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Professional Courtesy: Eat Less Dog Food by Dr. Thomas Giacobbi

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Categories: Practice Management, HR and Accounting;
Professional Courtesy: Eat Less Dog Food

Network quality control should start small but aim big


by Thomas Giacobbi, DDS, FAGD, editorial director

There is a great expression often attributed to the tech world but can be applied to any business: “eating your own dog food,” or “dogfooding” for short. This refers to a company using its products or services in its daily operations, which not only provides them with valuable feedback but also follows the axiom, “If it’s good enough for our customers, it’s good enough for us.”


Some past experience in this arena
When I first moved to Arizona in 1998, I was three years out of dental school and I needed a job. As you would expect, most jobs were associateships and employee arrangements that paid a percentage of production or collections. I was married and my wife and I wanted to buy a house, so a fixed salary was more appealing to secure a mortgage.

A checklist for going
out-of-network
  1. Analyze your current mix of PPO networks.
      2. Decide which you can live without.
  2. Notify the company you want to terminate the relationship.
      3. Anticipate a waiting period before you are officially “out” of network.
  3. Communicate immediately with patients about your intention to leave.
      4. Have this conversation in person with as many people as possible—it’s more effective than sending a generic letter.
  4. Provide a smooth transition for patients.
      5. Allow patients to switch networks when their open enrollment period begins.
  5. Check your retention.
      6. Measure remaining patients in that network after 6, 12, 18 and 24 months.
I was pleasantly surprised to find such an opportunity to work for a dental insurance company that owned its own dental offices. Cigna Dental had hundreds, maybe thousands, of dentists around the country who were serving Cigna patients as “in-network” providers. In hindsight, this was the dental insurance version of dogfooding. If they had all these dentists treating their patients, why not open a few dental offices and serve their patients as well? It makes sense because Cigna would have the ability to streamline claims processing and the dentists worked on salary. The model seemed to work for many years, but two years after I started working there, Cigna sold all seven offices to a DSO. I guess a dental practice can’t survive on dental insurance alone!

The new ownership performed as you would expect, and trying to make a random patient population fit a production goal is not my kind of dentistry. I immediately started looking for another opportunity and I was blessed to be hired by Dr. Howard Farran at Today’s Dental. The rest, as they say, is history.


An update on going out-of-network
Today, some 23 years after that turn of events, I’m here to revisit the topic of dropping out of a PPO network, which has experienced a resurgence of discussion lately on Dentaltown’s online message boards. In my December 2021 column, I said I was then in-network with four PPOs but after Jan. 1, 2022, it would be only three. I’m here a year later to say we had a successful transition, but I’ll caution anyone considering such a move that it will take some time. A brief description of the process I followed is in the box at top right.

At the one-year mark, I can report that I have no regrets about the decision, and I was pleasantly surprised by the number of patients who are still with the practice. I will also add that going out-of-network is not for everyone; every practice is different and some are perfectly happy with their current mix of network participation.

However, if your practice capacity is strained, your reimbursements don’t match the cost of doing business or you want to tap the brakes, then going out-of-network may be for you. Consider a measured approach by dropping one of the smaller PPOs in your practice first, to gauge how well your team handles the transition. My hygienists and the front office team did an excellent job communicating with patients and making notes in their charts so we could keep track of who was notified. When patients asked why I was going out-of-network, I’d simply reply that as our expenses went up across the board, reimbursements had not increased and leaving the network was our only option.

Do you have questions or a story to share about leaving an insurance network? Please join the discussion associated with this article below. You also can reach me via email at tom@dentaltown.com.

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