So, it seems like the trends in dentistry are either to be a low-volume FFS office or a PPO/Medicaid mill.
My question here is, how the following business model works? I know maybe 1 or 2 dentists who practice this way and seem to highly enjoy it. I haven't asked them about the details, though, so was wondering if anyone here would have any experience regarding this model.
How about the very small, 2-op dental office with maybe 1 front desk and 1 RDA just doing good ol' general dentistry? Even if you were in-network with most insurances, if you produce much less than you would in a mill setting, you could still possibly walk away with the same amount of gains for yourself after overhead.
Thoughts on this approach? I have a feeling this model would make practice more enjoyable.
First of all, there is no such thing as PPO/Medicaid mill. PPO allows the patient to go to any office; HMO assigns a patient to an office. Medicaid programs like Denti-Cal are mostly for community centers or FQHC's, although a few private offices elect to take accept them. Reimbusment-wise, it's typically PPO>HMO>Medicaid. I say typically because there are numerous coding and billing acrobatics of variable legal and ethical caliber that can be applied to all three models in order to increase revenue.
There are FFS offices that are either completely out of network w/ PPO insurances are in network with with one major player only. I generally consider an FFS office to be one that is at least 50/50 in-network/out-of-network. Then there are PPO offices, those that have FFS less than 50% and are very insurance heavy (in-network with many PPOs). This is important to understand that ALL FFS offices accept PPO insurances. HMO insurance offices may also accept PPO plans, but those are typically lower tier practices (otherwise, they would drop HMOs). By lower tier I don't necessarily mean lower quality work, just different treatment portfolio.
The approach that you describe doesn't make any sense. I will venture a guess that you simply misunderstand their business operations. 2 op office means the following - very limited number of active patients; almost no ability to double-book, take on ERs, and see walk-ins; high probability of the DDS doing their own hygiene (which is a production killer), among many other limitations. Lack of more ops doesn't mean that your overhead is much lower. If you have 4 ops, you can still have only 1 front desk and 1 RDA. The biggest red flag in your "model", however, is being in-network with most insurances, which means you are not an FFS office by definition.
In closing, I will leave you with two advices.
One, forget the word production as a marker of success. I consult on this stuff for a living and it's the biggest mistake I see all docs make. When I hear "production", what people actually mean is "collection", which, in business terms = Revenue. Revenue is only 1/2 of the equation for Profit, the over is "Expenses". So, don't worry how much you produce, rather worry about what you are left with after your expenses.
Two (this one is more important) - you are a dental student, so focus on clinical education and get clinically the best you can be. You can muse over business and practice models when you are out in the field for a year or so. Otherwise, you'll waste hours creating imaginary worlds where PPO/medicaid offices exist.
