#AskT-Bone – Ep35 – High Quality Dentistry


Hello and welcome back for another episode of #Ask T-Bone on the T-Bone speaks podcast!


Well I’ve been on a little bit of a hiatus and I haven’t really been keeping up with doing the #Ask T-Bone segments. A couple of reasons, one: August and September are busy months with kids getting back to school and things like that; and then with SIROWorld this year it kind of really threw me off being out of the office, so we can be away from things, and so I’m trying to get back on there. And then the other reason also is we had a little low in the questions or quite honestly a lot of the questions were same questions that we have answered before, maybe in a slightly different format. So, I don’t really even quite honestly respond to those. I’m assuming that you’ll go back and listen to all the segments there. So, I greatly appreciate if you continue to submit questions and we will recommence doing the #Ask T-Bone segments.


So, here’s a question that I received actually quite a time ago, this is:


T-Bone I’ve been following you for some time, great blog and I listen to all the podcast that you have done. Where can I learn more about how to do high quality Dentistry utilizing technology with PPO fees?

Thanks, I look forward to your future posting and podcast.


Is a great question quite honestly, There is a lot of things that get into this, and I would say to begin with I think the most important thing is Mindset. So, again, I think the mindset is that you cannot allow Insurance to dictate the type of Dentistry you do, and what you diagnose for your patients.


Now, insurance does to a certain degree dictate the amount on the fees that you can collect on certain types of Dentistry, but it does not dictate the type of Dentistry that you can do, and what you should diagnosed.

So I think that’s first and foremost.


I would say the secondly, you’ve got to learn to add a camera to your practice.


Now, I’m not a fan of intra-oral cameras, I’m talking about a digital SLR and extra-oral camera. I think soon enough we will be taking these pictures with iPhones and not even digital cameras anymore. And, I think you gotta show your patients what’s going on and get them involved in their what we called code diagnosis of their condition. And then, I think part of the philosophy also has to be you got to give your patients a chance to say yes to the best. So you can’t wait for patients to come in saying I want this done, sometimes you have to give them the option of getting those things done. And talking them through it and being able to show them examples.


So, I would say without question digital photography is one of those things.


Now, often times when people say high quality Dentistry, I think all Dentistry should be of high quality. And by that I mean it should have impeccable close margins and should be functional and look pretty nice.

That doesn’t mean it has to be Masterpiece work, especially on the PPO fees, but it has to look pretty nice, and has to have good functional margins, and good functional occlusion. So that to me defines high quality.


Now, I shouldn’t even say that defines high quality, quite honestly that defines what I consider standard of care, which honestly is high quality in many situations.


Now, when someone says to me, I want to do high quality dentistry, what they’re really saying to me, or what I’m hearing or what I believe that means, is that you want to do more aesthetic work, and you want to do more complex care, where you’re doing multiple things at one time with patients.


So, let’s talk about Aesthetics.


So, under the PPO fee schedule most of us to getting anywhere between $600 and $900 per restoration whether it is in the front of the back, and sometimes are limited on being able to use all Ceramics although I think that’s going away quite a bit. So, again my overall method of this, as a CEREC office, is that we utilize CEREC for our restorations. So if a patient needs a restoration we offer a CEREC restoration. It’s going to be a standard restoration either simply stained glass or a polished restoration depending on what we’re doing. And then that’s what their PPO covers. So, on the posterior 99% of the time that’s more than adequate. Now, on the anterior, I would say is 50%/50%. 50% of the time our patients are happy, they got a Vita shade guide in the mouth to begin with, where they have multiple Restorations done over the years. But 50% of our patients want aesthetic dentistry the way they want their Dentistry to really blend and match in. Now, can that be done with CEREC? Absolutely. Can that be done time efficiently in the PPO setting? I would say no. I allocate about an hour and 15 minutes for a single crown on the PPO’s and if it’s going to take longer than that due to shade matching, standings, glassing, things of that nature; Then there is an up charge for that, and what do I mean by that? It means, I give my patients the choice of having a master ceramist or masters ceramist level work done, to make their tooth blend in and we charged in our office anywhere between $350 to $600 additional for that depending on how particular the patient is and what exactly we are doing. Or I give them the option of having a standard, you know, basically a block that comes from the machine that will do some minor staining and glazing too. And that we can do for the PPO fee. And what we find is that 50% of the time, patients say “I’m happy with the standard crown”, and 50% of the time the patient say I want “Master level work”. And Master Level work, you need to deliver Master Level work. You shouldn’t charge and not deliver Master Level work.


