Bravo! Kudos to Lorraine Hollet and Dr. Pat Wahl for focusing on the right side of the equation. Too many dentists have a cost-cutting mentality - as opposed to a revenue-enhancing mentality. In other words, they think, "how can I save a few bucks?," as opposed to, "how can I increase my revenue base?" It only makes sense then that many view outside financing as an expense instead of a vehicle for increasing production.
Dentistry would be well served to look at the business practices of other elective medical specialties such as plastic surgery. Studies show that practices that utilize outside financing often see a 30 percent increase in production.
Yet perhaps the most compelling reason to require payment at the time of service is the big bite that "time" takes out of every dollar we produce. Inflation, lost interest, and the cost of envelopes, postage, staff time, and overhead robs us of approximately 7 percent each month. After one year, the uncollected dollar is worth only 26 cents!
Outside financing is a win-win-win - for the patient, the practice and the doctor.
Jon Norton, DDS
Enhance Patient Financing
Debating Dr. Hamric
In his article "Gross a Million ellipse Send No Statements" (November issue), Dr. Hamric makes some very good points. His advice on building trust and rapport with patients and having a highly skilled staff person making good financial arrangements is right on the money. He also gives some advice that is not only wrong, it may lead you into very serious financial difficulties. Dr. Hamric's advice to fire your consultant if he or she tells you one-and-a-half month production in accounts receivables is OK may be very short-sighted.
I have studied management with the Pride Institute for the last six years and have been enormously pleased with what it has done for my practice. The consultants for the Pride Institute do espouse that receivables in the range of one-and-a-half to two months production may be OK. Firing them would have been one of the worst decisions I could have ever made. Not only have they helped me double my practice - while working no evenings or weekends, taking over six weeks of vacation per year, not participating with any insurance plans, and working only 165 days per year - but they have taught me to really understand the numbers that drive our dental businesses.
The advice that I find dangerous to your financial health is using an outside credit source with any patient, including those who receive a reduced fee through some insurance provider agreement. Non-recourse credit provided to your patients will result in a fee to you that will be as high as 10 percent. This discount, added to a fee reduction through a provider agreement, will have a very major negative impact on your net income. If your office overhead percentages are in the average range, a 20 percent discount of your fees will result in a decrease in your net income of 70 percent! Following this plan is a way to gross $1 million and net not very much! For another financial agreement option that you may want to offer to selected patients, see my article in the February 1999 issue of Dental Economics, "The Collection Rate Of Your Dreams." You can save yourself a 10 percent fee by offering an auto-debit program to credit-worthy patients.
Finally, I would debate Dr. Hamric's statement, "The only money that should be on your books is what is outstanding in insurance. That's all - no debate!" After 20 years of practice, I have many wonderful patients that will scrupulously honor a well-constructed financial arrangement and are far more deserving of an extra two or three weeks to pay than any insurance company that I can think of. I would hope that you do too.
Michael Gradeless, DDS
More on evidence-based care
I read with great interest the article by Vicki Anderson entitled "Evidence-Based Care." Indeed, this twist on reimbursement by the dental insurance companies is a troubling concept. Evidence-based care originated in the medical reimbursement arena and appears to be another means to control costs. Once again, insurance carriers are attempting to apply cost-control concepts that have been successful in medicine to dentistry. Fortunately, we have several things going for us. The first is that we are independent of the hospitals. The second is that dental care has kept pace with inflation. Finally, preventive dental care has been an overwhelming success.
In the past two decades, hospitals have formed alliances with insurance carriers to limit costs and ensure the capture of a particular HMO's patient base. Without legislation that binds us to the insurance carriers, we, as dentists, have the ability to walk away from any plan that we feel is not beneficial to our practice. Since we are independent, we have a choice in how much influence the insurance companies have in our lives. In my state (Michigan), we have had a dominance of dental insurance since 1974. In the past several years, I have spoken with many dentists who are no longer accepting assignment from insurance companies. These dentists are still practicing and claim that they have fewer headaches and lower overhead. As a group they are all walking around with smiles on their faces. Maybe there is something to this! I think that Linda Miles is correct in the sidebar to the article when she says that if the dentist says "no," there will be no dental PPOs, HMOs, etc. I would also agree with her statement that many dental plans are a joke. In my practice we have been limiting the plans for which we will accept assignment. Surprisingly, there have been few that have gone elsewhere.
The second point is that dental care is relatively inexpensive. We know that dental treatment has - for the most part - kept pace with inflation. Also, the emphasis on prevention has saved the public billions of dollars over the past 50 years. Since most insurance plans will cover a maximum of $1,200 to $1,500, it is not really that much of a benefit in today's economy. The result is that by not keeping up with inflation, the insurance carriers have lost a tremendous advantage. If the insurance companies had adjusted for inflation over the past 25 years and they were allowing up to $6,000 per year, it would be more difficult for the patients to see a practitioner who is non-participating or out of the network. Because the annual maximum is so low, many treatments - such as a root canal and crown or third molar extractions - exceed this maximum. In many cases, it is not too much to ask the patient to pay for the service and be reimbursed by the dental carrier.
Evidence-based care as described by Ms. Anderson is particularly troubling because the choice is removed from the clinician and patient. The insurance company uses statistics and outcomes rather than scientific data and clinical experience to dictate how you should treat your patients. Preventive care has been the hallmark of dentistry and demonstrated a remarkable improvement in the health of the population. To suggest that preventive care be limited in order to reduce cost is both short-sighted and incorrect. Obviously, this ultimately would be a boon to my oral surgery practice because I would see an overwhelming number of caries under existing restorations and periodontally involved teeth. Evidence-based care would not allow these problems to be picked up on routine examinations. I see numerous patients with the above-mentioned problems because they have stopped going to their dentists on a routine basis.
