Letters from Readers

Aug. 1, 2001
An eye-opener: two fee schedules
I'm sending in my Fee Survey. My question and frustration revolve around this topic and a related article in April 2001 Dental Economics suggesting yearly 5 percent fee increases ("Answering Some Questions About Fees," by Carol D. Tekavec, RDH).
An eye-opener: two fee schedulesI'm sending in my Fee Survey. My question and frustration revolve around this topic and a related article in April 2001 Dental Economics suggesting yearly 5 percent fee increases ("Answering Some Questions About Fees," by Carol D. Tekavec, RDH).

Since October, I have been trying to get my "yearly" fee schedule updated with Delta. Government data from the Internet benchmarked the increase in the most recent cost of living for this area as 5.5 percent. I applied for an across-the-board 5 percent increase and was told that it was 4.09 percent above acceptable levels. Five subsequent resubmittals with decreases in fees for 94 codes still leave me above "acceptable fee levels" and not covering the increased costs of doing business. All this with an unapproved 3 percent increase of $20 to my $725 crown fee, while a new associate who just joined Delta gets his $860 fee approved!

It is easy to advise leaving Delta, but when 70 percent of your patient base is with one insurance carrier, it is difficult to terminate that carrier. Letters to the California Dental Association over the last three years have been censored from their publications, and related letters to the AGD and the ADA have been ignored.

No one seems to stand up for dentists against a monopoly that enjoys favorable legislative conditions and status. Maybe you could be a clearinghouse to let individuals know what help is available in our stuggles not to be steamrolled by this Goliath. Elder members owe it to the profession not just to "hang in there until retirement," but to get the playing field leveled.

It might be eye-opening to ask for data on two fee schedules: the UCR schedule and the Delta schedule.

Michael G. Cook, DMD, FAGD
Milpitas, Calif.

Editor's Note:Great idea!

A fabrication?G'day, Mates. 'Ow yer doin' ...

I served as "ship's dentist" aboard The Island Mercy in the South Pacific from March 1997 until Nov. 1998, so Holland America Lines' dental program as described in Dr. Begalla's article in Dental Economics (January 2001 issue) sounded like a most interesting adventure.

I wrote to Holland America Lines twice, to Dr. Begalla, and to his hygienist who actually got the credit for writing the article. I didn't get even one response!

My opinion is that Holland America's dental program aboard ship does not exist now and never did — that the whole story carried by Dental Economics was a fabrication to provide free advertising disguised as a news article. How much kickback was there to the editors?

George W. Karr, DDS
Warsaw, Mo.

Editor's Note:I guess I missed a chance to cruise!

A standing ovation is in order!In response to Dr. Jack D. Griffin Jr.'s "If Mama Ain't Happy ... Ain't Nobody Happy" article in May 2001 Dental Economics, a standing ovation is in order!

I have been a registered dental hygienist in Georgia for nine years. I have worked for three different dentists, only one of whom has come anywhere close to being the type of doctor described in the article.

Dr. Griffin is to be commended for pointing out to dentists the downfalls of not caring for their staff. I, too, believe that if the staff is happy, the patients will be happy, in turn making the practice run more smoothly and productively.

I made this article available to my current employer in hopes that he gets the hint. Voiced requests for raises, benefits, etc., have gone ignored. As I write this, I am in the process of leaving this practice.

Doctors, take care of your staff, and they will take care of you. Praise them often, reward them regularly, and make yourself available to solve any conflicts that arise. Use the Golden Rule as your office motto: Do unto others as you would have them do unto you ... and they will!

Name withheld

A different strategy for retirementApproaching my sixtieth birthday, I was within two years of the contractual date by which I had agreed to sell my half of my practice to my partner. According to the agreement, I could retire on that date or remain in practice two days a week as an associate. I assumed I would continue in the practice I established 33 years earlier.