So, Master Leverl work, that involves making a provisional that blends pretty nicely, often times that’s actually a CEREC restoration that we make in ceramic so that we can communicate with the laboratory and sometimes outstanding glassed that. Then involves photographs and involves some communication and that involves maybe one or two times at the laboratory to get the shade exactly right. So you can not do that for $6,900. So we charge of cosmetic fee to our patients.


Now, some of you listening will say “you can’t do that… blah blah blah”. Honestly my patients you know, said that to me, and then I say, “You know what, this is what I offer, if you’re not happy with it here is a name of another dentist that takes your insurance”. Quite honestly we have been doing it for this way for 10 years now. We haven’t had any issues with it. We do have the patient sign off on the treatment plan, so they know that it’s a cosmetic upgrade fee. That’s not a lab fee, it’s a cosmetic upgrade fee. I think some contracts don’t allow you to charge of laboratory fee, or an additional lab fee. But, we charge a cosmetic fee, and the cosmetics fee really is not about the lab fee although that’s part of it. It’s more about the expert teeth, the photography, the communication, you know the extra that takes my time to go into it. At the end of the day I’m selling my time.


Now, how do you implement technology in a PPO practice?


I would say quite honestly you have to implement technology in a PPO practice. First we implemented CEREC, and CEREC allow us to do very efficient restorations in a single visit, where we can do that in the PPO fee schedule and not have to incur in lab fee, an impression fee, a second visit fee, a tear down setup. so I would say in the PPO practice, CEREC makes all the sense in the world you, certainly have to learn how to use it quite quickly and you have to get efficient towards you can do full coverage restorations in an hour, maybe to an hour-and-a-half maximum, to allow you to become efficient and make it justifiable. Now, the other thing I would say technology does is depending on the type of technology you are buying, I think one of the advantages of technology in the PPO practice is it allows you to expand the scope of the care you are providing. So for example, in our office when we introduced 3D imaging into our practice suddenly we were diagnosing better, we were adding implantology to our practice, we were able to evaluate joints, we were able to now evaluate airway and add sleep apnea to our practice, although you can do sleep without a Cone Beam, certainly, I want to make that clear. But implantology and Cone Beam, of course you can do implants without Cone Beam, but I would tell you there’s a world of difference in the comfort and confidence level that you have. So for me technology allows you to add procedures to your practice which will enhance your practice and typically these procedures that you’re adding are significantly more productive than your traditional fillings and crowns. In fact, I encourage you to listen to one of my podcast with the dental hacks where I talk about how crowns and fillings are killing your practice. I think the title of it was I want you to stop doing crowns and fillings and that should be a goal, honestly for you to stop doing crowns and fillings. So, hopefully this helps in answering that question, I would like to go dive into this little bit more. We are actually considering putting together a practice management workshop call practice shift and that’s about moving your practice what I call to the right, and really it’s about, really being able to build a successful PPO practice where is not successful defined by money but successful defined by the type of Dentistry you want to do and how to do it and how to really offer complete Care in a PPO environment. So if this is something that you be interested in, certainly just drop us an email at info at www.3D-dentist.com or visit www.tbonespeaks.com and drop us a note from the contact page there.
Thank you very much and please again do submit your questions, and thank you very much!

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