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New services, less reliance on PPOs marks success in 2021 and beyond

June 1, 2021
Dental practices that have thrived during the pandemic and into present day have a few things in common: diverse service offerings and decreased reliance on PPOs. If your practice relies on insurance/PPOs for most revenue, it might be time for a change.

What have we learned about ourselves and our practices from the cataclysmic events of 2020? Perhaps the primary lesson has been that as dental practice owners, we need to be quick to adapt to new stresses, conditions, and challenges, or our businesses will go by the wayside. We also learned another important lesson during this time: PPOs are not going to save our practices.

Now, with the benefit of some hindsight, we have a clearer picture of which dental practices really suffered financially and which practices were able to not only survive but thrive through 2020 and into the future. The results have been surprising.

Reliance on PPOs

Quick disclaimer: this article is not at all an argument against dental insurance or PPOs—both certainly have value for many practices. I do not advocate making dramatic changes to participation in these plans without a well-thought-out strategy ahead of time.

The first lesson is that dental practices built primarily on insurance and PPOs that mostly cover basic dental services and emergencies saw a large decline in patients and revenue as patients put off dental visits for as long as possible. We have certainly seen this trend continue into 2021. As I have described in Dental Economics articles from earlier this year, dental practice revenue plunged during this time and is only now starting to show signs of life and is still nowhere near what it was in January 2020. How long will revenue numbers take to recover? The truth is, no one really knows. Most likely, it will be quite a while.

COVIDomics in dentistry

Patient loyalty

Second, when it comes to patient loyalty, every dental practitioner who accepts insurance and participates in PPOs understands that patient loyalty only goes as far as the PPO list of dental professionals. These patients are not invested in your practice as much as you would like, and to think otherwise is a fallacy. Most dentists, including those in our own dental group practice, expect to see a January patient migration as patients are given new insurance and PPOs that we may or may not be affiliated with. Even if your practice is on a patient’s plan, in their minds, patients aren’t going to put their lives at risk to come into the dental office during a pandemic unless it’s an emergency.

How many times have you heard, “I really love your practice and would stay with you if you were on my new PPO doctor list.” We always let patients know that our doors are open for them to return, but ultimately, they follow their pocketbooks—you would, too!

What patients want

Now let’s look at dental practices that have done well during the pandemic and into 2021. Elective esthetic services which could be delivered safely exploded during 2020 and continue to be popular now. This is because patients with disposable income have had limited options for spending; thus, many decided to invest in their own facial esthetics. These procedures include dental whitening, Botox, dermal fillers, and PDO thread lifts. From a dentist and patient’s perspective, these treatments are much safer to accomplish than general dentistry; there are no aerosols, masks can stay on for many of these treatments, and the appointment time is anywhere from 5–30 minutes. Many of these patients were discovering facial esthetic treatment for the first time as they could experience procedures such as lip enhancements and lip/smile line improvements to make themselves look better and feel better during a difficult time. When it comes to patient loyalty, if you have received comprehensive live patient certification training and are able to deliver the best esthetic and therapeutic treatment outcomes, your patients will never go elsewhere. None of these services involve insurance or PPOs; they’re paid for by patients.

The Zoom boom continues

Consumers spend so much time on Zoom, being basically forced to look at themselves, and many don’t like what they see. This has driven patients to seek out facial esthetic services more than ever before. Dentists who added Botox, dermal fillers, and solid filler PDO threads to their list of services before the pandemic ended 2020 in much better shape financially than insurance/PPO dental practices, with many of them seeing the same revenue levels as 2019, even though they were closed for two months.

Let’s take a look at 2021. Insurance- and PPO-based dental practices are still struggling to recover. In the first quarter of 2021, data from a recent American Academy of Facial Esthetics (AAFE) member dentist study shows that Botox, dermal filler, and PDO thread services are up between 30%–48%.1 Some possible reasons include: more people being vaccinated, disposable income with fewer options on where to spend, masks coming off where appropriate, people getting out more to see friends and family for the first time in a year, more live events like holiday and wedding gatherings, and readiness to invest in facial esthetics more than ever before.


1. Unpublished internal American Academy of Facial Esthetics (AAFE) member study. March 31, 2021.

LOUIS MALCMACHER, DDS, MAGD, is a practicing general dentist and an internationally known lecturer and author. Malcmacher also serves as president of the American Academy of Facial Esthetics (AAFE). You can contact him at (800) 952-0521 or email [email protected].

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