Disclaimer: The following blog post is my opinion only. None of it is to be construed as irrefutable fact. Do your own research. Run your own math. Consult your attorney or your dog. Make your own decisions.
There has been a very active thread over at Dentaltown.com. It started April 5th, and it’s now 15 pages long. It’s titled “Delta Dental lowering reimbursement in WA.” I had been seeing it show up in the “Today’s Topics” page, but I ignored it for a long time. After all, I’m not in Washington. I’m not a Delta “provider” (hate that derogatory term). I’m not contracted with ANY dental plan. My practice is largely fee-for-service. What do I care? It doesn’t affect me, right?
Yesterday, something compelled me to read the thread. All fifteen pages of it. And, what I read is both frightening and enraging. If you’ll please indulge my nutshell version of what is going on in Washington is as follows. (And, I hope some WA dentists will chime in.)
WDS (Washington Dental Service – a member of Delta Dental Plans Association) is a major dental plan player in the State of Washington. Many dental practices depend on being a “provider,” as most of their patients are on the WDS plan. Back in 2009, WDS froze fees (no more annual increases). And, just this month, WDS announced they would be DECREASING fees 15%. If you account for an average dental practice overhead of 70%, this amounts to a 50% decrease in profit margin. Now imagine if half or three-quarters of your practice was WDS patients! This is the case for many dentists in Washington.
Apparently, Boeing (a very large employer in Washington) is the biggest WDS account. And, Boeing demanded that WDS cut their costs. If Boeing bails on WDS, then WDS ceases to exist. But, these events portend something even more sinister. There is evidence that WDS expects to lose a number of dentists, and they have plans in place to build their own clinics.
WDS (Delta) argues that it’s the economic times. But, reality is more nefarious. In these “tough economic times,” it should be noted that the CEO of WDS got a $101,000 raise and a $400,000 bonus.
Dentists in Washington are in a very tough spot. And, the deadline is June 15th! They got just a couple of months warning! Some are considering cutting hours, cutting staff, cutting salaries, and ultimately being forced to cut quality…. if they stay on the WDS plan. Some are genuinely concerned they may have to close up shop. Alternatively, they drop out of WDS and then face trying to keep their practice going without those patients. They fear that few of the WDS patients would choose to stay in the practice without the full benefit of their WDS plan. It reminds me of the song by The Clash, “Should I Stay or Should I Go.”
“If I go there will be trouble
An’ if I stay it will be double.”
It sure rings true. If a dentist leaves WDS, there will be trouble. And, if he or she stays with WDS it will be DOUBLE.
The term “Dental Warrior” has never been more apropos when it comes to our brethren in the state of Washington. And, I hope they do realize they are at war. WDS has declared WAR against dentists. Yet, they are trying to lull dentists into a false sense of security. “Were all in this together.” Bullshit! This is war. And, Washington Dental Warriors better lock and load. WDS is counting on the long-held tradition of dentists being divided (and unable to stand up against a hallucinated Goliath). I cannot find the attribution of this quote, but it’s worth saying, “No man owns the talents of another.” Dentists have the talent. Without access to that talent, WDS cannot exist. Dental Warriors have the power to withhold that talent. United, Dental Warriors are the REAL Goliath.
Personally, if I’m going to die, I’m doing it on MY terms. I won’t slave away and PAY my way into bankruptcy. I’d rather take my chances on my own. I’d rather work hard at marketing my practice and giving top-notch SERVICE to those patients who appreciate it. Maybe I’ll still go down in flames. But, it will be a blaze of glory rather than handing a victory to WDS. “An’ if I stay it will be DOUBLE.” Nope… I’d rather gamble on myself.
For those of us outside Washington… We should pay very close attention to this. If Delta is “successful” in Washington, you can bet Delta in other states will soon follow… and then other insurance companies. Washington is the beachhead of this war.
I will close with a quote by Admiral David Glasgow Farragut in the Civil War (referenced in the title of this blog post)… “Damn the torpedoes! Full speed ahead!”
And, I offer my dental brothers-in-arms a Navy blessing: Fair winds and following seas.
Followed by another quote I recently came across: “Every normal man must be tempted, at times, to spit upon his hands, hoist the black flag, and begin slitting throats.” – H.L. Mencken
UPDATE (10/1/11) Idaho’s Delta just did the same thing. Click here.
