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Some Office Visit Schedules Linked to Insurance Payment
By D. Kellus Pruitt; DDS
http://thebulletin.us/articles/2009/05/21/herb_denenberg/doc4a15404e56e5f308210565.txt
Here is the link to an article written by Herb Denenberg titled: “Some Facts Your Dentist Doesn’t Want You to Know”. In it, he shared with his readers some information about dentistry that is hard to find. I submitted the following comment.
Dear Herb Denenberg,
Yours was a great article, and as a dentist with 27 years in a comfortable practice and 32 years in an expensive marriage, I find your cost-saving points oh so painfully accurate. Nevertheless, I must honestly agree that not only can some patients safely go a year or more between check-ups (ouch!), but many don’t need bitewing x-rays every year either (Good thing neither my patients nor my wife read the stuff I write).
Of BiteWing X-Rays
Readers who are hopefully from places other than the east side of Fort Worth can easily understand that the more treatment and x-rays I recommend, the more money I make. I must honestly add that my devoted and trusting dental patients, like most Fort Worth dentists’ patients, are reliably willing to accept my recommendations for these kinds of procedures without questioning the need. Let me put it this way: Annual bitewings are an easy $56 sale, mostly because fee-for-service insurance pays for them at 100% anyway. (If an angry dentist should ask who told you that, it wasn’t me). That is why it should not be taken lightly my approval of the advice about dentistry published in the book “1,001 Things They Won’t Tell You.” And; they won’t, sometimes.
Ethics and EBD
True to ethics I learned at the University of Texas dental school, in San Antonio (UTHSC), in the last six months, my hygienists and I have been determining which patients are safe to go a year and a half without routine bitewing x-rays. They are commonly taken every year simply because it has always been that way, and that interval was adopted as the minimum time most insurers allow. As readers can see, not a hint of Evidence-Based Dentistry [EBD] was involved in that determination. It was just a 1950’s guess.
Extended Prophylactic Schedules
This week we found four candidates in our practice for extended schedules. Our honesty will save these patients (their insurance companies) money by eliminating unnecessary care. And I really, really hate saving insurance companies money, on principle alone.
In My Defense
In my defense of continuing to maintain a large number of my patients on 6 month prophys and 12 month x-rays – and with the hope of restraining local dentists from throwing rocks through my windows – let me say up front that most people still need the old-school schedule in order to prevent disease. And, a few of the more fragile cases need x-rays and cleanings even more often than insurance allows.
Assessment
My patients and I are fortunate that I can freely charge the prices I deem necessary in order to put my patients’ interests above my wife’s. Let’s face it. Ethics are invisible to dental patients and they are not free. Ethics are a precious courtesy that dentists who accept managed care insurance find themselves forced to eliminate because contracts prevent them from raising fees as the market demands. Managed care dentistry is dentistry by the lowest bidder with no quality control. I only wish that someone would have pointed out that chunk of information in the book. Now, I’d better have my wife go ahead and start my car in the morning when she grabs the paper.
Conclusion
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Filed under: "Doctors Only", Career Development, Ethics, Health Economics, Health Insurance, Managed Care, Practice Management | Tagged: ADA, bite wing X-rays, cavities, Darrell Pruitt, DDS, dental visits, DMD, EBD, evidence based dentistry, Herb Denenberg, UTHSC |
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Dr. Pruitt,
Good post; and how true.
Now, who can write a post on the economic facts that your [insert professional-name here] doctor, podiatrist, optician, optometrist, chiropractor, financial advisor or planner, stock-broker, insurance agent, accountant, hospital CEO or physical therapist doesn’t want you to know?
Cynthia Mandy Petty-Smith
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My father had all his teeth pulled and dentures made at the age of 26. It saved him a lot of money over his lifetime. Thanks to food blenders and liquid food supplements, humans don’t need teeth to survive. The same can’t be said for cows.
Since we don’t need teeth, the dental profession can be total dis-intermediated to everyone’s financial advantage. Accordingly, the only dental health care services that should be paid for out of the public purse should be tooth removal, period.
Replacements of any kind would be cosmetics not covered services any more than there are government program to pay for lipstick. And, as final genuflection in the direction of dental evidence, I have to note that cex is better (and safer) without the hazardous presence of sharp-edged teeth.
Smooth gums: The Final Solution to Expensive Dentistry.
Ed Hodges
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Dr. Pruitt,
Here is the link for an article titled: The American Way of Dentistry
[The oral cost spiral].
http://www.slate.com/id/2229632?GT1=38001
Any comments?
Cindy
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Cindy,
I wish to thank you for bringing this important article to my attention. I’ll work on a response today.
Author June Thomas’ knowledge of dentistry is rare in a reporter who organizes information so well for readers. Ms. Thomas wrote a very good article, even if it was off-balance. Although “The American Way of Dentistry – The oral cost spiral” isn’t a press release, it’s very insurance-friendly – if not cozy.
