KDA Today
KDA Today
For Immediate Release
Date: Feb 20th, 2015
Contact: Dr. Garth Bobrowski
Phone: 800-292-1855
Email: info@kyda.org
Think Big!
OK. THIS IS A TEST. In the last issue of the KDA TODAY, page 8, there was an article on how to get your insurance plan participation analyzed (hopefully, before you signed up). On more occasions than I can remember, I have had many dentists complain to me about their insurance reimbursements (mine included). The test is how many of you read that piece, and better yet, how many of you had at least one of your insurance plans analyzed? Last year I was talking with a state legislator about Medicaid and Insurance companies: poor reimbursements, non-covered services clauses, unnecessary paperwork issues, etc. I laid out a bunch of papers to prove my point to him; after a few comments, he asked, “Did you sign their contract to be a participating provider?” Well, my answer was, “Yes”. (As many of us have done.) He pretty much shot me down when he said, “Well, you have signed with ‘THE WOLF’” - pretty much saying that I did not have much recourse. The insurance companies and managed care organizations have rooms full of lawyers, legal analysts and statistical analysts. How many do you have in your office? Participation in any insurance plan is a choice I have to individually decide on to see if it will fit my business model and can I make any business profit to continue my services to my community. I know dentists around the state who have not “signed up” with any insurance plans for decades and THEY CONTROL THEIR DENTAL PRACTICE - not the insurance company. My point in all this is to say, “Yes, you do have help.” Let your membership in the KDA/ADA work for you. Call the KDA/ADA help phone numbers. A Facebook friend sent out this quote from Dr. Steve Maraboli about RELATIONSHIPS and it can be applied to our personal relationships as well as our business relationships: “If you put up with it, you’re going to end up with it. Set the standard you want and don’t settle for less.”
We need your help and ideas in running this great organization called the KENTUCKY DENTAL ASSOCIATION. I was on the phone tonight talking with a young dentist in another county. I understand that it is creepy and scary to think about being a leader in any organization. I told him that he would be surprised at how much care and concern is given to our younger colleagues. We do want you involved and understanding the issues that affect your ability to practice dentistry. Please don’t stick your “head in the sand” and think that someone else will take care of you. Just like prepping that first cavity on your first live patient, you have to start somewhere and learn the process, the ropes and the expectations. You can be a helper just by being a legislative contact person, being willing to take a check to a legislator, being on a committee within your society or at the KDA level. I understand that when we get off work, we don’t really want another job when we get home. But, honestly, a lot of these efforts or committees do not take up a lot of time. So, I want to encourage each and every one of you to do something. Do something to improve or help in your dental association.
Why would insurance companies want to be a part of Medicaid? Anthem and Humana are now part of the managed care organization (MCO) dental mix. Aetna and others are in the medical mix. Here is a tidbit of information for inquisitive minds; did you know that the Medicaid managed care organization (MCO) plans made $235 million in EBITDA in Kentucky in just the 3rd quarter of 2014 (profits)? Now, these MCOs cover medical, dental, vision in the state of Kentucky. So, they made that much money in one quarter…HMMMMMM. Taxpayer money leaving the state. I don’t know all the contractual deals the MCOs have with the state of Kentucky, but I believe it is in their contract with the state that they are allowed a 10% profit. Anything over 10% they are to return to the state. What bothers me is that the dentists are out there working for Medicaid, taking care of Medicaid patients in their communities and most are operating at a loss with no guarantees of gaining any profitability. Please look back at Dr. John Thompson’s editorial comments in the last KDA TODAY VOLUME 66, NUMBER 6 for further information and a better understanding of the Medicaid issue within the state. Also, I am getting this information from Citigroup, INC. Managed Care Weekend Update, week ending November 29, 2014. I am NOT a financial guru, but this is a 24-page report on the web from Citigroup discussing the MCOs’ profitability. I do not understand all their language and abbreviations. So, I hope someone who does understand all this can respond to the editor and me in the next KDA TODAY. PLEASE, do not get me wrong, I am enough of a businessman that I realize a business has to make a profit to be viable, but I STRONGLY feel the dentist has been left out. The Medicaid dentist has not had a fee adjustment since 2002 and two of the MCOs (Coventry Cares and WellCare) have cut their reimbursements to the Medicaid dentist another 10% to improve their bottom line. I, personally, and with the KDA, will continue to work through the great leadership provided by Dr. Susie Riley, Chairperson of the Dental Medicaid Technical Advisory Committee (TAC) and through the KDA Medicaid Workgroup to make things better for the dentist providing the care.
I applaud the Governor for his efforts and acknowledgement of oral health issues in our state. In his State of the Commonwealth Address on January 7, 2015, he mentions several initiatives that are improving the lives of Kentuckians. He asks all to join with him to improve our health, our workforce, our families and our economy. We know that dentistry is about 1% of the total healthcare budget. Not much, but hey, we are in there. And I believe we have a great opportunity to work with the Governor, the policy makers in Frankfort, the legislators and our dentists across the state to come up with ideas to set a goal for better oral health for all Kentuckians.
Years ago there was a workforce preparedness initiative that helped fund dental care. It was limited to fixing only the front teeth for people to help them be workforce ready. Medicaid has gone much further than that nowadays, but it seems like there is a worsening situation of getting Medicaid patients to keep their appointments. I am also a member on the Medicaid TAC and one item that has been pushed for has now come available. There is now a code number for cancelled appointments (D9987) and a code number for missed appointments (D9986). You cannot get reimbursed for filing this code, but I want Medicaid dentists to use these codes to better track these missed or broken appointments. This may provide a help when and if we get dental health care coordinators in our state or in communicating with the MCOs. I have mentioned to policy folks in Frankfort that we really need to see behavioral changes/attitudinal changes with our patients, in that they will be responsible to keep appointments, to get their teeth fixed at the basic level, to present a SMILE that boosts their confidence and self-esteem. I truly believe this ties in with the Governor’s ideas for improving oral health and general health. I really believe we need to work more with the stakeholders (patients to policy makers to anyone who cares) to see what dentistry can do to help change the attitude of fixing a tooth at a time (even though that is what we have to do) to a broader venue of building that personal confidence and self-esteem. It just seems that we do the same-ol’ same-ol’. THINK BIG. If you have ideas, please let me know.