Jameson Files Episode 151: How to Navigate PPO Relationships in Your Practice
Our transcript of the discussion between Lois Banta and Jameson Files host Carrie Webber has been lightly edited for flow. To enjoy the audio conversation, you can watch on YouTube or listen to our podcast on iTunes, Google Play, or Spotify.
Utilizing Your Dental Practice’s “Why” to Help Navigate Relationships with PPOs
Carrie :
Welcome to the Jameson Files. I’m your host, Carrie Webber. Thank you so much for joining us once again for another episode, or perhaps for the first time. We are certainly so glad to have you with us as we continue to bring information and resources and experts to you to help you be as productive, as profitable, and as fulfilled in your dental practicing life as you can possibly be. Today, I am so excited. We are coming to you from the Jamon offices in Oklahoma City, and look who I have here, our dear friend and colleague in the dental realm, Lois Banta.
Lois Banta:
So excited to be here and doing this with you for the first time. A real honor, and I’m sure we’ll share a few giggles.
Carrie :
Maybe so. We just need to try and keep ourselves under control. We’ll see.There are no rules in this. I’m just so glad to see you face-to-face and to have you in the room with me. This surprised us because we have collaborated together, and we have Lois as a guest educator and presenter on the Grow pathway that is launching as we speak on the very popular and needed topic of how to navigate PPO relationships in your practice. It’s going to be a phenomenal resource for all of you that are on Jameson’s Grow learning platform. We’re very excited to share your knowledge with the members of Grow.
How to Make Healthy Decisions about Your Relationship with PPOs in Your Practice
Today we’re going to dip our toe into that topic a little bit because it only seems right to keep carrying forward the conversation that we’ve started here about PPOs. How do you navigate those relationships? How do you make healthy decisions about your relationship with PPOs in your practice? Do you have one? Do we need to perhaps step out of one? Do we need to do something different in the months and the years to come to help you in your pursuit of your ideal practice vision? Really, that’s what it all comes down to.
Lois Banta:
It’s such an important decision to make, and it’s one of the most difficult decisions that practices in our industry make. It’s scary. There’s a lot of thought that has to go into it, and if you don’t do it the right way, you could lose all your patients. So it’s a pretty serious topic right now, especially with the insurance reimbursements being lowered across the board with many of the plans. Practices are taking a really big financial hit. It’s really time to consider where you are in that relationship and where you want to go.
Carrie :
It’s interesting because you’ve been educating dentists and teams for a long time, 23 years now. Jameson has been in the industry as a company for 32 years, and over those years, the landscape has really, really changed. We’re seeing this continuous shift, and truly two paths diverged in a woods, and you need to decide what path to take. As you’ve said, it really has to align with your “why”.
Lois Banta:
Yes. You have to be very passionate about why you’re making the decision. As soon as you can wrap your heart around your “why”, the decision becomes fairly easy, but you still have to pay very close attention to the process in making that decision. But ultimately, back in the day when insurance was even invented, I think in the seventies, there really weren’t a lot of in-network plans. It was just insurance coverage, and it typically covered most of the patient’s dental care for a 12 month period. And now those maximums haven’t changed, not because of the insurance industry, but because of employers’ budgets not wanting to pay high premiums for those benefits. So the maximums don’t change, but the cost of that dentistry has changed greatly. So somewhere along the line there became this process of, if you become an in-network provider and you make a contractual deal with us to lower your fee-for-service fee, you’ll be able to get more patients.
So it was used as an avenue to acquire more patients, but it became the beast. It was a really great idea, and maybe it is still a great idea for some practices. Some practices can manage it very well, but the ones who are really getting caught off guard and caught by surprise with the insurance industry lowering reimbursements and increasing adjustments, have really taken a hit in the pocketbook. And that’s when it becomes a really important decision. Where’s your tolerance level? When is it time? And once you’ve made the decision, it’s time, how do you do it?
Myths that Prevent Practices from Making Healthy Decisions about PPOs
Carrie :
I know that you work with a lot of teams in retreats and in your mastermind sessions on how to do this and on how to make these decisions. At Jameson, we help practices step out of relationships in PPOs all the time. But I think you and I both know that sometimes that process and releasing the fear of the “what if” with practices can be very difficult. What’s some of the pushback that you see and experience that you’ve overcome with practices? Let’s bust some myths here that may be preventing practices from making really healthy decisions about this.
Lois Banta:
It’s the noise that plays in your team’s heads where they’re very, very sensitive to what they feel the patients want and need. So it’s a perception. You’re going to get the pushback when the team has a general perception that it’s going to cost the patient a lot more money. So one of the myths is that it’s going to cost the patient a lot more money. Insurance reimbursement typically increases when a dentist changes the relationship with how they work with them. So they’re no longer in-network, so they’ve removed the barrier of having to charge a lower fee. They charged the fee-for-service fee. Typically, the reimbursement will catch up to that fee-for-service fee. So one of the myths is that your patient’s out-of-pocket expense isn’t going to go up by the amount that the practice is writing off. The practice is writing off those dollars because the dentist signed a contractual relationship with that insurance company to lower their fees, therefore increasing adjustments
Carrie :
I think you’re going to have to go on the Grow pathway to get all the details, or go see Lois in lecture, or bring her in for a retreat. Something that really resonated with me was the reality of the write-offs. A lot of decisions are being made, or not being made, in dental practices without the practices doing the due diligence to understand really what your relationship with these plans are.Some of the most painful realizations are when a practice is meeting their production goals, high-fiving each other, thinking this has been a great month, and then bam, you’re cut up at the knees because you just wrote off 50% of what you produced that month. You worked your rear end off for that. You had some really “aha” moments in that part of your presentation.