UPDATE (5/22/12) CEO of WDS says “Dentists just need to work harder… five days a week.”
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I have been following that thread since the beginning and it doesn’t look good for the dentists. I predict that Delta Dental WILL get their way because a decent number of dentists will not bail. Not saying that is right or wrong, but I predict the dentists will lose on this one.
Mike, you are spot on once again. You can be damn sure that if Delta Dental gets their way in the state of Washington, it doesn’t bode well for dentistry as a whole. Other insurance companies will do exactly the same, keeping more and more money at the top while screwing the dentist. Those dental providers in WA had better have stock in Johnson & Johnson because there will be a run on KY (not the state) and sales will be huge (sorry, just trying to insert a moment of levity in this serious matter)!
Keep up the good work Mike.
Thanks, Derek. I have to wonder if this is the death-spiral into socialized healthcare. The big player inscos reduce compensation so much it puts private dentists out of business, while they build insurance-financed clinics (that will employ those dentists who closed up shop). Then when the people are not satisfied with that, the gov’t will step in and take it to the next (lower) level.
And, that may leave a very lucrative niche for the remaining few private care dentists. I don’t want to see any of that happen to my profession. But, if that’s how it goes, I will be positioned for that market. However, I’d much rather see us united against this intrusion into the sacred relationship dentistry has always had with our patients. I’d rather see the free market prevail.
I started my practice ~2 years ago and will never surrender to the massive suckiness that is insurance. This is what happens when your GIANT corporation is run by a guy who sucks at dentistry. God bless America.
The irony here is this: I love, truly love, dentistry. When I siting chairside and doing my ‘thing’ it’s a pleasure and honor to serve my patients. After 19 years, I’m getting pretty good at it too. It’s the insurance/corporate etc. crap that will drive me out as soon as I can afford it. The losers in the end is not us, it’s the patients.
So, get rid of the crap and keep doing what you like, Bob! 🙂
I practice in S. Florida, which is similar to S. California when it comes to the presence of managed care. I don’t participate. I mean not at all. I have not signed any contracts. No HMOs. No PPOs. Dentists say they don’t have a choice. They do. It’s not an EASY choice. And, I will definitely say that it has NOT been easy for me. But, I am the captain of my ship. 92% of my patients are totally self-pay. Only 8% have a benefit plan. It has taken a LONG time to get here, and I’m still not “there.”
I also love being a dentist. Really love it. I decided a long time ago to be a dentist on MY terms. But, if there ever comes a day when the government stipulates my licensure upon participation in a socialized system or entitlement program… It will be the day I leave the keys to the office on the counter and walk away.
Wow – if there is a rainbow its’ got to be that the dentists here will need to work hard to educate the patients on the value of the service they are providing and why ‘benefit’ plans are not necessarily a ‘benefit’ to their health!
The cream will rise to the top and provide the education and continue to serve those who value the product…..
Smile!
Warren
Success in Dentistry and Life!
Socialized health care is based on a lie that the government can provide something for the people which they cannot provide for themselves. Even though this is irrational and unsound, it is pandering to an uneducated and conditioned society of people who have been trained not to think (or do) for themselves. The dictators of developing nations appease the poor masses with empty promises as well. Is this what America is becoming? Financial markets and the U.S. dollar’s falling value indicate a strong likelihood. Great blog, thanks for the post!
If I am not mistaken this WDS story is a repeat of some areas of the east coast where insurance controlled the dentists in company towns. I am sure someone has studied this much more than I. But the story goes: “Accept our fee schedule if you want to see any of our patients”. I believe the end result helped reinforce the maxim, you get what you pay for.
David Hansen to Dr, Jim, Don, Gregg, Kokich, Kokich, kphil, Arcus, Arcus, info, Steve, Dr, Dr, Ralph, Dr, Roy, Johnson, rrksail, David, Dr, carlyc.hansen, Shade, ggdl, Tim, Dr, Greg
show details May 8 (4 days ago)
Thank you Kim for your insight and ability to see that there is no pure truth or equitable reasoning being spoken by WDS or the governor.. ” WDS can do whatever it wants to do”, were the words spoken to me by Dr. Marc Cooper in our last conference call one week ago. He recommended that we have to adopt a new business model such as large multi-provider clinics already in existence on the East Coast. In the fine city of Olympia, this has already begun so that dentists can reduce costs by more efficiently using a dental clinic’s hours of operation. This is a reasonable and exceptional idea, however may not provide enough cost cutting measures to make Dentistry profitable with the new insurance plans mandate.
