{ business solutions } by Missouri Dental Insurance Services Who Is Running Our Practices? by MERLE NUNEMAKER, DDS M
any of us opened/purchased our practices with the thought of being our own boss—running the show and making the decisions we felt would be best to make it all work. Or we are working for someone who is han- dling those choices as an associate in a private practice, in a corporate setting or a public health clinic. Whatever the situation, there is the sense that operational determinations are handled “in-house”.
That simply may not be reality for some, and are we looking at it changing even more in the future? Many practices are providers for numerous insurance programs and consequently are bound by certain fee schedules—which tend to be slow to change reimbursements up- ward while our overhead seems to increase at a much higher rate. I’m no economist, but that is not what I would call a balanced equation.
So, why not just quit being a provider for any plans and collect full fee from our patients? Some offices out there have managed to do that, and I applaud your ability to do so. On the other hand, depending on your practice demographics, that simply will not work. I have talked with several folks who are, for example, in an area of a large factory and those patients constitute a bulk of their practice, so not being part of their plan is not an option. I know others who look at a poorly producing plan they want to drop, but upon further examination real- ize they have 100+ patients with that insurance and have to determine if those folks will leave them or not. It’s a gamble we have to decide whether or not we’re willing to roll the dice on.
We have a legislative agenda history that is, let’s just say, a tad heavy on the insurance side of things. Currently it’s downcoding and credentialing; before that was updating provider lists, silent PPOs, and capped fees on non-covered services. We have had some amaz- ing legislative folks on our side who have been successful in passing legislation, but the list could and probably will continue in the future. Plus, it seems like every time we get something passed to the benefit of our patients and practices, someone finds a loophole and we are scrambling the next year or two to close it. This year is no exception.
None of this is new to most of us, so why continue reading if I’m tell- ing you nothing in particular? Well, it is prompted by MDIS’ work on the Dental Vision Hearing (DVH) plan with the Missouri Optometric Association (MOA). Simply, we need more of you to sign up to be providers. “Whoa! You just gave a litany of problems that may be as- sociated with being a provider for insurance plans!” No, I’m not really talking out of both sides of my mouth—bear with me, I’ll explain.
The optometrists have experienced many issues that have made practicing successfully more difficult. I would say they are “ahead” of
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us in some ways, as to the extent of how they have been negatively impacted. Consequently, the impetus arose for them to make the DVH plan a solid alternative to the status quo. We feel this would be a way for us to stay “ahead” of the game. At the very least, if we can have a solid panel of providers, we may be better positioned to have a connection that would enable us to deal with changes more rapidly as time goes on.
We’ve heard from the MOA docs that they would encourage us to get on the same insurance page as a group, if not for today, for the future. Obviously, there are many things we cannot do which would appear to be collaboration in violation of anti-trust legislation. That does not include being a provider for the DVH plan and being part of some- thing we feel is a potential viable alternative for us and our patients.
We have publicized the plan in many ways, so hopefully you have received sufficient information about it. I really need to repeat the basic facts in that it is easy to sign up, there really are no downsides to it, and you can help our association all at the same time. Please don’t ever hesitate to contact me with any questions. The website and my information are listed below, and thank you in advance! f
Dr. Merle Nunemaker is a past president of the MDA as well as former Legislative and Regulatory Chair. He now is serving as the member liaison for the MDIS Dental-Vision-Hearing (DVH) program. Contact him at merlenunemaker@gmail.com or 816-645-8728. Visit mdis4dds. com/dvh for more complete information, including an FAQ document and the provider agreement to sign up.
