Managed Care

[1992Corolla]

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Just wondering what the general SDN consensus is on this topic. The article displays mine and I was curious.

Beware the growing allure of managed care.

 

[aphistis]

Just wondering what the general SDN consensus is on this topic. The article displays mine and I was curious.

Beware the growing allure of managed care.

Managed care is a terrible thing for the profession, and I intend to avoid it at all cost.

 

[armorshell]

Introducing a functionally useless third party into the doctor patient relationship, especially one that is solely interested in turning a profit, seems like a pretty poor idea to me.

I'll eat ramen for the rest of my life, I'll practice in the most barren part of the Alaskan tundra if that's what it takes for me to avoid managed care.

 

[gryffindor]

Good post on your blog, 1992Corolla.

This is an area I wish more dentists I meet would talk about their candid experiences with it. Dental insurance is any form (HMO, PPO, etc.) is not good for our profession. I cringe everytime a non-dental friend or acquaintance says "Oh, I have a GREAT dental plan!" I saw lots of these plans when I worked in NYC and I am doing my research to stay as far away as I can when I get out on my own.

I don't know why it's not obvious to dentists, some of the most highly educated people out there, that if no one signs up, then the plans wouldn't exist. To me, it seems like there needs to be more education at the dental school and residency levels to help the new grads better understand the intricacies of being a preferred provider so they don't get swayed by signing bonuses. I have been to a bunch of practice management lectures aimed at orthodontic residents, and none of them ever discuss what it really means to your bottom line to be a "preferred provider" for a PPO or HMO. In fact, at the AAO meeting this year, I attended a lecture aimed at office managers and other staff that discussed insurance benefits in detail and answered all sorts of complicated insurance questions from the staff members in the audience. I was surprised that there were almost no doctors in attendance - it's like the orthodontists didn't care and it was the office manager's job to "deal with the insurance" even though it affects how the doctor's business runs.

One aspect of all this that confuses me are the anti-trust laws that surround the whole issue. So we as dentists can't tell each other "Don't sign up" yet the insurance companies can continually stack the contracts in their favor and screw the dental providers because their pockets are much deeper than ours and it is hard for a single doctor to fight back without destroying his livelihood.

 

[1992Corolla]

All good posts. Would you guys mind spreading the word by mass emailing the article to your classmates? I think this is one way to decrease its popularity. If you are 'anti mass emailing' then at least forward the link to some of your buddies.

 

[Daurang]

Unfortunately, a bunch of you will owed $400,000 out of dental school plus another $400,000 for your sparkling new office. With few patients coming through the door, you'll be desperate to sign up for anybody and that's when dmo grab you by the neck.

 

[reapply2007]

One of the reasons dentistry is still a good trade is that it is largely small proprieterships and has the ability to avoid managed care and shady contracts. But you still need to pay the bills and stay proficient and getting an insurance company to pay for the top shelf procedures will eventually consume so much of your time it's ridiculous. The short term cash payout is tough to turn down.

 

[mg777]

yes managed is garbage and will ruin the profession if we have insurance companies telling us how to do our job. See what happened to the medical profession.
check out what's gone in Florida with pelican dental concepts, a great answer to managed care supported supported by the ADA

www.pelicandentalconcepts.



The American Dental Association supports fee-for-service and freedom of choice dental plans. The FDA has promoted Direct Assignment and Direct Reimbursement for many years because these dental benefit plans feature freedom-of-choice of dentist, fee-for-service and eliminate third party intervention with the doctor-patient relationship. It's this simple when it comes to Direct Assignment:

* Dentists may provide optimal and well-timed dental treatment based on plan designs. Dentists and their patients determine the best course of treatment - with no outside interference or unnecessary restrictions.
* Dentists may accept assignment of benefits, which can speed up payment instead of establishing complicated payment schedules with patients.
* Preserves dentist-patient relationship
* Reduces paperwork and red tape in the office
* No more calling for pre-authorization of treatment, pre-determination of benefits or submission of radiographs.

Dentists, who choose not to accept assignment of benefits, can receive payment directly from the patient and the Direct Assignment plan will revert to Direct Reimbursement - Here's How:

* Patient pays for services
* Patient remits standard ADA claim form directly to the plan administrator for processing
* Benefits are paid directly to patient, less any office visit co-payments that may applicable to the plan.

Dental offices have served as one of the best distribution points for educating the public about the advantages of DA/DR. If you would like to join us in the education of employers and patients please, contact us for more information or fill out a referral form.

View the Referral Form

 

[1992Corolla]

Unfortunately, a bunch of you will owed $400,000 out of dental school plus another $400,000 for your sparkling new office. With few patients coming through the door, you'll be desperate to sign up for anybody and that's when dmo grab you by the neck.

