Carol Tekavec, RDH
In the world of managed care and insurance, there is a rule of thumb concerning patient subscribers: Given enough time, people`s perceptions of what actually is happening can be changed.
In the world of employers and employee benefits, there also is a rule of thumb concerning health-care delivery. This rule says: Health care is a commodity and all providers are the same.
The two perceptions work together to shape the expectations that consumers have concerning health care in general and dental care in particular. Dentists and dental-service purchasers often are on opposite sides of the expectation spectrum. Our perception of what is happening involves our own prejudices and fears; employer-purchasers look at providers and treatment options in a pragmatic way.
Dental personnel understand the vast differences that can characterize treatment from one office to another. Purchasers of dental care react to office differences at the bottom-line level - i.e., what will treatment cost. Both groups have a different perception of what actually is happening in the dental-treatment arena.
Dental care and roof repair
Dental-care purchasers do not believe that health care is exempt from economic principles that govern all service businesses. They point to challenges that face most in these industries, be they dental providers or roof repairmen:
1. A lack of consumer knowledge concerning the service being purchased.
When a hail storm damages a roof, the consumer must rely on the expertise of the repairperson concerning what needs to be done and how much the repairs will cost. Few consumers have any knowledge of roofing materials, estimated time for repairs or costs of supplies. They must rely on the roofer to provide both the information and the repairs. While there is a vague consumer perception that one roofer might provide a better roof than another, consumer capacity for evaluating the job performed is generally lacking.
In dentistry, there is some consumer knowledge of dental treatment and dental-health principles, but it varies widely. Few patients have any knowledge of dental materials or techniques, estimated time necessary for restorations or the costs involved. They must rely on the dental office to provide both the information and the treatment. While there is a general consumer perception that one dentist might provide a better treatment plan than another, patient capacity for evaluating dental care is minimal.
2. The use of specially-trained persons to provide the service.
Persons repairing a roof must have knowledge, gained by training or experience, in how repairs are made. Dentists require years of special training; staff members have varying amounts of education.
3. Liability for inadequate performance of a service.
If a roof is repaired in a shoddy manner, the next time it rains the roof may leak. The roofing company would be liable for any damage caused to the house. If a patient receives dental treatment that is later determined to be inadequate, the dentist would be liable for damages caused by the treatment.
Does this mean that dentistry and roof repair are the same in the perception of the public? In many cases, the answer is "yes." However, to use the same premise embraced by managed care: Given enough time, this perception can be changed.
It currently is estimated that 45 percent of the total U.S. population, or 117 million persons, have dental benefits. Of this 45 percent, one-third are enrolled in dental HMOs and PPOs. Employers feel that 80 percent of their employees will continue to follow the benefit dollar. (Current managed-care industry thinking is that it takes only $10 less in premium-cost-per-month to move an employee family from one medical primary-care physician to another. Employees are regarded as having even lower dental expectations and loyalties.)
But, times are changing. Employers are beginning to recognize that they may be paying for managed-care services that their employees are being prevented from receiving. Health-care anecdotes regarding barriers to treatment already have resulted in legislative changes. General feeling about quality concerns are giving rise to a demand for increased methods of evaluating dental plans on the basis of expanded standards and not just cost alone.
Employers want useful measurements that must include the anecdotal experiences of patients, but contain wider bases of information.
Credentialing of health-care providers and health-care plans is likely to be an employer desire for the year 2000 and beyond. Standards will include criteria concerning technical ability, patient perceptions and appropriateness of care.
Where will the standards come from? One organization among several already providing credentialing is the Insurance Dentists of America (IDOA). The IDOA has a database built on claims data from individual dentists providing treatment partially paid for by traditional insurance and PPO plans. Every year, millions of procedures are tabulated. Information, such as individual utilization rates, practice patterns and malpractice experience, can be provided.
Cost and quality
Three factors influence the cost of both dental treatment and roof repairs. They are: 1) the type and extent of the service, 2) the frequency of the service and 3) the expense for personnel and materials. While cost is important to consumers considering dental care and roof repair, a fourth factor significantly influences the equation. That is, how good will the service be?
Credentialing and cost may persuade consumers to try one provider over another, but perceptions of quality will convince them to stay. When choosing a dentist or a roofer, consumers rely heavily on word-of-mouth referrals from others. If the service received is satisfactory, the consumer tells several other people. If the service received is unsatisfactory, the consumer tells even more people.
If a roofer is associated with a certain insurance company and has contracted to provide repairs on a limited-cost basis, many consumers initially may engage that roofer. If the services received are poor - even if the roofer has all the "right" credentials - consumers may complain to the insurance company and refuse to sign up with the roofer in the future. The roofer may obtain a bad reputation and lose business despite his association with the plan.
If a dentist is associated with a certain dental plan, many patients initially may come to that dentist`s office. If the services are perceived as poor - even with the "right" credentials - patients will complain to their employer and the insurance company and refuse to see the dentist in the future. The dentist may obtain a bad reputation and lose business.
Both of these scenarios are basic to the free-enterprise system. Regardless of payment mechanisms and restrictions, there always will be room for excellent roofers and excellent dentists. Consumer perceptions of what really is occurring will support them and help them succeed.
Carol Tekavec, RDH, is the author of two insurance-coding manuals, co-designer of a dental chart and a national lecturer. Contact her at (800) 548-2164 or at www.steppingstonetosuccess.com.