editorial
The Conglomerate/Consumer Transaction v. The Dentist/Patient Relationship Large corporate entities force themselves into the lineup between dentists and patients in a high stakes game for the conscience of oral healthcare delivery.
D
entistry steps up to the plate. As practitioners, we fight off daily deceptive pitches from managed care organizations (MCOs), product manufacturers and non-dentist-owned practice management organizations. Pitches in the form of onerous contracts, misleading marketing and aggressive business tactics intended to defeat the dentist/patient relationship and replace it with a conglomerate/ consumer transaction. These intrusions corrupt the professional norms and legal standards that currently govern the relationship between dentist and patient with marketplace greed. Dentistry must come to bat to defend our ethical and legal commitments to patients in the face of these powerbrokers’ profit-driven assault on the rights and duties inherent in the dentist/patient relationship to protect our professional status and strengthen society’s trust in our oral healthcare leadership. Managed Care’s Knuckleball in the Dirt MCOs’ game plan seeks to replace dentists as the primary decision-makers in oral healthcare treatment planning. MCOs sell the bogus myth of bargain basement quality dentistry and need dentists on the sidelines when they design their self-serving strategies. Their cost-containment schemes result in limited benefit plans that attract patient populations that either cannot afford or elect not to routinely pursue optimal oral health. Insidiously, MCOs create an implied MCO/patient relationship that portends to protect patients from what MCOs falsely portray
2 APRIL 2021 The New York State Dental Journal ●
as over-treating dentists otherwise incentivized to provide high-cost, complex procedures. MCOs lead off and broker deals between these prospective patients, their unions and their employers. They wield their newfound power over these patients’ future choice of dentists as leverage against the dentists available to serve these populations. Under pressure to retain and attract patients in this market, many dentists succumb to one-sided provider agreements with MCOs. These onerous contracts force dentists into the roles of obedient subcontractors who abdicate their authority in the treatment planning process to MCOs. Here, MCOs deliver their knuckleball in the dirt: fee schedules set intentionally below the costs necessary to deliver services within the legal standard of care and ethically. MCOs toss this erratic pitch with no intent for the ultimate treatment to hit the legal and ethical strike zones. They base these arbitrary fee structures upon aggregate cost calculations that bear no relationship to the actual costs necessary to properly treat individual patients, and are set solely to protect the MCOs’ profit margin. Regretfully, many dentists swing and sign these provider agreements. However, when dentists act as mere subcontractors bound to follow the MCO business plan, they can miss meeting the legal standard of care and their ethical duty to act in their patients’ best interests. In the best case scenario, dentists do not swing and refuse to agree to terms that hinder or preclude them from achieving these standards.
