As you know, our company works from the outside-in. Unlike most other practice management consulting entities that work from the inside-out, we spend time and resources engaged with many other domains of health care, particularly medicine. Why? Because dentistry is part of the health care system and dentistry always follows medicine; i.e. solo to group practice, increased dominance of 3rd parties, and the list goes on.
Dentistry has always delivered breakthrough innovations at the level of clinical and diagnostic technologies. Three-D Imaging, lasers, Cerec, Invisalign, new composites, electric hand pieces, microscopes, loops and headlamps, and digital radiography have all become common place over the last decade. The same is true in basic practice management through computing where nearly every office is now paperless. But one thing that has not changed much in the history of dentistry is the culture of dental practice.
Simply put, a culture describes and governs the ways a company’s owners and employees think, feel and act. Like water to the fish or air to the bird, culture is to any enterprise. Culture is the field in which people and actions occur and culture ultimately determines the relationships and actions with it. Culture is king.
Whether a single practice, an eighteen operatory group practice, or a five-hundred dental office managed group practice, the only thing that’s changed in dentistry has been the equipment. Dental practice has had the same culture forever. A culture dominated by “I,” and lacking “we.” A culture where collaboration and partnership are missing.
A culture has yet to be designed where dentists work together to create a better clinical delivery system for patient care. A system where more patients can be seen at a better cost. A culture where prevention is truly a promise, not a platitude. A culture where quality is measured, not just spoken about. Where peer review, chart review, and patient outcomes are vital and public.
By the way, if you can envision this kind of culture of innovation for dentistry, contact me.
It’s been confirmed. The truthfulness and soundness of what we declared is now being echoed by everyone in the industry. The evidence is now undeniable. And, we have patiently watched as dentists have moved from shock and denial through anger and fear, and are now turning the corner into acceptance.
As a company, we are extremely proud that we took the stand in June 2011 before a not-so-friendly dental society in Pierce Country Washington and presented what we perceived as the future.
For me personally it was a huge risk. My career and my business were at-stake. I had little agreement or support from the dental community. But it was clear to me that this future was coming and I took it on as my job to get dentists ready to succeed in this new world. Now it’s what everybody knows. As further corroboration here is the most recent publication from the Chicago Dental Society, Where is Dentistry Going?
From that point in June 2011 forward we have built programs to educate, train and develop dentists to form managed group practices (Future Strategies and Get Smart Program), we put on conferences (The SUMMIT in Seattle last February and the SUMMIT in Chicago last month) to educate dentists about DSOs and MSOs. We have made videos, written articles and done interviews.
And as the future unfolded and it continued to validate our predictions and perceptions, dentists realized that someone was actually working not to protect and preserve their past that was disintegrating, but someone actually out there producing programs to enable dentist-owners to succeed in this new future. To this end we would like to deeply thank the early adopters for taking the risk with us in completing our programs and to congratulate them on establishing dentist run managed group practices.
Thank you for sharing in our vision that dentists need not surrender or succumb, but dentists are fully able to be leaders, owners and executives in this new future.
The world of dentistry is changing. Rather than be paid for repair, reimbursement will be based on different criteria. “Applying Risk Assessment and Evidence to Plan Design” is a very well done article by Dr. Chris Smiley in the Michigan State Dental Journal that presents what the future will be in reimbursement.
“A recent study entitled ‘Patient Stratification for Preventative Care in Dentistry’ … came to the conclusion that little evidence supports biannual preventative care for adults. The study… showed that over time there was no significant difference for low risk patients for tooth loss based on frequency of once or twice annual dental cleanings.”
This new order of reimbursement will be fostered by the employers and government, the purchasers of dental insurance and certainly by the insurance companies themselves.
Lastly, since solo practice is geared toward repair, and the more repair you do the more money you make, I suggest you read this article and consider what you will do in the future as these changes occur.
Solo practice is built on a fee-for-service model which encourages “the more restorative dentistry, the better.” An essential element in this model is the hygiene program which, in many cases, acts as a reservoir for future restorative care. But now evidence is emerging which suggests that some patients don’t need to see their dentist more than once a year if they aren’t at risk.
More bad news for solo practice dentists.
Insurance companies will most certainly lock onto these findings to press for much greater risk management allowing them to justify that patients only need one visit/year unless the risk requires more prevention or they have advanced periodontitis. The decrease in revenue to the hygiene pool in the GP office will surely result in fewer referrals to specialists as GPs will need to expand their services in order to sustain their production levels.
Check out PreViser, a well regarded risk management utility.
A new model of reimbursement in medicine is emerging and its application will improve outcomes and reduce costs. Its use in dentistry will soon arrive as well, given 3rd parties are fully engaged in this model, and you know they will talk to their colleagues in dentistry.
I recommend you read this Harvard Business Review article, How to Design a Bundled Payment Around Value, particularly the portion about how this reimbursement is designed on value that is perceived by the patient, combined with clinical outcomes and shorter cycles of care.
I won’t go into the economics, but the greatest limit to access to dental care is cost. Dentistry is the second highest out of pocket expense after pharma and the costs go up aggressively each year. Not a great cycle. Patient visits per dentist decreased last year compared to the year before. I wonder why.
I have heard for many years, what happened to physicians won’t happen to dentists. Third party dominance, group practice, more employees than owners – that will never happen. Well, it is happening to dentists. And the way medicine will get reimbursed will also happen in dentistry.