This is a valid point however it can be avoided if desired. My only response will be from a comment left by Teresa Duncan on the site where the article was featured:

Great points. There is also the very real administrative costs to belonging to the plan. When our offices participated with Guardian, Metlife, Delta and United Concordia PPO’s, the paperwork was considerably more involved than straight fee-for-service (FFS) plans. My boss was just starting out & yes, we needed to fill the chairs. We spent absurd amounts of time appealing denials and sending in paperwork that was “lost”. Don’t forget the cost of your staff duplicating radiographs if you’re not digital.

Denials of crowns and periodontal procedures would come back within 2 weeks - no way were they ever seen by a consultant dentist. When you send in an appeal they require a month for evaluation. A month to evaluate? But I thought you were able to evaluate and deny within 2 weeks? Frustrating.

Over the years, we got off the plans. You have to have your ducks in a row to get off PPO plans - it took us a lot of team meetings to get our vision and verbage down. More cost involved there too.

If you can avoid participating, there are ways to make it work. Too many people need dental care and there aren’t enough dentists. Your colleagues that join up right out of school aren’t giving themselves enough credit.

I can see where the new dental graduate can falter at the plans they offer, but in the long run they are doing themselves no good in my opinion. Just spreading the various issues of dentistry so when faced with this option, an educated decision can be made.

 

[Daurang]

True. A LOT of time and money and resource is spent appealing denials. I simply stopped doing it appeals and let the patients deal with it or they can pay for it themselves. It can take insurance 3-4 months to preapprove a crown and even then they'll repeatedly reject payment after you finish it and send them xray. They'll say they lost the preapproval or lost xray when you call 3 months later and there's not a dang thing you can do about it. With persistence, you'll eventually get pay after another 3-4 months. I've even had one insurance paid only for left side SC/RP but rejected payment for right side SC/RP on a patient who hasn't been to the dentist in five years. It's so ridiculously silly I just write it off as a loss rather than waste my time arguing and resubmitting.

 

[armorshell]

Unfortunately, a bunch of you will owed $400,000 out of dental school plus another $400,000 for your sparkling new office. With few patients coming through the door, you'll be desperate to sign up for anybody and that's when dmo grab you by the neck.

Ah, the beauty of being so densely idealistic that you're willing to cripple yourself financially to stick with your guns 👍

 

[fightingspirit]

....

 

[blankguy]

Does the fact that dentistry is overwhelmingly dominated by independent practitioners as opposed to MD which are significantly based in large groups(i.e. hospitals) have anything to do with this?

 

[KOM]

Where's the original article? Or is the article you're referring to just the article highlight you ahve on your webpage?

 

[doc toothache]

Managed care is a terrible thing for the profession, and I intend to avoid it at all cost.

All good posts. Would you guys mind spreading the word by mass emailing the article to your classmates? I think this is one way to decrease its popularity. If you are 'anti mass emailing' then at least forward the link to some of your buddies.

Introducing a functionally useless third party into the doctor patient relationship, especially one that is solely interested in turning a profit, seems like a pretty poor idea to me.

I'll eat ramen for the rest of my life, I'll practice in the most barren part of the Alaskan tundra if that's what it takes for me to avoid managed care.

Considering the fact that most of you have, as yet, not made it out the front door of a dental school, you appear to be present yourselves as pretty well versed on the nuances of dental insurance. In the Alaskan tundra one is more likely to have to settle for blubber rather than ramen. Whether we like or dislike traditional, PPOs or DMOs has little relevance. The decision of whether to accept or reject insurance assignments is solely a business decision that is borne strictly by an individual practitioner. Wishing to have a fee-for-service practice is one thing and accepting the reality of the demographics of the practice setting is another. A private practice in an area where within a 2-5 miles radius there is an overabundance of medicaid patients is not going be very successful unless there is a willingness to accept such insurance. If you wish to call out the National Guard to assist you in mass e-mailing, more power to you. To suggest, however, that those in private practice who accept insurance assignments posses less gray matter is, at best, disingenuous. If they are not particularly business savvy, they will soon find out the disadvantages of DMOs or PPOs.

 

[johntara04]

Considering the fact that most of you have, as yet, not made it out the front door of a dental school, you appear to be present yourselves as pretty well versed on the nuances of dental insurance. In the Alaskan tundra one is more likely to have to settle for blubber rather than ramen. Whether we like or dislike traditional, PPOs or DMOs has little relevance. The decision of whether to accept or reject insurance assignments is solely a business decision that is borne strictly by an individual practitioner. Wishing to have a fee-for-service practice is one thing and accepting the reality of the demographics of the practice setting is another. A private practice in an area where within a 2-5 miles radius there is an overabundance of medicaid patients is not going be very successful unless there is a willingness to accept such insurance. If you wish to call out the National Guard to assist you in mass e-mailing, more power to you. To suggest, however, that those in private practice who accept insurance assignments posses less gray matter is, at best, disingenuous. If they are not particularly business savvy, they will soon find out the disadvantages of DMOs or PPOs.

