Tuesday, December 20, 2011

The Negative Impact of Dental Insurance

In the mid 1980's dental insurance came into vogue, dramatically changing the way dentists do dentistry. Prior to dental insurance a visit to the dentist was simple: he would tell you what you needed, you would get the work done and then pay for his services out of pocket. With the introduction of dental insurance suddenly a third party was making decisions about how much services should cost, what services each individual was eligible for, and how many services that individual could have done. Dental insurance became a huge business! One that has had a lot of negative impact. Because of insurance companies, patients would no longer have proper treatment if their insurance refused to contribute toward those services. Often patients wouldn't complete treatment because an insurance maximum was reached and there would be no more benefits. 

In the 1990's along came the invention of the HMO (Health Maintenance Organization) in both medicine and dentistry. HMO's were new and no consumer really understood how they worked. All the consumer knew was that they paid a lot less in premiums and received a lot of services for free. What the consumer didn't know hurt them: when you join an HMO you have been put on a list that has been assigned to a specific dentist. Most likely this meant that you had to change from your usual dental provider to one that was also on a list. The dentist is paid a monthly amount to see the patients on his or her list. 

There are many problems with trying to provide dentistry this way. The first is the list, which is usually out of date. If a patient has selected an office but has not yet appeared on their insurance company's list then the dentist is not obligated to see the patient. The second is that the provider list is always out of date. Dentists who appear as providers on the list may have dropped their participation or are no longer accepting any new assigned patients. The lack of organization within the insurance companies hurts the patients: they are paying huge monthly fees but are no longer able to get services rendered in a timely fashion or at an office nearby. 

Then there was the invention of the DMO (Dental Maintenance Organization). This is similar to an HMO, but instead the dentist charges a percentage of their usual fees to patient's with DMOs. To counter this, dentists began raising their fees for most services, many times doubling their fees so they wouldn't lose money to DMOs. Patients without dental insurance would have to pay extraordinary amounts for certain services. This caused a ripple effect throughout dentistry because dentists' fees were rising 10% to 25% per year when inflation was less than 5%. Dentistry became much more expensive because of HMOs and DMOs. For example: a crown in 1990 would go for around $500, but by 2000 a crown cost over $1000. 

When I opened my office in 2001 we accepted several HMO/DMO programs. By 2005 we had become so overwhelmed by the same programs and decided to discontinue our participation. We still accept hundreds of insurance programs: Delta Dental is the creme de la creme of dental insurance companies on my hate list. This company has not raised the amount they pay dentists for certain services in over eight years! They are so difficult to work with that many Delta Dental members can no longer find participating dentists nearby. This is unfair to the dentists and unfair to patients who are now, thanks to insurance companies, forced to pay exorbitant amounts of money for dental work regardless of whether or not they have insurance. 

So we came up with our Family Plan- a reduced fee plan available only at my practice. The patient pays us a yearly fee, usually less than the premiums for an HMO/DMO, and in exchange receives cleanings, exams, and x-rays for free. They also receive a substantial discount on our other services. We have been able to provide the same program with no increase in per year membership ever. It's still just $99/ year! 

A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403

Tuesday, December 13, 2011

The Evolution of Dental Implants

In 1982 I saw a television program about the exciting use of dental implants. The program suggested that dental implants would be placed by every dentist within the next few years. Ten years later I entered dental school excited to learn about dental implants and... nothing. Although dental implants were around and were successful, they were not taught to general dentists. It was felt that only specialists, such as oral surgeons, should be placing dental implants. We were taught that there were so many risks involved with placing a dental implant that we would be foolish to try. So I let the subject of dental implants sit on the wayside until 2005.

In 2005 I got sued. A hockey player was hit in the face and his two front teeth were sheered off at the gum line. I attempted to heroically save the teeth and they subsequently failed two years later. After two years of legal process I was found not negligent as the plaintiff ignored my statement to "immediately have the teeth removed and implants placed at the first sign of failure." The lesson I learned was to stop beating around the bush and start placing implants. I realized that placing dental implants is usually very simple once you get over the overwhelming technology of each system. Now I have developed my own surgical techniques that allow an implant to be placed in less than five minutes. I hold classes in my practice a couple times a year to teach these techniques to other general dentists.