At present, one of the premier MDTs in Seattle, informed me that 25% OF ALL CROWNS PLACED IN PATIENTS IN THE UNITED STATES ARE FABRICATED IN CHINA. ANOTHER HIGH % ARE FABRICATED IN MEXICO.
The five star hotel in Cabo San Lucas promised that their water supply and gourmet food met such high standards that I did not have to be concerned about contamination. Therefore, the fact that I vomited for half of our lovely vacation and had the “Aztec Two Step” so severe that I could defecate through a screen door from a distance of ten feet must have been attributed to too much dancing of “The Macarena” the night before. For those who know me, I do not drink alcoholic beverages EVER, NOT EVEN NEVER, for the last 27 years, so too much tequila and worms cannot be considered in the differential diagnosis. My point is that these cost cutting measures from “out sourcing” are highly suspect in the professed delivery of quality that we have been taught and our patients deserve. Once more, we are not obligated to tell our patients anything about our future cost cutting, or shall I say “cutting corners” measures in the delivery of their care.
Foreign Officials promise that materials of only the highest quality are used in their fine artistry. Apparently, lead has been an acceptable ingredient in their exported children’s toys for only a decade or two. Lead has also been found in the ceramic crowns that were fabricated, received from China and analyzed by research chemists in the USA. Officials in China had guaranteed that their crowns were of the highest quality, which I must interpret meant that the lead was of the highest quality available.
A few years ago, I took my family to Whistler for the annual AAED meeting. We usually take a few extra days to vacation, and as a surprise, I signed my son up for some private wind surfing lessons. The lake was pristine and the teacher had what appeared to be a professional photographer taking photos of my son’s lesson. I struck up a conversation with the photographer who turned out to be the instructor’s husband taking photos to put together a sales brochure for her, I asked if he was a professional photographer, to which he responded that no , he was a “Transplant Surgeon that practiced at
The UCLA Medical Center in Los Angeles, California.” Although he was a native Canadian, he lived in the 3rd generation Lake Cabin close to Whistler, B.C. which he declared that he could not afford at present Canadian salary and real estate prices. He commuted every two weeks back home to be with his family for 4 days.
I was extremely curious, so I asked why he would go through such extreme effort and sacrifice to practice in the USA instead of Vancouver, Canada. He was very clear and to the point. “Canadians do not want a quality health care system. They want a free health care system.” End of discussion. I was stunned then, and I believe that is what we are beginning to see the start of now in the profession of dentistry in the USA.
Either way one chooses to go in this decision, to sign up or not to sign up, there will be an emotional, physical and financial hit felt in your practice. The first step is to inform your patients what this will mean to them. The second is to be a real teacher about what quality is. After all, the Latin derivation of Doctor is “Teacher”. Next question. Are Dentists Doctors? We better be now! Teach them that “Idiopathic amalgam or composite resin hyperplasia” is really sub-standard dentistry. However, in the words of my friend and mentor, Dr. Jack Gould, “It’s not a sin to place an overhang, but it is if you just leave it there.” I seriously doubt that with the advent of cheaper, higher volume dentistry whether any of us can afford to take the time necessary to book another appointment to rectify the problem by doing the procedure over until it is worthy of being called quality dentistry. “Mediocre” may be the new “Standard of Practice”, or maybe worse.
Sincerely,
Dave Hansen DDS, class of 1978 U of W School of Dentistry and future or present dinosaur entering into endangered species list with “The Spotted Owl”, however not protected by any Government Agency.
– Show quoted text –
Great post, Dave!
WDS or other corporate chains can always set up their own clinics and hire the hungry new grads who will work for pennies on the dollar. New grads are graduating with $300-400k debt easily, paying full price for tuition and earning half price when they get out. We need to re-evaluate the dental schools in the U.S. as a whole to determine supply vs demand so we are not shooting ourselves in the collective foot.
