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.
Want your practice to succeed in the 24-7 online world? A successful strategy requires meeting your patients where they already are online.
I’m wondering if any other dental practices are having problems with WDS approving, allowing and stating an amount they will pay for a procedure, on the Predetermination, then denying final payment based on a history violation that was not stated on the Predetermination. Patients are making what they believe are educated decisions to proceed with treatment based on these documents. What’s next?
On April 4th, Washington Dental Service announced they were lowering the fees for all Premier and PPO programs. As many WDS member dentists have reported, the fee decrease is an average of 15 percent of their existing filed fees. WDS explains in a letter to members that the decision was necessary due to the challenges they are experiencing with increased competition from their competitors, particularly “low cost insurers.” In order to reduce the cost of their premiums, they had to reduce the fees paid to providers. On their web page, in the frequently asked questions section for providers, they state it is unlikely that provider compensation will go up again.