Understanding the True Cost of PPO Relationships in Your Practice
Lois Banta:
Yeah. The twofold analysis is analyzing all the data of production, collections, and adjustments. Then if you’re going to dig a little deeper in it and really analyze the “by code” adjustment percentage, most practices realize that they’re struggling when the doctor goes to pay the bills at the end of the month and suddenly, “Hey, we’ve produced all this money. How come I don’t have enough money in my bank account?” Because they haven’t really gone in and done a deep dive as to which plans they’re adjusting the most dollars off, which ones are not allowing the benefit when the benefit should be there. It puts the practice in a hypothetical position that the team tends to adopt, so the thing causing how to react to everything is based on inaccurate data.
Then the team starts having these conversations with the patients telling them that they can’t do this or that because their insurance doesn’t allow it. Then the practice is at risk for diagnosis and treatment plan discussions based on what the insurance does and doesn’t cover, which of course is not in the patient’s benefit. It’s almost like a scare tactic that then drives the mindset. And that’s where you’re going to get a lot of pushback from the team with that mindset, because they’re so entrenched in what insurance will and won’t cover, what maximums are going to happen, and when they’re maxed out or whether there’s a deductible. It drives the conversation instead of letting the practice drive the conversation with what is truly in the patient’s best interest.
Carrie :
It’s interesting. I was just kind of reminiscing back to the last AADOM conference. I was on a panel, and you were the moderator of the panel. And I always say: why don’t they just put all the insurance speakers and experts on the panel, because the questions are always about reimbursements or being in-network, or changes that are being made to the agreements? And you know, you found yourself working a little harder.
Lois Banta:
I did. I found myself being on the panel and being the moderator.
Carrie :
Again, the point always is that your practice vision can be whatever you want it to be, and if being in-network is important to you and how you want to care for patients, that’s great. You do you, but understanding what that means and what that’s going to have to mean in terms of how you run your practice is important.
Lois Banta:
You’re going to have to make financial decisions on your expenses. A lot of practices make these decisions based on where their overhead starts or stops. If they paid attention to the overhead part first they would make different decisions. Overhead is driven by gross production. Net collections pays the overhead. So when the gap gets bigger, because you’re writing off more dollars, you’re not putting as many dollars in the bank, but your expenses are actually going up because you have to do more dentistry in less time. That’s what the average practice thinks. Well, I’ll just do more dentistry in less time, and then it’ll be fine. But the more dentistry you do in less time, the more times you’re turning a room around, the more times you’re using your sterilization equipment, the more times you’re using your instruments, the more products you’re using, the longer your hours sometimes. Well, all of that is overhead. So the minute you increase your productivity, if you’re in-network, you’re actually increasing your overhead more than if you were not in-network. So you start running on this terrible treadmill. Another myth or misconception is that you can just see more patients in less time and do more dentistry in less time, and it’ll offset, but it actually creates a worse nightmare in the overhead department. So that’s one of the myths.
Carrie :
So, busting these myths and getting over that obstacle that might be in your mind or in your team’s mind is important. Also do the due diligence, run the reports, audit your plans, figure out the reality of your practices relationship with these plans. How many patients are on these plans? What are the write-offs? Do your homework so that no matter what decision you make, it’s an educated decision. It’s a decision based upon the reality of your practice numbers.
Lois Banta:
Right. When you know the real numbers, you can make informed decisions. If you are guessing what the numbers are, you’re going to be wrong a hundred percent of the time.
Executing a Plan to Step out of Relationships in PPOs
Carrie :
Lois, to shift gears a little bit, you do some really great education on how to execute a strategy if you want to go out of relationship with a plan and the steps to take and so on, but something that might be challenging for practices is consistency in executing that plan and strategy. So what would be some recommendations or some advice you would give to stay consistent in executing that process?
Utilizing Morning Huddle Time to Stay on Track
Lois Banta:
Well, the secret to that, and I happen to know that is the Jameson philosophy as well, is to have a really good effective morning huddle to introduce the starting of the management of changing that relationship in your morning huddle. So you identify the key patients who may have those plans. Let’s say you’ve decided to change your relationship. Here it is January 1st. Now you want to choose six months from now. So July one, you want to opt out of in-network status with three different plans. So in your morning huddle, you identify the patients that are on your schedule who have each of those plans.Then you identify, which of these patients we are going to have this really important discussion with. Then you start having the discussion as soon as the patient checks in.
