To all my dental colleagues:
Many of you already know my position on WDS and the recent changes. It has been said that I “have it made” or “have made my money” or that “it is not your fight or going to affect you” or that “great for you to preach and say things when we are the ones living and practicing today.” I guess I have caused some resentment or suspicion of my motives for my writings and statements about WDS and the profession. I am and always have been passionate about the profession and it is unfortunate if this was the reaction. If so, happily this may very well be my final rant on the subject. However, for credibility’s sake, I must point out that I have lived through 3rd party intrusive attempts twice in my 33 years in practice AND that I am still in practice half time. So, I am still affected by all of this, but also have perspectives derived from years in the game that I hoped to make more valuable, more worth my struggles in obtaining them, by sharing them. Being threatened over a longer time span by WDS, I can understand the above reactions by those with more “time-skin-in-the-game” than myself, but discounting a message often is a strategy to lessen the distress the message may cause. But does that serve us very well?
I encourage each and every one of you to attend the upcoming WDS membership meeting on November 11th in SeaTac. Buses are coming from Spokane and around the State; getting to SeaTac for us should not be a burden. If you have plans, cancel them, if you have patients, reschedule them, if you have no interest or are apathetic or defeated, change that.
WDS has scheduled a room for 750 dentists (out of over 4000 members in the State). And they pointed out there is little standing room available. The available room size is another insult to our profession AND the membership WDS apparently respects so little. They expect to continue to see the apathy and lack of backbone that they have predictably counted on so far in this challenge. If we do not overflow this room and the meeting with incredible numbers, then the battle is over and the capitulation of the dental community for their profession and their patient’s best interest, that seemed to start right from the beginning when the majority seemed to accept WDS’ reasoning without a fight, will be complete. And at that point, without an overwhelming “Mad as hell and not going to stand being taken for granted anymore” turnout, the chance for “change we can believe in” with WDS will be over, forever. And at that point, there is nothing anyone can do to help us – as we will have willingly given away the farm and many of our ideals, especially which our patients are all treated the same – no class warfare in our delivery decisions and outcomes.
The choices that the WDS management has made to deal with their competitive concerns, real and perceived, were centered only on reimbursement reductions to members alone, rather than on strategies to reduce treatment costs per patient overall. Such a narrow and myopic choice to reduce company treatment costs solely on the backs of its once valued members will certainly have permanent downward spiraling pressures to accelerate this short sighted shift of the cost burdens to the dentists alone. We dentists are the ones who face the angst of the daily conflicts of providing the best that dentistry can increasingly offer to our patients in an environment of decreasing abilities to do so. The treatment options we can provide our WDS patients are effectively reduced not only because of the decreasing reimbursement levels but because of the monopoly that WDS and others have on setting our fees outside of the yearly insurance annual maximums and more importantly, by the policy of not allowing patients the free choice to pay the additional cost to “upgrade to first class” when the better quality treatments require it. But to allow such freedom for the choices that the dentist and patient should be able to make for themselves would be to admit that the plan covering their care is deficient in serving their best needs. And this constant conflict to free choice will be, to coin a word we hear in politics so much these days,…..“Progressive.” Other 3rd party insurers are already considering lowering their allowances as they see the WDS allowances on the secondary coverage claims we all submit for our patients. Within months, these companies will effectively have the data points they need to know the entire range of allowed fees that we dentists are accepting…. And they will adjust their allowances downward.
I was recently at a CDE course discussing advanced restorative techniques, the best of materials science, treatment planning and the proper place and critical need for great lab support. (like we can get in China and overseas – right?) I watched and talked to some of the participants because the morale in the room was poor and significantly different than in past courses. Everyone was down, defeated, and expressing…. “Great treatment, but we cannot even begin to delivery this in our practices with our cost structure pitted against the reimbursement schemes of WDS.
That Change is coming and even necessary is without question. But with the dental communities’ lack of even a push back, let alone active resistance, we will fail in pressing WDS for “Change we can believe in!” Hell, we were never even asked for input, advice, or suggestions about ways to lower WDS’ costs in ways that would affect the profession in a reasonable way and affect our patients in the least damaging way. In this single failing, WDS showed how little respect it has for the membership and has failed the membership, the employers, and the patients who HAD trusted them with their respect and loyalty for so long. For as long as WDS has been in existence, the membership WAS Washington Dental Service’s greatest asset. In an unbelievably poor and very short sighted action taken by the management and Board of WDS, by not involving the membership in this process to lower costs ostensibly to stay competitive, we have been told to our bare faces, “You are no longer assets, you are just commodities to be manipulated!”
As an example, just three simple suggestions that could lower costs without sacrificing quality or the quality of coverage across the remainder of the fee structure:
1. 2nd molars are roughly 5% of the patient’s chewing efficiency, so we are no longer covering 2nd molar dental implants, abutments, and crowns for lost 2nd molars. The cost savings would be significant; if the patient desires this treatment, negotiate with the dentist for coverage of this non allowed treatment at a fee that allows the treatment to be completed well as the patient’s free choice.
