Comparing medical managed care
to dental managed care.
Hello!
Hey! Here we are again getting right back into the
groove. (*)
There was a very interesting article in the New York
Times this morning. It emphasized to me the vast
misunderstanding that we have when we erroneously
compare Medical Managed Care with Dental Managed Care.
As explained in the article, the reason why medical
managed care came into being was that too many non-
emergency people were going directly to the hospital
emergency rooms for fairly simple problems. This ends
up being an extremely costly process and most often, is
not warranted. It is far better to encourage the
patient to consult their primary care doctor first.
Its a considerable health care savings all of the way
around.
With dental managed care (I am speaking of capitation
programs in this regard), the patient is offered free
or low cost services only as an entry into the dental
office. Any of the more sophisticated services --
composites, crowns, root canal, bridgework, -- becomes
strictly the patient's responsibility.
Who are the dentists who are participating in these
cheezy managed care programs? Are these the highly
specialized, economically-saavy offices? Well, not
necessarily.
They are the exact same guys who offer standard fee-
for-service dentistry! In fact, the participants are
practically everybody around here!
Some of these providers are the very same guys who do
a little cosmetic dentistry, a little overblown
dentistry, some regular dentistry, plus plenty of bait-
and-switch dentistry too. Therefore, the entire
managed care industry becomes reduced to nothing more
than a newer kind of sales pitch.
Advertising your skills as a "Cosmetic Dentist" gets
you more referrals these days than advertising yourself
as some kind of a "Pivot-Tooth Dentist!" Too bad.
Some of those pivot-tooth dentists were really pretty
skilled.
Current dental practice management gurus admonish us to
forget about the pivot teeth and just concentrate on
concocting some huge treatment plan. You do this in
lieu of fixing teeth.
Of course, for this to happen, you will definitely need
the cameras, the gizmos, the 'puters, the bells and
whistles, plus the whole gang working on your side.
Gosh! That little cavity sure looks bad when it
gets magnified 100 times normal size displayed there
on a 20 inch monitor!
Next, we place in motion all of the necessary financing
to avoid getting stung. Here's one guy who even
advertises on page 120 of the June issue of the
Philadelphia Magazine. At 1/4 page, its a pretty
expensive ad too.
"A new smile ... a new you.
Interest free financing available."
The patients who do not pass muster (bad credit, no
credit) just go right back out the door and then let
dental neglect take its course. This is not like an
acute myocardial infarction taking place here.
Dentistry has experienced a recent paradigm shift. It
has changed from a health-care activity to what amounts
to no more than a commercially-oriented activity. When
dentists are expected to advertise their services to
survive, is it any wonder that every single patient
becomes nothing more than a customer? Why have we
allowed unnecessary treatment planning and "contracting
of our services" to replace standard fee-for-service
treatment?
This is a far cry from that thing known as medical
managed care, which can be an effective method for
reducing overall costs. Dental managed care reduces
costs for no one at all.
Cheers,
Joel M. Eichen, D.D.S.
(*) Back in the groove.
I bought 'thisy-here' newfangled computer and its a
real scorcher too. The total cost was $550 including
the monitor plus a nifty color printer thrown in for
good measure. Well, if I went along with a 3-year
sign-up with MSN, the whole computer package would have
cost me only $150.
However, there is no MSN in my future. What to do?
I paid the whole $550 but now I am pretty busy saving
the MSN fee to make up the difference. Here's how I do
it.
I gave up earthlink.net and now I simply sneak onto the
superhighway through FreeLane (e{*filter*}.com). This means
I am not required to take a turnpike ticket and
therefore I do not need to pay when I get off.
Next, I use mailgate.org to read sci.med.dentistry
through http (hypertext protocol). The only problem
there is that posting is so v-e-r-y s-l-o-w through
http!
To solve that, I signed up with mailops.com. Now I can
read sci.med.dentistry through http (similar to reading
through deja.com) or read it through nttp (news
protocol) by using Forte Free Agent. This is my regular
newsreader. Forte really flies! The real benefit is
that now I am posting these messages through FFA which
is pretty durned quick.
That's still the perennial problem with web-based
stuff. Like managed care, it gets too bogged down!
