Dentistry and the effects of managed care?

[Dentalist]

Hey SDNers,

I heard that dentistry is not subject to the effects of managed care and reductions in federal funding that have affected other health care profession. Can someone elaborate on this? How is dentistry not subject to them? How have they affected other heatlh care profession such as medicine? I would appreciate your comment. Thanks.

Regards,
Dentalist

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[DrJeff]

When you look at the healthcare dollars spent every year, the "medical" dollars are much greater then the "dental" dollars. Since politicians love to get as much press as possible they like to focus on the big things, and hence dentistry got "left behind"

This has been the best thing for the dental profession. We've been able to watch how the insurance has been raping the medical profession and taking away alot of the doctors autonomy of practicing due to managed care(It pisses me off to no avail to think that in many cases its some GED weilding insurance company staffer has as much say about what test a patient gets as the MD/DO based on whether or not its on the "approved" list) In seeing what has happend to our medical colleagues, and the fact we from time to time we actually as dentists have a few brain cells in our head, we as dentists have decided that we won't let this happen to our profession. In my office, we'll frankly drop our insurance plans that we are providers for before signing up with a DMO (and with the few patients we'd end up loosing, we still end up making more $$ than accepting the ridiculous fees that the DMO pays for all its folks). In all honesty the only people that like the managed care scheme is the insurance companies, since their profits are way up.

I'm just waiting for some type of federal anti-trust scandel to hit the insurance industry, or some Enron-esque scandel to casue the serious realignmnent/overhall that is needed.

Basically, you'll find almost all dentists opposed to managed care taking over our profession, and we've found that if you don't sign up for it, the insurance industry can't force it down our throats

 

[sxr71]

Originally posted by DrJeff
When you look at the healthcare dollars spent every year, the "medical" dollars are much greater then the "dental" dollars. Since politicians love to get as much press as possible they like to focus on the big things, and hence dentistry got "left behind"

This has been the best thing for the dental profession. We've been able to watch how the insurance has been raping the medical profession and taking away alot of the doctors autonomy of practicing due to managed care(It pisses me off to no avail to think that in many cases its some GED weilding insurance company staffer has as much say about what test a patient gets as the MD/DO based on whether or not its on the "approved" list) In seeing what has happend to our medical colleagues, and the fact we from time to time we actually as dentists have a few brain cells in our head, we as dentists have decided that we won't let this happen to our profession. In my office, we'll frankly drop our insurance plans that we are providers for before signing up with a DMO (and with the few patients we'd end up loosing, we still end up making more $$ than accepting the ridiculous fees that the DMO pays for all its folks). In all honesty the only people that like the managed care scheme is the insurance companies, since their profits are way up.

I'm just waiting for some type of federal anti-trust scandel to hit the insurance industry, or some Enron-esque scandel to casue the serious realignmnent/overhall that is needed.

Basically, you'll find almost all dentists opposed to managed care taking over our profession, and we've found that if you don't sign up for it, the insurance industry can't force it down our throats

That is so true. If no one signs up for it they simply cannot make inroads into our profession. A DMO cannot be successful without a decent network. If we start caving, then we will all be screwed just like physicians are. It all boils down to having a united front with regard to these issues.

 

[organic]

the other day, I just thought of something that is really interesting.

The fees based on UCR paid by insurance companies for PPO dental patients vary according to the Zip code of the office. Why is it determined that way?

None of other prefessionals are paid according to the zip code of their offces/ homes, even though there are differences ajdusted according to standard of living in each state. Still, the materials dentists buy don't have different prices based on the zip code, the cost of running a dental office doesn't base on the zip code ( may vary from state to staste, but not by zip code) ...I wonder how the insurance companies came up with this idea of UCR?

thanks, any input is very much appreciated

 

[DrJeff]

Originally posted by organic
the other day, I just thought of something that is really interesting.

The fees based on UCR paid by insurance companies for PPO dental patients vary according to the Zip code of the office. Why is it determined that way?

None of other prefessionals are paid according to the zip code of their offces/ homes, even though there are differences ajdusted according to standard of living in each state. Still, the materials dentists buy don't have different prices based on the zip code, the cost of running a dental office doesn't base on the zip code ( may vary from state to staste, but not by zip code) ...I wonder how the insurance companies came up with this idea of UCR?

thanks, any input is very much appreciated

Basically the UCR fees are established by zip code to to a relative representation of what true market fees are in that geographic area. For example in my rural part of Northeast CT where I am, my office gets around $800 for a crown. Some of my colleagues down in Southwest CT might get twice that as the average fee, because the market commands that. accordingly, they have higher costs of living there, but if I send the crown off to the same lab then we're paying the same fees to have it made. (I like to use this one as a great selling tool my patients that they're getting their crown at half the price as they would "in the city")

The big problem with the UCR fees is how often they're updated and how accurrate is the data used to calculate them. The geographical portion isn't that big a deal. Plus, remember the actual fee thats set as the UCR is the 90th percentile of the fee survey, so you can judge where you fall in.

 

[organic]

Dr. Jeff,

Would you think it is more advantageous to have an office with a zip code that is allows for higher UCR fee ( probably higher cost of living, rent...but higher fee) or is it better to have an office in an area with lower UCR fee ( lower cost of renting, living, but lower fee as well) or there is no obvious advantage in either?


Of course, there are many other factors to consider, but just to simply the comparison....

thanks for your input

 

[DrJeff]

My honest opinion on that subject is that it's 100% personal preference. Realistically if you're happy where you're living, it will show in your practice, and vise versa.

Plus, there are alot of pros + cons to high UCR areas and lower UCR areas. In the high UCR area, one can assume that there is more disposable income around which opens up some opportunities that may not exist in a lower UCR area. On the flip side, many folks(reguardless of what the UCR figures in that area are) are of the "do it if my insurance covers it" mentality. So you may collect more for the endo, but not get to do the crown until the next calender year whereas in the lower UCR area you may very well be able to do both the endo and crown i the same calender year, and thus have a higher production in a shorter time even though you have lower fees

Basically if you want to live in the country and in general be ina lower UCR area, do it. If you want to live in the city in a higher UCR area, do it

 

[organic]

thanks Dr. Jeff for your sound opinion

I have read and heard about some dentists who no longer take any insurance anymore.

I also have witnessed many patients who have the attitude of " I will do whatever the insurance will pay for"

So I truely wonder how these insurance free dentists made the transition. They all seem happy and despise insurance companies. ...

 

[sxr71]

I don't know about insurance, but most dental insurance plans offer only a discount on services and maybe one ortho treatment per child for life.

I haven't really seen any dental plans that will pay for anything like endo work other than maybe provide 30% off.

Of course I say this without any real knowledge of how things really work.

 

[organic]

standard plan usually has endo ( basic works) covered 80% with 50 dollars deductible. But there are variations. I remember one of the working dentists in this forum posted a long message explaining how dental works are covered. You might want to do a search and check it out!

 

[sxr71]

Thanks, I'll do that search.