Many dental providers desire to be fee-for-service. Join Nick Partridge, president of Five Lakes Dental Practice Solutions, as he covers how to:
- Evaluate your practice to determine feasibility of leaving.
- Quantify the potential impact of leaving plans.
- Develop the safest strategy to leave plans.
- Leave plans using Five Lakes’ analysis and timeline.
- Get patients and staff on the same page when leaving a plan.
Step 1: Assess Your Current State.
Step 2: Do the Math.
Many practices are focused on PPO negotiations to maximize reimbursements. Yet negotiating reimbursement rates is only part of a comprehensive PPO participation strategy. When developing an insurance participation strategy for your practice, often it makes sense to consolidate participation. Thus, the opportunity presents itself to leave PPO plans! Other times, providers are at capacity or at wit’s end and want to drop PPOs. Making a sound decision to leave PPO plans comes down to math. In this episode, Nick discusses the different calculations needed to:
- Compare payer fee schedules
- Calculate production per patient
- Calculate estimated break-evens
While not everyone enjoys a solid 7 minutes of math, these calculations are essential to putting a plan in place to leave PPOs.
Step 3: Plan Your Exit.
When PPO negotiations aren’t enough and you’re ready to leave plans, it’s important to analyze and thoughtfully plan your exit.
Leaving PPO plans requires a comprehensive review, consideration of employers, patients, treatment in progress, fee schedules, and more. It’s important to plan your exit in a way that does not cause lasting financial damage to the practice in the form of lost patients, open chair time, cash flow problems and lost revenue.
Step 4: Analysis and Timeline
In the fourth episode, Nick continues the case study, focusing on two ways Five Lakes’ approach helped clients meet their goals.
During the planning process for leaving networks, Five Lakes helped determine how to maximize reimbursements and streamline participation. The effort helped shrink participation, which led to fewer plans to drop. Through PPO negotiations and optimizations, the practice would realize more than $42,000 annually, producing a substantial ROI.
Step 5: Prepare for the Aftermath.
Leaving PPO plans is an exciting yet stressful exercise. Make sure you’ve thought through your plan. In the fifth and final episode, Nick outlines key considerations for the entire dental team as you begin exiting PPOs. Critical decisions that must be made related to the office’s financial policy and communication plan are highlighted. Nick also discusses the importance of tracking results so you’ll be able to fine-tune your plan.
