Shifting Dentistry from Insurance Slavery to Fee-for-Service

Transitioning to a 100% fee-for-service model has significantly boosted both the joy and profitability of our operations, freeing us from the constraints imposed by Dental insurance companies. This strategic pivot could be transformative for your practice as well.

As the head of a forward-thinking Dental group that has transitioned some of our Dental practices to thrive as fee-for-service operations and get away from the clutches of PPO insurance plans, I've witnessed firsthand the detrimental impact that insurance companies have on the autonomy and satisfaction of Dental professionals. Insurance carriers have significantly impacted the professional satisfaction of doctors and dentists, who entered their fields with a commitment to providing dedicated healthcare. These professionals sought careers that, while demanding, would not require excessively long work weeks and would offer fair compensation. Unfortunately, the practices of insurance companies often make them feel undervalued and overworked, detracting from their initial enthusiasm for their chosen careers.

These Insurance companies often nickel and dime on every aspect, leading to either poor patient treatment or an insurance-driven treatment plan that is frequently suboptimal. Moreover, there's a widespread misconception among the public that doctors and dentists earn a substantial income as private practitioners. However, the reality is far from this perception, especially considering the years of training and the significant responsibility involved in patient care. In dentistry, this issue is particularly pronounced; dental practices have long been victims of oppressive insurance plans. Few have managed to escape these insurance strongholds, which typically results in either providing substandard treatment dictated by insurances or delivering high-quality care and spending ample time with patients but receiving minimal compensation for their efforts—akin to offering Ritz Carlton service at Motel 6 prices.

Drawing from this challenging landscape, I am eager to share vital strategies that can elevate your dental practice's financial health and enhance service quality. Embracing a fee-for-service model involves a thoughtful departure from conventional reliance on Preferred Provider Organizations (PPOs). If you're considering this shift, it's essential to understand the steps involved, from assessing your current involvement with PPOs to fully transitioning to a fee-for-service framework. Here, I outline a first hand approach to help you rethink your engagement with PPOs and initiate a strategic move towards greater financial autonomy and service excellence:

Step 1: Assess Your Current PPO Involvement

Begin by identifying how many PPOs your practice is involved with, including both the number of contracts and the depth of these networks. Many practitioners are often surprised to find they do not have this information readily at hand. Knowing your starting point is essential for making informed decisions.

Step 2: Understand Patient Distribution

Analyze the percentage of your patients covered under the PPO plans you participate in. This step is crucial to gauge how deeply these plans are integrated into your patient base and to what extent your fees are adjusted downwards due to these contracts.

Step 3: Calculate Financial Impact

Determine the total annual financial impact of participating in PPOs. This involves calculating the fee adjustments these plans require. If your practice management software does not readily provide this data, you might consider utilizing specialized tools that offer a clearer financial overview.

Step 4: Evaluate Scheduling Constraints

Examine your hygienist and doctor booking schedules to see how far out appointments are booked without openings. This evaluation will help you understand the demand and capacity of your practice, which is crucial before any policy changes.

Step 5: Identify Least Beneficial PPOs

Pinpoint which PPO plans offer the least benefits to your practice in terms of patient volume and revenue. These plans might be the first candidates for elimination as you move towards a fee-for-service model.

Step 6: Assess the Feasibility of Dropping a Plan

With all the data gathered, consider whether it is financially and operationally feasible to stop participating in one of your less beneficial PPO plans. It's important to educate yourself on common pitfalls through educational resources or consultations to ensure a smooth transition.

Additional Strategies for Strengthening Your Practice

If it's not immediately feasible to drop a plan, other strategies could help improve your practice’s financial health, such as enhancing new patient flow, improving patient recall and retention, increasing case acceptance rates, and introducing new, cost-effective treatments.

Projected Revenue Increases

By implementing these strategies, you could potentially increase your practice's revenue by 10% to 20% annually. Such financial growth can pave the way for a more significant shift away from dependency on PPOs.

Final Thoughts

When your practice is well-prepared and demonstrates robust financial health, you might consider eliminating one or more PPO plans. Always refer back to educational resources to avoid common mistakes during this transition. Personally, transitioning to a 100% fee-for-service model has significantly boosted both the joy and profitability of our operations, freeing us from the constraints imposed by PPOs. This strategic pivot could be transformative for your practice as well.