Medical insurance has been using tiered systems to provide care to patients for some time. A tiered system categorizes physicians by quality and cost efficiency standards. While the patient chooses their provider, the patient's copay may vary based upon the provider tier that is chosen. Insurance companies can reimburse different tiers on different fee schedules potentially allowing network providers with better outcomes higher reimbursements. An example of medical insurance tiered system:
Providers meet excellent quality and/or cost efficiency standards
Members pay the lowest copayment
Providers meet good quality and/or cost efficiency standards
Members pay the mid-level copayment
Providers who are outside the insurance network
Members pay the highest copayment
As you know, trends in dentistry typically follow trends in medicine. While the tiered provider system is not yet here for dentistry, the concept of evaluating the quality of dental care has been on the horizon for some time, and will shortly be utilized by major dental insurers. How will this work?
A leader in this type of data analytics is P&R Dental Strategies. They have developed a unique, objective, quality measurement program for dentists. Their methodology, called DentaQual, leverages a nationwide, multi-payer dental claims database (DentaBase) to measure quality by analyzing cross-payer claims and dentist utilization data. Quality is measured based on metrics scored in each of 5 categories.
The DentaQual score for a dentist is based upon an individual dentist's "standard deviation from the norm", the norm being the average practice behavior of a dentist's peers in a geographic area. It is not based upon predetermined or subjective benchmarks such as user reviews.
As the largest dental insurer in Arizona, Delta Dental of AZ, will soon make these quality scores available to patients to help them in selection of their dentist. Other insurers such as United Healthcare and other Delta Dentals have already incorporated this platform and it's probable that other insurers will follow suit.
In order to better understand the purpose behind these metrics and how insurance companies will be using them, we have invited Mr. Mike Jones, President and CEO of Delta Dental of Arizona to participate in our upcoming seminar. Mr. Jones will provide us with an update of current and future initiatives and explain how Delta Dental will be leveraging these new metrics.
We have also invited Mr. Michael Urbach, President of New Markets for P&R Dental Strategies to come and explain how DentaQual works and what affect they expect to have on the dental insurance marketplace.
We look forward to their presentation on Tues, March 22, 2022 at 6:00pm at Superstition Springs Endodontics.
During the 2020 spring shutdown, due to the COVID-19 pandemic, I found myself at home with my family looking for ways to entertain ourselves. We planned daily "quarantainment activities" like playing indoor games, outdoor games, cooking competitions, bike rides, ping pong tournaments, movies etc. At some point, we began to watch back seasons of the CBS reality show "Survivor". In this show, a group of very different people get stranded on an island, with just the clothes on their backs. They compete individually and in teams but ultimately have to vote each other off the island until there is one remaining survivor. We did some major binge watching, but it was fun. Watching the drama of such different people put in a stressful environment, competing for food & small comforts, making pacts with each other and ultimately doing anything to survive in the game - including the all too famous "blindside" was just too entertaining to look away!
At the same time, we all found ourselves in a business survival mode. How do we handle our emergency patients? Do we layoff employees? Can we get a PPP loan? Can we get it forgiven? What happens if someone on staff gets sick? How do we pay for sick time? If a staff member gets sick, do we have to shut down the office? What if my family gets sick, can I come to work? How do I handle the hygienist's concerns? How do we manage our team's anxiety about the whole situation? How long will this go on? etc. etc. The threats to our businesses and livelihood were real and we all felt a little "blindsided" by COVID-19.
Survival is what the brain is designed to do. The brain identifies threats and keeps us alert and aware of them at all times. Unfortunately, sometimes this state of arousal can create challenges and problems when it comes to communicating, collaborating, solving problems, setting goals, and leading a team in your office. Modern neuroscience is teaching us many new things about the brain and cutting edge leadership is taking advantage of that new knowledge.
Our upcoming Inner Space Seminar, will discuss how brain based leadership focuses on understanding how the brain works and using that information to our advantage. David Rock, of the Neuroleadership Institute, has described five social domains that the brain treats as primary rewards or threats. Since your office is social system, understanding these concepts can change the way you communicate, lead your team and interact with your patients more effectively.
