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Washington State Dental Association

Guest Editorial: Dr. John R. Liu

By Dr. John R. Liu, Managing Partner, Eastside Pediatric Dental Group

It has been over four months since we dropped out as members of Washington Dental Service. I have to admit, it has hurt our bottom line significantly as former patients choose to leave and seek dental care elsewhere. At times, it has been tempting to cave in, and go running back to WDS asking to be reinstated but, at the end of the day, I keep going back to “The Big Picture” and asking myself, why am I in the health care profession? 

As I’ve said before in the past, we’ve not had a fee increase since 2008. When we lost one staff member, we made a conscious decision not to rehire for that position. We’ve even laid off one member of our staff. Early on, we took a cut in the partners’ pay in order to give staff a cost of living raise. We delayed upgrading our computer hardware and software. We’ve also seen increases in our costs and in particular, our medical coverage for our staff went up 20 percent in 2011! To accept a 15-18 percent decrease in fees just was not a sustainable move for us in the long term and here’s why:


1. Our fees are already pretty reasonable and low. Other insurance plans like Aetna, MetLife, and United Concordia, already reimburse us at within $10-$15 of our fees without us being a member of their plans.


2. To cut our fees, we would need to either cut back on the quality of our care or increase the volume of what we do. I’ve heard stories of other dentists over-diagnosing and over-treating patients. This was shared with me both from a hygienist’s and a patient’s perspective. We are not willing to do that and will always have the well-being of our patients as our highest priority.


3. The cost of living index continues to increase every year, and our employees can only go so long without a salary increase before they must either change their lifestyles significantly or seek employment elsewhere.


4. The cost of our supplies continues to rise, and the need to replace older equipment also becomes a necessity in order to continue to provide the highest possible quality of care to our patients.


So what will happen or needs to happen? What are patients and providers supposed to do in this economy, and when did dental insurance companies- — long thought to be partners with dental providers — begin to behave like medical insurance plans, where physicians are not viewed as partners?


1. In order for the cost of dental care to remain low, dental providers and patients need to think independently rather then be driven by the demands and constraints of the dental insurance companies. If dental providers and patients continue to acquiesce to dental insurance companies, the cost of dental care ultimately will increase annually, dental providers will become employees of large clinics, and patients will have less choice of who they see just like what we have seen in medicine. “Managed Care” in medicine has done nothing to contain the cost of medical care — where costs have increased eight to ten fold — and it certainly will not contain the cost of dental care.


2. We all know prevention saves money, yet no one — including patients — are willing to seek preventive care on a regular basis. Dental insurance companies pay more for restorative care then preventive care. There is no incentive for one to remain healthy under the current system of dental insurance. Patients need to be willing to pay more attention to their own preventive dental health care needs and not treat their dental insurance like car or home insurance which is there to treat catastrophic incidences.


3. The dental profession needs to be proactive with its membership to monitor and stress the importance of ethical behavior in the diagnosing and treatment planning of patients. For the profession to truly stand with its head held high as a profession rather than being viewed as a trade, it must do this to retain its high regard in the public eye. It should not be the work of the state-run dental board to ‘police’ the ethical behavior of dental providers.


4. The dental profession needs to be more bold about truly advocating for the best interest of the patients. This means more than protecting the “status quo;” rather, it means being willing to look for alternative ways of keeping all patients healthy rather than concentrating on cosmetics and other esthetic restorative techniques and treatment. We should look for ways to improve the oral health knowledge and practice of everyone.


In summary, I think it is high time the dental profession looked out more for the best interest of patients regardless of the limits and constraints put on them by dental insurance companies, and patients should stop letting the limitations of their dental plans dictate their decision making when it comes to their oral health.

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