Dental Practice: PPOs vs OPPs?

By Dr. Thomas C. Reed

January 10, 2023

The Treadmill World

We live in a world addicted to consumerism and thinly-veiled desires luring precious discretionary dollars out of the wallet. As for investing in one’s health, society somehow has digressed into a mechanized, commoditized, and subsidized mindset. Leverage assumed by the omnipresent insurance plan often renders a provider with little say regarding the context and content of care. Unprecedented increases in cost of goods sold have plunked the average PPO write off into a 44-50% range only amplified by futile fee increases. Margin pressure generated by declining reimbursement rates reflects the most aggressive line-item expense never located on a P&L statement. Growing for growth’s sake attempting to out run the overhead squeeze is unsustainable regardless of one’s mastery of the “treadmill.”

Does this resonate with your personal situation? Approximately 90% of private practice dentistry is directly involved with PPO and/or reduced fee assistance programs. Fundamentally, nothing constructive has enabled dental benefits plans to evolve with economics and time. What once was a hedge against catastrophe no longer represents a definable insurance program but essentially a subsidized coupon book. Heavy participation with PPOs challenges the fundamental tenets for owning and running a healthy dental practice: autonomy, lifestyle, and financial independence. The notion of an entity disconnected from the doctor-patient relationship levying the final say upon healthcare decisions is a huge disservice to patients by encouraging reduced focus on the basics. Thankfully, foundational principles rooted in prevention and wellness greatly aid the delivery of oral health care outside the constraints of benefit plan mandates.


Insurance Independence  

The path to insurance independence is paved by challenges, unique stipulations, and calculated steps to successfully shed the proverbial handcuffs. Time in the marketplace and timing the decision generally outline the process. The following six elements are essential prerequisites to a reduction and/or full-scale elimination of insurance dependency:

  1. Know Yourself:Our greatest freedom is the freedom to choose our attitude.” -Viktor Frankl
  1. Know Your Data: “When performance is measured, performance improves. When performance is measured and reported back, the rate of improvement accelerates.” -Pearson’s Law
  1. Know Your Team: “The achievements of an organization are the results of the combined effort of each individual.” -Vince Lombardi
  1. Know Your Community: The greatness of a community is most accurately measured by the compassionate actions of its members.” Coretta Scott King
  1. Know Your Services: “If you do the work you get rewarded. There are no shortcuts in life.” Michael Jordan
  1. Know Your Consumer: “Life is a matter of choices, and every choice you make makes you.” John C. Maxwell

Is it time to make PPOs Other People’s Problems?


Thomas C. Reed, DDS

Owner City Center Dental Group

Follow me in the Twisted Kaleidoscope room of DSN