The survival of fee-for-service dentistry

Jan. 1, 1999
Dentists lamented the obstacles to providing quality care in a national survey. The first step is to escape the bad plans imposed on the profession by the insurance industry.

Dentists lamented the obstacles to providing quality care in a national survey. The first step is to escape the bad plans imposed on the profession by the insurance industry.

Joseph A. Blaes, DDS,

Editor, Dental Economics

Recently, 3M Dental Products implemented an unique program designed to find out what burning issues are facing today`s dentists. The program included an advertising campaign that encouraged dentists to identify key issues affecting their business and practice. In addition to running full-page advertisements in a variety of dental publications, 3M also mailed questionnaires directly to thousands of dentists across the country.

Dentists share common concerns regarding the obstacles facing their individual practices and the profession as a whole. The number one "burning issue" was increasing fee-for-service dentistry. Dentists indicated that they need to generate more fee-for-service patients and procedures to augment their overall business. One dentist said, "Patients think that, if it`s not covered by insurance, it must not be necessary."

Since I have become the editor of Dental Economics, I have passionately supported the survival of fee-for-service dentistry. I believe that this is in the best interest of dentists and patients. It is a win/win situation. How can I possibly do my best dentistry if I am concerned about what a insurance or managed care program will cover? It is the same as diagnosing and treatment planning according to the patient`s perceived financial condition. How do we know what the patient wants? It is our obligation to do a complete examination, diagnosis, treatment plan, and case presentation. Our obligation is to tell patients what problems exist in their mouths and the best ways to correct them. Then patients decide what they want.

I dropped insurance in my practice 15 years ago. It happened one day when my dental assistant told me that the patient who had just left the office with her new partial denture had paid half of our fee. The woman was "covered" by Delta Dental, and she felt I had agreed to that fee in my subscriber agreement. I immediately called a team meeting, and we discussed the implications of dropping Delta. When the only negative was that some patients might leave the practice, we all agreed that Delta had to go! I have never looked back and have never regretted that decision. Sure, we lost a few patients, but most of them came back when they could not find another practice like ours. Our biggest problem was getting Delta Dental to send the checks to the patients.

For years, Delta has made itself out to be the dentist`s friend. After all, didn`t we "own" the company and support it with a percentage kickback? Delta claims to be supporting fee-for-service dentistry when in reality it is nothing more than a PPO. Delta Dental of Missouri hides the fact that it is a PPO and will not give out a schedule of allowable fees. You must submit your fees and have them approved annually. That was always a fun exercise of submitting fees, having them rejected, and then resubmitting a slightly lower fee until we finally found one that was close to their maximum. It was an extremely frustrating exercise, and I do not miss it at all.

Wake up out there! Only you can save fee-for-service dentistry. The ADA won`t do it, nor will the AGD or any other alphabet soup. If the 3M statistics are accurate (I believe they are), then what are you to do? If you do nothing, then dentistry will probably go the same route that medicine has, and the DMOs will dictate the standard of care.

You must take control of your own destiny. That means getting out of the bad plans! That means getting the continuing education you need to become proficient at the new dental techniques such as cosmetic dentistry, implants, prevention, and perio therapy, to mention a few.

You must expose your mind to new ideas and new treatments. Patients are becoming much more sophisticated today. They expect their dentists to be on the cutting edge of treatment and technology. In order to be able to diagnose and treatment plan an esthetic case, you must know what the options are and be able to deliver an excellent case. One dentist told me recently that he could not understand all the interest in esthetic dentistry because he very seldom saw any patients who needed that kind of treatment and were interested in it.

Perhaps this is like the hammer and nail story: "If your only tool is a hammer, you tend to see every problem as a nail." Find the courses; get the information now!

My good friend, Dr. William Dickerson, has founded a wonderful place to learn about the "Esthetic Revolution." Several years ago, he started the Las Vegas Institute for Dental Studies to pass on his experiences with esthetic dentistry and the effect that it can have on a dental practice. The Institute soon outgrew his private practice space. In August, Dr. Dickerson opened a free-standing, 22,000-square-foot, state-of-the-art-teaching facility to train dentists and staff (including lab technicians) about esthetic dentistry. He has made a commitment to the survival of fee-for-service dentistry. Have you?

Dentistry is at a crossroads. You have the option to either provide patients with uncompromised quality dentistry, or you can succumb to the pressures of managed care, letting the insurance companies dictate your treatment options. Dr. Dickerson believes strongly that every dentist and staff member needs to hear this essential message. He has committed to a series of lectures during January in California. This will be a charitable event, and all proceeds from a modest registration fee will go directly to the "Give Back a Smile Foundation."

I think this is a terrific idea. For five days, Dr. Dickerson will travel to nine cities, presenting his message on how to prepare yourself and your practice for the next century. This is life-changing stuff. This is a great opportunity to hear the message that Bill is teaching throughout the world about the practice of dentistry. I urge you to take advantage of this opportunity. The door of opportunity does not stand open forever. Go through that door while you still have the chance.

Dr. William Dickerson will be presenting a nine-city, two-hour program tour titled, "Mandatory Information to Position Yourself for Success in the Next Century." Take just two hours out of your life to find out how to prepare yourself and your practice for the next millennium that is so critical to your future. Each two-hour presentation concludes with a roundtable discussion with a panel of experts answering your questions.

The proceeds from your $49 registration fee goes entirely to the "Give Back A Smile Foundation," a charitable organization that benefits victims of domestic violence who have been dentally traumatized.

To register for the program, call the Las Vegas Institute for Advanced Dental Studies at (888) 584-3237.

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