What Puts the Patient in the Chair?
Delta’s “Premier” is not “PPO”
Dental Insurance Today — February 2017
Having lived in a dental benefit family, as well as this industry, for the better part of the last 40 years, it has been rather eye opening for me.
As a preteen-age “plaster jerk” working in my father’s dental lab, I learned the importance of early stage preparation and execution. It’s the minor, often overlooked, details that will fail a case. Skip the prep of the impression, mix the stone inconsistently, pour the model incorrectly, misread the plain on a shallow margin and the die is wrong. When the die is wrong, the wax up, investment and casting will also be wrong. At this point, the ceramist has unknowingly already failed. When the little stuff gets overlooked or misinterpreted, it has a tendency to cause big problems down the line.
The reality of today’s uncertain healthcare marketplace is fueling consumers to rethink the significance of the once sovereign doctor / patient relationship. The ever evolving role of the third party payer is now more quickly taking precedence in the patient’s interpretation of healthcare and its dental component. Yesterday’s models of healthcare delivery are not applying to the wants and needs of today’s patient base. Now more than ever, savings, convenience and immediate gratification at the point of transaction motivates our patients. However, what about the point of transaction? Can it be saved?
Let’s break down the transaction into its various evolutionary phases so as to better grasp the root of this growing issue.
Point of Transaction
The traditional single-doctor dental practice remains, to this day, the standard by which dentistry is seen and measured. Take 1.2 dentists, add 1.6 hygienists, a clinical assistant or two, along with a pair of administrators, and you have a typical 4.6 chair dental office. Is this demographic delivery model an endangered species? Many in the profession say it is. But wait…
Now let’s take a second set of traditional single-doctor demographics and add it to the existing 4.6 chair facility. Essentially, we now have two complete office teams under one roof and operating as one entity. This small group working simultaneously has the ability to see and treat more patients at varied times of the day. This better serves the larger segment of the population than the traditional, single-doctor practice can working alone.
Tweak your employer and employee numbers, along with values, and we now have a small group practice ready to be part of a larger organization. This is referred to as either a Dental Service Organization (DSO) or Management Service Organization (MSO). Compare and contrast the two on your own if you so desire but, in a nutshell, the differences are basically in who actually owns what.
Is this the organizational model destined to take over the dental profession? Some say it is inevitable. Many have thrown up their hands in surrender while others have thrown up theirs in anticipated hopes of selection. Is the return to the point of transaction that which all of dentistry is seeking?
Is the private practice of dentistry soon destined to the same evaporating extinction suffered by Dr. Marcus Welby and Dr. Steven Kiley?
As yesterday’s naysayers speak gloom and doom with the passing of dentistry’s golden years, the entrepreneurial spirit burns bright in the next wave of organizational development. Dentistry and its most honored profession have yet to realize its greatest potential. This upcoming wave sees, and is building, its foundation upon the rebirth of the missing component. Through its void and led astray is the continued maturation of dentistry. The profession and association went one way, while its clients, customers and patients were continuing elsewhere to their own destination.
The future of dentistry is no longer based upon the fee for a crown. For all too long, dentists placed hollow value in their offices based upon the number of crowns delivered each week, month and year. Add a few more dollars to the mix and raise all your fees 3% a year, and your patients will follow you till the end of time. That was the hope and dream of yesterday that led dentistry astray. The concept that fee for service reimbursement was the only representation of quality was one of the final nails in its coffin.
You see, fee for service is not, and never was, a measure of quality. Quality is represented solely with, and by, the hands, eyes and soul of both the doctor and the patient being served. Fee for service is merely payment received based upon completed procedures. Put the widget in the box. Put the box on the truck. For each box you put on the truck, you get a single dollar. The more boxes you put on the truck, the more dollars you get. That is fee for service. The more you do, the more you get.
The failure of today’s corporate DSO and MSO concept is that they are still entrenched in yesterday’s failed concept of fee for service. All too often the treating dentist is “forced by fee” to over-diagnose, as well as over-treat, based upon the wants and needs of quota driven management. This, rather than delivering quality as well as appropriate patient care, is their Achilles heel.
Management cannot determine appropriateness in the absence of peer reviewed professional diagnosis. That is but one of the failures of today’s corporate delivery concept. With time, supply and demand will continue to change the scope and culture of this delivery system, bringing them back to their point of transaction.
Not far behind are some of the multi-doctor group practice models. Be they general or multi-specialty, they too place over relevance on the fee for service concept. They see that if the full UCR for a molar root canal is $1300, but the plan maximum allowable is only $900, they think they lost $400. If the office does three of those today, they think they threw away the entire fee for one more completed root canal. Was money lost doing the procedure at a reduction to the full fee? The only way they lost money was if the chair remained empty. The root canal was done for $900 because you did not have a patient ready, willing, and able to have the procedure for the full fee of $1300.
Now with the two previous examples, consider this: Are you doing that $900 endo with used recycled reamers and files because you are not getting your full fee? If the procedure fees were for a crown rather than endo, would you use a cheaper lab or send the case off shore? Please don’t think for a minute that this would be a reasonable solution. If selected treatments are in any way based upon reimbursement – everyone loses. Control is achieved in the appointment book and not the operatory.
The single doctor concept still holds the magical key to tomorrow’s continued entrepreneurial success. It is here where the basic fundamental building blocks that encompass the point of transaction were born, nurtured, matured and will continue to evolutionarily guide the profession.
The rebirth of the new, expanded single-doctor concept is rapidly approaching as a potential and viable dental delivery mechanism.
This administrative framework is not based on the individualistic fee for service concept, but does live and grow with its corporate DSO and MSO cousin. The main difference is that the dentist is paid to be a dentist rather than a piecemeal sharecropper paid a dollar for every box put on the truck. Think about how you pay your administrative team. Do you give them a dollar each time they answer the phone? Do they get another dollar when they schedule an appointment or collect patient copay? Now, how about your clinical team? Is an explorer worth more than a mirror?
When doctors are paid to be doctors, appropriateness of care returns to being paramount. Thus, the point of transaction becomes realized. What point of transaction?
I’m talking the doctor / patient relationship. Throw a pebble into a pond and the ripples radiate from the center point of impact. In the dental office, that point of impact or contact is the core of the doctor / patient relationship as everything we do is a result of the patient being in the chair.
So tell me, who is sitting in your chair – and why? Was it the point of transaction or the patient’s benefit plan?
Dentist chair photo ©2012-2017 EnchantedWhispersArt
“The Nation’s Leading Reimbursement Expert”
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