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Value Added Dentistry and
Dental Insurance
We live in a world that is driven by consumer demand for options in every facet of the purchasing process. Twenty years ago a cup of coffee was served either black or with cream and sugar. Today, buying a cup of coffee is much more complicated and expensive. Starbucks has learned that consumers enjoy the opportunity to upgrade and customize their coffee purchasing experience. Starbucks has also learned such freedom of choice can be very lucrative. In fact, they’ve made millions and millions of dollars making sure that consumers feel in control of their purchasing experience. Most successful industries that deal with consumers have evolved much like Starbucks has. From Denny’s to Mercedes, success comes from giving consumers exactly what they want. The companies that have overlooked the power of consumer choice have paid the price with failure.
One of things I teach dentists to do is to re-evaluate their fee schedules to match not only the new dental technology now available, but the expectation of consumers. The response I get is so predictable, that I feel at times like I’m listening to a tape-recorded message that the insurance companies provide to dentists. The discussion goes something like this:
“Dr Jones, I see that you only offer two basic crown types. A PFM and a generic all-porcelain crown.” Then Dr. Jones says, “Oh no, we frequently place Empress Crowns as well as some Zirconia crowns and bridges. When we use one of those materials we just submit it to the insurance company using the basic porcelain crown code.” Then I say, “Well, maybe you ought to charge a little more for those types of crowns. I know your lab fee is much higher for that type of crown and the insurance reimbursement for an all-porcelain crown is just a few dollars more than a PFM. You’re leaving a lot of money on the table.” Then Dr. Jones says, “Well, I can’t do that. I signed a contract and I can’t raise my fees. If I do, I’ll get in trouble with the insurance company.” Then I say, “Did you sign a contract stating that you would provide these patients with the finest crown, from the best lab, no matter what their insurance coverage was?” Then Dr, Jones says, “Well, I see your point but I still don’t think the insurance company sees it that way.”
At this point, I tell Dr. Jones that nearly every PPO contract he’s ever signed or will ever sign makes allowances for patients who would like to “upgrade” to a more expensive crown, or bridge or filling or whatever. The bottom line with these insurance companies is they don’t want to have to reimburse the dental practice any more than they have to. As long as the patient is billed for anything above and beyond the “code” they don’t have a problem. And, they make it clear that the patient must provide written consent of their decision.
If you’d like to test my theory, try this easy experiment. Call one of your PPO providers and tell them that you have a lovely young lady in your office that has fractured her two front teeth in a swimming pool accident and two crowns are required. Then, tell them that the lovely young lady is insured by their company. Tell them there is no way you would ever place a PFM crown or even a basic all-porcelain crown in such a beautiful girl’s mouth. You have a lab you’d like to use, but their crown fee is extremely high. Then, tell them that the patient is willing to pay more out of pocket to have the best crowns available. You just wanted to confirm with her insurance company that it was OK to provide her with the best care available.
I think you already know what the answer will be every time. The insurance companies can’t keep their patients from getting the best care available and they would be medically negligent if they forced you to drop your standard of care. I’ve even had discussions with administrators at dental insurance companies who openly admit that their codes and compensation haven’t kept up with dental technology or inflation. And as I stated before, as long as the patient is willing to cover the cost of the upgrade, the insurance company is OK with the decision. In fact, dental insurance companies are tired of the bad rap they are getting because dentists don’t understand the flexibility that they truly have.
The actual process of submitting the paperwork is quite simple. When the treatment is provided, you simply submit two codes. The first code is for the basic crown procedure, and the second is for the material or product upgrade the patient opted for. The second code is one of many, that you can customize for your practice, and the insurance company isn’t ever expected to reimburse you or the patient for those parts of the treatment.
My partner and I teach many seminars every year in this simple adjustment in the way dentists see their fee schedules. It is amazing to see the new profit that is experienced within a practice as well as the improvement in the patient experience.
Lorne Lavine, DMD is the Founder and President of Dental Technology Consultants. Dr. Lavine holds two prestigious certifications, the A+ Certified Technician designation and the Network+ Certified Professional. These designations demonstrate proficiency in computer repair, operating systems, network design and installation. Dental Technology Consultants provide dentists a full range of services relating to the implementation of technology.
