P RESENTED BY C HARLES B LAIR , D. D. S. C HARLES B LAIR , DDS I VE - - PowerPoint PPT Presentation

PRESENTED BY CHARLES BLAIR, D. D. S.

THE FUTURE OF DENTISTRY THE RATE OF CHANGE IS STAGGERING.

CHARLES BLAIR, DDS

“I’VE NEVER SEEN ANYTHING LIKE IT!”

SO, WHAT’S HAPPENING?

IN A NUTSHELL…

• PPO’s are Dominating the Types of Plans
• A Shift to Corporate Dentistry
• A Shift from Solo to Multi-Doctor Practices
• Entrepreneur Dentists Owning 2-5 Practices is increasing
• 4,000 Labs Going Out-of-Business in 4 Years
• 35% of Crowns are Made Offshore
• $100,000 Per Year for Private Dental Schools
• More Patients with Less Money and are Deal/Discount Oriented

TODAY’S DENTIST

 Passion is Dentistry  CEO/Wears the “Hats”  Business activities distract from patient care or they are ignored  Cottage Industry-generally solo, some multi-doctor  Don’t think corporately

AREAS OF CONCERN



Startling Shift to PPO Plans



Dilemma of When (Not If) to Join PPOs



Lack of Busyness for Many



Continuing Sick Economy



Negative Patient Conduct/Skeptical



Patient Shift to Value/Negotiating Attitude



Concern for Overtreatment and Ethics



Corporation Encroachment



Concern for Sale of Practice and Retirement

SO WHO’S IN AT LEAST ONE PPO?

 Out-of-Network < 15% of dentists  PPO Participation > 85% of dentists

CURRENT STATUS – NON-PPO PRACTICE



 new patients and  busyness



Revenues are down only 5% - 10% in many cases



Living off the practice for the last several years



Running off patients, not gaining patients



Poor front desk communication with new PPO patients calling



Poor recall system with patients leaving for PPO dentists

ASSOCIATESHIP A

VAILABILITY



Non-PPO practices are suffering – no associate capacity



Retirement plan balances , dentists are working longer



Increasing corporate opportunity for employment, check JADA ads., etc.

NATIONAL DATABASE – BIG BROTHER!

 2 – 3 Database Companies  Contributions to the dentist database are made by insurance companies  Procedure mix of 175,000 dentists are spotlighted  Data is used to target over utilizers  Will be used to restrict or exclude providers  Will be used to recruit Exclusive Provider Organization (EPO) networks

IS UNDER ASSAULT… THE COTTAGE INDUSTRY OF DENTISTRY

FUTURE OF DENTISTRY

 Dental PPOs are at a tipping point and mirror medicine’s – Now!  **MUST PRODUCE MORE TO HOPE FOR THE SAME INCOME**  Dentistry is a $115 Billion industry and corporate dentistry will increase.

It is compounding from $6 billion of revenues (largest corporations) - - A tipping point!

SHIFT TO MULTI-DOCTOR PRACTICE

• Many more two-three doctor practices, solo is declining
• More entrepreneurial dentists owning 2 – 5 practices
• Many more large corporation practice locations with 2 – 3 doctors with 2,500

– 3,000 square foot facilities

DENTISTS SCOFF UNTIL REALITY!

Must produce 20-25% more (In hopes to make same income.) No one is not immune!

DENTAL PROFESSION’S FUTURE

LET’S LOOK AT CORPORATIONS

MOST ARE CORPORATE NOW!

 Restaurants  Small Bookstores  Small Groceries  Drug Stores  Hardware Stores  Sports Stores  Office Supply  Small Jewelers  Funeral Homes  Hometown Banks  Physicians  Dental Supply Dealers and Labs

Who’s left standing? Who works four days a week? DENTISTS Are Next!

CORPORATE DENTISTRY TODAY

 Cleaning house - 3,000 locations!  Moving from low end to middle market consumer  After the consumer, who is price sensitive and needs financing  Accessible Care/Accept PPO Plans/Insurance Friendly  In-house discount plans for non-insurance patients – A growth market  Convenience/Parking/Specialist on Site  $6 billion industry - A tipping point!  Hospitals or insurance companies could get into the mix

DENTAL MANAGEMENT SERVICE ORGANIZATIONS (DMSO)

Types:

• A. DMSO Owner – Non-dentist ownership
• B. DMSO – Management only – They will allow private-owned practice to
• thrive. Co-ops will evolve. DMSO’s could save a cottage industry!
• C. Hybrid DMSO – two of the basic types

DENTAL MANAGEMENT SERVICE ORGANIZATIONS (DMSO)

1. Cold Start Model – Less stable DDS providers/heavy advertising. 2. Buy and Grow Model – More stable DDS providers who were bought out and they remain. Sometimes they are mentors for young dentists. This is a decreasing model for large corporations.

NON-OWNERSHIP DMSO-SERVICES ONLY



Predict these will be formed



True non-ownership of practice – DDS owns practice



Compensation



Fixed Fee



Variable Fee - Is this fee splitting?

