View larger version (40K): [in this window] [in a new window]   Figure 2. Reported percentage of practice gross receipts from patients participating in dental plans, by number of plans in which responding dentists participated.

Effect of dental plan participation on practice. In the survey, we asked responding dentists if participation in any PPO or capitation plans affected various aspects of their practices.

PPO plans. As shown in Table 1, more than one-half of PPO-plan dentists reported that participation in the dental plans increased their patient base, gross income and expenses. Their opinions on plan participation and net income were more divided: 39.6 percent of responding PPO-plan dentists said that plan participation increased their practices’ net income, 25.5 percent said it decreased their practices’ net income and 34.9 percent reported no change.

Characteristics of largest dental plan. Dentists enrolled in either type of plan were asked specific questions about the largest plan (in terms of numbers of enrollees) in which they were involved.

PPO plans. Almost half of PPO-plan dentists (47.6 percent) reported that they joined their largest PPO plan within the three years prior to the survey. When they joined this plan, many dentists had to provide certain documentation for review. Most commonly, this review involved current fee schedules (55.6 percent of responding dentists). Other information—such as an office audit, economic credentials or a review of utilization patterns—was requested from less than 20 percent of responding dentists affiliated with PPOs.

Dentists reported that their largest PPO dental plans had certain allowances and restrictions. A large majority of the plans (89.1 percent) allowed participating dentists to be providers for other plans. More than 60 percent of the plans required use of usual-and-customary fee schedules (69.2 percent) and limited the number of routine preventive procedures (66.8 percent).

Responding dentists’ largest PPO plan typically required a discount from their usual fees. This discount varied by region, with the largest discount in the Northeast (Figure 3). Discounts in all four regions were more than 20 percent.

View larger version (30K): [in this window] [in a new window]   Figure 3. Dentists’ reported average percentage discount from usual fees as required by their largest affiliated preferred provider organization dental plans, by U.S. census region.

Capitation plans. Dentists participating in capitation plans had been affiliated with their largest capitation plans for some time. About one-third (34.4 percent) of responding dentists reported that they had been affiliated with their largest capitation plan for between three and five years, and a similar percentage (30.9 percent) had been affiliated for between six and 10 years. When they contracted with this plan, dentists reported, the type of review most often required was an office audit (52.1 percent) or a review of the practice’s current fee schedules (51.2 percent).

Most (83.0 percent) of responding dentists’ largest capitation plans allowed the dentist to be a provider for other plans. A majority of the plans limited the annual number of routine preventive procedures (61.6 percent) and had a utilization review program (60.9 percent).

Responding dentists also reported the types of procedures covered by the monthly capitation payment by their largest capitation plans. More than three-quarters of these monthly payments covered diagnostic procedures, preventive procedures and restorative fillings. Just over one-half (54.2 percent) of capitation-plan dentists reported that the plans’ monthly capitation payments covered endodontic procedures. But less than one-half of the capitation-plan dentists reported that their monthly capitation payments covered restorative crowns, periodontal procedures and oral and maxillofacial surgery.

There was some regional variation in capitation-plan coverage of various types of procedures, as shown in Figure 4. Dentists in the Northeast region were especially likely to report low levels of coverage, while Western dentists were more likely to report higher percentages of coverage than were dentists in other regions.

View larger version (37K): [in this window] [in a new window]   Figure 4. Coverage of selected dental services by dentists’ largest capitation plans, by U.S. census region.

Satisfaction with largest dental plan. With regard to their largest dental plan, participating dentists were asked to indicate on a four-point scale how satisfied they were with their participation in the plan. The possible responses were "very satisfied," "somewhat satisfied," "somewhat dissatisfied" and "very dissatisfied."

PPO plans. The largest percentage of PPO-plan dentists fell into the "somewhat satisfied" category (44.5 percent). About one-quarter of PPO-plan dentists (27.8 percent) fell into the "somewhat dissatisfied" category. When we summed the "very satisfied" and "somewhat satisfied" categories, dentists in the Midwest region had the smallest "satisfied" percentage (49.8 percent), while dentists in the South had the largest such percentage (58.1 percent).

Among the responding dentists who reported some level of dissatisfaction with their largest PPO dental plan, the most commonly reported reasons were related to fees (71.7 percent). The next most commonly mentioned reason for dissatisfaction fell into the category of limitations placed on dentists by the plan (34.7 percent).

One of the most commonly cited reasons for dentists’ dissatisfaction with dental plans was the patient care limitations that the plans placed on dentists.

Capitation plans. Responding capitation-plan dentists gave a slightly different distribution of answers to the same question. A much larger percentage of capitation-plan dentists (29.0 percent) said they were "very dissatisfied" with their largest capitation plan than did PPO-plan dentists (15.1 percent). When we summed the "very dissatisfied" and "somewhat dissatisfied" categories, the majority of capitation-plan participants (54.0 percent) expressed some level of dissatisfaction with their largest capitation plan.

When asked to explain their reasons for dissatisfaction with their largest capitation plan, the majority of responding dentists (54.0 percent) identified fees as the primary reason. The next most frequently cited reason was the limitations the plan placed on dentists. These limitations included dentists’ concerns about being able to provide just the minimum level of care for their patients, difficulties in referring patients to specialists and not having a voice in treatment options.

	CONCLUSION

TOP ABSTRACT SUBJECTS AND METHODS RESULTS CONCLUSION REFERENCES

 
Overall, this survey showed that dentists participating in PPO dental plans were quite satisfied with those dental plans. Almost three-quarters of these dentists expected to renew participation in their largest PPO plan when the current contract expired. Nationally, 55.7 percent of PPO-plan dentists expressed some level of satisfaction with their largest PPO plan. More than one-half of dentists participating in these plans reported an increase in patient base owing to their participation, although results on the dentists’ net incomes are mixed.

Capitation-plan participants were somewhat less optimistic than were PPO-plan participants. Though the majority of capitation-plan dentists (61.4 percent) expected to renew participation in their largest capitation plan when their current contract expired, the majority of these dentists (54.0 percent) expressed some level of dissatisfaction with that plan. The majority of capitation-plan participants reported an increase in their patient base because of their participation but mixed results with regard to net income.

Participation in PPO dental plans seems likely to rise, given the results cited above. However, the number of patients represented by these plans still remains relatively small. The survey found that the percentage of dentists’ patients covered by PPO dental plans represented just over one-quarter of their patients.

Capitation plans seem to be less attractive to dentists. The percentage of dentists in these plans decreased since a 1996 ADA survey (which was conducted in a slightly different fashion from this survey).³ The majority of dentists participating in capitation dental plans also expressed dissatisfaction with their largest plan.

Dentists who expressed dissatisfaction with both types of plans, and those who did not join them, cited low fees and concerns about the quality of service allowed by the plans as their primary reasons for dissatisfaction or nonparticipation.