Dental reimbursement rates have failed to keep pace with the cost of running a dental practice for decades, and the gap has reached a breaking point, according to Thomas Allen, DDS, dental director of Old Farm Dental in Salt Lake City.
The industry is facing mounting pressure from a number of fronts, but they all circle back to reimbursement rates. As operational costs continue to increase, stagnant reimbursements put dentists in a tough position when it comes to staffing.
“What we’re looking at is the perfect storm situation where it’s staff shortages, it’s cost of doing business, it’s insurance reimbursement, and all together it’s at a point now where it is make or break,” Dr. Allen told Becker’s.
In the past, dentists have increased their production and seen more patients each day. Now, their schedules are maxed out and they still have to make up for the gap.
When the time does come for dentists to renegotiate their contracts with insurers, the increases are marginal, at best. The low reimbursement rates are not only impacting private practices and dentists, but are also straining how DSOs, which have a much higher cost of doing business, have to operate.
“These companies will renegotiate every two to three years, but I’ve never seen them increase fees by more than 2 or 3%,” Dr. Allen said. “They’re throwing us bait. It was something we were doing well enough, production-wise and collection-wise, for a lot of years where we could just agree and keep patients happy. Now we can’t. You can’t be nice anymore if you’re going to stay in business.”
So is there a fix in sight? Dr. Allen said the American Dental Association has leverage it hasn’t fully used on reimbursement specifically, pointing to instances where the ADA has pushed insurers on other fronts.
“I think it’s doable from an ADA standpoint — they could push insurers in that direction,” Dr. Allen said. “They’ve used their influence elsewhere in the insurance industry, pushing for fairness in claims processing. It’s got to be done the same way with reimbursement.”
According to Dr. Allen, there have to be legislative changes to regulate the insurance companies and provide some relief for dentistry, beyond advocacy alone. The empty promises from payers about increasing rates aren’t working.
“I think it has to be more legislative. The profit margins are there for the insurance companies to share that with us through reimbursements,” Dr. Allen said. “We as dentists are our own worst enemy, because we see what the insurance companies do and we go, ‘Well, that’s wrong,’ and then go, ‘Okay, let’s get back to work.’ We have to go one step further — I think it can be legislated.”
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