{"id":944,"date":"2022-08-30T15:21:52","date_gmt":"2022-08-30T15:21:52","guid":{"rendered":"https:\/\/blog.advancedpracticemanagement.com\/blog\/?p=944"},"modified":"2022-08-30T15:21:52","modified_gmt":"2022-08-30T15:21:52","slug":"balancing-ppo-participation-2","status":"publish","type":"post","link":"https:\/\/blog.advancedpracticemanagement.com\/blog\/balancing-ppo-participation-2\/","title":{"rendered":"Balancing PPO Participation"},"content":{"rendered":"
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FEBRUARY 15, 2016<\/span>\u00a0<\/i><\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n
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    By Bill RossiFor many practices, PPO participation is their biggest expense after staff wages (or even greater than staff wages in some cases).\u00a0 Historically, dental practice collection percentages had been 95%+ (of gross production).\u00a0 Now it\u2019s not uncommon to see collection percentages at 70-80%\u2026and sometimes less.Most dentists join a PPO in the hopes of gaining or retaining patients.\u00a0 No dentist likes to lose patients, and when you do lose a patient because you\u2019re not in the network, it can be a powerful inducement to sign up for a PPO.Once you\u2019re participating in a PPO, it\u2019s easy to feel there\u2019s no other choice.\u00a0 However, you don\u2019t have to take everything the PPOs dish out.In many areas, the PPOs will have the majority of the providers in the area but no PPO has 100% of the providers.\u00a0 Therefore, it is possible to survive and thrive outside the participation of any one PPO.\u00a0 For most doctors, it\u2019s a matter of having the right balance.As a general rule of thumb, if you\u2019re collecting less than 90% of your gross production, this should be reviewed.\u00a0 If you\u2019re collecting less than 80%, chances are very high that you would benefit by cutting back on PPO participation.\u00a0 It\u00a0is<\/u>\u00a0possible to cut the PPOs and keep the patients!For example, take a look at your own practice.\u00a0 You probably have patients that are already seeing you out of network.When deciding where to cut back on PPO participation,<\/u>\u00a0look first for plans that are 15% or less of your patient base and have \u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00ad\u00adfee allowances with greater than a 30% discount.Providers have more options in a marketplace that has a greater variety of PPOs.\u00a0 You don\u2019t have to be chained to any one PPO.The worst case scenario is to be in an area where 90% of the insurance is through just one company.\u00a0 That makes it tough!\u00a0 Fortunately, that\u2019s not the case everywhere.\u00a0 Cut back one at a time.You may be participating with group plans that include multiple PPOs.\u00a0 There can be \u201cPPO creep\u201d on these plans where you can sign up for several plans and then find out several more had been added despite the fact that you didn\u2019t directly contract with them.Sometimes you\u2019re better off directly participating in the PPO network and sometimes you\u2019re better off just dropping the network altogether.\u00a0 And to add to the complexity, sometimes the PPO network pays better out of network than it does in network.If you are netting less than 35% of your collections and gross staff wages are in line(<27%) and you don\u2019t have extraordinary equipment\/facility expenses, then the PPO\u2019s are the likely culprit.PPOs are sort of like the casinos in Las Vegas.\u00a0 The \u201cHouse\u201d has all the odds in its favor.\u00a0 However, as a player, you can play smart, and sometimes you don\u2019t have to play at all!\u00a0 You have more power than you think.For most practices, two to four plans are the right mix.\u00a0 You can adjust the participation in plans just like you\u2019re adjusting ballast in a hot air balloon.\u00a0 Cut back the plans one by one until you have the right mix of profitability and busyness.\u00a0 Every year negotiate fees for the plans with which you have contracts (a topic beyond the scope of this article).It\u2019s been my experience that most doctors join a plan too impulsively or leave a plan too irrationally.\u00a0 This is a serious issue and deserves serious analysis.\u00a0 A good look at your PPO situation can do more for your bottom line than almost everything else.\u00a0 You can add $1,000\u2019s and even $10,000\u2019s to your annual profits.We all know that hard work, integrity and skill make a difference in your success, but don\u2019t forget the other component,\u00a0courage<\/strong>.\u00a0 Serious consideration and a bit of courage can save you\u00a0a<\/u>\u00a0lot\u00a0<\/u>of sweat and stress.Bill Rossi and his team at Advanced Practice Management are actively involved in the ongoing management of over 220 dental offices in the Upper Midwest and monitor over $30,000,000 per month in Dental activity.\u00a0 They are nationally recognized experts in dealing with PPO issues.<\/em><\/p>\n<\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"

    FEBRUARY 15, 2016\u00a0 By Bill RossiFor many practices, PPO participation is their biggest expense after staff wages (or even greater than staff wages in some cases).\u00a0 Historically, dental practice collection percentages had been 95%+ (of gross production).\u00a0 Now it\u2019s not uncommon to see collection percentages at 70-80%\u2026and sometimes less.Most dentists join a PPO in the […]<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"wds_primary_category":0,"footnotes":""},"categories":[4],"tags":[],"class_list":["post-944","post","type-post","status-publish","format-standard","hentry","category-dental-practice-management"],"_links":{"self":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/944","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\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/comments?post=944"}],"version-history":[{"count":0,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/posts\/944\/revisions"}],"wp:attachment":[{"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/media?parent=944"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/categories?post=944"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.advancedpracticemanagement.com\/blog\/wp-json\/wp\/v2\/tags?post=944"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}