Eventually college students will figure out the ROI for dental school doesn’t make sense. You’re better off investing in a McDonalds franchise.
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So, what we have here is insurance companies driving dentists to form partnerships and corporations to reduce overhead and stay afloat. Which further exacerbates our “access to care” issue (having to roll 2-3 deep is counterproductive to getting healthcare providers out in the rural areas that can only support 1 dentist at most). I just dont understand how , as an industry, we are robbing peter to pay paul, and then trying to solve the problem by graduating more dentists. Who’s steering this boat?
Steven
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Washington Dental Service, this States local Delta Dental insurance company has been a slow growing cancer for its Premier member Dentists for decades. They eliminated or limited our fees for services to less than our practices real inflationary pressures for decades. The longer a dentist was a member, the worse it became financially. New dentist’s right out of school would be able to charge more than a dentist with 20 years of experience. It was a barely tolerable system, but now they have completely changed all the rules, which will dramatically decrease the quality of future dental care in Washington State forever. This new mandatory policy is not even close to the original agreements dentists signed up for, and most of us would have never agreed to such a deal. What’s the point of signing a contract if one party can change all the rules at any time for their sole financial benefit? The Premier Plan used to be kind of like a traditional dental insurance plan, except they limited the annual fee increases, and procedures a dentist could bill. However, after the economy crashed 4 years ago, for the first time ever, WDS froze dentist’s fees. Most dentists were ok with that for the first couple years, because raising fees during these trying times didn’t seem right. So even though all our expenses go up every year, we were fine with no increase in our fees, and took it on the chin for the benefit of our patients during these tough economic times. On top of the WDS freeze in our fees, our billings were also considerable reduced because many patients lost their jobs along with their dental benefits. To make matters even substantially worse, 2 years ago, in addition to the freeze in dental fees, WDS, forced all its WDS Premier Member dentists to take a 15% across the board cut of all their fees charged to WDS and Delta patients. Prior to this cut we use to charge all our patients the same fees. However, after this decision by the WDS board, this is no longer financially possible. Our non WDS patients are now charged our regular fees, and WDS patients get at least a 20% discount compared to the rest of our patients. For the Dentist that translates into a 50% reduction in the dentist wages when treating WDS patients. So if we do a procedure on a regular patient and the dentist makes $100 on the procedure, then we do the same exact procedure on a WDS patient, a dentist will make $50 for the same exact procedure. If you had your own business and you took a 50% cut in pay when you did business with certain individuals, could you afford to provide them the same service? If WDS will not pay for some services like buildups or bases to prevent sensitivity or improve the longevity of a restoration, then why should we do them? If WDS forces it dentist to take a 50% cut in pay, then what they are actually saying is that member dentists should provide that service in half the time or less, using the cheapest materials available. The Premier Plan is not even close to a traditional dental insurance plan anymore, and it should be illegal for WDS to call it one. Even after patients benefits are exhausted, WDS still forces its member dentist to discount everything 20%, even though WDS will pay nothing. There are already certain types of crowns and implant restorations which may be the best option for a particular case, but will now never be an option for WDS patients now, because the WDS fees are totally inadequate. Like many skills, there are 100’s of ways to provide the same dental service. The highest quality of care is no longer possible with these reduced WDS fees. Most dentists have done many procedures at no cost, or reduced cost for some of our patients, without recognition. This is no longer possible, because WDS and Delta patients are now our exclusive obligatory charity cases. Whether you like it or not, if you have WDS or Delta Dental insurance you are a charity case now. There is nothing premier about the Premier Plan; for Dentists it’s nothing but a premier piece of crap PPO plan. The only reason WDS calls it a Premier plan is because they charge employers more for it. Many WDS member dentists never joined any of these PPO plans because we chose to provide only the best care for our patients. The only plan we were on was the WDS Premier Plan, because it was not a PPO plan. All PPO plans, force the dentists who joined them to accept substantially reduced fees. However, now the WDS Premier Plan fees are virtually the same as its crappy PPO plan, in fact, WDS PPO patients can now go to any WDS Premier Member dentist.
