Dentists resist pull of managed care

Dentists resist pull of managed care

Diane Freeman

Business Report Correspondent
Although managed-care companies continue to try and edge their way into the Northern Colorado market, most dentists here say they resist signing up for the programs due to lower reimbursement rates and less control of their practice under the plans.Many managed-care plans permit only basic work on a dental patient, even though they contain "hold harmless" clauses in their contracts so that the dentist is responsible for any problems the patient encounters later, said Dr. Ed Robison, a dentist in Fort Collins and president of the Larimer County Dental Society.
"That˜s where it˜s a disadvantage," he said. Because the managed-care companies dictate what the practitioner can do for the patient, they˜re basically "trying to practice dentistry," he said.
Many dentists chose the profession partly because they like being small-business and the autonomy it provides, he said. Dentists have learned to beware of managed-care plans after watching physicians lose much control of their practices to managed care, he said.
"I˜d rather fling burgers than work for one of those companies," he said.
Because the economy is so strong currently in Northern Colorado, there˜s no real incentive for dentists to sign up with these types of plans, he noted.
"We don˜t have any empty chairs," he said.
Another Fort Collins dentist and consultant, Dr. Michael Iacoboni, said the general population of dentists resists managed care because it shifts the risk to the dentist and under-reimburses practitioners.
If a dentist charges $100 for a procedure that costs him $80 to perform, he makes only a $20 profit. But managed-care plans can cut that profit down from $20 to $5 because of discounts they offer to patients, he said.
Because of the area˜s robust economy, most local dentists operate thriving practices and lack the incentive to sign up with insurance plans that offer lower reimbursements, he said.
Iacoboni said managed-care companies continually try to enter the Northern Colorado market but he hasn˜t noticed any new insurance carriers aggressively trying to make headway into the region lately.
"Managed care has a minority share of the market because of its reimbursement practices," he said. "Managed-care plans have a guaranteed profit on their end, and they are always trying to increase their market."
Dentists who do work with managed-care companies accommodate them by buying materials in bulk and adapting their operating systems to handle lower reimbursements, he said.
About 80 percent of Colorado dentists belong to Delta Dental Plan of Colorado, but that is because the company˜s indemnity plan offers a relatively high reimbursement rate. In contrast, the company˜s capitation plans are under -subscribed to because of the strong economy here, Iacoboni said.
Dennis Phillips, vice president of marketing for Delta Dental Plan of Colorado, said the insurance plan covers the employees of the city of Fort Collins, the city of Loveland and several school districts in Northern Colorado. Delta Dental is offered only to groups of 10 or more employees.
"The dental profession hasn˜t welcomed managed care," Phillips said. "HMO dental programs are not widespread."
He noted that dental insurance plans lag behind medical managed-care plans by about 10 years.
While about 75 percent of the dental profession is in solo practice, the opposite is true of the medical profession, where the majority of physicians work in group practices or clinics.
Delta Dental contracts with dentists who opt to belong to one of its three major plans. The Premiere program is an indemnity plan in which the dentist generally receives his customary fee for reimbursement from the carrier, Phillips said.
"We pay the dentists their usual fee, and they agree to our policies," he said.
In Fort Collins, about 70 dentists belong to the Delta Dental program, he said. Delta Dental covers 480,000 people in Colorado.
The company also features a Preferred Option plan that covers city of Fort Collins employees. Much like a preferred-provider plan, it allows employees to go out of the network of dental providers by paying a deductible fee if they choose to see a nonnetwork dentist.
A third option resembles an HMO dental program and restricts treatment to a closed group of dentists who are paid to treat so many patients for an employer through a capitation program.
"Dentists don˜t like that, but employers like them because the premium is low. It˜s the dentist who is at risk," Phillips said.
While many dentists resist managed care, there has been some growth in that area because many dentists would rather switch over to the plan than lose a patient whose employer starts offering that program, he said.
"There˜s marketplace pressure that˜s dictating what types of programs are used. It˜s the purchaser making the decision," Phillips said. "It˜s a marketplace-driven thing."
Because Delta Dental has relatively high reimbursement rates, it obviously attracts a lot of participation within the state, said Tom Oberle, executive director of the 2,400 member Colorado Dental Association.
Managed care has been involved with dental practices for many years. Dentists are generally willing to participate in these programs as long as compensation is reasonable, because it˜s a way to bring in more business, Oberle said.
In recent years, many dental-insurance plans have tried to enter the state and solicit dentists for membership in their programs, he said.
Plans that offer adequate compensation and benefits usually have no trouble creating a network, he said. But those with less than adequate compensation encounter resistance from dentists who find that the plans are not affordable for them, he said.
"There˜s a lot of competition among dentists, but they resist underfunded care," he said.