Plan For Face-to-Face Conversations with Patients
Please don’t send a letter right away. Please don’t call the patients right away, because you are not in control of their reaction. It is very, very important to have face-to-face conversations with your patients. And in order to do that, you really want to have an earnest effort at identifying which patients on the schedule today we are going to have that conversation with. What that does is lessens the feeling of being overwhelmed. You may have 500 patients you’re going to have a conversation with, but maybe only five of those patients are on your schedule today. It makes it much more manageable.
Carrie :
One bite at a time.
Lois Banta:
And here’s the really great outcome of that. The first five patients you have the discussion with, you’re going to be terrible. You give yourself permission to fail at the discussion, but as you start doing this every single day, you get really, really good at it. The reason to do it in the morning huddle is that’s when the entire team is available. And your patients might be asking insurance related questions chairside, so it puts the assistance at ease, or the hygienist at ease, or even the dentist at ease when the patient introduces this topic. Maybe you are not going to have the total discussion with the patient chairside, but you’re going to be able to build the bridge to the person in your administrative team that has managed that discussion very successfully. So many times, your discussion is in the handoff.
The patient might say, “I hear you’re dropping me.” Then you can respond to the patient by saying, “No, we’re not dropping you. We are changing our relationship with how we work with your plan. We want to make sure that no third party gets in the way of your important discussions in treatment.” And that’s the passion behind the “why” that I talk about all the time. If you don’t understand and can’t wrap your heart around your “why”, the words aren’t going to come easily.
Carrie :
I love that recommendation of utilizing and maximizing your time in the huddle to stay on track, to make it feel like an attainable goal, to have these conversations, to keep it in front of mind for everyone. It’s such a perfect example of how to more successfully utilize the time of a daily huddle. I think a lot of daily huddles die because they aren’t being used appropriately– that time isn’t being executed effectively.
Lois Banta:
It’s a schedule review.
Carrie :
Right. We’re reading the schedule to each other instead of having the intention of utilizing that time to get all hands on deck, get all eyes on the prize, and make that the most successful day possible as a total team effort. If you are setting a goal and setting an action into place to change a relationship with a plan, use the huddle to keep that in front of mind. It’s just like an internal marketing effort that you may be trying to press, or asking for referrals, or whatever the case may be. It’s just such an important time to remind everyone that we’re all in this together. Here are the people that are coming in today that we need to make sure that we have a conversation with, because relationships first. Patient-focused practice. That’s a great utilization of that time.
Having a Strong “Why” Will Help You Explain Your Decision Confidently
Lois Banta:
And it’s the best opportunity to really get the team to buy into the process. Some patients will push the envelope and ask, “Why are you dropping my insurance?” “I’m so sorry that that’s what you think. We’re not. We are just not letting the third party influence our discussion, so we’ve changed our relationship with how we work with that insurance.”
Always, always ask the patient what questions you can answer for them about this, because if you honor the patient in that way, they won’t leave you for the wrong reasons. Some patients are going to choose to exit your practice, but you really want to make sure that you have a good backup plan of helping them back into the practice.
Carrie :
For those of you that are perked up and are thinking that this was the pep talk you needed to hear, remember, get really solid on your “why”, your practice vision. Make the decisions based upon what’s best for you, your practice, and your patients, then your entire team will be able to stand firm and be confident in that decision, in those conversations. Work on those conversations, those communications skills. Lois does a great job of giving recommendations and verbal skills of how to do that.
Make the decision based on the evaluation of your practice numbers. Once you’ve done that work, make those educated decisions, and then make sure that you’re making time in the day to all stay ready, and making sure we’re accomplishing this goal one patient conversation at a time.
How to Learn More About PPO Relationships with Lois Banta
I’m super, super excited that we are launching on Grow, The New Pathway, featuring Lois as your presenter and educator on how to navigate these PPO relationships, how to do your due diligence and make those decisions and talk about verbal skills, and how to engage in those conversations with your patients. So Lois, thank you so much for doing that with us.
Lois Banta:
I’m very passionate about this subject matter. So I welcome any questions, conversations, or challenges. I’m happy to make myself available to answer any questions that practices have about this process.
Carrie :
I love that. So you can find the pathway @grow.jmsn.com. How can they reach you directly to talk more in depth about your retreats or about the services you provide?
Lois Banta:
So my email is lo**********@***il.com. You can call me at (816) 223-3529, or you can go to my website, ljbseminars.com. There’s a lot of information there about Masterclass retreats or regular retreats at a location of your choice. I’m doing a wonderful City Slicker retreat in May with Kathy Jameson, which sells out every time we have one. There’ll be information on my website about those courses as well.
Carrie :
Wonderful. And if you’ve never seen Lois present or even in lecture form, I encourage you to go find her, and let her just give you the gift of her knowledge and passion and expertise. It’s worth your time and effort. So my friend, thank you for joining me for this episode. I appreciate you.
Lois Banta:
A true pleasure.
Carrie :
And thanks to all of you that continue to be a part of our Jameson Files community. We’re so glad you’re here and so grateful for you. Be well, and we’ll see you next time.
Carrie Webber:
Thank you for joining us on this episode of the Jameson Files. Visit us online. You can subscribe to this podcast on iTunes, Google Play, or Spotify. See you next time.