#AskT-Bone – Ep11 – The ‘Hybrid’ PPO Practice


Hello and welcome back to another episode of ask T-bone! Today we have a wonderful question submitted and the question read:

Hi T-bone! Thanks for a great podcast on insurance. Your idea of the quote hybrid practice and quote really resonated with me and I believe it will be the future non corporate Dentistry. I was curious, in your model do you, as the quote on quote senior doc participate with the PPO plans?


For those of you unfamiliar recently we did a quote and quote debate on dental insurance with my good friend Gary Takacs and dr. Alan Mead of the dental hacks and of the thriving dentist show, and it was a great episode in which we talked about various aspects of dental insurance. What is dental insurance, the different types of dental insurance, and Gary and I debated on the concept of going insurance free vs the concept of building a practice around Insurance. And in the podcast certainly being insurance free is the ideal, but the truth is very few of us are ready to do that. So one of the concepts I introduced in this podcast was the concept of a hybrid practice. And what I mean by a hybrid practice is that there’s multiple docs, at least two, and where their senior doc does not participate with the PPO. Now the practice is still in the PPO, but those patients who see the senior doc will be considered a fee for service or Indemnity insurance patients. Now the beauty of this is that your patients who are Insurance driven can choose to have either your partner or your associate partner do the dentistry. Now, the reason I like this model and I want to clarify, this is not a model that I have implemented yet but it is a model that we are working towards. I will say that by 2017 this will be where I will be in my practice. And quite honestly I think we’re ready for this now in our practice, what holds me back is my own fear. My fear of what would happen, my fear of what will my patients do, will I be able to maintain my associate or not maintain my associate, all these things that are important to me. So it’s really more about the fear, but I’m convinced that this model makes all the sense in the world. So, what happens now is

how do we get to a point where we’re ready for this?

Number one I think the first thing that you have to do is I think you need to develop an associate partner in your practice. And this is a person who will be able to take on some of the workload, will be able to do what I called General Dentistry. If you refer to my blog post on “the faces of Dentistry, moving your practice to the right”, you’ll see that I talk about practice is having a Gentle Dentistry face, and advance Dentistry face, and an emotional Dentistry face. When your practice move into that overlap between General Dentistry and advanced Dentistry, this to me is a great time to consider dropping out of the PPO as the senior doc within your practice, because you need to have an option to be able to provide care for patients in the insurance model.

Now, why not just completely drop Insurance?

To me that boils down to, why would I want to give away a patient base that will help feed my advance and emotional dentistry? And that’s what really having a societal Partners really do for you. It creates a patient base that you can now have to quote and quote self refer patients to yourself. So my goal is to get out of PPO myself, maybe not all at once, but certainly, for me my target is MetLife having to go away because it pays the least. I find it very disheartening that my associate 1 year out of school gets paid the same as I do as a 15 years practicing dentist for crowns and feelings and things of that like. So my answer to that is that I need to slowly go out of participating with the insurance. Now, what this also means I need to be prepared to cut down my hours, which isn’t a bad thing, I need to prepared to see less patience, which isn’t a bad thing, but I need to be prepared that these things will go against the grain of my thought process. We always equate busyness to productivity, and that’s not totally true. So what we need to do is get prepared for all of these things. What else do we have to do to get prepared? We also need to have services in our practice. We’ve got to be beyond the fillings and crowns, and we have to be doing other services, we have to be doing things like dental implants, Orthodontics, things like more complex restorative care, maybe more than single-unit, onesies and twosies, made may be beyond that, maybe we need to be into the anterior segment, not this a cosmetic practice, but things that take more skill. You know something that you can sell your patient to deliver that value that paying more for your services and your expertise make sense. You know if you’re a traditional general practice just doing fillings and crowns, you don’t really have any differentiation, nothing set you unique, so why would a patient choose you to do that? So many dentists who take insurance do good Dentistry. So many dentists who take insurance provide painless Dentistry. So there’s not much differentiation on those services that are commoditized. So I think it’s important to have more services in your belt so that way you can become the pseudo specialist in your practice, where your associate when they see more complex things that your associate may not be comfortable with yet, those things can transfer over to your side of the practice and you can do those and get paid properly for those. And then, those patients who love and trust you, and those patients who want to be with you, who are willing to pay your normal value you worth, now, they can choose to see you as well and still get some benefits from the dental plan. To me there’s not much negative in this business model. So, again I do want to clarify that I have not done this yet we are in the planning phase of doing this. I’ve certainly heard of people doing this with great success, the keys are going to be: One you have to have an associate partner in your practice, where you can have someone to take care of that patient base, you have to have additional services within your practice, and you have to have a good business principles into practice. I think it would be important to be able to have payment options for your patience to be able to say yes to you doing the Dentistry at a higher fee, by simply telling the patient you can make payments to make this happen. Because there will be patients that want to see you, but they don’t necessarily want to pay more. But if you give them the option of making payments, it will be more amenable to it. So again, to me this is part of moving your practice to the right by getting away from those things that we dislike about insurance, and the things that we dislike about insurance or the fees that they limit us to the limitations that they create for you in your mind and one of the things that we want to do is we want to move away from those. So the step to move away from limiting your practice by fees, is for you to get out of the insurance model yourself, but keep your practice within the insurance model, because in my opinion is a great way to build a great base, and then that base can feed some of the more advanced procedures that you’re doing.


Hhopefully this made sense and help clarify the concept of the hybrid PPO practice, and if you have any additional questions again please visit www.tbonespeaks.com and leave a question for us. These questions that we receive from the listeners, are those questions that drive our podcast and continue to have me taking moments out of our Lives to go ahead and answer these questions. So I only asked a few things of you: Number one, that you go on iTunes and leave a review for us on our podcast. Number two that you share a podcast on social media as was trying to increase our listening reach, and number three: that you consider coming to any of our speaking event and or workshops so that we can help your practice move forward and move to the right.


Thank you very much!

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