Leadership and Communication in Dentistry

Joseph P. Graskemper

• Publisher: Wiley-Blackwell
• Year: 2019
• Print ISBN: 9781119557210
• eBook ISBN: 9781119557135
• Edition: 1
• Topic: Medicine
• Subtopic: Dentistry

This book provides practical strategies for dentists to effectively and confidently communicate with many dental insurance issues, as well as with their patients and members of their staff. Providing real-world examples and sample letters, the book includes specific guidance on how to handle common communication scenarios to avoid being caught off-guard or unprepared.

Leadership and Communication in Dentistry begins with a unique section discussing communications with insurance companies, including negotiations, PPO contract issues, appeals letters, and more. It then includes chapters on communicating with patients, addressing how to listen to their concerns and motivate them, and staff, emphasizing how to be a better leader and institute office policies. The final section explores how dentists can use leadership and communication skills to improve their practice of dentistry.

• Provides concrete guidance on how dentists can confidently take the lead on conversations with dental insurance companies, their staff, and their patients
• Includes real-world examples of how to lead through communications
• Divided into sections covering communications with insurance companies, dental patients, and staff members
• Teaches that being mindful of proper communication and leadership skills will create a true balance for the successful dentist leader to become successful at living

Leadership and Communication in Dentistry is a must-have resource for any dentist or dental student wishing to improve their communication skills.

Section 1
Leadership and Success in Communication with Dental Insurance Companies

With the continuing intrusion into the practice of dentistry, dentists must have a full understanding of the insurance company’s provider agreements, dental care limitations, and policy manuals; thereby, allowing the dentist to become an advocate for the patient and be successful in his or her dental practice.

1
Understanding Insurance Companies

Let no feeling of discouragement prey upon you,
and in the end you are sure to succeed.

Abraham Lincoln

Our doubts are traitors, and make us lose we oft might win,
by fearing to lose.

Shakespeare

Whether you accept dental insurance or not, you as a dental office owner must master certain communication skills to properly provide care for those patients with insurance coverage. Dental insurance has made such an impact on the patient's perspective of how they choose their dental care that it directly or indirectly affects all dental offices. Therefore, this section presents basic understanding and some sample letters for proper communication on a wide variety of dental insurance issues. Dental insurance companies have become a major stakeholder in dental healthcare. Beginning in the 1950s and really blossoming in the 1970s, insurance companies are now a major payer for dental services. Dental insurance, like all other insurances, was intended to be a help for patients to obtain needed dental work. Dentists even founded their own dental insurance company called Delta Dental. Dental insurance was never meant to be the full payer or overseer of dental care. However, corporate profits do change viewpoints resulting in corporate control of how, when, and where dental care is provided. With this intrusion into the doctor–patient relationship and having a focus on making a profit for their shareholders, insurance companies have exerted more and more control over the procedures that would be covered, and if, how, and when those procedures will be paid for. Even though the insurance company makes the rules, we can take the lead in making the rules work for us, our practices, and our patients. We must take control of this intrusion through proper advocacy for our patients.

First you have to understand the insurance conundrum to better communicate with insurance companies just like understanding your patient's needs and wants to better communicate with them.

It is a conundrum because the insurance companies exist primarily to make a profit for its shareholders while providing health services to trusting clients, who expect untethered coverage. The term “insurance companies” includes self‐administered and self‐funded dental coverage. Some jurisdictions do not apply insurance company rules and regulations to self‐administered or self‐funded dental coverage plans. As always seek proper legal advice regarding your state's policies, rules, and regulations. To make the system work, there are procedure limits and yearly monetary limits regardless of patient needs. However, we must work together for our patients and our mutual survival. Merely saying you do not work with dental insurance companies is not being realistic for most dentists.

Briefly, there are basically two types (exclusive of government‐supported programs such as Medicaid) of insurance managed care, Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO), with there being several types of both. The major difference between all plans is the manner in which the dentist is paid. There are also many other stipulations in the contract that are beyond the fee structure. An HMO often referred to as a capitation plan when it pays the dentist a monthly fee for each client/patient assigned to the dentist whether or not the patient comes to the office for dental care. In turn, the dentist will provide needed dental care with no further cost to the insurance company and at little to no cost to the patient. The less treatment provided or even if the patient does not come for appointments, the dentist makes a larger profit. This clearly puts pressure on the dentist to provide the least costly alternative treatment (LCAT) rather than the ideal treatment the patient may need or want. It also may create an ethical practice management dilemma of the duty to provide insurance‐covered treatment and the loss of income.