2. If a patient is missing 3 or more teeth in an arch (not counting 2nd molars), the allowed coverage would be a partial denture. Prior to dental implants, dentists studied, trained and knew how to fabricate excellent partial dentures. I placed them for over 20 years and they serve excellently if made and delivered properly. If the patient wants implants (or the less preferable bridgework), they can pay for it as a non covered benefit, a justifiable policy because they have been well cared for by an excellent partial denture service. Note that this is no different than WDS’ regular down coding of composite restorations to the amalgam fee or the many other increasingly common “down codings. “ While this compromise may SEEM radical…. It is not as radical as what WDS has done in wreaking such havoc for ourselves (as we try to deliver the best care with costs rising and fees pushed back 10+ years), for our staffs (being laid off or rehired at lower (livable?) wages), for our fine dental labs (being stabbed in the back by dentists they have served so well for years as we hightail it to large or out of country labs), and lastly for our patients who clearly risk the degradation of the quality they receive by all of the above, by lowered (read double) standards of care, or by the pressure to over-treat (unethical of course) that we all know exists and is increasing, to try to make up the shortfall or simply to make the appointment time pay for itself. What the hell happened to practicing the Golden Rule in all that we told, treatment planned, or delivered to our patients? Unless we can lower treatment costs in ways that preserve quality as well as the dentist’s and the patient’s autonomy and decision making…..the honesty that is the Golden Rule will fade into the history of a dental profession that reached the zenith of its technical abilities while the dental community’s lack of involvement allowed that zenith to be for all intensive purposes unobtainable by our WDS patients who do not even have the right to “choose” from a member dentist a higher fee for a service that allows care be delivered in a better way. Considering that dentistry is also treatment being delivered to our bodies, I guess the “right to choose” what is done to our bodies is only reserved for the more politically correct choices.
3. Years ago, the ACP program was WDS’ attempt to find the over-treaters among us. Defining overtreatment can be elusive and problematic; the ACP program was flawed, though its intention was well meaning. However, regardless of the profession’s uneasiness with this subject, we all know that there are over-treaters among our ranks. They harm the profession, the employer costs, and of course the patients who are being over-treated usually without “full disclosure” of the alternative plans and the pros and cons of each. Without that, our patients have no ability to discern what is, or if, they are being over-treated. Again…. As stated above, “What the hell happened to practicing the Golden Rule in all that we told, treatment planned, or delivered to our patients?” Instead of manipulating dentists by forcing an unrealistic fee structure and system upon dentists and patients, during these vulnerable times for all of us, WDS could have used this vulnerability to make things better, not worse, by coming to the members with something like, ”You all know that there are over-treaters and over-utilizers among your ranks. We tried once with the ACP program to address this unspoken but costly problem for the profession and we clearly failed. So, faced with a reduction of benefits as the alternative, knowing that addressing over- utilizers will help lower employer costs… Why don’t you members tell us how YOU think we should manage this problem!”
I can accept that WDS sees real concerns on the horizon. I can accept that costs need to be managed more effectively. I can accept that employers are putting pressure on WDS. I can accept that dentists who sought a short term competitive advantage for personal gain did sign up for “cheap” plans that put pressure on WDS for change. I can accept that the challenges to WDS are real and that we dentists need to change to address these concerns!
I have a hard time accepting that WDS is no longer intent on being the best Delta, being the trend setter in quality care and benefits management that they once were and was a big part of their mission to their member dentists, employers, and patients. Seemingly without wanting to advertise this, it would appear that WDS’ primary loyalty these days is horizontally to the National Delta Association who is putting much of this pressure on WDS to change its administration.
What I cannot accept without protest is that WDS appears to have altered or overstated the real risks of antitrust be that the percentage dentist memberships of the Board versus the provider compensation committee or the proposed by law changes, that WDS appears to have failed to mention that part of these fee changes came from the other Delta’s pressure on the once best Delta – WDS – to “get in line with us on your fees and benefits, you are making us look bad,” and that WDS has failed to respect and involve the membership “as members” in the decision that change is needed and most importantly, if so, how to best implement changes in ways that preserve the quality of our practices and the care we deliver and the free choice for ourselves and our patients.
The upcoming meeting of the membership is your effective “last chance” to work for the betterment of the dental profession rather than capitulate without a voice. I urge you to attend and make your voices be heard. If some among you fear taking a stand because you are afraid of reprisals from patients, WDS, or the government, recognize that you are just feeding the crocodile hoping that he will eat you last!
I have always striven to be an asset to my profession, my community, WDS, and most importantly, my patients who trust my treatment advice and delivery.
I refuse to be reduced to “a commodity.”
John S. Weaver, DDS