ASSOCIATION OF MANAGED CARE DENTISTS SURVEY 2003

This years AMCD Survey of California's Managed Care dentists has revealed that Providers are not doing well with the capitated model of reimbursement, and the majority of dentists are no longer signing up for additional capitated dental plans.   Furthermore, those dentists who responded that their net incomes have increased, squarely give the credit for their success to increased PPO patients, and a decrease in the capitated portions of their practices.

Additionally, dentists continue to be doubtful of their ability to continue accepting capitated plans if patient benefits are expanded beyond “needs- based” care to include “wants-based” care. 

INADEQUATE REIMBURSEMENT
With 96% of the respondents reporting that cap rates and co-payments do not provide sufficient revenue to meet overhead and return a fair profit, it is not surprising that 58% of providers are no longer signing up for additional cap plans and that 41% remain closed to new enrollment from some of their present plans.  Fully half of the respondents (50%) state that their future goals are to decrease their capitated base of patients, and only 20% are looking to capitation dentistry as their source of future growth for their practices. Although these numbers reveal that dentists are not as aggressive towards reducing their dependence on capitated plans as last year, it is still striking that in a recessionary economy, where patient volume is down, dentists are still looking to drop capitation patients. 

Managed Care dentists have good reason to feel that reimbursement and capitation is not attractive as 73% report their net incomes are either decreasing or staying the same over the past 2 years.  Alarmingly, 45% of those who report AN INCREASE IN GROSS REVENUE, also report NO INCREASE, OR AN ACTUAL DECREASE IN NET INCOME!!.  This indicates a strong disincentive to “grow” ones practice with the capitated dental model.

EXPANDED PATIENT BENEFITS
Capitated managed care plans, the least expensive form of dental coverage, were designed to provide good “needs-based” dental care in a cost effective manner.  While even indemnity dental plans, the most expensive form of dental coverage, have annual maximum benefits (typically  $1,000-$2,000/yr.), CAPITATED PLANS HAVE NO SUCH LIMIT.  Because dentists are financially stressed under the present system, how could Provider Networks survive if required to deliver unrestricted care.....even more patient benefits....than indemnity plans and at greatly reduced reimbursement?  Respondents indicate that they could not!

The potential for managed care plans, for the sake of gaining market share, or government agencies to mandate, in the name of consumer protectionism, an increase in patient benefits under these programs is worrisome.  Nearly 95% of dentists are quite concerned about the effects of including “wants-based” care in capitated dental programs.

Download a PDF of our complete survey.