There are several PPO formats. One, which I call Full PPO, has a PPO fee structure based on an agreed‐upon reduced fee schedule that is paid in full by the insurance company. There is also the Percentage PPO, which has a fee structure based on an agreed‐upon reduced fee schedule that is paid in part by the insurance company and in part by the patient, each paying their percentage of the full agreed‐upon fee depending on the treatment provided. The Patient PPO is based on an agreed‐upon reduced fee schedule that is paid in full by the patient.

Per the ADA survey, 73% of dental patients have some type of dental insurance, and 92.7% of dentists have contracted with two or more PPOs [1]. This clearly indicates the depth of dental insurance into the individual dentist's office.

Having provided dental care for patients for over 40 years, the impact of dental insurance companies has grown such that most dentists have experienced the impact of the dental consultant on the doctor–patient relationship and the decision‐making process to provide their patients with optimal dental care.

Prior to dental insurance, there was only the doctor and the patient, relying on the doctor–patient relationship to determine the treatment to be rendered and how it would be paid for. It would be a mutually agreed‐upon treatment from which the patient would receive optimum dental care without any intrusion from outside their doctor–patient relationship. It would give the patient autonomy in their decisions regarding their dental care. Now, insurance companies, being the major payer for dental care, want to have a say in what treatment will be rendered and how it will be paid for. Not being physically in the operatory to partake in the doctor–patient discussion and treatment decisions, they must rely on an ever‐increasing need of information to substantiate and verify that treatment was needed and completed. The final decision making on how a patient should be cared for is and should continue to be between the doctor and the patient. Hence, the dentist must fully understand insurance companies and how to work with this unavoidable intrusion into the doctor–patient relationship to provide proper care for their patients.

Contrary to the common belief that dental insurance has lowered the cost of dental care, it has actually increased it. By issuing a lower contracted fee schedule and requiring more dental office staff time to verify the patient's eligibility, submit a predetermination, resubmit with additional documentation, reverify eligibility, resubmit for payment, and process bulk checks for numerous patients, insurance coverage has increased the cost of providing dental care. Compare this to a patient merely paying in full at the end of each visit. To help cover the additional costs of accepting dental insurance, which many times includes hiring another employee, the dentist's Usual, Customary, and Reasonable (UCR) fee must be increased to offset losses incurred by accepting dental insurance or risk reducing income and/or insolvency. Hence, the non‐insured patients must pay higher UCR fees to offset the lower insured fees.

The dentist, if accepting insurance as a panel or listed dentist, must understand his or her duties to the patient do not change. The dentist, adhering to the ADA Code of Ethics, should be aware of patient autonomy, non‐malfeasance, beneficence, justice, and veracity. The proposed treatment must not cause harm to the patient and must improve the patient's well‐being. Many times, the insurance company will provide coverage for the LCAT per the policy. Being an insurance‐accepting dentist creates a relationship whereby the dentist must be open to treatment alternatives and not offer only the most optimum treatment that is outside of insurance coverage. Maintaining the patient's autonomy throughout the decision‐making process is paramount in maintaining a healthy, trusting doctor–patient relationship. The standard of care must also be considered when allowing the insurance company's LCAT policy to rule over patient care. If the proposed LCAT is not in the patient's best interests and/or below the standard of care, the dentist should appeal it or simply not provide the substandard care, even if the patient wants it due to lowered costs. To do so would expose the treating dentist to a possible lawsuit for malpractice by providing substandard care. The dentist may not point to the insurance company for liability due to the fact the dentist actually provided the treatment. Hence, if the LCAT is not within the standard of care, the dentist must refuse to provide such treatment even if the patient agrees to it.

The dentist also needs to have a better understanding of business decisions needed to become involved in dental insurance due to the fact that some dental insurance fee schedules are very unreasonable and not conducive to proper patient care. These should obviously be discarded so as not to force a dentist into a standard of care issue. When the unilateral “take it or leave it contract” is presented to the dentist, it contains a “negotiated” fee schedule. The dentist normally reviews the fee schedule, besides oth...

Table of contents

• Cover
• Table of Contents
• Preface
• Acknowledgments
• Section 1: Leadership and Success in Communication with Dental Insurance Companies
• Section 2: Leadership, Communication, and Success for Your Practice
• Section 3: Leadership, Communications, and Success for Your Self
• Index
• End User License Agreement