Doctors who take insurance are not doing the best they can for their patients. I don't know all situations, and I don't know all the reasons why docs want to/feel they have to/pressured into signing up to be providers, but once you start to accept insurance, you are no longer free to give your patients the best possible care. What is covered by the insurance co. becomes your treatment options while other, better treatment options are glossed over. It has happened in medicine, and if dentists continue to accept insurance, it will happen in our profession.

 

[doc toothache]

Doctors who take insurance are not doing the best they can for their patients. I don't know all situations, and I don't know all the reasons why docs want to/feel they have to/pressured into signing up to be providers, but once you start to accept insurance, you are no longer free to give your patients the best possible care. What is covered by the insurance co. becomes your treatment options while other, better treatment options are glossed over. It has happened in medicine, and if dentists continue to accept insurance, it will happen in our profession.

And you would know this because....

It is not the insurance company that dictates the treatment. The choice is made by the patient. They are the one who decide on what the final treatment modality is going to be. If patients are unhappy with the fact that some programs do not cover posterior composites and the procedures are downgraded to amalgams, they can choose to upgrade the treatment plan. Indeed some do, while others do not.

 

[diagnodent]

So what you are saying Johntara is that dentists who accept insurance are commiting ethical violations? I don't believe it. A dental student making ethical judgements on dental treatment. I find it funny that dental students are all knowing of managed care. I hate to break it to most of you, but you will be a prefered provider provider on many ppo's and many of you will be an hmo/dmo provider especially when you first start out. Anyone with 300+K in school debt who says no to managed care now will later realize it is needed to pay the bills.

 

[KOM]

In the Alaskan tundra one is more likely to have to settle for blubber rather than ramen.

We have caribou too on the tundra. 😉

 

[johntara04]

And you would know this because....

It is not the insurance company that dictates the treatment. The choice is made by the patient. They are the one who decide on what the final treatment modality is going to be. If patients are unhappy with the fact that some programs do not cover posterior composites and the procedures are downgraded to amalgams, they can choose to upgrade the treatment plan. Indeed some do, while others do not.

Most patients are not smart enough to know what will be in their best interest, especially when it comes to money vs. health care. Insurance takes away the credibility from the doctor and disregards his treatment plans. In a lot of patients eyes, "choosing to upgrade the treatment plan" is not a realistic possibility. So, they will do what is not in their best interest, not because they understand the treatment plan, not because they understand the ramifications of their decision, not because they trust the doc, but because Delta (an accountant) told them what to do.

 

[johntara04]

So what you are saying Johntara is that dentists who accept insurance are commiting ethical violations? I don't believe it. A dental student making ethical judgements on dental treatment. I find it funny that dental students are all knowing of managed care. I hate to break it to most of you, but you will be a prefered provider provider on many ppo's and many of you will be an hmo/dmo provider especially when you first start out. Anyone with 300+K in school debt who says no to managed care now will later realize it is needed to pay the bills.

You are putting words in my mouth. You can't deny being a "provider" takes away options when you treatment plan for those patients. Taking away options will sometimes take away an option that will be better for the patient. Doctors that are purely fee for service are better able to give their patients the best possible treatment, no matter what that is. You can't deny that.

 

[diagnodent]

Sorry Johntara but you backed yourself in a corner. You said, "Doctors who take insurance are not doing the best they can for their patients." That equates to saying they are commiting ethical violations.

It's very idealistic to say what you will and won't do while you're in school. I thought I was going to be pro baseball player in elementary school. I know you have so much experience in a ffs dental office, but that doesn't equate to knowing how to run an office on your own.

Why do you have such a paternalistic few of patients? You are not the all knowing dentist? Many factors play in to patient's life decisions. Getting breast implants is typically not a doctor's position it is a patient's decision, but is a medical procedure. Let patients make their own decisions, provided patients know the consequences of their decisions.

People will pay for what they want not what they need. That is the key.

 

[johntara04]

Sorry Johntara but you backed yourself in a corner. You said, "Doctors who take insurance are not doing the best they can for their patients." That equates to saying they are commiting ethical violations.

It's very idealistic to say what you will and won't do while you're in school. I thought I was going to be pro baseball player in elementary school. I know you have so much experience in a ffs dental office, but that doesn't equate to knowing how to run an office on your own.

