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PPOs vs OPPs?

We live in a world addicted to consumerism and thinly-veiled desires luring precious discretionary dollars out of the wallet. As for investing in one’s health, society somehow has digressed into a mechanized, commoditized, and subsidized mindset. Leverage assumed by the omnipresent insurance plan often renders a provider with little say regarding the context and content of care. Unprecedented increases in cost of goods sold have plunked the average PPO write off into a 44-50% range only amplified by futile fee increases. Margin pressure generated by declining reimbursement rates reflects the most aggressive line-item expense never located on a P&L statement. Growing for growth’s sake attempting to out run the overhead squeeze is unsustainable regardless of one’s mastery of the “treadmill”.

Does this resonate with your personal situation?

Approximately 90% of private practice dentistry is directly involved with PPO and/or reduced fee assistance programs. Fundamentally, nothing constructive has enabled dental benefits plans to evolve with economics and time. What once was a hedge against catastrophe no longer represents a definable insurance program but essentially a subsidized coupon book. Heavy participation with PPOs challenges the fundamental tenets for owning and running a healthy dental practice: autonomy, lifestyle, and financial independence. The notion of an entity disconnected from the doctor-patient relationship levying the final say upon healthcare decisions is a huge disservice to patients by encouraging reduced focus on the basics. Thankfully, foundational principles rooted in prevention and wellness greatly aid the delivery of oral health care outside the constraints of benefit plan mandates.

Insurance Independence 

The path to insurance independence is paved by challenges, unique stipulations, and calculated steps to successfully shed the proverbial handcuffs. Time in the marketplace and timing the decision generally outline the process. The following six elements are essential prerequisites to a reduction and/or full-scale elimination of insurance dependency:

Know Yourself: “Our greatest freedom is the freedom to choose our attitude” -Viktor Frankl

The practice owner is the driver of the process and must profess the mindset for success.

Know Your Data: “When performance is measured, performance improves. When performance is measured and reported back, the rate of improvement accelerates.” -Pearson’s Law

Accurate data in the PMS system coupled with precise accounting analytics fosters a valid measuring system for the true cost of PPOs.

Know Your Team: “The achievements of an organization are the results of the combined effort of each individual.” -Vince Lombardi

Human capital is by far the most essential line item not listed on a company balance sheet, and its true worth is expressed within the culture of the operation.

Know Your Community: “The greatness of a community is most accurately measured by the compassionate actions of its members.” – Coretta Scott King
The relationship aspect of dentistry is by far the most foundational principle and is greatly challenged by a 40-50% financial haircut.

Know Your Services: “If you do the work you get rewarded. There are no shortcuts in life.” – Michael Jordan

Today’s opportunity for a GP to pursue, master, and deliver above and beyond bread-and-butter services is tremendous.

Know Your Consumer: “Life is a matter of choices, and every choice you make makes you.” – John C. Maxwell

Optimizing relevancy within the community is essential for weaning off PPO contracts.
Is it time to make PPOs Other People’s Problems?

Hopefully, you are taking note of how these fit into your personal business plan and journey. If you have questions about where to begin or are strongly considering a move toward insurance independence, please feel free to schedule a discovery call today and discover all that is possible with Dynamic Dental Ascension.

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