Managed Care 
Author Message
 Managed Care

This article has been electronically reprinted with the permission of
the author, Bryan
Quattlebaum, DDS.  Dr. Quattlebaum is the author of "Managed Care in
Dentistry" (PennWell
Books -- 1-800-752-9764)

An orthopedic surgeon in Sacramento was lamenting about the role of
specialists in managed care
provider networks.  The real problem, in his mind, was not that a
specific plan would fail to entice
every local orthopedic surgeon to join the panel, but rather that any
particular plan could only use
three or four of them anyway.  Indeed, several of his colleagues had
left Sacramento after newly-
created specialty networks had "dried-up" their pool of available

With the advent of Preferred Provider Organizations (PPO), traditional
dental plans simply had to
duplicate their provider panels -- one for primary care and a separate
one for specialty care.
Discounted fees were negotiated for both sides, and the general dentists
from one panel referred
their patients to the specialists in the other panel.

Managed care will dramatically alter even this arrangement.  Specialists
will discover that long-
nurtured relationships with referring dentists can persist only if both
specialist and primary care
dentist (PCD) are under contract with the same dental managed care plan.
 Even at that, there is
no guarantee that the PCD will be able to direct his or her referrals to
any one particular
specialist, since the dental managed care plan controls all referrals.

To the chagrin of most specialists, many prepaid dental plans (not
necessarily true "managed care"
plans) force their PCDs through some incredible situations before
allowing them to even request a
referral.  One prepaid plan requires the PCD to attempt to treat
children three times before a
referral will be considered.  Neither patient nor dentist gain anything
from such a requirement.

On a brighter note, reimbur{*filter*}t of dental specialists tends to be more
accommodating than for
the PCD, for whom capitation is the pre{*filter*} form of reimbur{*filter*}t.  
The National
Association of Prepaid Dental Plans (NAPDP) reported recently that one
of its member-plans had
as many as 12 different compensation systems for its dental specialists.

Specialists tend to make common mistakes when faced with dental managed
care.  One may cease
cultivating new referral sources; another may consider relocating.  For
the specialist who is willing
to face the future of dental managed care, these key strategies should
be kept in mind: 1) continue
to actively market your services and expand your referral base; 2)
assure your current referring
dentists that you are willing to consider following them into a managed
care provider network; 3)
initiate contact with those dental managed care plans already operating
in your community; and 4)
consider forming a multi-specialty practice with other dental

Keep in mind that in dentistry, specialists remain in the minority of
dental providers.  This is to
our profession's benefit, as the generalist-to-specialist ratio in
dentistry is very close to that which
our medical colleagues are attempting to achieve.  Both dental schools
and organized dentistry
must work to prevent an "over-population" of dental specialists.  Such a
situation, as the
aforementioned orthopedic surgeon was alluding to, is damaging only to

Sun, 29 Jun 1997 08:41:27 GMT
 [ 1 post ] 

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