People need to understand that dental insurance is nothing but a ponzi scheme. Unlike medical insurance that has unlimited benefits that pays 100% after you reach your deductible and copays, Dental insurance pays nothing after you reach the maximum benefit amount of $1000-$2000 per year, the same maximums they have had for over 30 years. So if you have an accident or any other situation that causes you to lose most of your teeth and the cost to replace them with implants is $75,000, your dental insurance will only pay $1000-$2000. The premiums companies pay is not anywhere near the benefits the employees will ever receive, because the middle man, the nonprofits like WDS, make millions in profits for their CEO’s, give the money away, or spend it on advertising to keep the ponzi scheme going.
If dentists are not allowed to raise our fees, or if WDS continues to reduce them, in a couple years these fees will be 35-40% less than what dentist charges their regular patients, which means the dentists will make nothing seeing these patients. Our cost of doing business was 60-70% of our gross revenue, and now with the fee reductions, it’s even higher. Forcing people to work for nothing is slavery. Dentists are now slaves, and WDS and Delta Dental are the slave masters. We understand that some companies don’t want to pay the premiums for traditional dental insurance. If that’s the case, then they should purchase a PPO plan for their employees. But what WDS did was just changed the Premier Plan into a PPO plan, and then forced their Premier member dentists who were never on a PPO plan to automatically be on it, without any discussion, debate, or notice. As in most things in life, you ultimately get what you pay for. You will not get Cadillac dentistry for the price of a Kia. WDS pulled a bait and switch on its Premier member dentists. Instead of selling their PPO plan to employers that refused to pay for the Premier Plan, they just shook down all the Premier dentists, like an organized crime boss and forced them to become a PPO provider and now they boast that there is nothing we can do about it. The only thing that didn’t change was the plans name; they still call it the Premier plan. It would be more appropriate for them to call it, the Deluxe Charity Case Plan. The best dentistry cannot be provided at these fees, but WDS doesn’t care, and they cannot enforce or detect if WDS Premier Dentists are providing it. The only way to make this plan work is for offices to join more PPO’s, see twice as many patients or more, in the same amount of time, and use the cheapest materials and labs available. You will not have to go Tijuana anymore, to get Tijuana dentistry. What WDS is indirectly suggesting is that member dentists need to lower their expectations for WDS and Delta patient care. Procedures that we used to expect to last 10-20 years or longer, really only need to last 5-10 years for WDS and Delta patients now. Some of the largest employers in the state provide WDS dental insurance to its employees, including Boeing, and all the State and local government employees who are mostly union workers. How would these union employees feel if their employers cut their salaries in half? You and your unions would never accept that and it would be all over the news, but you and your employers are allowing WDS to apply the same iron fisted non negotiable tactics to dentists, the same dentists who provide dentistry for you and your families. WDS could have just come up with a special plan for all Boeing and government workers, and given the dentists the option of being on it, but they were only concerned with their own financial gains and dictated that all the Premier Member Dentist’s succumb to their new policies. WDS is taking charity work away from the deserving people and now forcing dentists to provide it to union workers who have great jobs. Corporations, including nonprofits (WDS) are now making more money by stealing it from the “Premier” dentists. WDS cuts dentists pay so their executives can make more money. Their now making so much money from paying less for dentistry that they are also kicking back the savings to the corporations and government, with lower dental insurance premiums, all at the fiscal sacrifice of the dentists. All Dentists spent at least 8 years in college, and it costs dentists at least a million dollars for college, and to build or purchase their practices, without any help from the government, or the dental insurance companies. The government, corporations and union workers who purchase and have this insurance are causing a paradigm shift in the quality of dental care in this nation forever unless something is done now. This is no different than if the government mandated that all Medicare doctors accept all the same policies and reimbursements as Medicaid, but still called it Medicare. The overall quality of care for everyone with these plans would decrease dramatically, and patients would ultimately suffer in the end, but since it’s only teeth, and no one’s going to die without them, WDS, the government and these corporations just don’t care.
