Treatment compromised

In the opening paragraph of Dr. Limoli`s article, "Managed Care" [September 1995], he states, "Most alternate dental delivery systems do not encourage undertreatment or poor-quality dentistry." Later, when describing Capitation Contract Dentistry (CCD) Limoli says, "The office receives payment whether or not any dental services are provided to the members."

Nov 1st, 1995

Dear RDH,

In the opening paragraph of Dr. Limoli`s article, "Managed Care" [September 1995], he states, "Most alternate dental delivery systems do not encourage undertreatment or poor-quality dentistry." Later, when describing Capitation Contract Dentistry (CCD) Limoli says, "The office receives payment whether or not any dental services are provided to the members."

Any dental treatment involves overhead expense. In most instances, the attending dentist must make professional judgments on whether to treat and how to treat a specific dental condition. If the treatment of choice creates a significant financial burden on the dentist, this can`t help but become a factor in the treatment decision. If this is not encouraging undertreatment, I don`t know what is.

Furthermore, many managed care plans market themselves to too many patients while not contracting with enough dentists to provide the needed care. This can result in an overworked doctor and staff, unhappy patients, and low-quality dentistry. Also, many plans do not pay for specialty referrals for what is determined by the plan to be "routine" procedures. This can easily result in necessary treatment not being done, or a non-specialist being forced to perform procedures for which he or she is not adequately prepared. This clearly compromises the quality of care.

Having worked in offices that were under managed care, I can say firsthand that the quality of patient care can frequently be compromised under these plans. In the traditional fee-for-service practice, taking the time to relate to the patient as a fellow human being (internal marketing) and making a commitment to provide the very highest quality in dental care results in greater patient satisfaction, more patient referrals, increased financial compensation, and higher staff morale. This same approach, under managed care, is unnecessary, counterproductive, and far too costly for the practice.

When an office has both fee-for-service patients and managed care, the dentist is forced to raise the fees for non-managed patients when the capitation or fee schedule on the managed care side is inadequate. The fee-for-service patients are, in effect, subsidizing the cost of the managed care patients` dental treatment. Any alleged savings in cost for managed care are contrived and artificial, since it simply drives up the cost for those patients that are not covered under managed care.

I would caution any dental hygienist who is contemplating working in an office under managed care to seriously consider the potential for being required to render less than the highest quality treatment of which they are capable.

Dean Jewell

Las Vegas, Nevada

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