by By Laura Thill
DSOs continue to explore how a large number of practices can work as partners within an insurer’s network.
As more and more dentists join DSOs, business support functions – including insurance issues – are becoming increasingly centralized. Doyle Williams, DDS, vice president, carrier relations and insurance operations at Aspen Dental Management, Inc., has seen the shifting landscape firsthand. Formerly employed on the insurance side of the business, he notes it wasn’t long ago that “DSO-affiliated practices were told that they would be treated like any other practice.” Today, however, insurers dedicate people to DSO-affiliated practices in order to take care of any issues quickly, he points out.
Still, it can be a source of frustration to DSOs when insurance companies don’t recognize that each dental practice within the DSO is unique, with its own set of issues. “Insurers [often] want to treat all offices operating with the support of a DSO in the same way, as if they are all identical,” says Williams. “[They] sometimes fail to realize that while dental practices may operate under a common brand or with the support of the same DSO, each practice is owned and operated by an independent dentist. Just as with any other medical profession, dentists operating under a brand will have different treatment patterns based on their personal comfort and expertise.”
At the same time, “DSOs need to understand the importance of how a large number of practices can work as partners within an insurer’s network,” he continues. “Insurers should not be the enemy, nor should they wield an imbalance of power in the relationship.” Also, as new dentists join a dental practice with multiple offices, it’s important that the DSO track their movement across the practice’s offices to ensure their work is paid in network, he adds.
Better oversight
Belonging to a DSO means dentists can focus more on providing clinical care and less on management issues, including insurance. “The number of dentists who choose to practice with the support of a DSO continues to increase, and ranges from new graduates through dentists who are very experienced and perhaps nearing the end of their professional careers,” says Williams. “It’s a very attractive model to doctors. They maintain the pride that comes with owning their own practice, but also enjoy all of the advantages – whether that is buying power and economies of scale, or simply the camaraderie of being a part of a larger extended network of clinicians – that come with being affiliated with a DSO.” Not only that, insurers save money by not having to work with each practice individually, he adds.
DSOs, for their part, have gotten wiser in the way they oversee insurance issues throughout the organization. In fact, compared to the solo practitioner, they are more up to date on regulations, participating agreements, hiring laws, coding updates, patient financing, appeals and grievances and other aspects of a business, according to Williams. “Early DSOs existed prior to National Provider Identifiers, and their affiliated practices operated under one license number,” he explains. “This [presented] huge liability concerns in the early days, since insurers could not identify which dentist was performing which treatment. They would then brand an entire DSO as good or bad. Today, DSO-affiliated practices are much more like individual practices using a common vendor partner. The outsourcing of non-clinical support is efficient and desirable for successful DSOs, dental practices and insurers.
“A DSO’s responsibility to the dentists it supports is to provide business support – particularly the many hours needed to understand insurance policies – while allowing the dentists to [focus] on caring for their patients and overseeing the clinical care that is delivered in their practices by their teams,” Williams continues. “DSOs may watch for trends that identify an individual dentist as an outlier to the norm. They can explore these variances and provide the dentist with comparative data on trends and norms for other doctors, which is something a solo dental practice doesn’t have access to. If an insurer activates an investigation, the individual can be considered within a broader picture rather than a single actor.”
Looking ahead, Williams predicts that large DSOs will be able to negotiate better reimbursements due to their size and value to an insurer’s network. “They should also be able to show better value propositions and quality initiatives to help insurers meet reporting requirements in the future,” he points out. “Eventually, a DSO should replace many functions done by insurers today, such as credentialing, recruiting, enrolling, provider directories, fraud monitoring, pricing and more.”
