Breaking through cost barriers

Issue 6

Photo: Courtesy of Dental Patient Alliance It’s a scenario most dentists have lived out in their practice. You recommend preventive care or talk to a patient about other services you can offer, and he or she declines because it simply isn’t in the budget. These patients are skipping routine check ups and putting off care they need, which in the end only will cost them more.

Photo: Courtesy of Dental Patient Alliance

It’s a scenario most dentists have lived out in their practice. You recommend preventive care or talk to a patient about other services you can offer, and he or she declines because it simply isn’t in the budget. These patients are skipping routine check ups and putting off care they need, which in the end only will cost them more.

This frustrated Dr. Artemiz Seif Adkins, who has a private practice in Scottsdale, Ariz. She wanted to find a way to ensure her patients received the preventive care they needed as well as give them access to other services they may want but didn’t feel like they could afford. That’s why she developed the Dentist-Patient Alliance program, a program that enables patients to pay a one-time fee for an entire year’s worth of preventive dental care. Not only does Dr. Adkins receive payment up front, but it helps her patients cut dental costs by as much as 50% and gives them access to care they thought they couldn’t afford.

We recently talked with Dr. Adkins about this program and why it seems to work for her patients and her practice. Here’s what she had to say:

DPR:  Tell me a little about Dentist-Patient Alliance program. What’s the idea behind it?

Dr. Adkins: It gives my patients the ability to pay into a membership that gives them certain benefits, including preventive care for no cost and reduced costs on other services they need or want. I wanted to test the idea of whether it was possible to increase patients’ use of preventive care if you reduced the cost barrier. So far, it seems to be working.

DPR:  How do patients become members?

Dr. Adkins: They can just sign up for it. Membership is elective and we don’t limit membership. Any one who wants to be a member can be a member. Some people use it for the preventive care and others use it because they need a lot of dental work that would cost them more any other way. It’s attracting different people for different reasons.

DPR: How did you determine what each patient pays?

Dr. Adkins: It’s a one-time fee for a one-year agreement and ranges from $700 to $1,250 depending on the patient’s age.

DPR:  How many of your patients are taking advantage of this program?

Dr. Adkins: Last year I wanted to limit it to 100 patients to test the idea but ended up with 113 by the time it was done. Out of 113 patients, 110 of them used every single preventive maintenance service that I recommended, which was incredible. It’s more difficult to get people to do preventive care when they know if they come in there’s a bill attached. But with this program, people followed my professional guidance almost every time. I’m a new dentist and have about 2,700 patients, but my 113 members were responsible for half of my practice’s productivity last year. Once the cost barrier was removed, people felt free to use the services they perceived as unaffordable. They were calling us and asking if we could do those other services they had been waiting to do.

DPR: How many patients do you have signed up this year?

Dr. Adkins: I started the program again in May and have 65 patients signed up so far. It’s still growing. We’re going to continue for a year and see what happens in terms of patient behavior and perception. Some of last year’s members have re-signed and others have not. That’s one of the challenges of the program. I’ve been thinking about ways to keep them engaged for preventive reasons even after they’ve done everything they needed or wanted.

DPR: What do your patients seem to like about the program?

Dr. Adkins: I think it’s the same thing I like. It’s the idea that they don’t have to think twice about what I recommend because I don’t have a direct financial gain any more. Even though the great majority of us dentists have our patients’ best interest at heart, there are public confidence issues when people are given bad news in a place they don’t want to be at any way. They often think about the fact that I am in practice and I do gain financially from their illness. I wanted to see if it is possible to remove that stigma, that barrier. Is it possible to do this in a way where I get to be successful by keeping my patients healthier, by providing preventive care versus treating illnesses for them? I think that’s why patients were calling to ask if I could see them one more time before the year was over. It’s an incredible dynamic shift for the patient/doctor relationship. It’s small, it’s a nuance, but it changed their behavior so drastically in such a positive way.

DPR:  What gave you the idea to try this type of program?

Dr. Adkins: I’m a solo practitioner with no insurance affiliation and don’t believe in our insurance system so I’ve been looking for creative ways to give people more effective care. I was often frustrated by my inability to be as clinically effective as I could be because costs and complexities in our system sometimes make treatment impossible for patients. I could say to 2,700 patients I want some of you here twice a year, some every three months, but I never seemed to be able to get them anywhere near 100 percent compliance. I felt like I was chasing disease rather than treating it successfully. I was frustrated and kept asking myself, ‘What if I work for free?’ I have bills to pay so of course I can’t do that, but I wondered what else can I do so I can be more clinically effective? When you get 110 patients out of 113 that follow everything that needs done, that’s incredible.

I’ve seen some physicians do what they call concierge medicine where they limit the practice to fewer patients, which improves access but doesn’t provide much of a cost savings. Physicians don’t have some of the challenges we do. If a person has a cold it’s an office visit. If a person breaks a tooth it’s a crown. It seemed to me like maybe we can learn from that concept, but customize it to fit dentistry a little better. I also thought what if practitioners were able to individually become a community asset. Just like you go into Costco and pay a membership fee and get access to certain things at a reduced cost, can we do that with dentistry? Should we? That’s why the concept came to fruition.

DPR: How did your patients react when you told them about the program?

Dr. Adkins: It was a mixed reaction. Some people were automatic sign ups and thought it was the greatest thing. Others were skeptical. Some patients said there’s got to be a catch. It just can’t be. There’s a lesson in that. Growing up I never thought my doctors were trying to take advantage of me but people question us more now. The fact that at the end of the year patients had access to whatever they wanted, as long as it wasn’t going to hurt them and they followed my clinical judgment, by the end of it, the people who were questioning it were pleasantly surprised. There was no catch. This was a good experience. It was a positive experience for me knowing people agreed it was possible, if we work together, to improve the system. We can come up with creative ways to do this. This is just one example. The point is we can work with our communities and have them be part of the discussion of what they need.

DPR: What can other clinicians learn from this?

Dr. Adkins: I would say look at your communities specifically and see what they need. What I can do may not be the same as what they can do in their communities. If we don’t start to work with our communities, I believe the solo practitioners will be in trouble over time. It’s not a coincidence that most new dental offices going up are corporate-owned office. This idea is just one example of one idea that I tried and am glad it seems to be working for my community. I believe the more we can engage our communities, the more effective we can be, and I dare say the more successful.

Renee Knight is a senior editor for DPR. Contact her at


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