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<\/a>\nToo often dentists join PPOs hastily, or leave PPOs\u00a0recklessly. Bad decisions here can lead to thousands of lost\u00a0dollars or hundreds of lost patients.<\/p>\n
Over the years I\u2019ve worked with many practices deep into\u00a0PPO participation, others with no insurance participation at all,\u00a0and many somewhere in between. It\u2019s important to know what\u00a0to think about when deciding to sign up for a PPO, what you\u00a0need to do to operate successfully with PPO participation, and\u00a0how to best leave PPO participation so you\u2019ll lose the discounts\u00a0but not the patients. Each circumstance is different. Below I\u00a0offer various observations and thoughts for you to consider:<\/p>\n
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- Some of the most financially successful dentists I\u2019ve\u00a0worked with have been deep into PPO participation.\u00a0Despite the fact that theoretically they should be making\u00a0a quarter of the profit with a 30% discount (assuming a\u00a0normal 40% net, a 30% discount would only leave you\u00a0a quarter of the profits). These Doctors have defied the\u00a0<\/span>logic and netted well. So no smart practitioner should\u00a0<\/span>out-of-hand reject the idea of PPO participation.<\/span><\/li>\n
- Some Doctors with PPO participation are very busy\u00a0but they are not profiting well. They are on a treadmill.\u00a0<\/span>Ironically, the Doctors who are deepest into PPO\u00a0<\/span>participation are the ones who are in the best situation to\u00a0<\/span>leave but emotionally less likely to want to leave.<\/span><\/li>\n
- It\u2019s not uncommon for Doctors to not know which PPOs\u00a0they are signed up with, especially PPOs within Delta.<\/span><\/li>\n
- Doctors will balk at spending $3,000 per month in paid\u00a0advertising while at the same time writing off $10,000 per\u00a0<\/span>month in PPO discounts. Somehow not receiving $10,000\u00a0is less painful than writing a check out for $3,000.<\/span><\/li>\n
- Practices that drop a PPO, don\u2019t prepare their staff and\u00a0<\/span>send letters can do serious damage to their practices.<\/span><\/li>\n
- PPOs are not going to go away. You need to learn how\u00a0<\/span>to deal with them wisely based on your specific practice\u00a0<\/span>situation and resources. It is dangerous for me or any\u00a0<\/span>consultant to make blanket statements about anyone\u00a0<\/span>participating or not. There are too many individual\u00a0<\/span>factors involved and variations between marketplaces.<\/span><\/li>\n<\/ol>\n
Are You Considering Joining A PPO?<\/h3>\n
What if a new PPO is coming to town and they claim to\u00a0have signed up a couple of large local employers? Usually they\u00a0are also working on signing up dentists in the area. It\u2019s sort of\u00a0a chicken and egg problem for them. Do they get the business\u00a0first or do they get the provider network first? Anyway, for this\u00a0example let\u2019s assume they have already signed up businesses in\u00a0your area. Naturally, you\u2019ll be tempted to sign up to avoid a loss\u00a0of patients. In most cases it\u2019s not best to sign up with a PPO\u00a0for defensive reasons. Why not wait and see? Chances are the\u00a0PPO has out-of-network benefits and if that\u2019s the case, many of\u00a0your patients are likely to stay with you. Through one of your\u00a0patients or by contacting the employer directly, get your hands\u00a0on a benefit booklet. Often you\u2019ll find the out-of-network benefit\u00a0set is not significantly different. It\u2019s just a matter of whether or\u00a0not the patient goes to an office that\u2019s agreed to a lower PPO fee\u00a0schedule.<\/p>\n
You see, one of the things you\u2019re supposed to get with\u00a0PPO participation is more new patients. That\u2019s your quid pro\u00a0quo. \u201cI\u2019ll take the discounts if they\u2019ll send more new patients\u00a0over here to help me fill my chair.\u201d However, if you sign up\u00a0for a PPO plan and simply convert patients you already have to\u00a0discount patients\u2026ouch! You just lose income! So rather than\u00a0take a certain loss of income because you might lose patients by\u00a0waiting and seeing you\u2019ll be able to know if you are really losing\u00a0them. Then make the judgment if the loss rate is too high to sit\u00a0on the sidelines. You can join the PPO then. They\u2019ll be glad to\u00a0have you on board. There is no need to rush to sign up.<\/p>\n
Usually PPOs at this point will offer a fairly good fee\u00a0schedule. Keep in mind that what they offer at first may not\u00a0be their top offer. You can negotiate with them if they need\u00a0providers badly enough.<\/span><\/p>\n