It is my opinion that June Thomas accidentally advanced misinformation that Evelyn Ireland has been desperately shopping around lately. (Just between you and me, Cindy, I think Ms. Thomas was had). Evelyn Ireland is the executive director of the National Association of Dental Plans (NADP), and was quoted in Thomas’ article. NADP members, such as Delta Dental, United Concordia, BCBSTX and others sent her out on the circuit where she is courageously elbowing and scratching for a place for her bosses as future stakeholders in health care – hopefully while the government is still in a mood to spend money. I think most dentists already suspect that the future of Evelyn’s employment hangs in the balance of her success in this PR chore. If it doesn’t, it should.
In my mind, I’m putting together a comment to follow Thomas’ article. Here is something that immediately comes to mind:
How much should Americans pay NADP members for expensive, restrictive and intrusive dental benefit plans, just to give them a reason to go to the dentist?
I say give employees the money they earn and let them decide for themselves if find dentistry useful in their lives. Americans don’t need dentistry brokers or middlemen siphoning off money for their dental care, and we certainly don’t need to be giving them tax subsidies (Gasp!).
Yep. I can already tell that this one is going to sing.
Thanks, Cindy.
D. Kellus Pruitt; DDS
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Cindy, here is my response which I sent to June Thomas today:
Evelyn Ireland – NADP misinformation source
I recently began following a series of 7 very well written and surprisingly accurate articles called “The American Way of Dentistry” by June Thomas. She began posting them on Slate.com on September 28. Today, she posted number 5. “Why Poor Folks Are Short on Teeth.”
http://www.slate.com/id/2229630
I know why. It’s called NADP.
June Thomas’ knowledge of my profession is impressive at a time when so much calculated misinformation about the business of dentistry permeates the market – often strategically promoted by stakeholders who would raise the cost of dentistry, not to improve dental care, but to quietly carve out their chunk of profit. In Thomas’ latest addition to her series which focuses on those who cannot afford dental treatment, she points out the tragedy of Deamonte Driver, a 12-year-old from Maryland who died from an abscessed tooth. If Alyce Driver, Deamonte’s mom, could have afforded the fees charged by a local dentist in the free market, with or without government help, that would have been a more beneficial solution to the access problem than for the government to pay so little that dentists refuse to accept Medicaid. In most states, Medicaid is cruel false hope. Who can disagree with that? How do we pull dentistry back into the competitive free market, where dentists charge fees that are commensurate with the value of their product? Dr. Adam Smith has left the building, and children are dying. These kids don’t need managed care. They need dentists.
June Thomas writes, “Still, most middle-class Americans—even those with health and dental insurance—tend to be more aware of the price of dental treatment because they’re more likely to have to pull out their checkbooks when they visit the dentist.”
Apart from becoming more discerning shoppers who naturally reward dentists who treat them right and punish those who don’t, what happens when Americans become more aware of the price of treatment? They keep better care of their teeth. The hidden, cruel cost of “discount” dentistry run by CEOs whose malfeasance is out of reach of the FTC is the worst thing to ever happen to dental care. It must be exposed.
The first thing we must do is to eliminate the refuge of unfair business practices in the insurance industry by striking down the McCarran-Ferguson Act of 1945. This Act strategically shields insurers from anti-trust oversight by the FTC. Not unlike traditional monopolies and old school collusion, absence of accountability is a business advantage that keeps the cost of dental insurance artificially high while it serves to blur the true market value of dental care. As a result, dentists charge naïve patients what the insurers allow, not what patients are willing to pay. Our fee schedules are based on an artificial market being badly controlled by stakeholders. Dental benefits companies take their cut first and then make dentists fight to be paid their fair share. I’m referring to parasites such as the members of the National Association of Dental Plans (NADP). Did you know that NADP members’ managed care dentistry that they offer through their preferred providers is dentistry by the lowest bidder, and there is no quality control? How beneficial is that for NADP? How good is it for consumers?
On September 29, June Thomas posted the third in her series, “The oral cost spiral.” Just like her latest work, she did a fine job. But though number 3 is not a press release, it’s very insurance-friendly – if not cozy.
http://www.slate.com/id/2229633/pagenum/all/#p2
In consideration of the accurate reporting in her other works, it is my opinion that June Thomas accidentally advanced the same misinformation that NADP executive director Evelyn Ireland has been desperately shopping around lately. Ireland was sourced in Thomas’ article. NADP members, such as Delta Dental, United Concordia, BCBSTX and others sent Ireland out on the circuit a week or so ago where she is courageously elbowing and scratching for a place for her bosses in dental care – hopefully while the government is still in a mood to spend our grandchildren’s money. I think most dentists already suspect that the future of Evelyn’s employment hangs in the balance of her success in this PR duty. If it doesn’t, it should.
