I’m tired of talking about insurance benefits. So much is being said today about “changes in health care,” but the conversation really tends to be more about changes in insurance benefits. I think the time is right for those of us in dentistry to lead the way into a different conversation; a conversation about health.
We have a lot to learn about health; a lot to explore with our patients. Beyond education there is a place for authentic dialogue; an exchange of ideas in which there is learning on both sides. Beyond a mechanistic model of health is a true understanding of vitality, of what it means to thrive. This kind of conversation requires that we set aside our bias about know what is “best” for our patients. It requires that we suspend assumptions; that we let go judgment; that we find in our hearts compassion — for fellow travelers on the road to health.
I’m not suggesting we ignore the realities of dental insurance in our lives and in the lives of our patients. I’m not idealizing the desire our patients have for health, or the possibilities they are able to see for themselves. I am keenly aware how important is to pay attention to the productivity and profitability of a dental practice. I just believe that we are at an important transition in regard to health care, and we can either “wait and see” how it turns out, or we can participate in shaping it.
I’d like to suggest a formula for health, both the health of your patients, and the health of your practice:
CSJ + PO + FF + MOP = Health
The first part of the equation has to do with Care, Skill, and Judgment. This refers to all aspects of how you care for your patients. We have a responsibility to develop skills in helping patients choose health as well as in delivering excellent technical dentistry. Success depends on clinical excellence and our capacity for understanding, patience and compassion. Our care, skill, and judgment make up the first, essential part of the formula for health.
The next part of the equation has to do with agreement on Preferred Outcomes. Our best homecare suggestions and treatment recommendations are meaningless unless we are moving toward mutually agreed upon outcomes. It creates the context for every choice we ask patients to make and every option they ask us to offer them. We can learn to help patients shape their preferred outcome by helping them see what Dr. Bob Barkly referred to as their “probable future” and their “possible future.” Without the context of a preferred outcome they cannot be fully informed of the implications of their choices.
Another element to factor into the equation is a Fair Fee. There are a number of ways to determine a fair fee. It can be based on your overhead, on comparables in your community, on time, on skill level, on degree of difficulty, etc. You must choose how a fair fee will be determined in your practice, but it should be based on solid principles which allow you to deliver the quality of care to which you hold yourself accountable. It is one of the most truly unique aspects of your practice. The degree to which you own the fairness of your process has everything to do with your ability to offer your work proudly and to stand behind your work.
The final piece of the equation has to do with Method Of Payment. This part of the process includes, for example: cash or credit card, payment plans, insurance reimbursement, and loans from wealthy relatives. It is an appropriate part of the equation, but it is not a part of the Fair Fee. They are two separate elements. Only when you have that clarity can you accept your fee graciously, or choose to appropriately adjust it, or decide to waive it completely.
If you choose to accept a credit card payment, you understand it is discounted by the fee you pay the credit card company. If you choose to accept what an insurance company decides is appropriate you do the same. That does not change what you have determined to be a fair fee. When you choose to accept something other than your fair fee you must consider the effect of that decision on the care, skill and judgment you will bring to the case; the outcomes to which your patient aspires; and the practice standards to which you hold yourself accountable. You may want review one or more of those elements to choose your course of action. You may want to consult your patient on any of those elements for their input, choices, and understanding.
The sum total of the formula is Health. Healthy choices by your patients must be freely chosen and fully informed, and that is true regarding your choices for your practice. They should not be in conflict with each other. One should support the other. We do not support healthy choice by hiding, protecting, ignoring, avoiding, and always taking the easy way out. Health is a choice and it is a worthy goal.
When I work with groups with this formula we explore each element in depth in terms of the part we can play in each part of the process. Where can we influence? Where might we be impeding the process? What are the possibilities we may not be seeing? Where are the opportunities we may be missing, the options we may not have considered? I hope you will enjoy exploring, asking questions, seeing new possibilities. I hope you and your patients can learn to celebrate the benefits of a healthy life. I hope you will become a part of a new conversation; a conversation about health.
Mary Osborne, RDH