When I moved here, I was extremely impressed with the overall unsurpassed quality of care many dentists were providing in this state. WDS claims that we had the highest fees in the nation. We also had the highest quality of care in the nation, and the highest costs associated for providing that service. Does the average dentist here really make more money based upon the average costs of living here? In fact, many of us have small practices and modest incomes but always took the time to provide the best care for our patients, no matter what our costs. However now, with the economy and the WDS forced cuts some of us are barely staying afloat. Everything in this State costs more especially in Seattle; rents, supplies, lab fees, employee salaries and benefits, plus we are the only State in the nation that taxes businesses on gross revenues (B&O tax). Dentists pay the highest B&O tax rates, and the State even raised our rates 2 years ago. Our B&O tax rates are higher than the largest corporations here, including Boeing who can easily afford to pay them. WDS and Delta don’t pay any taxes, their nonprofit. Delta is making similar cuts in other states to its Premier member dentists. WDS and Delta could care less about the patient’s dental care, and employers and employees who have WDS and Delta Plans are indirectly promoting WDS, and obviously don’t care either. This is undoubtedly the biggest issue ever affecting the overall quality of dentistry in the USA. This decision is egregious, and WDS is so pretentious, they still have the balls to call themselves a nonprofit. I think of a nonprofit as only being concerned with the welfare of others, not their finances and filling their board members pockets with cash. WDS and Delta whose executives make millions are not a nonprofit, but the Premier member dentists are now. The commercials they run now are unrelenting, I guess because their nonprofit, they need to spend all that extra cash their saving now, since they will not pay for quality dental care anymore. They keep bragging about 90% of the dentists being members. They never mention that 90% of the member Dentist hate WDS and Delta Dental insurance and think they are nothing but a bunch of thieves, hell bent on destroying our profession. The other 10% are complete PPO Dental Clinics. For dentists, who are not on other PPO plans, WDS is the worse insurance you could have. If someone would do a blind survey of Premier dentist feelings on WDS and Delta, these numbers would be proven. Every dentist I know hates WDS and Delta dental. It is the plague to a dental practice and now even more than ever. The greed at WDS is insatiable, they demanded that dentists cut the fees we had 4 years ago by 15% and continue the fee freeze indefinitely. If that wasn’t bad enough, now they are refusing to pay claims at an alarming rate (just ask any Dentist); however their bonuses are at record levels. WDS states that, “rapid changes are occurring in our health care delivery system.” They forgot to mention that they are 100% responsible for demanding these changes. The dentists with small offices will either go bankrupt or be forced to sell their soul and go to the dark side of dentistry, a 100% PPO Clinic. Over time, these will become huge corporate PPO Clinics, where they herd you in like cattle, treat you like a number, in the fastest and the cheapest ways possible. We have all lost some patients to PPO offices, because patients think they will save some money and get the same service. However we have all had many of them return, after unnecessary procedures were done poorly. I just tell them, “What did you expect? You get what you pay for.”
If our dental organizations are incapable of doing anything on the most important issue affecting the quality of dental care in our history, then there is no point in being a member anymore. If we can’t raise our fees annually with WDS and Delta because our cost of doing business raises annually, then this will be the last year I will be a member of the WSDA and ADA. I suggest every other dentist do the same. We must leverage ourselves in every way possible. There is no other issue in the history of dentistry in the USA that is more important than this one, and no one including the dental organizations really cares, because they all just go on doing business as usual, when they should be focusing all their energies on this issue. We can always rejoin these organizations if they can stop the slave masters from enslaving us. It does not matter what feeble actions the dental societies do at this point, only the results matter now. So spare us the BS and make something happen. Why don’t we have our own dental insurance plan, and market it to every business and government agency that provides Delta Dental insurance.
Without much thought the WDS board has substantially and forcefully lowered the future quality of dentistry in Washington forever. Not all of us have huge practices, and had only modest incomes; our emphasis has always been in providing the best care at any cost. With the economy and WDS forced nonnegotiable cuts some dentist are now barely staying afloat. When a dentist quits WDS, they send letters to all their patients, recommending that they would be better off going to another WDS member dentist. However, if you want to find the finest uncompromising dentists, it’s really easy. You won’t find them on any web site, in a magazine, or in any advertisement; they are the 10% who are not members of WDS and Delta. These changes will not occur overnight, but this is what is going happen, because WDS went from being a slow growing cancer to an extremely fast growing one, and these are the measures WDS dentists must take, just to survive. https://www.facebook.com/pages/Washington-Dental-Service-Sucks/141928125982995
Wow! That’s a lot of “stuff” there! I would be much easier to read if you broke it up into paragraphs. 🙂 Thanks for your comments!