A follow-up conversation with David Darab DDS MBA CEPA, Darab Business Advisors to his most recent guest author submission The Art of Leading: Innovate, Don’t Imitate led to an interesting question…is it possible to innovate in an insurance driven practice environment – or for that matter as an employee within a corporate entity or DSO?
This question occurred to me as the natural outcome of observations. In my current vocational station, I am able to follow the treatment planning decisions of other doctors and I am always – frankly – shocked how treatment planning is insurance-centric. In some instances, patients are not even presented with the option of an alternative to proposed treatment – extraction, not root canal for example. Is this coming from some declaration originating from on high vis-a-vis the C-suites? Is that a prejudicial decision based upon a perceived ability – or inability – for a patient to pay for treatment insurance may not “cover”? Or is it the notion that the only reasonable option is the one that’s reimbursed? Either way, it’s “bad medicine”. “Doctor” in Latin means “teacher” – your job is to inform and provide patients with options. That is not only your job…it’s your duty.
You cannot provided patient-centered care around an insurance policy. If this is true – and it is – you cannot always provide innovative treatment while constrained by limited reimbursement. And if you are an employee within a corporate practice or DSO, for obvious reasons the same is also true.
Dentists are not the only providers guilty of recommending insurance driven treatment – physicians also fall prey. Is this a mindset that has so permeated healthcare – whatever it’s domain – that providers have become brainwashed? Or is it the belief that what insurance will reimburse is the de-facto “standard of care”? I would maintain IT IS NOT. And when you cannot provide the care that you believe is needed, “moral injury” ensues.
I am confident to say I NEVER only propose treatment that is insurance reimbursable. In fact, in many instances, I’ll propose exactly that which insurance will not reimburse followed by a reason why. In many instances, patients will say “well my insurance doesn’t cover that” to which I’ll reply “I providing treatment for you, not your insurance policy”. You cannot provided patient-centered care around an insurance policy. If this is true – and it is – you cannot always provide innovative treatment while constrained by limited reimbursement. And if you are an employee within a corporate practice or DSO, for obvious reasons the same is also true.
“Doctor” in Latin means “teacher” – your job is to inform and provide patients with options. That is not only your job…it’s your duty.
Providing patient-centered care is not only “good medicine” it’s also good risk management. You are not required to propose care that only provides reimbursement through a third party payer. Patients need options and you as a licensed provider are required to provide them.
So – even if you are an employee – start thinking outside of the box. Begin by giving patients all the treatment options you are able to competently provide…not just those that are on the list of reimbursable treatments by the patients insurance carrier. If you’re not capable of providing an option, make the appropriate referral. Don’t recommend an option that simply fulfills your “daily production quota”. And of course, if the patient chooses a reimbursed treatment that goes against your moral grain, DON’T DO IT.
Innovation will come naturally if you are passionate about your endeavor and you will have to move away from an insurance driven mindset as a direct consequence. And yes, since you may have created an insurance driven monster in the past, you very well may be witness to patients leaving your care. But, as many will witness in an upcoming series about moral injury by Dr Jennie Byrne, being true to your passion is part of learning to appreciate yourself. It’s important work for not only you, but for your patients too.
Success is liking yourself, liking what you do, and liking how you do it.
~Maya Angelou