PPO or Not to PPO....that is the question

After assessing numerous practices, one of the first questions I'm asked is "Should I stay in network with the insurance companies." There is not a simple yes or no answer. There are three options. Fee for Service....no participation with any insurance company; In network with all insurance companies (PPO's) or Partial enrollment. As some of the insurance companies are lowering their reimbursement which will affect your bottom line, it will be necessary to seriously consider your options.

Fee for Service: Full fee and full payment. No write-offs and no negotiating. Patients come to see you, you diagnose, patients decide on treatment and you get paid 100% of fees charged. Sounds ideal but there are factors that must be taken into consideration. Your location, your competition, your patient base, patient demographics, timing, your fees and your vision for the practice,

PPO - sign up with every PPO....work twice as hard for half the money, use double the supplies and double the time in sterilization because you have to see double the patients just to meet your goals. Creates a chaotic atmosphere not to mention the lousy taste it leaves in your mouth. Pun intended.

You can decide on 'Partial participation' with the insurance companies that have reasonable reimbursement.

So how do you decide and where do you start? Know your numbers and know the demographics of your patient base. If you don't know how to do it or what to assess, get someone to help you. I recently completed a 'virtual assessment' for a dentist who wants to drop a major insurance company that he felt "75% of my patients have".

After I completed his virtual assessment we were able to determine the true percentage of patients with the various insurance companies he was in network with. We also created a plan for when his practice can support dropping the major insurance company!! (who is once again lowering their reimbursement to the dentist!) Through the assessment, I determined there was major problems with their computer recare system, their TRUE active patient base along with other issues that would 'kill' their practice if he just dropped it. However, we were able to put a plan together to slowly drop the PPO's over a certain amount of time so that it would not financially impact his practice or the patient base. This was a dream come true as he has not felt good about going to work for a long time...it wasn't fun and he had lost his passion for dentistry. Teaching the administrative team effective scheduling techniques allowed the practice to limit the write-offs on a daily basis. Over time, this adds up to thousands of dollars. Through my assessment, I was able to look at the significant discounts, write-offs, freebies, family rates and adjustments given to the 'fee for service' patients that was also making a significant impact on the bottom line.

Do your due diligence....know what you can do today to make an impact and have a plan to eliminate over time. 95% of the dental practices I work with complain about the write-offs, the PPO's etc. but no one is doing anything to rectify the situation. It all starts with a plan. Stop complaining about all your write-offs and adjustments and take your practice back.

Nancy completes virtual and 'on-site' practice assessments to address your specific concerns about insurance participation, internal team stress, leadership concerns, incentives, policies, hygiene programs/liability, treatment coordinating, productive scheduling vs. a busy schedule, communication within the team and any other concerns you may have. You have to assess your patients in order to provide a short and long term treatment plan. Why aren't you assessing your practice to have a short and long term business plan for the practice? Email me your concerns and so somethng about it. nancy@Klassolutions.com