Why do you have such a paternalistic few of patients? You are not the all knowing dentist? Many factors play in to patient's life decisions. Getting breast implants is typically not a doctor's position it is a patient's decision, but is a medical procedure. Let patients make their own decisions, provided patients know the consequences of their decisions.

People will pay for what they want not what they need. That is the key.

By saying "people will pay for what they want not what they need" you are are taking the responsibility off yourself and throwing it on the patient. You are the doctor, you know better. The patient doesn't.

Again, you are putting words into my mouth. That is simply your elaborate interpretation of what I have written. I have never said doctors are unethical because they are insurance providers. All I have said as a doctor, when you limit the treatment options your patients will realistically accept, you are, as I said, not giving your patients the best chance for the best possible oral health. You can't deny this. When you become a "provider" you limit what a large portion of your patients will accept when it comes to treatment planning them. Physicians complain about this all the time, how the insurance companies dictate treatment. You sit there and talk down to me, even thought I speak the reality of the situation. That is the way it is.

When you sign up for insurance, you are limiting what options your patients will accept when it comes to their oral health. This means allowing a patient to get a less than ideal treatment because that is what the insurance co. told them is better. You can't deny that (which you haven't during all of your soapbox speeches).

We as dentists, have nobody to blame for insurance dictating treatment and providing a situation where less effective treatment is done. It is our faults. If nobody accepted insurance, this wouldn't be an issue. We have brought this situation on ourselves.

 

[diagnodent]

I have to laugh at this, sorry, "I speak the reality of the situation. That is the way it is." You know the reality of private practice from a dentist's perspective? I doubt it because you are not a dentist. I'm not talking down to you on my soapbox I am trying to give you reality. If you graduate with 300K in debt you are going to have few options upon graduation. You along with many of those on this board will be working for a "western dental" or "Castle dental" so they can make their student loan payment.

I don't think managed care is bad b/c all social classes need acess to dental care. If everyone was ffs then your patient pool would be limited. Not every patient is ffs, there is a limited number of these types of patients. Many if not most patients are insurance driven. If you own your office then you are dealing with a health care business that is driven by profit. If the only way you can make a profit is to accept managed care then you do. Not everyone shops at nordstroms even though it is better than walmart. Get some perspective.

 

[Daurang]

Doctors that are purely fee for service are NOT better able to give their patients the best possible treatment. Doctors that are purely fee for service will more likely offer fraudulent treatment, expensive treatment, unnecessary treatment, and cosmetic treatment the patients may not need or don't even need.

Dental ppo are reasonable most of the time. If the patient doesn't want to pay out of pocket for what's not covered, then that's the patient's preference; it's unlikely this patient will ever convert to a fee-for-service patient anyhow and it's unlikely the patient will ever step feet in your office in the first place.

 

[docj1]

Doctors that are purely fee for service are NOT better able to give their patients the best possible treatment. Doctors that are purely fee for service will more likely offer fraudulent treatment, expensive treatment, unnecessary treatment, and cosmetic treatment the patients may not need or don't even need.

Dental ppo are reasonable most of the time. If the patient doesn't want to pay out of pocket for what's not covered, then that's the patient's preference; it's unlikely this patient will ever convert to a fee-for-service patient anyhow and it's unlikely the patient will ever step feet in your office in the first place.

Dental PPOs are not reasonable. If a patient doesn't want to pay out of pocket than that is their decision. Freedom of choice is a great thing. They don't have to go to a fee for service dentist. Actually now that I think about it, they lost their freedom of choice. If PPOs and HMOs went away, I feel sorry for the poor SOB that has based his patient population on the people who are looking for the best deal. Given the option most patients would prefer to have regular insurance, not PPO/HMO.

Saying that "doctors who are purely FFS will more likely offer fradulent treatment", shows that you have no clue how the system works. PPOs AND HMOs ONLY BENEFIT THE INSURANCE COMPANIES. That is fact.

 

[Daurang]

Of course ppo and hmo only benefits the insurance company and I abhor them just as much as you do. If your office is ffs-only and located or Beverly Hill or Sarasota, I am very happy for you. A vast majority of Americans just aren't so wealthy enough to have disposable income laying around waiting to pay for our "ideal" treatment plan. There is the ideal world and there is the real world.

 

[DrJeff]

Doctors that are purely fee for service are NOT better able to give their patients the best possible treatment. Doctors that are purely fee for service will more likely offer fraudulent treatment, expensive treatment, unnecessary treatment, and cosmetic treatment the patients may not need or don't even need.