A few days ago, I watched a CNBC discussion of how Health Reform will affect vision and dental plans which featured Ireland as a guest.
http://www.cnbc.com/id/15840232?video=1239875545&play=1
The discussion was between Rob Lynch, CEO of VSP Global, who represents eye care benefit plans, Evelyn Ireland representing dental care insurers and CNBC’s Erin Burnett. Ms. Ireland protested: “Under the House bill all coverage for children would be removed from family policies. She pointed out that once the children move on, studies show that 60% of parents are less likely to keep buying dental benefits policies sold by the NADP members.
So how much should Americans pay NADP members for expensive, restrictive and intrusive dental benefit plans, just to give them a reason to go to the dentist? I say give employees the money they earn and let them decide for themselves if they find the intricate handwork dentists useful in their lives. Americans don’t need dentistry brokers like the NADP siphoning off money from their dental care, and we certainly don’t need to be giving them tax subsidies. (Gasp!)
Since dental benefits are not taxed as income if they are offered by employers, NADP businesses have been quietly subsidized by taxpayers for decades. Here’s a common sense idea: If parents with fixed incomes were provided not only lower costs of dental care from free market competition, but also extra cash from tax savings to spend wherever they choose to spend it, could we trust them to be accountable, or does the nation’s poor need NADP executive director Evelyn Ireland to stand between children like Monte Deamonte and affordable treatment?
If parents of grown children choose to spend their savings on taffy instead of floss, is there really room in the healthcare budget to insure Americans against chronic stupid? Children and the very poorest Americans need help with their oral care. Some adults, on the other hand, need to experience a toothache or two to re-align their priorities about their health. It is often a life-saving experience.
It is cruel to enable unaccountability when extractions are soo cheap for one who has a raging toothache? If hospital ERs are flooded with infected teeth, they should simply hire full time dentists. What do you expect? There appears to be a market for emergency dentistry. I think it could become a profit center. Children don’t have to die.
Later in the news segment, Evelyn Ireland reveals the self-limiting thought process we’ve grown to expect from healthcare stakeholders. She claims that if children’s dental care is made a part of medical coverage, many would be forced to change dentists. Like reporter June Thomas, CNBC’s Erin Burnett failed to ask a logical follow-up question such as, “Excuse me?”
The painfully camera shy executive director of the NADP represents managed care dental companies like Delta Dental, Cigna, UnitedHealth, United Concordia and BCBSTX. Their contracts only last 12 months at a time. That means that the business model of those entities Ireland represents causes children to change dentists regularly. Evelyn Ireland is asleep.
D. Kellus Pruitt; DDS
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A strange thing has happened that I haven’t yet figured out. I can no longer log on to the TDA Facebook, and I cannot find the TDA on Twitter either.
I’ve emailed the TDA to see what is happening. Surely it’s a technical glitch and not something foolishly regrettable. Don’t you think?
Darrell
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Lee Ann Johnson kicks D. Kellus Pruitt DDS off of TDA Facebook
From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
Sent: Thursday, October 01, 2009 6:30 PM
To: ‘leeann@tda.org’
Subject: RE: where’s the TDA facebook?
Dear TDA employee Ms. Lee Ann Johnson:
I think someone hung you out to dry, and the possible opportunity for discussion was not lost on this TDA member with unanswered questions.
Thanks for responding to my question about why as a TDA member I can no longer log onto the TDA Facebook. As I imagine you putting together the difficult email that a nameless superior instructed you to send me today, I suspect that you have enough on the ball for the directive to give you ethical discomfort. If it didn’t bother you, then perhaps you too are part of the problem.
You, I, the nameless TDA superior and several friends, all recognize that blocking a TDA member from TDA information is a cute way to delay the resolution of the TDA’s traditional problem with transparency concerning issues like BCBSTX and the NPI number. One of these days we’ll all laugh really hard about it. Here’s an idea, if you’ll provide me the name of your super, I’ll find his or her face somewhere and draw a portrait. What do you think, Lee Ann Johnson? Don’t you know someone will be surprised!
And did you really have to block me from the TDA Twitter account as well? Come on. Isn’t that just a little too petty for a professional organization?
It’s pretty easy to see that all it takes is one transparent dentist to scare the water from ADA leaders on not only the national level, but the state level as well. I find this incredible. I think my friends find it entertaining.
Today, a TDA employee proved that what the TDA needs right now more than anything else in this beautiful state that was founded on courage is transparency. To further this goal, I am inviting you, Lee Ann Johnson, or the person responsible, to discuss the issues in your letter.
“You may have already received this from Facebook, but TDA has recently been informed of your numerous abuse reports by group members.”