If a PPO in your area made a big splash by setting up\u00a0a couple of major employers who you do not have a lot of\u00a0patients with, then you can adapt the strategy of joining the\u00a0<\/span>PPO when they first are signing up the big company because at\u00a0<\/span>that point, many patients might be making decisions about their\u00a0<\/span>insurance and you might pick up new patients who you might\u00a0<\/span>not have otherwise received. Your strategy here can be to bring<\/span>these patients into the practice and if the discounts become\u00a0<\/span>insufferable two or three years later, drop the plan and you\u2019ll still\u00a0<\/span>keep a lot of the patients. Of course, it\u2019s important to check to see\u00a0<\/span>if the plan does have out-of-network benefits, if you can drop at\u00a0<\/span>any time of the year or just specific times during the year, and you\u00a0<\/span>have to look at your own situation; how much in full chair time do\u00a0<\/span>you really have? How well are you doing at retaining patients?<\/span><\/p>\n
With any PPO decision, joining or leaving, it\u2019s sort of like a\u00a0person going on a new drug or exercise regimen. The person\u2019s\u00a0physical condition has to be known. So all the basics of practice\u00a0management apply. Whatever your PPO participation or not,\u00a0the stronger your practice is organizationally and otherwise,\u00a0the better you\u2019re able to deal with any decision. Again, many\u00a0doctors will take tens or even hundreds of thousands of dollars in\u00a0discounts every year but faint at the idea of spending $10,000 on\u00a0management advice or staff training to fortify their practice.<\/p>\n
If You Are Already Participating In PPOs<\/h3>\n
PPO discounts often run 15%, 20%, even 30%. To be\u00a0successful you can either outrun or outgun the discounts. By\u00a0outrunning the discounts I mean this: If you can produce twice\u00a0as much as the average dentist per hour you can overcome a\u00a030% discount. This means you really have to pay attention to the\u00a0factors of capacity such as: scheduling, staffing, delegation and\u00a0teamwork. Also, leveraging your practice time and talents with\u00a0technology, rooms and equipment. Many dentists participate in\u00a0PPOs but they don\u2019t really change gears. They just sign up for\u00a0the discounts and hope to \u201ckeep busy\u201d and let the chips fall.<\/p>\n
The whole thrust of what I\u2019m saying is, you\u2019ll do so much\u00a0better if you realize the ramifications of your decision and the\u00a0realities of your situation so you make the right moves. You\u00a0can\u2019t do the Pankey\/Dawson new patient intake format on deeply\u00a0discounted patients. You probably won\u2019t want to refuse to sign up for any insurance or PPO participation and work Monday\u00a0through Thursday from 8:00-4:00 in an invisible location with no other marketing efforts and expect to fill your chairs.<\/p>\n
You can \u201cout gun\u201d the discounts by offering discretionary \u00a0patient services that don\u2019t come under the PPO fee restrictions such as Invisalign, Veneers, Implants and Bleaching. Profitability\u00a0in those areas offsets the deep discounts in the others. Sometimes by just negotiating with the PPOs you can greatly increase your reimbursements. We\u2019ve helped clients gain many thousands of dollar for their bottom line through correct negotiations with their\u00a0PPO. Don\u2019t overlook the fact that you can ask for annual increases.<\/p>\n
Sometimes when you ask, you\u2019ll get a bump\u2026but when you don\u2019t they\u2019re not going to go out of their way to give you more.<\/p>\n
If You Decide To Leave A PPO<\/h3>\n
Let’s say a certain PPO is 30% of your practice base. If you drop that PPO you could potentially lose that entire 30% but it is unlikely that you will 50% of those if you have decent out-of-network benefits. So for the purpose of this example, let us say that you have “at risk” 15% of your patient base.<\/p>\n
You have two goals in mind:<\/p>\n
- \n
- To minimize any loss of patients.<\/li>\n
- To slow down\u00a0any loss of patients.<\/li>\n<\/ol>\n
If it takes two years for you to experience the full effect of\u00a0the attrition and you lose 7% of your patients per year, chances\u00a0are if you are working to otherwise fortify the practice (see\u00a0below) you will be able to overcome that 7% loss per year.<\/p>\n
If it takes two years for you to experience the full effect of\u00a0the attrition and you lose 7% of your patients per year, chances\u00a0are if you are working to otherwise fortify the practice (see\u00a0below) you will be able to overcome that 7% loss per year.<\/p>\n
If you send letters to patients announcing the PPO departure,\u00a0you will intensify and accelerate any loss you will experience.\u00a0These letters are not always read. They can confuse or irritate\u00a0people. They usually sound self-serving. I feel that a lot of times\u00a0doctors and staff send the letter out of fear of confrontation with\u00a0a patient. Letters once sent, can\u2019t be \u201cunsent.\u201d That\u2019s why I feel\u00a0it\u2019s so much better to talk to patients face to face. In this way,\u00a0you\u2019ll see almost every PPO patient you have at lease one more\u00a0time. You can refine and hone your message. If and when you\u00a0decide to give up and just send letters, you\u2019ll write a better letter.\u00a0Even then I suggest sending them out in small batches at a time.<\/p>\n
Here\u2019s where training your staff is so important in explaining to\u00a0patients that you\u2019ve changed your status:<\/p>\n
\u201cMrs. Smith, since the last time you were in we\u2019ve changed\u00a0our status to an out-of-network provider for XYZ Insurance\u00a0Company.\u201d<\/p>\n