Hiossen Dental Implants
To get to this point, I began by taking hundreds of hours of continuing education, including hands on and hands off surgical courses. I realized that my initial thought 15 years earlier was absolutely correct, implants are very easy to place and are very successful. So why aren't more dentists placing them? Cost and time. There are dozens of FDA approved implant systems in the United States. Each system uses its own set of instruments and components. Every time we select a new system it may cost $50,000-$100,000 in monetary investment, and the dentist is required to be educated in proper use of the implant system. This means taking more hours of continuing education, up to 100 hours for each system. We currently employ three systems in our office, plus a state-of-the-art digital radiograph.

The technology for dental implants is constantly evolving. Dental implants can now replace the need of almost any bridge, denture or partial denture and can be used to replace one or all of a patient's teeth. They are comfortable, natural in appearance, and can last a lifetime. We have now moved implants into our daily routine in our office, and we currently use a "non-surgical" technique. This new technique eliminates any cutting and stitching of the area. Healing times have also dramatically decreased from 16 weeks to 6 weeks, and in many cases we can place a tooth on the implant immediately. Now we routinely place hundreds of dental implants in our office every year with a 96% success rate.

A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403

Tuesday, December 6, 2011

Waiter! There's a zombie in my soup!

I like food. I like good food, fancy food, and I really like theme food. You know the restaurant with flaming tiki torches and a pig rotating over a spit? That's my kind of place.

There's a well known restaurateur in Philadelphia that has a dozen or so themed restaurants, and every restaurant, although different, has the same cloned waitstaff. I swear there is a blood sucking zombie in the back biting each one until they get that glassy stare. Every waiter gives the same introduction, announces the specials with no enthusiasm, and proceeds to serve in a robotic fashion throughout the night. I like to break the cycle by listening to the table service behind us, and when the waiter comes to our table I stop him before he has a chance to deliver his table-side performance by preempting him. Yes, I fully understand the theme of this restaurant from its inception to the imprisonment of the chef to the stove, and the overall environmental impact this locally grown meal will have. Yes, I know each special and how it is prepared. And no, I would not like to order the Chilean sparkling water that has been passed through the gills of a shark and then blessed by a shaman while performing a head shrinking ceremony.

This always stops the waiter. Then I get the stare. They don't know how to handle it; the script they have been made to memorize and have been quizzed ad nauseam by upper management has fallen apart! I am in my glory!

What does this have to do with dentistry? Scripting! The same management technique used to provide identical service in restaurants has been adopted for use in dentistry. Now we can have zombies in the dental office.

You can always tell when you have contacted a scripted office. They are much like the zombie waitstaff: always starting with the same introduction, a little meaningless information about the dentist, and ending with a "how may we help you today?" Usually I can spy these offices from a mile away just by looking at the dentist's credentials. There is always a mention of attending a world-renowned institution of post-graduate education that teaches a life-changing, advanced technique. Some of this "prestigious" education is about learning new and advanced ways to treat a patient's teeth, but a good part of it is about how to treat a patient's journey through a dental practice. All patients are treated the same by each member of the staff who are all zombies reading off of a cue card.

There is a massive amount of articles on the internet guiding dental offices toward scripting. They include exact phrases to use under every circumstance so each patient can have an identical experience. In my opinion, scripting like this sucks the life out of the practice. It creates an impersonal atmosphere, making each patient feel like a number and not an individual. It denys the employees the freedom to flaunt their colorful personalities and takes away from any element of fun in the office. I like to keep my office fun, unique and interesting so I say no to the zombifying effects of scripting!

A Family Dental Care Center: Dr. Seth Rosen
2030 West Main St. Norristown, PA 19403