The Elephant in the Room

The decline in reimbursement rates can be directly attributed to the number of dentists signed up as PPO providers. It’s a basic supply and demand principle. The more providers willing to take a cut in reimbursement rates, the more the rates get cut. Rates will only go up if there is a drop in the number of willing network providers. As long as network provider numbers are healthy, reimbursement rates will continue to drop. As The American Dental Associations Health Policy Institute (HPI) has recently shown, the trend of reimbursement decline has been steady for several years. Inflation and Cost of living THE ELEPHANT IN THE ROOM have increased, yet dental reimbursement rates continue to decline. The willingness of dentists to sign up as a PPO provider has been the main cause of overall dental reimbursement decline. Not all dentists are willing to sign on for a cut in reimbursements. On the graph below, it is known that Montana Dentists traditionally do not sign on with PPO plans. Therefore, reimbursement rates in Montana have increased while most of the nation has experienced decreases in dental reimbursement. Utah is well below the national average in regards to the amount of reimbursement decline occurring over the past few years. This is directly related to a high number of dentists on PPO plans.

There has been a lot of discussion and social media chatter recently, in regards to dental office frustrations with dental insurance companies. There has been hope that some entity can come in and rescue them from compromises they have agreed to over the years by signing up as PPO providers. With inflation and COVID caused increases to overhead, dental offices are finding themselves at the crossroads, where expenses can no longer be met at the reimbursement rates currently offered by many PPO reimbursement rates. The decline in reimbursement rates can be directly attributed to the number of dentists signed up as PPO providers. It’s a basic supply and demand principle. The more providers willing to take a cut in reimbursement rates, the more the rates get cut. Rates will only go up if there is a drop in the number of willing network providers. As long as network provider numbers are healthy, reimbursement rates will continue to drop. As The American Dental Associations Health Policy Institute (HPI) has recently shown, the trend of reimbursement decline has been steady for several years. Inflation and Cost of living have increased, yet dental reimbursement rates continue to decline. The willingness of dentists to sign up as a PPO provider has been the main cause of overall dental reimbursement decline. Not all dentists are willing to sign on for a cut in reimbursements. On the graph below, it is known that Montana Dentists traditionally do not sign on with PPO plans. Therefore, reimbursement rates in Montana have increased while most of the nation has experienced decreases in dental reimbursement. Utah is well below the national average in regards to the amount of reimbursement decline occurring over the past few years. This is directly related to a high number of dentists on PPO plans. Our state has one of the highest percent of solo practitioners in the nation. The number of dentists per 100,000 population is dropping in Utah. Young dental students have a huge debt load coming out of dental school. Dental income in Utah needs to improve going forward, or we will have a hard time keeping a young dentist that decides to practice in Utah. One way to increase dental income is by decreasing PPO dependence. Dental incomes will increase if PPO participation decreases. See the current national dental earnings graphic below. This is the Elephant in the room. If you want to improve your individual position and help contribute to an overall effort to improve dental reimbursement, take a look at which PPO plans you are contracted with. Evaluate if it is wise for you to continue the downward trend with this PPO. Ask your Office manager, they

can tell you which plans are hurting your practice. Then have the courage to act. It will only change if YOU take action. Start dropping plans, especially the ones causing you frustration and stress. Those reporting to have begun this process, unanimously claim less stress and more profit. Ultimately, they are happier!! If you seem to be unhappy with insurance companies, take hold of your own future and listen to sound advice. At the same time, you will be doing your part to help improve the overall situation in our state. Be a part of the solution rather than participate in the cause of the decline. Together, we can get rid of the elephant in the room and eat it up, a bite at a time!

Dr Val L Radmall UDA Executive Director

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