The PPO Goliath

What can one practice do against the PPO Goliath? Dental Economics’ Chief Editor Dr. Chris Salierno says: “We can fight. Together. We can choose to no longer accept the shrugs and groans of indifference from our defeated colleagues. We can choose to play by new rules. We can leverage our combined strengths. We can fight for the rights of our patients.”

In his 2013 book David and Goliath: Underdogs, Misfits, and the Art of Battling Giants, Malcolm Gladwell sought to understand how the terrifying odds of a battle can be turned upside down. He reminded us that David didn’t win his fight against Goliath by playing by the giant’s rules. Gladwell believes underdogs should be courageous, think outside of the box, and, sometimes, turn their greatest weakness into their greatest asset.

I’ve certainly felt like David when my office manager presents me with yet another strip of red tape imposed by a third-party payer. I’ve felt powerless when patients blamed me for not having anticipated an obscure benefits rule that denies coverage for legitimate care. What can one office do against the PPO Goliath?

We can fight. Together. We can choose to no longer accept the shrugs and groans of indifference from our defeated colleagues. We can choose to play by new rules. We can leverage our combined strengths. We can fight for the rights of our patients.

I can hear some of you crying out that acting together against third-party payers would violate antitrust laws. That can be true. In 1986 the Supreme Court agreed with the FTC’s claim that the Indiana Federation of Dentists was in violation of the Sherman Act when it required its members to withhold radiographs from third-party payers, who were making alternate benefit decisions. But that doesn’t mean dentists can’t organize and fight unfair PPO practices. Just last year we saw the California Dental Association successfully settle a lawsuit against Delta Dental of California regarding contract violations. And there are other battlegrounds in Washington, Massachusetts, and elsewhere.

This issue collects different stories about the PPO landscape. Authors share their frustrations and offer insights on how to play the game better. But I’d like for those of you reading these words right now to take things a step further. Reach out to your local dental societies and start a dialogue with your fellow colleagues. Let’s identify the areas where third-party payers are overstepping, interfering with the doctor-patient relationship, or even breaking the law. We can fight Goliath together.

Cheers,

Chris Salierno, DDS

csalierno@pennwell.com

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