Dental ppo are reasonable most of the time. If the patient doesn't want to pay out of pocket for what's not covered, then that's the patient's preference; it's unlikely this patient will ever convert to a fee-for-service patient anyhow and it's unlikely the patient will ever step feet in your office in the first place.

Back up the bus big time here! FFS docs are more likely fraudulent Lets say that you have a patient with extensive caries on #30 and an apical lesion with greater than 95% of the bone level around the tooth and #31 IS present. The FFS doc discusses endo/build up/crown with the pateint who opts for it AND the associated fees. The PPO/HMO doc with the same patient proposes the same treatment plam, but the insurance clinging patient declines that treatment because of a) the co-pay b) most PPO's/HMO's WON'T pay for a core build up😕 and c) the extraction will cost them less

Obviously there is NO implant OR bridge coverage for the HMO/PPO, so now you've extracted #30 and left them with an edentulous area, whereas the FFS doc has them restored in a fully dentate situation.

Also personally I've seen more questionably placed restorations from the HMO/PPO practices than FFS practices, its a volume thing IMHO. If you're charging less, you often need to make up the difference by billing more. Bills need to be paid if you want to stay in business afterall. And generalization can be great can't they

 

[Daurang]

I accept zero dmo and only two ppo so I didn't have to resort to the type of "overbilling" you were referring to. I take my "fraudulent" back and my apology.

I thought quite a few if not most ppo allow for implant and/or bridge nowadays. You mean I've been doing all these implants and bridges and not get paid for? I better go audit my office manager because I've been fooled.

 

[DrJeff]

I accept zero dmo and only two ppo so I didn't have to resort to the type of "overbilling" you were referring to. I take my "fraudulent" back and my apology.

I thought quite a few if not most ppo allow for implant and/or bridge nowadays. You mean I've been doing all these implants and bridges and not get paid for? I better go audit my office manager because I've been fooled.

Are they paying for the implant crown or implant body?? Crown only in my part of the world😡 And unless you're prices are ridiculously low and/or a few of your patients are lucky enough to have a dental insurance plan with a realistic yearly maximum, a big portion of that bridge your doing for your patient won't be covered either.

Now back to your original "fraudulent" FFS statement, if your referring to the folks that enjoy doing 20 veneers on a 20 year old who realistically just needs some bleaching and a little enamaloplasty and/or minor ortho just so they can get "pretty pictures" of their work up in some dental junk journal, well then I won't disagree with you. BIG difference though between a FFS "bread and butter" dentistry office and a FFS "dental spa" office.

 

[johntara04]

I have to laugh at this, sorry, "I speak the reality of the situation. That is the way it is." You know the reality of private practice from a dentist's perspective? I doubt it because you are not a dentist. I'm not talking down to you on my soapbox I am trying to give you reality. If you graduate with 300K in debt you are going to have few options upon graduation. You along with many of those on this board will be working for a "western dental" or "Castle dental" so they can make their student loan payment.

The bolded part in your paragraph is such a silly thing to say. To completely dismiss me, even though I have years of experience working the business side of dentistry, because I am not a doctor is laughable. Do you read dentaltown? Do you ever notice that a lot of the most informative posts on that site are not from dentists? They are from lawyers, office managers, assistants. You know the medical side of dentistry better than I do. That you know. You know nothing about my experience from the business side, and to make an assumption on that is silly.

Again, I am not stating the rightness and wrongness of the situation. Like the example Dr Jeff gave, when you become a "provider" you limit the options your patient has. That is what I am saying, and that is reality. You can't deny that, and you haven't.

I don't think managed care is bad b/c all social classes need acess to dental care. If everyone was ffs then your patient pool would be limited.

If everyone was ffs, your patient pool would not be limited at all. In fact, your potential patient pool would be larger, because nobody would kept out due to the insurance they carried.

Not every patient is ffs, there is a limited number of these types of patients. Many if not most patients are insurance driven.

If dentists didn't accept insurance, patients wouldn't have it.

 

[johntara04]

Of course ppo and hmo only benefits the insurance company and I abhor them just as much as you do. If your office is ffs-only and located or Beverly Hill or Sarasota, I am very happy for you. A vast majority of Americans just aren't so wealthy enough to have disposable income laying around waiting to pay for our "ideal" treatment plan. There is the ideal world and there is the real world.

You are not thinking about this properly. Insurance does not save the poor. If anything it hurts the poor by tying their hands when it comes to treatment they could receive. If every dental office was ffs, market place dynamics would still be in play. There would your stereotypical "Sarasota or Beverly Hills" offices, but there would also be "cheaper" offices. Not every dentist could/would be able to/would want to have an upscale office. FFS has not ruined dentistry, but insurance has the potential to. Look at the medicine side.

