Will this insurance move put an end to solo practices?

December 14, 2016
Dr. Marc Cooper

Dr. Cooper's professional career includes private periodontist, academician, researcher, teacher, practice management consultant, corporate consultant, trainer, seminar director, board director, author, entrepreneur and inventor.Dr. Cooper has studied with masters in many disciplines, participated in formal business educational programs, and worked as an independent contractor with top-flight consulting companies. In 2011, Dr. Cooper was selected as a coach for the prestigious TED Fellows Program.The Mastery Company has been in existence since 1984. Dr. Cooper's client experience in dentistry includes solo private practice, small partnered practices, managed group practices and retail corporate enterprises. Dr. Cooper has worked with numbers of health care entities such as insurance companies, clearing houses, bio-technical companies and disease management companies, as well as the senior executives and boards of large hospitals and hospital systems and a number of their related physician groups. In addition, Dr. Cooper has worked with Silicon Valley start-ups and Fortune 500 companies. He has worked with dental clients in the U.S., U.K. Canada, Chile, Brazil, Portugal, Italy, Greece, Dubai, Abu Dhabi, Oman, Singapore, New Zealand, Australia and Israel.Dr. Cooper is author of eight successful books; Mastering the Business of Practice, Partnerships in Dental Practice, Running on Empty, SOURCE, Valuocity, Valuocity II, Valuocity III, and The Elder. His electronic newsletter reaches thousands of subscribers in 31 countries. Dr. Cooper also co-developed a suite of online dental practice management assessment tools.Dr. Cooper can be contacted at:info@masterycompany.com

Dr. Marc Cooper explores how a new policy decision by major U.S. insurance companies could have far-reaching effects.

Insurance companies Guardian, Met Life, and others are now reducing, or not covering, numbers of restorative procedures, especially implants and crown and bridge, for out-of-network dentists. They are still maintaining reimbursement at a reduced level for in-network dentists.

Given that 70 percent of patients have some form of dental plan, numbers of patients are leaving out-of-network dentists given their insurance no longer will pay, at least at some reimbursement level, for the recommended restorative care.

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This will drive solo dentists once again to thoughtfully consider their future. If they become in-network dentists, the third party’s fee schedule must be accepted. This will drive their revenues downward. If they don’t become in-network dentists, patients will exit since many decide on their dental care based on cost.

What are the choices solo practicing dentists have?

  • Become an in-network dentist.

  • Sell to an existing group practice.

  • Become a Concierge dentist.

  • Form their own group.

  • Reduce their expenses and personal income to match the reduction in revenues.

When the context changes, everything changes within it. The context has changed and insurance companies, given they are driven by their bottom-line, are changing right along with it. My work with dentists to form group practices has dramatically increased-ain’t no mystery why?

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Dentists in solo practice will be unable to survive in this new context. The ADA, State Boards, state dental societies and all their political organizations cannot stop this from occurring. And the reason managed group practices are growing at 20 percent per year, while solo practices are shrinking at 7 percent per year, is managed group practices can handle these changes in third party reimbursement.