https://www.youtube.com/watch?v=gEcKkM2Qcn4

Our transcript of the discussion between Lois Banta and Jameson Files host Carrie Webber has been lightly edited for flow. To enjoy the audio conversation, you can watch on YouTube or listen to our podcast on iTunes, Google Play, or Spotify.

Utilizing Your Dental Practice’s “Why” to Help Navigate Relationships with PPOs

Carrie :

Welcome to the Jameson Files. I'm your host, Carrie Webber. Thank you so much for joining us once again for another episode, or perhaps for the first time. We are certainly so glad to have you with us as we continue to bring information and resources and experts to you to help you be as productive, as profitable, and as fulfilled in your dental practicing life as you can possibly be. Today, I am so excited. We are coming to you from the Jamon offices in Oklahoma City, and look who I have here, our dear friend and colleague in the dental realm, Lois Banta. 

Lois Banta:

So excited to be here and doing this with you for the first time. A real honor, and I'm sure we'll share a few giggles.

Carrie :

Maybe so. We just need to try and keep ourselves under control. We'll see.There are no rules in this. I'm just so glad to see you face-to-face and to have you in the room with me. This surprised us because we have collaborated together, and we have Lois as a guest educator and presenter on the Grow pathway that is launching as we speak on the very popular and needed topic of how to navigate PPO relationships in your practice. It’s going to be a phenomenal resource for all of you that are on Jameson's Grow learning platform. We’re very excited to share your knowledge with the members of Grow. 

How to Make Healthy Decisions about Your Relationship with PPOs in Your Practice

Today we're going to dip our toe into that topic a little bit because it only seems right to keep carrying forward the conversation that we've started here about PPOs. How do you navigate those relationships? How do you make healthy decisions about your relationship with PPOs in your practice? Do you have one? Do we need to perhaps step out of one? Do we need to do something different in the months and the years to come to help you in your pursuit of your ideal practice vision? Really, that's what it all comes down to.

Lois Banta:

It's such an important decision to make, and it’s one of the most difficult decisions that practices in our industry make. It’s scary. There's a lot of thought that has to go into it, and if you don't do it the right way, you could lose all your patients. So it's a pretty serious topic right now, especially with the insurance reimbursements being lowered across the board with many of the plans. Practices are taking a really big financial hit. It's really time to consider where you are in that relationship and where you want to go.

Carrie :

It's interesting because you've been educating dentists and teams for a long time, 23 years now. Jameson has been in the industry as a company for 32 years, and over those years, the landscape has really, really changed. We're seeing this continuous shift, and truly two paths diverged in a woods, and you need to decide what path to take. As you’ve said, it really has to align with your “why”.

Lois Banta:

Yes. You have to be very passionate about why you're making the decision. As soon as you can wrap your heart around your “why", the decision becomes fairly easy, but you still have to pay very close attention to the process in making that decision. But ultimately, back in the day when insurance was even invented, I think in the seventies, there really weren't a lot of in-network plans. It was just insurance coverage, and it typically covered most of the patient's dental care for a 12 month period. And now those maximums haven't changed, not because of the insurance industry, but because of employers' budgets not wanting to pay high premiums for those benefits. So the maximums don't change, but the cost of that dentistry has changed greatly. So somewhere along the line there became this process of, if you become an in-network provider and you make a contractual deal with us to lower your fee-for-service fee, you'll be able to get more patients.

So it was used as an avenue to acquire more patients, but it became the beast. It was a really great idea, and maybe it is still a great idea for some practices. Some practices can manage it very well, but the ones who are really getting caught off guard and caught by surprise with the insurance industry lowering reimbursements and increasing adjustments, have really taken a hit in the pocketbook. And that's when it becomes a really important decision. Where's your tolerance level? When is it time? And once you've made the decision, it's time, how do you do it?

Myths that Prevent Practices from Making Healthy Decisions about PPOs

Carrie :

I know that you work with a lot of teams in retreats and in your mastermind sessions on how to do this and on how to make these decisions. At Jameson, we help practices step out of relationships in PPOs all the time. But I think you and I both know that sometimes that process and releasing the fear of the “what if” with practices can be very difficult. What's some of the pushback that you see and experience that you've overcome with practices? Let's bust some myths here that may be preventing practices from making really healthy decisions about this.

Lois Banta:

It's the noise that plays in your team's heads where they're very, very sensitive to what they feel the patients want and need. So it's a perception. You're going to get the pushback when the team has a general perception that it's going to cost the patient a lot more money. So one of the myths is that it’s going to cost the patient a lot more money. Insurance reimbursement typically increases when a dentist changes the relationship with how they work with them. So they're no longer in-network, so they've removed the barrier of having to charge a lower fee. They charged the fee-for-service fee. Typically, the reimbursement will catch up to that fee-for-service fee. So one of the myths is that your patient's out-of-pocket expense isn't going to go up by the amount that the practice is writing off. The practice is writing off those dollars because the dentist signed a contractual relationship with that insurance company to lower their fees, therefore increasing adjustments

Carrie :

I think you're going to have to go on the Grow pathway to get all the details, or go see Lois in lecture, or bring her in for a retreat. Something that really resonated with me was the reality of the write-offs. A lot of decisions are being made, or not being made, in dental practices without the practices doing the due diligence to understand really what your relationship with these plans are.Some of the most painful realizations are when a practice is meeting their production goals, high-fiving each other, thinking this has been a great month, and then bam, you're cut up at the knees because you just wrote off 50% of what you produced that month. You worked your rear end off for that. You had some really “aha” moments in that part of your presentation.

Understanding the True Cost of PPO Relationships in Your Practice

Lois Banta:

Yeah. The twofold analysis is analyzing all the data of production, collections, and adjustments. Then if you're going to dig a little deeper in it and really analyze the “by code” adjustment percentage, most practices realize that they're struggling when the doctor goes to pay the bills at the end of the month and suddenly, “Hey, we've produced all this money. How come I don't have enough money in my bank account?” Because they haven't really gone in and done a deep dive as to which plans they're adjusting the most dollars off, which ones are not allowing the benefit when the benefit should be there. It puts the practice in a hypothetical position that the team tends to adopt, so the thing causing how to react to everything is based on inaccurate data.

Then the team starts having these conversations with the patients telling them that they can't do this or that because their insurance doesn't allow it. Then the practice is at risk for diagnosis and treatment plan discussions based on what the insurance does and doesn't cover, which of course is not in the patient's benefit. It's almost like a scare tactic that then drives the mindset. And that's where you're going to get a lot of pushback from the team with that mindset, because they're so entrenched in what insurance will and won't cover, what maximums are going to happen, and when they're maxed out or whether there's a deductible. It drives the conversation instead of letting the practice drive the conversation with what is truly in the patient's best interest.

Carrie :

It’s interesting. I was just kind of reminiscing back to the last AADOM conference. I was on a panel, and you were the moderator of the panel. And I always say: why don't they just put all the insurance speakers and experts on the panel, because the questions are always about reimbursements or being in-network, or changes that are being made to the agreements? And you know, you found yourself working a little harder.

Lois Banta:

I did. I found myself being on the panel and being the moderator. 

Carrie :

Again, the point always is that your practice vision can be whatever you want it to be, and if being in-network is important to you and how you want to care for patients, that's great. You do you, but understanding what that means and what that's going to have to mean in terms of how you run your practice is important. 

Lois Banta:

You're going to have to make financial decisions on your expenses. A lot of practices make these decisions based on where their overhead starts or stops.