There is the ideal world and the real world, and the simple, real world fact is, if there wasn't dental insurance, all patients would have better options for their their oral health.

 

[johntara04]

Now back to your original "fraudulent" FFS statement, if your referring to the folks that enjoy doing 20 veneers on a 20 year old who realistically just needs some bleaching and a little enamaloplasty and/or minor ortho just so they can get "pretty pictures" of their work up in some dental junk journal, well then I won't disagree with you. BIG difference though between a FFS "bread and butter" dentistry office and a FFS "dental spa" office.

This is what I tried to say in the above paragraph. You just say it so much better than I do. 🙂

 

[1992Corolla]

KOM - If you really read the article then you would have seen that I highlighted an original article available only by subscription. I had access to it from one of my dentist friends but I have linked to the source of the article - The McGill Advisory - on the website. I merely highlighted the original article in my article. Sorry I can't make it available. You could try to email the McGill report and ask for a copy - the email correspondence I had with them was very professional and flexible. I am sure I could have reprinted the article word for word had I asked, but that was not what I wanted.

There is some interesting conversations going on. I like it. One thing I find is funny - there are always a few of you that are recently graduated or been in practice for a while and for some reason a 'better than thou' attitude is brought forth. Just because we are 'merely dental students' doesn't mean we don't know what we are talking about or that we can't discuss the relevant topics in dentistry. The argument 'You don't know anything about insurance because you are still D2' is silly. Granted, we don't know everything - no one ever will, but we still have a good grasp and this is one reason I think it is good to talk about these issues. How much better prepared for the real world will we be when we are faced with various choices and are educated in the decisions we have? Maybe this arrogance wasn't what you intended (those of you who responded this way), so I apologize if I took it the wrong way - sarcasm doesn't compute on the internet.

From this discussion I have some questions: These are serious questions.

Is there a way to survive in the dental business by having a practice located in a lower than average income level community AND NOT doing a managed care program?
If yes: What would it be like?
If no: Why pick an area like that to begin with?

If the answer turns to altruistic ideals - fine, but why not do two practices then? Have a normal practice in a nice neighborhood with a good patient base and then work the other lower income level two days a week?

Coming out of school with tons of debt: The majority of graduates have tons of debt, but not all of them chose these managed care programs and most of them do fine. Why would the significant amount of debt make someone choose a program that will most likely decrease their income over the next 5-10 years (as this is the way the managed care programs work)?

Lastly: I am not forcing anyone to email this article or discussion to anyone, but the more the word spreads the easier it will be to keep these greedy insurance companies out of the business - helping all of us - including patients. Email it or not, but many students and maybe many doctors don't know the crutch these companies make for them, if not the first year out of dental school, then later down the line. All my opinion, I am open for others and am willing to have my paradigm shift a little.😉

 

[DrJeff]

Is there a way to survive in the dental business by having a practice located in a lower than average income level community AND NOT doing a managed care program?
If yes: What would it be like?
If no: Why pick an area like that to begin with?

You just described many of the practices located in rural areas of the US. And in many cases, these are also some of the most profitable practices in the US also.

Small towns are generally fueled by small business which don't generally participate in major managed care plans. Believe me when I tell you as a small town dentist, I regularly get business owners asking me about the type of dental plans they're looking at for their employees, and I flat out tell them if they're looking at a managed care plan for their employees if they'd enroll in something for their business where the bottom line is your required to accept a HUGE discount off their regular fees. The business owners usually see my point quite clearly.

The big concept to get from this discussion may very well be that their ISN'T just 1 business model to use to run a dental practice. You need to be able to adapt to the area that you practice in, and no as much as you try, you won't be able to please every last patient that walks through the door, but generally you'll be able to keep a large percentage of them happy, and they'll keep coming back.

 

[doc toothache]

We have caribou too on the tundra. 😉

Ramen+ blubber+ caribou = variety = well balanced diet.

 

[doc toothache]

Just because we are 'merely dental students' doesn't mean we don't know what we are talking about or that we can't discuss the relevant topics in dentistry.

Email it or not, but many students and maybe many doctors don't know the crutch these companies make for them, if not the first year out of dental school, then later down the line.

And on which side of the equation is the arrogance?

To completely dismiss me, even though I have years of experience working the business side of dentistry, because I am not a doctor is laughable. You know nothing about my experience from the business side, and to make an assumption on that is silly.

Most patients are not smart enough to know what will be in their best interest, especially when it comes to money vs. health care. Insurance takes away the credibility from the doctor and disregards his treatment plans. In a lot of patients eyes, "choosing to upgrade the treatment plan" is not a realistic possibility. So, they will do what is not in their best interest, not because they understand the treatment plan, not because they understand the ramifications of their decision, not because they trust the doc, but because Delta (an accountant) told them what to do.
If dentists didn't accept insurance, patients wouldn't have it.

