Not a bad way to do it, but not for me.
The Pankey Dentist: In dental school and is some CE courses we are taught "perfect dentistry". I don't think that many would argue that a gold inlay with glass smooth margins is a better restoration than an amalgam, or a porcelain onlay is better than an MODBL composite. So why don't we stick to our guns and just prescribe these restorations to all patients regardless? In my opinion, we have to disgnose the mouth as well as the wallet. After a while you get a feel for what people can afford. I may recommend a MOD composite even though I know that a porcelain onlay may be a better restoration. Anyway, these HMO dentists typically recommend perfect ivory tower dentistry and if the patient does not want it, they can leave. Again, they (the doc) still get the check and more patients on the plan.
As I have stated in other posts, I don't think HMOs are "the devil". I think that they are definately waning in popularity though. You really just have to make an educated choice on whether to participate or not. If you live in an area with a depressed economy and all the workers have an HMO plan, I would think that the majority will go to an HMO dentist. If you practice in this city, you may do OK by not participating, but chances are you won't be very busy. I think HMOs allow some people with limited income access to dental care that they just could not afford elswhere.
Obviously if you practice in an affluent area where HMOs are not prevalent then the descision to particpate is optional. In my town there are a lot of HMOs. I don't participate and I am doing fine. When you get out of school, you will have a ton of choices to make business wise. Its all a numbers game.
August
The Patient Rapist: This is the evil HMO dentist you hear about. HMOs pay a monthly check (capitation check) per head that your office is expected to see. This "practictioner" makes money by signing up with as many HMO plans as possible and does her/his best to not see the patient. If one makes it in, the doc prescribes all sorts of unnecessary dental work that is not "covered" by the plan and is thus paid in full by the patient at the denists' normal fees.
The Costco Dentist: Hign volume, low customer service, clean but basic facility. You know the place. I get about $800 for a crown. I schedule one hour. I probably spend about 40 minutes working on the patient the rest is schmoozing. No schmoozing at the HMO! Basically if you get $350 per crown and spend an actual 30 minutes per patient, you can do two crowns at the HMO for every one crown at my office. You'll get about $100 less and may have to use a diffrent lab that may not put in occlusal stain or tertiary anatomy, but the margins will be tight occlusion sound etc. You just won't get asked if your kids like Kindergarten! Not a bad way to do it, but not for me.
The Pankey Dentist: In dental school and is some CE courses we are taught "perfect dentistry". I don't think that many would argue that a gold inlay with glass smooth margins is a better restoration than an amalgam, or a porcelain onlay is better than an MODBL composite. So why don't we stick to our guns and just prescribe these restorations to all patients regardless? In my opinion, we have to disgnose the mouth as well as the wallet. After a while you get a feel for what people can afford. I may recommend a MOD composite even though I know that a porcelain onlay may be a better restoration. Anyway, these HMO dentists typically recommend perfect ivory tower dentistry and if the patient does not want it, they can leave. Again, they (the doc) still get the check and more patients on the plan.
As I have stated in other posts, I don't think HMOs are "the devil". I think that they are definately waning in popularity though. You really just have to make an educated choice on whether to participate or not. If you live in an area with a depressed economy and all the workers have an HMO plan, I would think that the majority will go to an HMO dentist. If you practice in this city, you may do OK by not participating, but chances are you won't be very busy. I think HMOs allow some people with limited income access to dental care that they just could not afford elswhere.
Obviously if you practice in an affluent area where HMOs are not prevalent then the descision to particpate is optional. In my town there are a lot of HMOs. I don't participate and I am doing fine. When you get out of school, you will have a ton of choices to make business wise. Its all a numbers game.
August
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PERFECT3434
thank you very much.
i think that your post really answered the question. i still think that its totally unethical for a dentist to "rape" a patient or the HMO for that matter.
having worked at a dental office now for several months, i have totally realized how not only the HMO's and dentists rape patients, but the whole medical and private insurances as well.
although my dentist doesn't participate in managed care, i still have had the opportunity to know all about it. i truely believe that its wrong for a dentist to do unnecessarry procedure and i feel that eventually (in the long run) the dentist will come on top even under the managed care plan. so why not be a dentist that you once pledged to be?
i think that your post really answered the question. i still think that its totally unethical for a dentist to "rape" a patient or the HMO for that matter.
having worked at a dental office now for several months, i have totally realized how not only the HMO's and dentists rape patients, but the whole medical and private insurances as well.
although my dentist doesn't participate in managed care, i still have had the opportunity to know all about it. i truely believe that its wrong for a dentist to do unnecessarry procedure and i feel that eventually (in the long run) the dentist will come on top even under the managed care plan. so why not be a dentist that you once pledged to be?
P
PERFECT3434
i guess that was a though question to answer. or is there no dental pledge. but wait, i saw my dentists pledge hanging on a wall.
is the pledge just a formality?
is the pledge just a formality?
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