Our upcoming Inner Space Seminar will be presented by Jason Hales DDS, MS on Thursday, Nov. 11th, 2021, will review these leadership concepts and help you survive as a leader in your practice.
At a recent Inner Space Seminar, Dr. Jason J. Hales discussed dealing with cracked and fractured teeth.
At Superstition Springs Endodontics, one of our five core values is "Partner for Success". To us this means, that we are successful when our partners are successful. As we have focused on this value, we have come to more clearly understand who our partners are, and how we can help each other be successful.
At SSE, our partnerships are primarily with our referring dentists, but also include other important providers of supplies, IT services, legal services, accounting services and even janitorial services. While insurance companies are often viewed as an adversary, we should look to build partnerships with them, when possible.
A 2009 study by the L.C. Williams & Associates Research Group details a group of dentists who refer less than 10% of their root canals to endodontists. This group of dentists have a very different perspective about working with endodontists. They tend to believe that they perform the same quality of endodontic treatment as specialists at a lower cost. They are less likely to admit that certain difficult cases should have been referred to an endodontist than their peers who refer more than 10% of their endodontic cases. These dentists are also less likely to describe an endodontist as their partner in delivering quality dental care. As you can imagine, these are not the dentists that we are interested in working with.
Defining this value of partnership has given us the freedom to realize that while most of our patients come from general dentists, there are times when we are forced to choose which dentists are given access and priority of our time, schedule and expertise. As you can imagine, those dentists with whom we have a partnership will get that priority. While working with this previously described group of dentists typically brings frustration, working in sync with partner dentists, and the relationship with them, is a rewarding and fulfilling part of our work.
A partnership is a relationship that benefits both parties. At SSE, this is what partnership looks like to us:
Our partners know:
- We will take care of their patients when in pain.
- We will stand behind the work we do for their patients.
- We will treat their patients the same way that they do.
- We will support their treatment plan.
- They can contact our doctors directly at anytime with any question or concern.
- Their patients will return more confident in their dentist and appreciative of their referral to SSE.
- We will do everything possible to help them be successful.
We know our partners:
- Respect our team and their efforts to serve their patients
- Respect our time and are patient and flexible in getting their patients in
- They know our treatment is worth the cost. They encourage patients to see the value in coming to our practice regardless of insurance benefits or distance traveled.
- See us as a valuable part of their dental team - not just an emergency service or someone to call to bail them out when they get in over their head.
- See value in the work that we do for their patients. They recognize the expertise that comes with endodontic specialization.
- Are comfortable calling our doctors directly to help them deal with any especially difficult case or situation.
We understand that referral patterns in dentistry can change for many reasons. The previous study found that the longer a dentist was in practice, the more positively they perceived their endodontist colleagues. Younger doctors were more likely to say that economics of treatment and their availability are more important factors when deciding whether to perform or refer to an endodontist. As doctors become more experienced, better acquainted, as professional relationships grow stronger through improved communication and experience together and as teams get to know each other and work together partnership improves. Sometimes doctors are discouraged from referring to endodontists because of their employment status as an associate dentist. Sometimes an owner doctor gets busy enough to choose procedures that are more profitable for them (crown & bridge) or they just get tired of searching for the MB#2 and look to build a partnership with an endodontist.
Our mature partners (and by mature I do not mean age) express to us that they feel that relieved sending their patients to SSE because they know the experience their patients will have and how it will move them forward in their treatment plan. While many of these partners may still perform some endodontic treatment, they become experts at diagnosis and case selection. They recognize the cases that will save them time and money by referring rather than treating. If you could ask them, they would explain that they are more successful and profitable by the working partnership they have with SSE.
Because of our value "Partner for Success", our partners are given the highest priority in our schedule. While we try to accommodate everyone who needs to be seen, our partners are given priority over self-referred patients, online referred patients or patients from offices that we don't have an established and working partnership.
We appreciate working with the best dental practices around and are always excited to make new partners. If you are looking for the kind of partnership described above, please let us know so that we can take the steps to build a stronger relationship with you and your team.
At our last Inner Space Seminar, Dr. Danny Masters and attorney Amber Masters discuss financial principles to managing debt so it doesn't manage you.