There is no question our dental profession as we know it is rapidly changing and business as usual will not suffice to remain on the cutting edge. The external force from "dental insurance," and the impact it is having on our profession needs to be explored. Dental insurance was hailed as a tremendous benefit for patients and doctors many years ago. Employers were able to provide a benefit to their employees that allowed them to gain access to the valuable benefit of preventative dental care and services for the treatment of dental disease. Another external force our patients face is that every product advertised in the media includes a beautiful smile elevating their desire for the services offered by our profession. The dentist has enjoyed the increased awareness of the patient base who are now able to seek oral health care through having dental insurance.
So yes, dental insurance has been part of a very successful partnership within the dental profession bringing a tremendously high level of oral health to many populations in our country that did not have that option previously.
But, where are we trending today?
The practices that Leadership by Design supports in transitions, growth and development reveal some very alarming trends that cannot be ignored. The scope of today’s article is to challenge you to do the following:
A full assessment in your practice of the facts for each insurance company you have signed a contract who is a participating provider. Does your insurance administrator have a current contract available to review the benefits between the patient and dentist? This needs to be part of her job description. As insurance companies hold the dentist accountable the dentist/staff must hold the insurance company accountable.
How can we do this effectively?
Intentional determination and persistence with accurate record keeping must be part of the process.
It starts with careful documentation of timely quality service received by various carriers:
The State Corporation Commission/Bureau of insurance licenses, regulates, investigates and examines insurance companies, agencies and agents on behalf of the citizens of the Commonwealth of Virginia. (https://www.scc.virginia.gov/boi) They are here to serve you when there is failure of insurance companies to deliver the contractual services agreed upon.
What are the write-offs from the fee schedule for various services?
The dentist must track this metric by each insurance company if they intend to make accurate decisions. How many patients have been seen in the last year under each contract? The dangerous trend I see in the wide scope of practices across Virginia is 25-50% write-offs are becoming common. The write-offs are approaching the total staff salaries and benefits in many offices. It is not uncommon for me to work with solo dentists who are writing off as much as $300,000.00 annually.
A dentist is not at the negotiating table when contracts are developed between the employer and insurance companies. The benefit package often plays second fiddle to the cost of the program when being evaluated by the employer. I served on a large school board for 7,000 employees and vetted health benefits proposals. The low bid for dental benefits often is awarded the contract. Neither the provider nor what they will be reimbursed for was provided. The dentist needs to understand the reality of the market place.
The fear that grips many practices is "I must participate even if I am not covering my expenses to do the procedures.” Many procrastinate on making the tough decision to drop programs that are not sustainable for a profitable practice. These kinds of important decisions require strong leadership that can lead both staff and patients. Do your patients come to you because you are on their insurance program or because your team consistently provides an exceptional experience every time they come to the office?
Creating this type of culture is critical in order to generate a strong "word of mouth referral" especially if you are considering the reduction of participation in different insurance programs. As mentioned earlier, starting with a fact based assessment and developing a solid plan is a good start that will take you in the desired direction. All aspects should be considered on an individual practice by practice basis with a clear vision laid out of what lies ahead. Where do we go from here?
A recent publication in the VDA highlighted a new business model bringing over 60 practices together providing strength in numbers. It is important to sit down with your insurance administrator to make sure it is understood that business as usual will not suffice. Provide him/her with the tools (contracts, training, etc.) to develop the communication skills with the Commission on Insurance when it is necessary.
Connect with ADA Benefit Plan Analyzer
This is a great benefit you have as an ADA member. For $160.00 this plan can be purchased through the ADA Store, and if applied correctly can be an outstanding business tool. They will run "What If" scenarios for plans you are either using currently or under consideration. Analyze the cost and benefit before you pull the trigger on participating with an insurance program. There are other roads to building your practice beyond saying “yes” to every insurance contract.
If you say yes, then train your staff to keep accurate records and hold the insurance companies accountable to the terms of the contract. Most offices are not maximizing the use of their software programs in filing for insurance. Turnover of staff often results in the loss of continuity in the use of software. Having a trainer come into the office annually canresult in an excellent return on your investment.
Ask yourself the following:
1. What is the current status of insurance in your practice?
2. What steps can you take to strengthen your position and not be a passive victim ?
3. Which resources can you use to increase your knowledge base to hold insurance companies accountable and develop your staff ?
It is a great profession, but it is not for the faint of heart. Explore your choices, develop your leadership skills and move forward with a plan. Please feel free to call for further conversation on this topic.
Dr. James R. Schroeder practiced dentistry in Richmond and is the founder of Leadership by Design. If you have any questions or would like help implementing a change in your office, contact Dr. Jim Schroeder at 804-897-5900 firstname.lastname@example.org.
Dr. Jim Schroeder is the Founder of Leadership by Design. He has been writing about leadership and organizational growth for over 30 years.
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