Quality and Costs in Dentistry
By Steven A. Fishman, DDS, FADL, FICD
Current models for consolidating dental offices are based on fixed fee schedule dentistry. This familiar model, prevalent in medicine, is attractive to businesses and individuals aiming to control healthcare costs. However, it lacks a quality control measurement system. For participating dentists, the appeal of any PPO (Preferred Provider Organization) or enrollment plan is a steady flow of new patients. Unfortunately, administrators of these plans do not monitor service quality. Historically, the dental industry has not supervised the quality of care provided.
Impact on Quality and Service
Any business model that strictly limits costs and revenues while maintaining high service levels must sacrifice quality. Customer service is fundamental in dentistry, requiring staff to assist patients before, during, and after treatment. The number of required staff correlates directly with patient volume, indicating that higher quality care necessitates more time and fewer patients per period.
Improving quality in dentistry requires additional time and costs. As dentists primarily provide services directly, increased quality means more attention to detail and longer patient interactions. Higher quality also necessitates more expensive materials and procedures. Currently, controlled fee dentistry balances high auxiliary staff utilization with minimal dentist-patient time, using economic materials and low-fee labs to control costs.
Challenges and Questions
No dental practice model demonstrates a reduction of costs while increasing quality. The gap between fixed fee schedule providers and diminishing fee-for-service providers is widening. Addressing this, we must consider several questions when studying dental industry trends:
- What percentage of patients are willing to pay more for quality dental care?
- What are the characteristics of patients interested in this?
- How much more are they willing to pay?
- Can a cost-efficient, high-quality dental service model be developed?
- How can efficiency be increased?
- How can quality care be monitored and measured?
- Can this model be implemented on a large scale?
- What profile should the dentists have for this model?
- Would this model be attractive to these dentists?
- Could businesses incorporate this model into their healthcare benefits?
- What marketing strategies would suit this model?
These questions guide us in developing a feasible dental practice model that balances cost control with high-quality care, ensuring that patients receive the best possible treatment without unnecessary financial burden.
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