Gregory J. Tarantola, DDS
What will it take for your practice to thrive and prosper into the 21st century in a managed-care environment? You can begin by clarifying the real issue, which, by the way, is plainly not private fee-for-service vs. managed care. The real controversy is a much more fundamental, global issue: comprehensive care in a relationship-based practice vs. limited care in a manufacturing-based practice. The latter type of practice is characterized by quickly performing "manufactured" units of dentistry on a large number of people without building interpersonal relationships. Time primarily is spent "performing" on teeth, thereby severely limiting the amount of time available for planning, preparation, education, motivation, training, consulting and simple relationship-building.
The irony is that the manufacturing-based practice can assume many forms: an HMO, PPO, capitation operation, indemnity insurance-driven, retail and even private fee-for-service!
They all differ in only one area: how revenues enter the practice. They are similar in that time spent is essentially in the "manufacture" of dentistry. This fact makes it absolutely impossible for a private, fee-for-service practice to differentiate itself from the manufacturing practice where a "crown is a crown." There is no time to provide individualized care based on the patient`s circumstances, objectives or temperament - or to provide meaningful educational experiences for the patient.
Clever marketing can create the perception of quality care. If patients believe the care they receive is no different from dentist to dentist, it`s no wonder they opt for the lowest fee that a managed-care practice can offer. A private, fee-for-service practice cannot compete on a manufacturing basis. Private, fee-for-service practices must prove to the patient that there is a difference. When you practice comprehensive, individualized care, you distinguish yourself in a very positive way. A comprehensive-care, relationship-based practice is, by nature, a differentiated practice.
What makes this style of practice so special and able to prosper in the coming, seemingly uncertain, future?
Comprehensive care has as its benchmark an extensive understanding and working knowledge of the entire masticatory system. This understanding goes far beyond just the teeth and periodontium and reaches into the area of the TMJs, neuromuscular system and occlusion. Optimum comfort, function, health and beauty, combined with longevity, are achievable for each patient with this knowledge. By becoming an expert in the form and function of the masticatory system, you become a physician of the masticatory system and not just a dental provider.
Comprehensive care does not mean that everyone gets a full reconstruction, but rather each patient receives appropriate care that addresses all the components of the masticatory system. It may be a simple alloy, if it is placed with consideration for the periodontium, TMJs, neuromuscular system and occlusion. By comprehensively addressing the entire masticatory system in a skillful, confident manner, with respect for the patient`s time and dignity, we go beyond the limits of what patients perceive to be a typical experience. By taking time to educate patients about the process, we teach them to value and appreciate the comprehensive care they are receiving as individualized and special.
The differentiated practice is dedicated to educating the patient. Doctor means "teacher" and as doctors, our primary role is to help our patients learn about the condition of their mouths, whether they are healthy or unhealthy, functional or dysfunctional. We must explain why problems have occurred, how they can be corrected and how to prevent them from recurring. Spend time educating and motivating your patients to the possibilities of comprehensive care and fine dentistry. The goal is to excite each patient to take action.
The differentiated practice is equally committed to nurturing relationships among the patient, the dental team and any specialists and laboratory technicians involved. Each person taking part in the patient`s journey to oral health helps create an unforgettable experience. The way any phone conversations are handled, the way the patient is greeted upon arrival at the office for appointments, the promptness with which the patient is seen, the graciousness extended to make the visit as comfortable and nonthreatening as possible, the willingness to take whatever time is necessary to address concerns - these are all important components of relationship-based care.
Make every effort to create a cohesive, dental-office team. Begin by developing a mission statement, as a group, that centers on providing comprehensive, individualized care in a relationship-based manner. Then, cultivate an office environment in which each staff member is capable and permitted to make decisions based on his or her understanding of the office mission and knowledge about his or her own area of responsibility. You want an office in which each team member believes in the mission and is an executive making appropriate decisions given that mission.
Every effort should be made to create a synergistic cadre in which each dental team member, specialist and even laboratory technician plays a vital role. Each will be a partner in the development and execution of a treatment plan appropriate for your special patient. Each will be a privileged partner working toward the common goal of the patient`s optimum oral health.
A manufacturing-based practice does not have the time for these efforts.
The fee a patient pays for our services should reflect the time dedicated to these efforts as well as the technical competence and skillfully applied judgment required to provide quality, individualized care. The dentist needs to know what it actually costs to provide the total service. A fee based on all these factors is a justifiable, fair fee.
A tragedy occurs when a dental team provides comprehensive, relationship-based care, but charges a manufacturing-based fee. A tragedy also occurs when a patient in a manufacturing-based practice has his or her time apportioned among multiple chairs with other patients, yet is charged a fee that reflects the time and cost incurred to provide individualized care to a single patient.
Patients do perceive and appreciate the value they receive from individualized care, especially when that value is believed in and communicated by the entire dental team. Patients are willing to pay a fair fee for a comprehensive service delivered with honesty and integrity.
Which style of practice do you truly want to develop? It is impossible to mix styles and be effective. Are you willing to do what it takes to transcend the manufacturing mode? Are you ready to commit to the discipline necessary to move forward in comprehensive, relationship-based care?
The future of health care may seem confusing and uncertain. However, I believe there is tremendous opportunity for happiness and reward in developing relationships and treating people appropriately for comprehensive oral health.
As Clinical Director of the Pankey Institute, Dr. Tarantola is a full-time faculty member and maintains a private restorative practice at the Institute. He is a member of the American Dental Association, Florida Dental Association, East Coast Dental Society, Academy of General Dentistry and American Equilibration Society.
