For many practices, PPO participation is their biggest “expense” after staff wages (or even greater than wages in some cases). Historically, practice collection percentages have been 95%+ (of gross production). Now it’s not uncommon to see collection percentages of 70%-80%...and sometimes less.
Most dentists join a PPO in the hopes of gaining and retaining patients. No dentist likes to lose patients and when you do lose a patient because you’re “not on their network”, it can be a powerful inducement to sign up for the PPO.
Once you are participating with a PPO, it’s easy to feel there is no other choice. But, please note the data below. Most PPO’s have participation of 45%-60% of offices in this particular survey. Granted, that’s the majority of offices. But for any of the individual PPO’s noted, 40% - 55% of offices aren’t participating. So for every plan you feel you must have, keep in mind there are a lot of Doctors that are surviving without having it.
And, if you aren’t participating in any PPO’s but your practice is foundering, maybe some participation would be worthwhile.
Insurance companies have the upper hand but things don’t have to all go their way! You do have power. Don’t assume that you have to be participating as much as you are. For most practices, a reasonable mix of PPO’s is what makes most sense. As practices mature and succeed, they are likely able to cut back on PPO participation. And, if you’re mostly busy, it doesn’t make sense to work at deep discounts.
Decisions regarding PPO participation involve serious risks and rewards. Too often Doctors will sign up with a PPO too quickly, or when they decide to leave PPO’s, leave them too recklessly. Every office must carefully consider its PPO participation. Smart moves here can add more to your bottom line than practically any other thing you can do. These stats are from a survey of 59 East Coast offices’* PPO participation:
PPO % of Offices Participating:
- BCBS 54%
- MetLife 46%
- Aetna 51%
- Cigna 58%
- United Concordia 58%
- Other 61%
Number of Listed PPO’s Responding Offices Participate With:
- 5/5 = 26%
- 4/5 = 16%
- 3/5 = 14%
- 2/5 = 14%
- 1/5 = 9%
- 0/5 = 21%
44% of offices participated in 2-4 plans, with 30% participating in 0-1 plans and 26% participating in all 5 plans.