Letters: Dentist rating systems
January 20, 2015
My concern relating to a potential dentist rating system is that, for example, a dentist might receive a highly favorable rating because they tend to select lower cost crown options such as N/P metals etc. There is, however, no means of rating a dentist who makes the decision to not do a crown at all because it is not indicated and the dentist's fee structure is such that he or she is not dependent on performing a certain amount of crowns per week in order to make up for money lost on poorly reimbursed diagnostic, preventive or operative care. I feel strongly that the PPO fee structures have resulted in many teeth being lost prematurely when crowns are placed because the dentist perceives that they have to in order to survive financially. The outcome of crown prep resulting in the additional cost of endo resulting in possible tooth removal is significant, even with the knowledge that endo has a 90 percent success rate. In other words, placing one crown for $1,600 when clinically indicated might be rated poorly when compared to a dentist doing multiple $600 crowns. How can a rating take conservative care (First, do no harm!) into account? Cigna has, in the past, made inflammatory statements on their explanation of benefits such as, "a member dentist would save you approximately $150 on this service." However, the truth is that the member dentist would be unlikely to have performed the same service because they cannot afford to do it if poorly reimbursed. The PPO practice model has evolved to be "do only crowns," not "do the right care."
Kevin Dawson, D.D.S.
The ADA is supportive of the concept of transparency. However, the ADA opposes any rating systems based principally on cost or nonvalidated utilization patterns that could potentially mislead our patients. Through several communications in 2014, the ADA Council on Dental Benefit Programs and Practice Institute provided feedback to Cigna that their methodology was scientifically flawed. In December 2014, Cigna announced the postponement of their rating system and noted that its goal is to develop an approach that is acceptable to the dental practice community.