What criteria should a practicing dentist use to determine if participating in a managed care plan(s) makes good business sense?

 Interview a representative of the insurance carrier you are considering joining to find out the pros and cons of participating.

 Negotiate the highest reimbursement rates you can that are as close to actual fees in the practice as possible. The fewer dentists accepting that plan in your area, the more leverage you will have to get fees increased.

 Determine how many patients in the practice the PPO plan participation will affect.

 Calculate the loss of income from accepting lower fees.

 Assess if the practice will need to alter their method of treating patients: − Do more dentistry in less time; − Pre-block schedule for the esti- mated influx of additional new patients;

− Adjusting other costs in the practice to help keep overhead down (i.e. using less expensive labs, buying cheaper dental supplies, shortening appointments to see more patients, etc.); and,

− Determine if this is the pace you wish to keep in the practice.

Are there “best practice” strategies for handling participation in managed care plans?

Before deciding to participate in the first place, consider these points:

 Ideally, not participating in PPO insur- ance plans would allow the dentist to clearly focus on patient care exclusive of insurance participation;

 If participation in a PPO plan is chosen, carefully research the demographic make-up of your practice. In particular, the number of patients who currently have the plan but elect to see you as a non-provider. If a major employer in your area offers this plan, it could poten- tially affect the financial well-being of the practice; and,

 Will participation in the plan interfere with the overall patient experience in the practice?

Looking for additional resources related to this topic? The ADA offers the following resources regarding contracts with Managed Care Companies:

 ADA Dental Benefits |  MDA/ADA Contract Analysis Service |

In regard to running your practice, the ADA offers its Executive Program in Dental Practice Management. Dr. Thein took the entire program online and “found it to be excellent.” Following is a brief overview: Match your passion for dentistry with a mind for business with the ADA Executive Program in Dental Practice Management. This web-based program takes on the tough practice management challenges today’s dentists must master, such as reducing costs, enhancing marketing strategies and practicing amid increased regulation. Dental practice management experts and first-rate business lectures—all carefully selected by the ADA for certificate fulfillment—merge to provide a comprehensive six-course certificate program in disciplines crucial to practice success.

Can a dentist take on too much managed care, how would they know and what are the possible consequences?

The simple answer is “yes.” Therefore, careful research when considering whether to par- ticipate must be done. Taking on too much managed care can overcrowd your schedule, create too many adjustments and write-offs, and increase the cost of overhead. Managed care is analogous to a discount retailer. You still can be profitable, but by accepting the lower few schedules, you must produce more (i.e. work harder) to generate the same profit.

What is the best way for a participating dentist to get out of a plan in which they no longer wish to belong?

I would recommend you consider following these steps:

 Analyze the plan by determining the percentage of: − Managed care patients vs total patients;

− Managed care production vs total production;

− Managed care collections vs total collections; and,

− Adjustments for each managed care plan to calculate the percentage of write-offs you will take compared to non-discounted production.

 If the resulting adjustment is more than 15 percent of gross production for a particular plan, that would be one to consider opting out of.

 Once the determination is made to opt out of participation, pay close attention to the “drop clause.” This is the provi-

sion that specifies how much notice needs to be given to the insurance company.

 Take six to 12 months to have face-to- face conversations with each patient on the plan to discuss the reasons for “changing your relationship” with the plan and how it will affect them person- ally. Special note: Most dental plans, when the “opt out” is selected, still will pay the practice insurance payments, and the out-of-pocket for the patient doesn’t increase by the amount the practice was writing off.

As a final reminder, please give careful con- sideration to participating in any plan that will potentially interfere with the quality of dentistry you render, your doctor/patient relationship and/or any decision-making capabilities exclusive of insurance plan con- sideration. f

David J. Thein, DDS, MSD, is a periodontist and associate professor at UMKC School of Dentistry. He is director of the UMKC Somers Clinic—which houses the Dental Faculty Practice and AEGD residency programs—and is course director for the practice management curriculum.

Contact him at 816-235-5253, or at He especially invites your feedback on this column and suggestions for future topics.

Lois Banta is President and Founder of Banta Consulting, Inc., a company that specializes in all aspects of dental practice management. She also owns and is CEO of The Speaking Consulting Network (speakingconsultingnetwork. com, located in Grain Valley, Mo. Contact her at 816-847-2055, or at

ISSUE 1 | JAN/FEB 2019 | focus 9

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