My Practice My Business: The Clinical Business of Dentistry

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I told you so.

I've said for years that Dental Loss Ratio laws were not going to solve the fundamental problem dentists have with dental insurance.

They're not going to magically increase your contracted reimbursement.

They're not going to stop downcoding.

They're not going to stop bundling.

They're not going to stop insurers from denying legitimate claims.

They're not going to eliminate non-covered-service restrictions.

They're not going to fix lousy fee schedules.

They're not going to stop insurers from manipulating plan design.

And they're certainly not going to make your hygienist, assistant, supplies, lab bill, rent, equipment, or payroll cheaper.

DLR regulates how an insurance company accounts for and ultimately uses premium dollars.

That's not the same thing as fixing dentistry.

And now Massachusetts is giving us a real-world example.

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Gingivitis and Periodontitis continues to be two dental conditions that are often under-diagnosed and under-treated. Why? Too many dental offices treat their patients to perceived dental insurance plan limitations, hygienists are not given the support they need to care for these patients, and antiquated protocols continue to be the norm.

We can and must do better. 

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In Part 2, Tracy and Rob take a deeper look at the Arizona Dental Board’s handling of regional block anesthesia. They explore the difference between an improperly billed service and a legitimate service that an insurance plan simply does not cover. They also discuss dentists’ ethical responsibility to accurately report the care they provide, the protections intended by Arizona’s non-covered services law, and the dangerous precedent created when regulators misunderstand dental coding. Ultimately, this episode asks: Who holds a dental board accountable when the Board gets it wrong?

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In Part 1, Tracy and Rob examine the Arizona State Board of Dental Examiners’ handling of a dentist’s billing for regional block anesthesia. They discuss the ADA ethical principle to “code for what you do,” why a procedure being excluded from most dental plans does not make the code improper, and how Arizona’s non-covered services law may apply. They also address a troubling question: How did this matter progress when the Board reportedly did not initially recognize that regional block anesthesia had its own dental code?

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Have you ever stopped to think about how much damage a single sentence can do?

Not an entire law.

Not an insurance contract.

Not even a court decision.

Just...

one sentence.

A sentence so small that most dentists have probably read past it for decades without giving it a second thought.

Yet that one sentence has quietly shaped reimbursement, influenced insurance company behavior, altered clinical documentation, and, in our opinion, cost dentists across America hundreds of millions of dollars.

"Local anesthesia is usually considered part of..."

That sentence has appeared throughout the CDT Code for years.

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Today I want to talk about something that has probably cost the average dental practice more money than almost anything else...

Not fee schedules.

Not inflation.

Not staffing shortages.

Not even dental insurance.

I'm talking about the unwritten rules that never actually existed.

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"When a dentist invests millions of dollars into a practice, who should that office be designed for?"

The patient?

The clinical team?

Or the dental equipment sales quota?

For decades, the industry has answered this question the same way, and most dentists have never stopped to question it.

The greatest dental offices are not remembered because they had the most operatories.

They are remembered because patients felt cared for from the moment they walked through the door.

Perhaps it is time we stopped asking how many operatories can fit into a building...

...and started asking how many extraordinary patient experiences can be created inside it.

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You may know dentistry.
 You may be clinically excellent.
 You may care deeply about your patients.

But if you are not running the business—with intention, clarity, and authority—then you are operating in a system you don’t fully control.

And in today’s environment, that lack of control is exactly what’s putting practices at risk.

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Increase clarity, confidence, and connection before the patient leaves your office, and the need to crowdsource disappears.

You won’t completely eliminate this behavior, but you can dramatically reduce it by controlling when, how, and why patients feel the need to “shop” your treatment plan.

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I want you to ask: 

Who’s making these decisions in my office to “hang up” on effective training opportunities? 

What power do they hold? 

And what opportunities are we missing? 

One of the most surprising things we encounter is when dental offices hang up on our team before hearing a single sentence about the training. Think about that for a moment. Here is a training program specifically designed to help dentists and their teams understand laws that directly impact their profitability, patient communications, and insurance interactions, and some offices choose to end the conversation before learning what is being offered. This was a free training opportunity sponsored by the UDA, and taught by those writing and passing dental insurance reform legislation, meaning Tracy and I at MPMB.

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