– No, I have not heard a single complaint from Facebook or anyone else, Ms. Johnson. I know that secretly, this news doesn’t surprise you, but some ADA members actually think the portrait idea is a creative and fun way to trigger improvement of TDA members’ involvement in organized dentistry. And don’t look now, Ms. Johnson, but it’s pretty obvious that unless you have some fresh and clever ideas up your sleeve that are Facebook ready, my portrait game sure beats the hell out of everything your creative crew has come up with so far. Or does the TDA prefer to have a Facebook where nothing moves? That would be a terrible waste of dues. Perhaps the TDA should follow BCBSTX’s lead and close the Facebook completely. The TDA could be the second bureaucracy I’ve driven off of Facebook. I could become a menace. I wouldn’t have put so much time into IMPROVING the TDA’s Facebook if I knew it was all going to be deleted in less than a second. That was rude.
It is not hard to recognize that the potential for membership involvement through social networks is exactly what at least one TDA leader fears more than anything else. What a bozo idea it was for the TDA to get involved with Facebook! What were they thinking?
How important is the quality of credibility to the new ADA President, Dr. Ron Tankersley? He only mentioned the word four times in four consecutive sentences in his interview by ADA reporter Judy Jakush less than a month ago. It looks to me like this tantrum the TDA is pulling is a huge sacrifice of credibility, just to continue to evade discussion about BCBSTX and the NPI number. This level of courage from dentistry’s leaders can’t be good for the welfare of dental patients in Texas.
As a concerned TDA member who has done nothing wrong, I am requesting that you document your statement about the complaints. I hope you understand that I simply cannot take your word for it considering that yours is a serious allegation that I take very personally. If you cannot share with me the names of the people who complained and the grounds of their complaints, I ask you to never mention the rumor again. I think you understand that you owe me at least the common decency you would afford a non-member.
“In order to continue the TDA Facebook group, we must abide by the Facebook Terms of Use and Statement of Rights and Responsibilities.”
That sounds exactly like the “whoosh!” of a TDA employee sidestepping accountability to a TDA member.
“TDA believes that your inflammatory comments on the NPI number and BCBTX and your drawing contest posts are in direct violation with these terms.”
Once again, Ms. Johnson, I ask you to show me proof of this. Otherwise, I must ask you to never mention these rumors again. If TDA members should ask you why D. Kellus Pruitt DDS is blocked from Facebook, you will have to say something like, “I am sorry, but I am not allowed to share that information with you.”
Good luck with that. It’s the kind of thing that eats at organizations from the inside. It’s demoralizing to have to protect the reputation of one’s boss with one’s own.
I can tell that you are probably unaware that for over three years I have tried to get the attention of the ADA on all three levels to discuss the NPI number and BCBSTX’s unfair business practices. Please tell your boss to meet me anywhere on the Internet so that we can solve the credibility problem which the TDA is experiencing. There’s a portrait and a crisp $1 bill in it for him or her. (Please, no phone calls).
Even if you never respond, Lee Ann Johnson, I’ll be difficult for you to ignore for a while. Watch Google.
Sincerely,
D. Kellus Pruitt; DDS
From: Lee Ann Johnson [mailto:leeann@tda.org]
Sent: Thursday, October 01, 2009 2:31 PM
To: ‘pruittdarrell’
Subject: RE: where’s the TDA facebook?
Dear Dr. Pruitt,
You may have already received this from Facebook, but TDA has recently been informed of your numerous abuse reports by group members. In order to continue the TDA Facebook group, we must abide by the Facebook Terms of Use and Statement of Rights and Responsibilities.
TDA believes that your inflammatory comments on the NPI number and BCBTX and your drawing contest posts are in direct violation with these terms.
Facebook Statement of Rights and Responsibilities
3. Safety
· Section 6. You will not bully, intimidate, or harass any user.
· Section 7. You will not post content that is hateful, threatening, pornographic, or that contains nudity or graphic or gratuitous violence.
· Section 9. You will not offer any contest, giveaway, or sweepstakes (“promotion”) on Facebook without our prior written consent. If we consent, you take full responsibility for the promotion, and will follow our Promotions Guidelines and all applicable laws.
· Section 10. You will not use Facebook to do anything unlawful, misleading, malicious, or discriminatory.
Lee Ann Johnson
[Director of Member Services & Administration]
Texas Dental Association
1946 S IH-35, Ste. 400
Austin, TX 78704
512-443-3675
512-443-3031 fax
http://www.tda.org
Go Green! Please do not print this e-mail unless it is completely necessary.
From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
Sent: Thursday, October 01, 2009 2:08 PM
To: leeann@tda.org
Subject: where’s the TDA facebook?
Hi, Lee Ann. Stephanie said I should contact you about the TDA Facebook. I cannot seem to find it. Is it a technical problem?
Darrell Pruitt; DDS
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