Interested in increasing your production by improving your team’s case presentation? Click Here
To reach Joel Harris Email him at Joel@thedentistsnetwork.net
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A Smart Exit Strategy: Mentoring 101
In the 17th and 18th centuries, artists, silversmiths and coopers learned their trades through apprenticeships at the hands of masters. It took years for apprentices to learn the basic skills and continuing to refine them was a life long process. Many practitioners have dedicated their lives to lifelong dental education, spending countless hours and dollars of continuing dental education as well as becoming accredited in professional associations and academies. Now the time has come for you to find a successor. This will be a daunting task. Where will you find someone who can “ fill your shoes”? The answer is that it will be a rare feat if you find someone who can join your practice and manage the caseload as well as the technical expertise that you possess. Using a sports analogy, you will more than likely not find a “free agent” who can step in and do the job, rather you’ll have to develop your successor in your “ farm system”, which of course is your own dental practice.
With the decreasing numbers of dental graduates needed to replace the ever-increasing number of retiring dentists, your chances are becoming more difficult. Therefore the best way to find that “diamond in the rough” is to create a mentoring program that will enable a young dental graduate to develop the necessary skills and experience to become your partner and eventually your successor. Mentoring is not just an observation program but also a direct “hands on” process that will entail many hours of personal interaction and coaching, the associate’s attendance at various educational programs as well as direct clinical supervision by you. While mentoring requires a great investment in time and effort, when you find the candidate with potential, the rewards and future earnings will be well worth it. Here are some guidelines for mentoring your successor:
- Create a structured program. In the beginning, you must see yourself as a teacher. Consider the first year as a customized residency program in private practice and clinical dentistry. Let your associate observe some of your complicated cases by sitting chair side with you and acting as your assistant. As time progresses, let them perform some of these advanced procedures with your input and feedback. It is assumed that during this first year your associate will be providing more routine clinical services.
- Case Presentations. Learning how you present your treatment plans is also critical to your associate’s development. How you effectively incorporate technology and other aides will be beneficial for them to observe. Try to schedule time before a several formal case presentations to afford an opportunity to tell you what they think and would present to your patient. Let your associate make several presentations of their cases. This affords you a great opportunity to offer feedback in honing their verbal and presentation skills.
- Schedule weekly meetings It is imperative that you schedule weekly meetings to review any significant cases or procedures that your associate did that week. Also review their time management skills to ensure they are adhering to their schedule. If adjustments need to be made because your associate is constantly running behind, re-evaluate their time units. We suggest that you schedule these meetings for the first 3 to 6 months. You will know when to discontinue them because there won’t be much to discuss. We then suggest that you reduce to a biweekly schedule. Finally we recommend that you schedule a monthly business meeting. Discuss production goals, outstanding patient balances and other management related topics.
- Establish a working environment. We strongly recommend that you pair your associate with your most experienced dental assistant during the fist several months of their employment. You can do this on a full time basis or on alternating half days if staffing is an issue. This will enable your associate to learn office protocol and procedures. Based upon their prior work experience this may prove invaluable. Your assistant can then give you feedback other patient matters as well.
- Paying a Salary. This approach also requires a financial commitment on your part. We recommend a guaranteed salary at least for the first 6 months. Since you are asking your associate to spend many hours in observation etc. they still have to pay their bills. Eventually you can revert to paying them a draw against their percentage of collections.
- Offer CDE Programs. We recommend that you enroll your associate in as many continuing education programs your budget can provide. Consider enrolling them in clinical participation courses. Although you hope that your associate will succeed and eventually become your partner to protect your investment in them as it relates to CDE, consider the option of requiring them to sign a promissory note that only will be enforced if they elect to leave your practice. After all, you may be giving them an invaluable opportunity and something they may take with them to another practice. So it’s fair to get repayment of your financial investment, if things do not work out.
- Share business acumen. The business of dentistry is not taught – it’s lived. Involve your associate in strategic thinking, goal-setting, and operational matters. Share your leadership philosophy, as well as your knowledge.
The best transitions occur when you are forward thinking and work toward creating your vision, rather than wait for it to happen. This approach is admittedly not for every practitioner. However if you consider yourself to be exceptionally skilled and worried about who can become your partner an approach such as this is worth considering.
If you would like to receive a complimentary market analysis, Click Here.
Questions regarding transitions? Email Dr. Snyder at Drsnyder@thedentistsnetwork.net.
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