DMO & PPO
12/23/15
Worst lab ever? DDS
Quote: (Tooth Carpenter)
What is the maximum resonable lab fees you can afford and still profitable when you are forced to take PPO crap ranging from $ 500- 600 a crown ?
Temp , impressions, cement etc $50 + assiatant salary around 30 ( hour and half) lets say a $99 crown.
now the total around $ 180 before other OH. So you make around 300 for hour and half for 1.5 hr of hard work working on a second molar even with a chepo lab !!!!
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If you are going to accept PPO fees of $500-600 you have to do it like the big boys, treat patients just like ins cos treat you. You have to upsell into non insurance contracted services, and if you are doing a single crown or a single anything, "find" something wrong with the adjacent tooth. And of course, don't forget the Arestin.
My fixed overhead per hour per service was $300. A crown in 2002 cost me $450 in allotted chair time. I would have folded if I had accepted those crown fees in 2002! I would have had to work harder and do things patients didn't need. Of course, I am not accusing anyone accepting $500-600 crown fees of doing bad things. Only that we know it is being done, regardless of reimbursement levels. Doing bad things makes taking low fees profitable.
Worst lab ever? DDS
My point, not well made, is that you don't need to spend $330 per unit to save chair time and sleep at night. Profit margins are shrinking no matter how you do the math. We as dentists need to find ways to do high quality dentistry less expensively. As they accounting for 10% of overhead, lab costs are in the crosshairs. Automation and economy of size have been helping lab profits rise. We need to be able to take advantage of those efficiencies as well, in the form of lower lab costs.
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Aug 2015 A Dentist comments regarding what DHMO's are doing
First I am not sure if i can disclose the name of the insurance as i am still a contracted provider but wanted to caution everyone on this experience i had with a particular DHMO plan.
Since it was a start up and i had no patients and in a very competitive area- I decided to accept few DHMO plans.
After extensive paperwork, unnecessary site visits etc-- they approved me as a credentialed provider. At first, they assigned me few patients- the representative said i will get more numbers as patients in the area will start choosing our practice. Time passes by and i see no improvement in the patient numbers. I see occasional new patient calls wanting to get themselves assigned to our office---few emergencies but mostly patients changing jobs, being laid off or moving out of the area. They would get assigned- get their initial exam,x-rays and cleanings ( which are free for the patient and the provider--paid $0 by the insurance) and go out of the capitation list next month. So I basically did the whole thing for their $5 office visit sometimes $0 office visit and about $2.50 monthly capitation payment. I saw this pattern happening-- called the insurance and asked why the patient was not assigned to me in the first place.
Here is what they told me happens----They never assign a patient to a dentist....patient has to choose a dentist, they only assign when patient calls---most patients don't know how DMO plans work--They don't choose a dentist when they start the plan. They do only When they have an emergency or when they are about to lose or change jobs ......So the insurance companies keep all the capitation $$ to themselves and only pay the dentist when the patient chooses a dentist.
Example scenario
patient enrolls January 2013 on the start of her new job--makes no choice of a dentist so is never assigned to a dentist-- On Dec 1st 2013 realizes she will be changing jobs next year and calls the insurance to find a dentist. Insurance assigns the patient to me in December. patient calls saying "I am assigned to your office" and demands to be seen at the earliest (as she is paying for the insurance since January and is entitled to a free cleaning). Following the contract guidelines we schedule him/her and perform free exam X-rays cleaning . January 2014 patient is gone from the list.....So insurance kept all the capitation $ from January 2013 to November 2013.
Imagine the number of patients who never even call to get assigned.
I always thought capitation works based on volume assignments to a dentist and hoping the patients don't show up ---I think this is not what is happening. i feel this is massive fraud and dishonesty . Looks like it is working very well for the insurance companies .
This is my understanding--may be i am wrong, but curious to see if anyone else observed the same happening