We have patients that are not very smart and are incapable of making a rational decision on their treatment options and we have the greedy insurance companies. Oh, and yes, we have a number of dental students and a resident who apparently have all the answers to managed care. It is also presumed that the smart dentists are those who are strictly ffs.
Does the greedy part of the insurance business apply only to dental and medical insurance providers or does the mix include say auto, fire, term life, disability, cancer, death and other type of insurance? Looking from the other side of the fence, one can certainly suggest that ffs dentists are greedy since we do not accept ppo/dmos because we are unhappy with not receiving our ucf.

As dental students you may well know enough about managed care to fill a small library, but without any practical experience, whether it is of one year or twenty, you are still left with zero credibility.

What you have left to learn in dental school is that your responsibility as practitioners is to provide patients with a diagnosis and offer treatment options with their concomitant advantages and disadvantages. It is the patient who is ultimately responsible for all treatment decisions. Upgrading a treatment plan is a realistic possibility. It is only a question of money.

And on the comment "If dentists didn't accept insurance, patients wouldn't have it." Isn't reality a beech? In the 80's the insurance industry predicted that 80% of the dental insurance would be DMOs. Guess what? It didn't pan out. Why? Because neither the patients nor the practitioners were happy with what they got. As a result, the popularity of dmos has reached a plateau where it is likely to stay.

 

[OceanDMD]

And on which side of the equation is the arrogance?






We have patients that are not very smart and are incapable of making a rational decision on their treatment options and we have the greedy insurance companies. Oh, and yes, we have a number of dental students and a resident who apparently have all the answers to managed care. It is also presumed that the smart dentists are those who are strictly ffs.
Does the greedy part of the insurance business apply only to dental and medical insurance providers or does the mix include say auto, fire, term life, disability, cancer, death and other type of insurance? Looking from the other side of the fence, one can certainly suggest that ffs dentists are greedy since we do not accept ppo/dmos because we are unhappy with not receiving our ucf.

As dental students you may well know enough about managed care to fill a small library, but without any practical experience, whether it is of one year or twenty, you are still left with zero credibility.

What you have left to learn in dental school is that your responsibility as practitioners is to provide patients with a diagnosis and offer treatment options with their concomitant advantages and disadvantages. It is the patient who is ultimately responsible for all treatment decisions. Upgrading a treatment plan is a realistic possibility. It is only a question of money.

And on the comment "If dentists didn't accept insurance, patients wouldn't have it." Isn't reality a beech? In the 80's the insurance industry predicted that 80% of the dental insurance would be DMOs. Guess what? It didn't pan out. Why? Because neither the patients nor the practitioners were happy with what they got. As a result, the popularity of dmos has reached a plateau where it is likely to stay.

Very well said. I am a "better than thou" practicing dentist as well, of course a ffs practice is the end all dream for a practicing dentist. I have major issues with insurance companies as well. It is known that the two highest sources of referrals for patients are #1-word of mouth internal, and #2- insurance driven(unless YOU DONT TAKE ANY INSURANCES). If you think you can graduate and open a 400k facility that is ffs(and dont tell me that you can do this with a starting cost of 200k because to entice ffs patients you need all the bells and whistles) you better move far away from cities and dental schools, and even then it is going to be tough to pay the bills.

But then again what do I know, I dont have as much "business experience" as apparently the others that express their opinions here.

 

[johntara04]

As dental students you may well know enough about managed care to fill a small library, but without any practical experience, whether it is of one year or twenty, you are still left with zero credibility.

LOL. Good for you all knowing dental god.🙄

 

[doc toothache]

LOL. Good for you all knowing dental god.🙄

You might want to consider saving your LOLs for a few more years when you could find yourself in your ffs office in Watts or a Monarch at the Castle in Beverly Hills.

 

[DrJeff]

You might want to consider saving your LOLs for a few more years when you could find yourself in your ffs office in Watts or a Monarch at the Castle in Beverly Hills.

Don't fear the wide open rural lands! They are your friends!😀

 

[johntara04]

Don't fear the wide open rural lands! They are your friends!😀

I found my town that I will open up shop in this weekend. 4,000 people, no dentist, and only 35 mins from a major city. Absolutely beautiful! 😀

 

[DrJeff]

I found my town that I will open up shop in this weekend. 4,000 people, no dentist, and only 35 mins from a major city. Absolutely beautiful! 😀

Sounds perfect! All you'll need to do is be a fair, good standing member of the community and you'll have a big percentage of that population in your office in a relative short amount of time.