***
[New York Times article]
October 25, 2000
Emergency Room, to Many, Remains the Doctor's Office
By JENNIFER STEINHAUER
Kim Kulish/Saba for The New York Times
At St. Francis hospital in Lynwood, Calif., emergency
room visits have risen 13 percent. Above, doctors
treated a stabbing victim at St. Francis.
SPECIAL TODAY
E-Commerce & Health Care
A special section examines the promise and problems of
New Economy health care. Plus, articles on business-to-
business exchanges, personal finance and the holiday
season ahead.
Of the many goals of the managed care revolution, few
had as much resonance as the push to get people out of
the nation's emergency rooms.
With health maintenance organizations, everyone was
supposed to have a primary care doctor who would manage
routine aches and pains. Preventive care would stave
off emergencies like acute asthma attacks, and better
use of family doctors would help ma ke emergency room
business dwindle.
It has not worked that way. Visits to emergency rooms
grew about 3 percent a year from 1997 to 1999 and have
risen 6 to 8 percent in the last year, a figure that
was expected to continue, said an emergency doctors'
group.
The reasons are similar to those behind other problems
in health care: the lack of access to primary care
doctors among the poorest Americans and a large number
of Americans who are without insurance, often because
of higher premiums. In addition, th ere are those who
simply find the emergency room more convenient.
In New York City, three out of four visits to an
emergency room are for nonemergencies, according to a
new study by the Commonwealth Fund, a private
philanthropic organization.
The promises of primary care have been dashed in large
part, health care experts said, because insurance
reimbur{*filter*}ts for primary care doctors are so low that
too few are willing to be in the field or to extend
themselves to late hours or weekends when emergency
care is required.
"The situation is grave," said Dr. Michael Gerardi, a
spokesman for the emergency doctors' group, American
College of Emergency Physicians. "We are a symptom of
the disease that is the health care system."
In many areas of the country, especially in cities with
large numbers of uninsured, emergency rooms are being
crushed under the increased volume and patient care is
often compromised, doctors said.
"We are not adapting very well," said Dr. Daniel
Higgins, the medical director of emergency service at
St. Francis Medical Center in Lynwood, Calif., where 27
percent of the patients are uninsured and emergency
room visits have risen 13 percent in fi ve years.
But in regions where hospitals still compete for
business, like New York City, and in areas with large
numbers of insured residents, emergency rooms are
learning to accept and even welcome the increased
patient load. Hospitals are making emergency ro oms
feel like a private doctor's office where waits are
short, coffee is pouring and the first question a
patient hears is about their condition rather than
their payment method.
"Five years ago there was all this talk about
inappropriate uses of the E.R.," said Dr. Dan Wiener,
chairman of emergency medicine at St. Luke's-Roosevelt
Hospital in Manhattan. "All we were focused on was how
to get them out. Now we are looking at h ow to give
these patients better service."
The emergency department is economically complicated.
It is the entree for large numbers of patients for most
hospitals about 52 percent on average in New York and
as many as 80 percent in some hospitals. In addition, a
hospital routinely earns mor e from an emergency room
visit than from one to a clinic.
But doctors and hospital executives said that insurance
companies have gradually lowered payments for visits to
emergency rooms, often resorting to what is known in
H.M.O. argot as "downcoding," or paying for the
diagnosis say, indigestion rather than the medical
tests to reach that conclusion say, tests for a heart
attack.
A patients' bill of rights, which is lingering in
Congress, would make this practice illegal; insurance
company executives insisted that it was more often the
result of poor billing practices by hospitals than
anything sinister on their part.
Uninsured patients have little choice but to get even
the most routine care in emergency rooms, which by law
must treat every patient who shows up. The number of
uninsured Americans rose by an average of more than a
million a year from 1987 to 1998 until it declined last
year, according to Census Bureau figures.
"A good one-third of our population is uninsured so we
would not expect any change in utilization with that
group," said {*filter*}ia Hastings, the director of the Los
Angeles County Emergency Medical Services Agency.
Danyelle Lee was one such person. The other day, she
took her 2-year- old son, Cartier, to St. Luke's in
Manhattan because he had diarrhea. She was so
accustomed to getting care that way that she has almost
stopped thinking about it, she said.
"I would like him to see just one person," Ms. Lee
said, "but they are friendly and nice here, so for now
it's
...
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Comparing medical managed care to dental managed care.