During the preceding five years, it had become evident that my partner and I approached dentistry with two very different styles. The level of conflict was becoming intense. One day, I called my attorney and said, "Get me out of here!"

I decided that, rather than retire, I would open a new practice 10 miles away. After careful analysis, I chose a 130-year-old farmhouse on the main street of a small, rural town. The area is the fastest growing township in Pennsylvania, with a 122 percent population increase during the last 10 years. The building had recently been restored; the owner opened up the first floor for a retail or office space. Working with decorators, I was able to carry the country look into the interior.

My thought was to start with only one treatment room and one assistant, just as I did 33 years earlier. The first assistant I hired was severely injured in an auto accident the week before I was to open. That day, my hygienist of 15 years popped in and said she would be the new assistant-secretary-hygienist.

It was fun buying new equipment. I purchased all ergonomically advanced equipment, along with intraoral cameras, digital X-rays, electronic apex locator, rotary endo equipment, laser caries detector, and completely networked computers with workstations in both treatment rooms (we're getting ready to add a third room).

It's been four years since I established my new office, and several amazing things have happened. Because of such a high patient demand, I recently hired an associate three days a week. I'm working three easy days each week, but we have 1,500 patients — adding an average of 32 new patients monthly.

I changed my style of practice as well. I have always enjoyed talking to my patients during their visits. Now I spend a little more time doing just that. And the result is interesting: I hear more thank-yous and expressions of gratitude in person. We know more about each other.

I don't concern myself with production and efficiency anymore, but somehow the numbers are quite good. I have more free time to pursue my interest in music. I play with an 18-piece jazz band, take weekly lessons from the best jazz musician in Philadelphia, and participate in four different community pit orchestras for musical theater. Starting over at 60 is great!

Richard Cohen, DDS, FAGD
Limerick, Pa.

What do I know? I'm just a dentist!What's with insurance companies? Dentistry needs to make some changes in how we respond to negative trends in the dental insurance industry. I have been practicing general dentistry with my husband for 15 years. We have seen life become more difficult for dentists and staff who handle insurance matters for patients. The rules change constantly, benefits are fewer, and they ask for more and more documentation of dental need.

Are insurance companies practicing dentistry perhaps? Do the dental consultants who review your claims have a license to practice? When they ask to see radiographs of Class II perio, do not see bone loss, and deny a claim for scaling and root planing, isn't that practicing dentistry?

Consider the articles on insurance fraud; the jest is that insurance companies regard every dentist as a potential fraud risk. But you know the majority of dentists are not out to defraud insurance companies. These articles indicate the true fraud is against dental practitioners. They are the ones who are on the receiving end of multiple stall tactics by insurance companies to pay a claim. The insurance company judges the dentist as to whether or not the dentistry provided was justified in its opinion. This is very close to practicing dentistry, don't you think?

Extremely popular and often discussed is the notion of dental offices becoming insurance-independent. This still allows patients to receive their insurance benefit, but it takes the dentist out of the loop. The patient pays for services (what a novel concept!) and receives the appropriate reimbursement directly from the insurance company. We do it, and it works. We are converting our office to this approach as we introduce this policy with each individual patient (this is especially appropriate for new patients).

Dentists must consider whether or not they want dental insurance unnecessarily aggravating their lives. Do insurance companies really have the authority to scrutinize dental claims? The concept of dental insurance consultants practicing dentistry without a license is interesting — the ADA should pursue this. Talk this up with colleagues and your local dental society to push for answers. Set in motion methods to head in the direction of being insurance-independent. Read the articles for ideas.

Insurance companies would save money if they eliminated claim reviewers, consultants, and X-ray handlers ... and just paid the claims! Why not simply pay the claim, not the staffing costs?

But what do I know? I'm just a dentist! Preserve fee-for-service dentistry! It's the best, because you can feel good about providing the best dentistry for our patients.

Dr. Ginny Murtaugh
Laguna Niguel, Calif.

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