In summary, I feel that this is yet another attempt by the insurance industry to reduce costs and increase profits at the expense of the patient and dentist. We should be glad that we are not in the same situation as physicians where they have little armamentarium to influence decisions by insurance companies. Evidence-based care appears to neglect prevention in favor of symptomatic treatment. If you find that the limitations placed on your practice by insurance carriers are too difficult, you have a choice - you can treat your patients without accepting assignment.
Paul M. Flynn, DDS, MBA
Policy coverage is the key
In her article, "Evidence-based care," (November issue) Vicki Anderson concludes, "Dentists will be pressured into doing more extractions and removable dentures. They will be considered more cost-effective than crown-and-bridge or endodontic procedures." I disagree and argue that dentists who educate properly, establish rapport with their patients, and minimize the impact of insurance on their practices will recommend what is best. Dentists should not make treatment decisions for our patients based upon their policy coverage.
Frank Finazzo, DDS
A new name
Dr. Bill Kimball's excellent article on application service providers (ASPs) in your November issue provided a clear, thorough explanation of why ASP technology has taken off in so many industries, and the potential it has to reduce practice management system administration headaches - and costs - for dental offices.
One of the ASP solutions mentioned in your article is vDentist.com, which was renamed PracticeConnect in September, when dentalxchange.com acquired software vendor Dentisoft. Interested readers who want more information on PracticeConnect are invited to visit www.dentalxchange.com or call (800) 624-2904.
Manager, Marketing Communications
Opportunities are needed
I would like to respond to Dr. Paul Homoly's recent article titled, "Is it time for a new gig?". I am a 42-year-old dentist with 16 years in private practice. Three years ago, I had to make the difficult decision to leave clinical dentistry due to an irritating nerve injury in my left arm. Armed with a professionally written resum
Education - "We are indeed in a crisis," says Richard W. Valachovic, DMD, MPH, executive director of the ADEA, when asked to describe the attrition rate of dental school faculty. More than 400 budgeted full-time dental faculty positions are currently available.
Dental schools do not have a cohesive widespread recruiting plan, thus look only to graduating students as their pool of talent. Teaching positions usually require some advanced dental education and/or research experience. A master's degree is essential for advancement. Schools ask for applicants to be licensed or eligible for licensure in their particular states. An experienced dentist looking to leave his or her clinical career is clearly at a severe disadvantage in vying for clinical teaching positions and graduate study programs.
Dental sales, practice management, and/or insurance consultant - The golden skills we possess are correct, but are not acknowledged by human resource managers and non-dental industry leaders. The questions they ask are "Why did you ever leave clinical dentistry?" and "What skills do you have that would be of benefit to us?" They act like I'm crazy to even apply to their companies. The corporate response to the skills we possess is that we are terrible leaders and most of us are practicing in the Dark Ages. We are considered followers. Manufacturers and distributors can hire key influencers in our profession and we will follow - it's as simple as that. The skills we possess are of little value in their world and it is easier for them to train people in product knowledge than it is in business/sales knowledge. Wow!
I am glad that Dr. Homoly's friend, Dr. Medford, was able to work passionately in another career. My passion remains dentistry. Unfortunately, due to a disability, I can no longer practice clinically. Do I have to give up my passion? Does my education and experience have no value? The American Dental Association is well aware of the need to address the reality that many dentists are seeking guidance relative to the process of changing careers. The unofficial number of disabled dentists alone in the United States is 10,000.
In the American Dental Association's "Alternative Dental Career Packet," it states the following: "Dentists are highly trained to practice clinical dentistry. The relevance of that training drops off precipitously when one seeks a non-clinical career. Because career opportunities available in clinical dentistry are relatively few, you may wish to consider a complete change in direction."
It is time for organized dentistry to use its position of power and address alternative nonclinical careers in dentistry with nonclinical dental industry leaders. To attract the brightest students to our profession and to help bring purpose back to many of our professional lives, we must require that the dental industry offer us the opportunity to expand our skill sets within its companies. In the process, dentistry is diversifying. We are broadening the scope of our education and increasing its value.
Douglas J. Brown, DDS
Responding to a letter
This letter is in response to the letter by Joseph P. Graskemper, DDS, JD, published in the November issue. My article "Your worst nightmare" was meant to educate dentists. Most dentists feel a malpractice suit will never happen to them. As an independent dental examiner, I also consider myself an advocate for dental excellence.
I take offense to this letter, particularly because of your law degree and four dental fellowships, to the partial quote you used in your letter. You, of all people, should know better than to misquote and only use partial quotes because of the legal ramifications involved. This makes me question your credibility.
My full statement was, "As an independent dental examiner, I have to opportunity to examine your record-keeping, radiographs, treatment plan, the execution of your treatment plan, patient information, and how you handled any complications that might have occurred. I get to scrutinize your treatment of a patient from the first time this person entered your office right up until the time the patient requested his or her records. If I accept a case, I truly and honestly feel the dentist has treated a patient in a substandard way."
If I "feel" (sorry you do not approve of my terminology) that a case is worth accepting because I have scrutinized every piece of documentation available to me, as mentioned in the complete quote. I also request additional crucial information that may be missing at the time of my evaluation. My acceptance of a case is based on research and facts which lead to my "feelings" about a case. My "feelings" are based on the facts.
As for an independent dental examiner being your best friend, that is absolutely true. Of the cases sent to me by attorneys, I "felt" more than 30 percent were fraudulent claims after reviewing the facts, and would not accept working on the case. I advise these attorneys drop these cases based on their lack of credibility.
Allen Kaufman, DDS