Sept. 1, 1996
It`s obvious managed-care companies have been attempting the "hostile takeover" of dentistry. We all know the methodology-the setting of fees, the hold-harmless clauses, the most-favored-nation clauses, the closed-provider lists, utilization reviews, provider report cards, implications (and threats) that you will be left out and on and on and on . . .

Jeff Hooton, DDS

It`s obvious managed-care companies have been attempting the "hostile takeover" of dentistry. We all know the methodology-the setting of fees, the hold-harmless clauses, the most-favored-nation clauses, the closed-provider lists, utilization reviews, provider report cards, implications (and threats) that you will be left out and on and on and on . . .

I have been reading letters to various publications written by Ed Schooley, a national dental director of CIGNA Dental Health. In one letter, Dr. Schooley "continues to be dismayed with the ongoing adversarial relationship between organized dentistry and managed dental care." It must be all the letters the ADA has sent out to insurance patients, explaining that their insurance company charged too much for their premiums (it is not the "usual and customary" premium for that area). "It only appears to be deepening as the focus is entirely on the cup being half empty," he writes. But who inundates our mail carriers with brochures telling us to "fill that empty chair-time," (at reduced fees of course)?

Dr. Schooley makes many good points in his letters, but he asks us to believe questionable logic. For example, "Industry and government want to know what they are getting for the health-care dollar. . . their dollars are purchasing treatment procedures but what is the correlation of these procedures to the dentist`s cost of rendering the same?" He then states, "The answers to these questions are the key challenges to the dental profession in the future." Key challenges? I don`t feel correlating or justifying a fee is a challenge at all, let alone a key challenge. By his very question, though, you gain insight as to exactly how intrusive these insurance companies plan to be. In another instance, after declaring the main reason people go to the dentist is because they have dental insurance, he asks, "Shouldn`t our common goal be to increase the number of people with dental coverage, irrespective of the type?" But, isn`t this strictly the goal of the insurance companies?

Shouldn`t our common goal be to educate the public about the tremendous benefits of good oral health and preventive dental care? Even insurance companies stress prevention, but not for the same reason our profession does. "Parameters of care development have been rejuvenated. Hopefully, these will not be a regurgitation of textbook language. . ." Yes, well, what did G.V. Black know anyway? And, "these (dental-outcome) studies would help the (company) representative as he/she would correlate the starting point for a dentist. . ." No comment! And my favorite, "Gone are the days of automatic, implied trust in the care-giver. There are a multiple of reasons for this erosion of trust, all of which are beyond the scope of this article." Perhaps Dr. Schooley would be courteous enough to explain that innuendo in another article.

Speaking of key challenges, I received a nice keychain in the mail from CIGNA Dental Health. It is a plastic tube, filled with shredded money. You may have received one, also. I use it often, but not to hold my keys. I show it to my patients when we discuss managed care and I challenge them to consider the thought process that went into such a gimmick. It carries my point nicely!

Managed-care companies and dentists have very basic differences in practice philosophies. If you can find it, dig out your practice`s mission statement. I have no doubt you will not find the words "insurance" or "control" mentioned anywhere. I bet all of you, however, make a reference to "patient care." I will even venture to say that most of you make a reference to "fair fee" or another similar term. On the whole, dentists are good businessmen. We have to be to remain in the marketplace. How many countless hours have you spent in practice-management courses learning how to do it right? How many of us have contracted with consultants to streamline our offices, from patient flow to follow-up, from income to overhead control? How many of us cringe at having to raise a fee to cover that new city tax or another costly OSHA requirement? How many agonize at having to buy that much-needed, new piece of expensive equipment, or wouldn`t buy it if it didn`t increase service to the patient?

Dentistry has been a struggle for us. We struggled through college to graduate in the top of our class. We struggled through dental school because it was intense and we were motivated. We struggle to build our practices because we are competitive and we do not like to lose. We have come too far to give away the very essence of what we have fought so hard for, simply because they ask us to. Let the managed-care companies cringe at the thought of raising their premiums (or lowering their payroll) to cover their costs. Do not be misled; we are not a part of that equation! What term do you use to describe a person who is unwilling to pay his fair share?

The dental profession has done an excellent job at controlling costs. We are right out there in the marketplace and we must remain competitive and viable to survive. Sure, some of our procedures are perceived as expensive, but "expensive" is a relative term. How much would you expect to pay for a set of tires that would last as long as a well-made set of dentures? From which would the patient derive the most benefit? Dentistry is a state-of-the-art profession. Our patients` needs are well taken care of, along with their desires. Through comprehensive treatment, we now can offer functional and esthetic results which are perhaps unsurpassed by any other profession! Unfortunately, insurance companies have failed to keep the pace, so now they pass the blame. How many cover implants? How many patients are denied payment for a bridge because the insurance company said a partial would suffice? We spend years building doctor-patient relationships. Who do you really think has your patients` best interests in mind? Who implies that you don`t? Look no further for the source of erosion. The amount a dental plan pays is determined by how much was paid for the plan. Explain that to your patient the next time he gets one of those "helpful" letters from his dental carrier.

Many state dental societies have dental-insurance plans which they endorse. By doing this, the state society can work closely with the insurance company and have input into the plan design, thus ensuring quality coverage. By the same token, the insurance company works closely with the dental society to get a good plan at a competitive premium. If the patient has a problem with coverage, he simply tells his dentist, who through dental channels has direct contact with the insurance company, and the problem gets solved quickly. The premiums are competitive, the patients get a quality plan, and the dentist doesn`t compromise his fees. This is a win-win-win situation. The ADA`s direct-reimbursement program is another worthy endeavor. All dental societies have contacts with business leaders in their area and it should be up to each society to get this word out. After all, it is in your best interest, and once the word gets out as to how well this works, more and more businesses will become interested.

Although we look to the ADA for action and leadership, it is still up to the individual dentist to plan his own future, and to guide the future of our profession.

The created health-care crisis has disappeared and the appeal of managed care is no longer in vogue. Manipulation and coercion are strategies of the hostile. Do not be misled into thinking otherwise.

The author has been a general practitioner in Monroe, LA, since 1984, with an emphasis on comprehensive family care.

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