If efficiency is essential, why do insurers keep hindering it?
Health care is a complex, multifactorial issue—one I can’t even try to explain all of my thoughts about. I can, however, point out a few important concepts and how they could affect how our patients expect us to deliver dental care at a lower price, and how we expect insurance companies to make that easier for us to do.
First, as the United States becomes richer and richer, this bids up the price of luxury items: U.S. spending on health care has increased from 1% of the gross domestic product in 1900 to 17.7% of GDP in 2017. And right now, much of that health care spending could be considered luxury-level purchases: Physicians are opening concierge-style doctor’s offices that cap patient enrollment numbers, which makes it easier for patients to get in and be treated on short notice. Americans are spending $30 billion a year out of pocket on vitamins and supplements. Your patients are coming in for clear aligner treatments and tooth whitening, in addition to cavity treatments and crowns.
I’m really excited that people are now paying attention to global warming—I’m not getting into a debate about whether you think it’s right or wrong; it’s more about the fact that no one even mentioned it as a concept until the past century. Let’s be serious about why people are now “woke” to this: It’s not just that they’re all fine, upstanding people—they’re concerned because now we’re living richer, happier lives and starting to comprehend how great Earth is. “Damn, this is actually nice,” they’re thinking. “I could lose all this!”
There’s another big force out there that wants health care to be free. I can’t get behind a plan where all of the people have zero skin in the game—I’ve seen the difference in work ethic between an associate dentist who’s just an employee and a dentist who owns the practice and is vested in its success—but I do love the heart behind that idea. I mean, if you were driving down the street and saw a sick child lying in the middle of the intersection, who wouldn’t stop the car and drag her back? Everybody should have that heart.
But the question remains: What’s the best way to do it? It seems like all the people who are talking about “free” don’t realize that they’re often the ones causing so much of the cost to start with.
Inefficiency and paperwork ratchet up costs and prices
I recently read that South Korea is about to launch a digital driver’s license app, based on an already-existing app used for ID authentication in mobile financial transactions. Soon, subscribers will be also able to register for their driver’s licenses on the app, and the digital version of the licenses will be accepted by police as a valid form of ID.
I, meanwhile, recently had to leave work to go down to the DMV and get a new license. While I was sitting there, I was thinking, “How many times in my 57 years have I had to go do this?”
One-third of all the costs of health care has nothing to do with the salaries of doctors, nurses or hospital care—it’s related to paperwork.
For 32 years, I’ve had a full-time employee who, every time a patient switches dental insurance, has to physically call the insurance companies to confirm information—because if we don’t, we know the number of errors and patient codes that are variously affected and can cause huge snarls. We could cut the price of health care by one-third by automating this type of information. Instead, the system is totally disorganized.
Ripe for digital disruption—
and improved productivity
Let’s talk about dental insurance companies. It’s 2020, and they’re still demanding that patients bring in paper forms and proof of coverage—which your employees then have to scan, enter and send via email. And then patients think, “Oh, I have to go to HR, because there’s a form I need to get before I can be seen for treatment.” They’ve got a toothache, but they have to flip a U-turn and drive back because they need to pick up that precious form. It’s 2020: This should all be done via app. Korea’s done it for driver’s licenses, but U.S. dental benefits companies are still cutting down trees.
And I’ll be clear: Saving trees is nice, but I don’t really care about the trees—I care about my labor costs. My No. 1 cost is always going to be labor—people. The dentist gets 30%, staff gets 25%, which is more than half right there. I don’t want to have to hire 10 people to do something that one person could do. That’s raising productivity.
A dentist’s economic status has been flat for 40 years; from 1980 to today, we’ve just been limping along somewhere around 1.5–3.5%. We see the same thing in the S&P 500—while you’re looking at the cosmos saying, “What is this dark energy?” the economists are wondering, “What is the drag on this economy?”
And while you’re quick to blame your tax rate, the only thing that economists see repeatedly is regulation. And you should really get it if you’re a dentist, because regulation is really just busy work, like unnecessary paperwork. Why do we need to have our army of people talking to their army of people when two cellphones could do all of it by syncing and scanning automatically?
The inefficiencies in health care at the insurance level are grotesque and insane. But insurance companies aren’t going to make changes out of the goodness of their own hearts—we’re going to need to court them, and to explain the potential savings to not just us but them as well. We’re being tasked with being more efficient when it comes to patient treatment, but that requires our partners and peers to offer us more efficient methods of payment and communication.
Don’t think this can’t be accomplished! It wasn’t that long ago that you’d have to hand your physical paper checks and a deposit slip to a human teller to deposit the funds, but today you can snap a couple of photos with your smartphone and upload the information to your bank app from wherever you’ve got cellphone service. Once enough customers demand the convenience, companies are obligated to create the technology required.