Just hope your real good at putting names and faces together, since you'll be running into ALOT of your future patients around town😀

That's still my weakness, the name/face connection. I'll recognize most of my patients around town (at lunch, grocery shopping, at my kids daycare center), but the majority of the time I can't remember their names. The weird thing though is what I can often remember about them is what tooth I worked on last, what operatory I worked on them in, and which one of my assistants I was working with that day😕🙄 Something simple like a name, nope, the minutia, yup. Go figure!

 

[aphistis]

And on which side of the equation is the arrogance?

Oh, and yes, we have a...resident who apparently ha all the answers to managed care.

I don't know about arrogance, but I can tell you which side the snide condescension is on.

Can you point out for me where I said anything at all about having the answers? Call off the dogs, please.

 

[doc toothache]

I don't know about arrogance, but I can tell you which side the snide condescension is on.

Can you point out for me where I said anything at all about having the answers? Call off the dogs, please.

You are right. Your only association is to have declared "managed care a terrible thing for the profession". That must be why in what is probably a typical large metropolitan area you are likely to find 30-40% of dental providers accepting DMOs and over 90% accepting PPOs. Somehow they must have missed this pronouncement.

 

[aphistis]

You are right. Your only association is to have declared "managed care a terrible thing for the profession". That must be why in what is probably a typical large metropolitan area you are likely to find 30-40% of dental providers accepting DMOs and over 90% accepting PPOs. Somehow they must have missed this pronouncement.

Get a grip, man. We're talking about a measly difference of opinion--and what an emotionally charged topic, too--and you're acting like I maligned your mother's chastity. If you think managed care is OK, good for you. I disagree, but I'm not going to sit here and trade snide passive-aggressive insults with you like we're a pair of 8th-grade girls.

 

[doc toothache]

…the day managed care invades dentistry and dental specialties is the day I move to Europe or dubai.

After reading the article you may wish you had your bags on stand-by.

Get a grip, man. We're talking about a measly difference of opinion--and what an emotionally charged topic, too--and you're acting like I maligned your mother's chastity. If you think managed care is OK, good for you. I disagree, but I'm not going to sit here and trade snide passive-aggressive insults with you like we're a pair of 8th-grade girls.

To say that "managed care is a terrible thing for me" is one thing but to declare "managed care is a terrible thing for the profession" now that's a whole different species of animal. Enrollment in a residency program doesn't exactly make one qualified to declare what is best for the profession, presently numbering ~150K. Statements such as yours, "managed is garbage and will ruin the profession" and "if no one signs, then the plans would not exist" are particularly disconcerting since they indicate that there is a fundamental failure in understanding that access to (managed) care is not just about dentistry and dentists. It is also about the patient, the main protagonist in this drama. More than half of the U.S. population is enrolled in some type of dental insurance, 16% with DMOs and 34 % with PPOs. Some might even suggest that, as a profession, we have the moral obligation to provide care to all patients including those that are ffs, have DMOs, PPOs, indemnity insurance or no insurance.

Invoking a mother's chastity must be your gentlemanly way of extricating yourself from trading "snide passive-aggressive insults like we're are a pair of 8th grade girls" and elevating it to the level of professional-to-professional.

See Gordon Christianson, Coping with the changing state of dental managed care at http://jada.ada.org/cgi/content/full/134/4/507

 

[Ebull]

 

[kurt10]

brother 1992 cololla,

That managed care word is a swear word to my ears.

 

[aphistis]

After reading the article you may wish you had your bags on stand-by.



To say that "managed care is a terrible thing for me" is one thing but to declare "managed care is a terrible thing for the profession" now that's a whole different species of animal. Enrollment in a residency program doesn't exactly make one qualified to declare what is best for the profession, presently numbering ~150K. Statements such as yours, "managed is garbage and will ruin the profession" and "if no one signs, then the plans would not exist" are particularly disconcerting since they indicate that there is a fundamental failure in understanding that access to (managed) care is not just about dentistry and dentists. It is also about the patient, the main protagonist in this drama. More than half of the U.S. population is enrolled in some type of dental insurance, 16% with DMOs and 34 % with PPOs. Some might even suggest that, as a profession, we have the moral obligation to provide care to all patients including those that are ffs, have DMOs, PPOs, indemnity insurance or no insurance.

Invoking a mother's chastity must be your gentlemanly way of extricating yourself from trading "snide passive-aggressive insults like we're are a pair of 8th grade girls" and elevating it to the level of professional-to-professional.

See Gordon Christianson, Coping with the changing state of dental managed care at http://jada.ada.org/cgi/content/full/134/4/507

See my last post. Have a good weekend.