\u201cWhat does that mean?\u201d<\/p>\n
\u201cWhile we\u2019ll still process the insurance for you, you might\u00a0see some change in benefits. However, we have many\u00a0patients on this plan and other plans that we\u2019re seeing on an\u00a0out-of-network basis and things work out just fine.\u201d<\/p><\/blockquote>\n
Believe it or not, most patients will simply shrug and kind\u00a0of see what happens. There is more involved here than I can\u00a0include in this article but over the years I\u2019ve found that basically\u00a0the less said, the better. Sometimes it is better to be reactive than\u00a0proactive. Keep in mind that you and your staff are already\u00a0seeing patients out-of-network through a variety of insurance\u00a0<\/span>companies and the patients are OK with it and you are OK with\u00a0<\/span>it. Yes, some families will change Dentists to maximize their\u00a0<\/span>benefits. However, unless you are signed up with every plan in\u00a0<\/span>your area and have the lowest fee schedule in your area, there is\u00a0<\/span>always going to be a better deal somewhere else for the patient\u00a0<\/span>financially. You invite patients in and do your best to do your\u00a0<\/span>best and work to make sure they feel value in their visits and in\u00a0<\/span>their relationship with you.<\/span><\/p>\n
If the PPO you are dropping has little or no out-of-network\u00a0<\/span>benefits, it may make sense to send a letter. This is the\u00a0<\/span>exception and not the rule.<\/span><\/p>\n
Make sure that you have a plan to fortify your practice:<\/h3>\n
If you\u2019re having a loss of capacity (cutting back in hours or a\u00a0partner leaving), then you may not need to otherwise fortify\u00a0your practice. However, assuming you want to continue\u00a0growing then you\u2019ll want to be working on other aspects of the\u00a0practice to beef things up. There is always plenty to work with.<\/p>\n
Chances are you haven\u2019t really tucked in all the corners of\u00a0your practice to get the best possible attraction and retention of\u00a0patients. Plus, in every practice there is a gap between what you\u00a0can do for patients and what they choose to have done. Closing\u00a0that gap is a lifelong professional challenge.<\/p>\n
Working with your team on clinical calibration and co-diagnosis can yield great results.\u00a0Many doctors overlook the fact that the amount of services offered and accepted per patient is\u00a0usually a greater factor in a practice\u2019s production than the number\u00a0of patients seen per se. Maybe you won\u2019t have the largest patient\u00a0base in the world but you can have the best care for patients. This\u00a0does not have to be a matter of high pressure sales techniques or\u00a0violating your core values. Indeed, done correctly, it\u2019s a matter\u00a0of putting your core values into action in your everyday work.\u00a0Experienced management help will guide you through\u00a0realistic alternatives to increase patient flow, profitability and\u00a0practice security.<\/p>\n
In Conclusion:<\/h3>\n
Recognize that you cannot wish PPOs away. Take time to manage your particular situation with the right strategies and training. Then, you\u2019ll keep solvent and secure.<\/p>\n
This article was originally published in The Profitable Dentist magazine. Bill Rossi is president of Advanced Practice Management.\u00a0He and his\u00a0associates are actively involved in the ongoing management of over 250 Upper Midwest dental offices. You may contact Bill at (952) 921-3360 or apm@advancedpracticemanagement.com.<\/span><\/address>\n<\/p>\n","protected":false},"excerpt":{"rendered":"
Sometimes PPO participation\u00a0is necessary, even desirable.\u00a0However, a little strategizing can\u00a0do a lot for your bottom line\u00a0and your peace of mind. Too often dentists join PPOs hastily, or leave PPOs\u00a0recklessly. Bad decisions here can lead to thousands of lost\u00a0dollars or hundreds of lost patients. Over the years I\u2019ve worked with many practices deep into\u00a0PPO participation, others […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wds_primary_category":0,"footnotes":""},"categories":[3,4],"tags":[47],"class_list":["post-510","post","type-post","status-publish","format-standard","hentry","category-dental-insurance","category-dental-practice-management","tag-dental-insurance-ppos"],"_links":{"self":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/510","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/comments?post=510"}],"version-history":[{"count":0,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/510\/revisions"}],"wp:attachment":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/media?parent=510"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/categories?post=510"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/tags?post=510"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
- Some Doctors with PPO participation are very busy\u00a0but they are not profiting well. They are on a treadmill.\u00a0<\/span>Ironically, the Doctors who are deepest into PPO\u00a0<\/span>participation are the ones who are in the best situation to\u00a0<\/span>leave but emotionally less likely to want to leave.<\/span><\/li>\n