LET’S COMPARE CORPORATIONS VS. TYPICAL DENTISTS

CORPORATE THINKING: IS THE PRACTICE FIRST?

 Corporation – Yes – They maximize profits through capital

spending first and then go for the bottom-line return.

 Traditional Dentist – No – Often the home cash flow

requirements win! Practice spending vs. home spending is at

• dds.

• 1. CORPORATE VS. TYPICAL DENTIST

 P & L Cost Accounting  Metrics/Monitors/Goals  Modern Facility  Convenient Location



In-House Discount Program

 Convenient /Expanded Hours  Marketing/Advertising      





     

CATEGORY CORPORATION TYPICAL

      

• 2. CORPORATE VS. TYPICAL DENTIST

 Business Staff Training  PPO Negotiation  Higher PPO Reimbursement  Coding /Administration  Hiring/Screening  Doctor CE  Third-Party Financing      Yes        

CATEGORY CORPORATION TYPICAL

 Poor  None  

Fair

 

Fair



Fair

• 3. CORPORATE VS. TYPICAL DENTIST



More $/Employee Output



More $/Square Foot Output



Expanded Procedure Mix – Endo/Ortho



Specialists on Site/Convenience

   





 

CATEGORY CORPORATION TYPICAL

 





• 4. CORPORATE VS. TYPICAL DENTIST

 Conflict Resolution  IT Department  Best Practices  Mentoring Environment  Screen Dental Technology  A/R Management  Payroll      





     Even

CATEGORY CORPORATION TYPICAL

     Fair  Good  Even

• 5. CORPORATE VS. TYPICAL DENTIST

 Lower Overhead  Lab Bill  Supplies  Lower Fees  Under-treatment  DDS Turnover          Rare  High*

CATEGORY CORPORATION TYPICAL

   



Gross under-treatment of Perio

  Much Less

*Low in some models

• 6. CORPORATE CRITICISMS!*

 Overtreatment  Sloppy Work  Pressure to Produce  Money Hungry  High  High  High  High

CATEGORY CORPORATION TYPICAL

 Some  Some  Some  ?

*View of mainstream dentists.

MEDICAL MODEL EVOLUTION

Solo Small Group Large Group

• Multi-

Location

Hospital Owned Insurance Industry Owned?

MD 50% W-2 (2012) MD 70% W-2 (2014)

DENTAL MODEL EVOLUTION

Solo Small Group Large Group

• Multi-

Location

Corporate Owned Insurance Industry Owned?

FUTURE OF DENTISTRY



GPs become more decathlon providers through technology – Expanded procedures, including implants



Less need for Specialists (Except Pedo)



Some Specialists will not have their own facility



Mid-Level Providers – Starting at Zero Number Now



Hygienists (RDH) – Periodontal Therapist (RDH)



Assistants – Prophylaxis (Scale/Polish)



Expanded Function Restorative Assistants (RDH/DA)



Less need for dental schools/dentists because practice output will greatly increase.

DENTIST STRATEGY (FOR NOW)



Think corporately, not like traditional dentist.



CHANGE WORKFORCE LAWS FOR EFFICIENCY BUT ALSO BETTER PATIENT CARE



Treat Periodontal Disease – You Must – Now!



Improved Communication to Convert N. P. Calls



Improved Communication to Retain Recall Patients



Expand Clinical Procedure Mix



Provide Moderate Clinical Treatment Intensity

STRATEGY (FOR NOW) CONT.



Increase Case Acceptance



Intraoral Camera



Digital X-Ray



Third-Party Financing



Patient Education Software



Depending on the local market, may consider Delta Premier and Cigna

• ut-of-network.



Get more efficient

 Same-Day Dentistry Capability  Unbooked (Extra) Operatory  Modernize facility/equipment

STRATEGY (FOR NOW) CONT.



Take Emergencies & Children



Hire a One or Two Day Associate



Shift to a Two Dentist Practice – Share Facility



Emphasize a Stable Patient Relationship – No Turnover of Dentist in Your Practice



Convenient Hours/Patient Financing



Insurance Friendly



Market

 Website/Advertise 

Consider In-House Discount Plan (This is the FUTURE)



Consider Consultants

STRATEGY (LATER) CONT.



Hire DMSO (Non-Owner) to manage the practice – no ownership by DMSO.



Co-Op



Marketing



Lab



Supplies



PPO Negotiation



Systems /CE



Share Out-of-Network Facility

SHORT/LONG TERM

HOW TO BE COMPETITIVE IN THE FUTURE

MODEL A

Solo Solo + 1-2 Day Assoc.

• Minimally competitive entity
• Must have business savvy
• Possible part-time specialist

MODEL B

Solo 2/3 DDS Group

• Minimally competitive entity
• Must have business savvy
• Possible part-time specialist
• May afford CBCT

MODEL C

Solo Group

Multi- Location Group

• Competitive entity
• Must have business savvy
• Part-time/full-time specialist
• Can afford CBCT, possible full-

time specialist

Thank you for attending! For more information, go to www.practicebooster.com

• r email info@practicebooster.com

QUESTIONS?