Fighting an Uphill Battle

Unfortunately, in recent years, statistics reveal that inflation and increases in overhead and other expenses have significantly outpaced increases in dental insurance reimbursement rates, stymieing practices' profits and making many dentists question their degree of participation. This month, Inside Dentistry's cover story examines how dentists are combatting the challenges of dental insurance and presents strategies to improve profitability, including increasing production, raising fees, ensuring proper coding, and negotiating with providers for rate increases.

The stagnation of reimbursement rates is having a profound effect on my hygiene program, and this is being amplified by another problem that has arisen since the COVID-19 pandemic-staffing shortages. It has become very difficult to find hygienists, and those still in practice are commanding significantly higher wages. However, in the past 2 to 3 years, the insurance programs that I participate in haven't raised my hygiene-related rates by more than 1% to 2%, which doesn't make up the difference. Although I've written and lectured extensively about how dentists can make hygiene a profit center instead of a loss leader, for the first time in my 38 years in practice, I'm questioning the viability of my formula for success. If, like associates, you're looking to pay your hygienists approximately 33% of what they produce, with today's insurance reimbursement rates, offering them competitive salaries requires an unrealistic increase in hygiene production.

Dentists helped to create this problem. When dentists join insurance programs as in-network providers, we put ourselves at their mercy regarding the fees that we collect. As out-of-network providers, we can still accept insurance patients and then balance bill them for the remainder; however, because this is unattractive to many patients who don't put a premium on dental care, finding an in-network provider has become the expectation. I only participate in-network with two insurance companies, so I could drop them and go out-of-network, but 67% of my patients fall under that umbrella, and I don't want to lose any of them. Therefore, I'm going to take a cue from the cover story and take action to renegotiate my rates. If stagnating rates are affecting your profits, check out the article. You're sure to find some ideas that can help you improve your bottom line!

Robert C. Margeas, DDS
Editor-in-Chief, Inside Dentistry
Private Practice, Des Moines, Iowa
Adjunct Professor • Department of Operative Dentistry
University of Iowa, Iowa City, Iowa
robert.margeas@broadcastmed.com