“This was a tremendous struggle for us to accommodate within our internal processes,” said Inge. “One of the issues that we had, was that Washington Dental Service was paying higher fees for services than some of our competitors.”
Recently, when WDS lowered their fees to dentists, some of you asked why we couldn’t do more. We heard your frustration, and were ourselves frustrated by our inability to move to your defense in a more concrete fashion. The truth is, anti-trust laws are extraordinarily clear in this respect: it is not permissible for us to intervene on your behalf, to organize or join with you in any action that might appear we were attempting to set or change fees, lest we face swift investigation and possible penalties by the Federal Trade Commission.* And to be clear: the same laws regarding organizing apply to you, as individuals.
I read with interest a recent article passed on by a Sullivan/Schein sales rep. In it, the management consultant wrote at length about math and demographic exercises you should apply to decide whether to join or stay in a PPO. What interested me the most and I found glaringly lacking was that there was no mention whatsoever of the need to eveluate the past practices of the PPO - has this PPO been improving the offers either to the patients or to the provider? Let me call this “track record”. It should be viewed as a forecast of what’s in store. If you discern a postitive trend, then perhaps you can take the numbers generated from following the advice of the consultant at face value, but if the track record is negative, you will be wise to introduce a modifier for this effect. Maybe 10% cut in your income projections would be wise for a PPO that has a mild negative track record and for one that has a moderate negative track record it might be better to apply 25% or greater cut in future income. Probably you would do well to increase your modifier significantly for situations where the track record is severely negative.