See the video: http://vimeo.com/30743539

There we go. I work at a company called TASC.  We are Treatment Alternatives for Safe Communities.  We are a statewide organization in Illinois, and for the last 30 years, we’ve been providing direct services and doing policy advocacy and policy development and research to help advance this tremendous opportunity to provide behavioral health interventions for people who are involved with the criminal justice system.

So, annually, we serve about 20,000 people who are involved in the justice system, mostly, today, people who are on probation and people who are on parole, and we have designed and managed a number of many kinds of projects that that connect the criminal justice system and community-based care.  We participate extensively on state and national planning on health care reform with this particular interest in mind.

So, our goals today in this webinar are, trying to advance this slide here.  There we go.  The goals of the webinar are:  To provide an overview of the current challenges in providing substance abuse and mental health services for justice-involved populations, which is essentially to provide the background, to understanding how the Affordable Care Act can, then, change this situation.  Then, further, how can we use evidence-based practices and services expansion to actually move the whole field forward and move our efforts to reduce recidivism and build community recovery dramatically forward.

There are certainly planning steps that we would recommend will be happening now.  We’ll talk about that towards the end of the presentation, and we’ll look a little bit at the financial and practical implications for the criminal justice system, specifically, of taking on these challenges.

So, first of all, what is the Affordable Care Act?  This a law known as Health Care Reform passed on March of 2010 and signed in March of 2010.  It’s hard to believe that’s almost a year and a half ago, but it is.  The goals, broadly, of the legislation are to extend access to underserved populations, to improve health outcomes, and to maximize efficiency of public health expenditures.  The Affordable Care Act, itself, is 2700 pages long.  I don’t know anybody who’s actually read all pages although I’m sure there are people who have, and there’s quite a bit of federal guidance.  Then, when you multiply that by every state in acting their own required processes, there’s quite a bit of administrative rule on this.

So, what we’re going to focus on for the Affordable Care Act is the one particular aspect that creates this big opportunity in the criminal justice system and the community substance abuse, mental health system, and that is the expansion of access to care for low income populations regardless of disability.  This expansion shifts us from planning on a program level to planning on a system level and creating enduring linkages between the criminal justice system and the community behavioral health system for purposes of good re-entry, good diversion programs, and reducing, ultimately, the number of people whose ongoing untreated mental health and substance abuse by bringing them into contact with the criminal justice system.

So, where are we in implementation?  The federal and state governments are currently in the planning processes and early implementation phases.  There were a number of requirements that took effect a year ago in September that, for example, the limitations on, the conditions of coverage to young adults up to the age of 26 being covered on their parent’s health insurance.  So, those are already in process.  There’s a number of things the state has to get done by 2013 in preparation for the expansion of coverage in 2014.  Those include building things like health insurance exchanges, setting up expedited enrollment procedures.

The federal government is in the process of determining what’s called the essential benefit plan, which will be the minimum services that have to be included in any expansion plan, whether it’s a Medicaid expansion plan or it’s a subsidized insurance plan that will be sold on the exchange.  The Medicaid expansion and the expansion of subsidized insurance actually takes effect January 1^st of 2014.  So, that is the target that we’re working towards in our state and many other states are working towards.  A lot of things have to come together at that point.

I do want to acknowledge the general error of uncertainty and concern that’s been generated by how we will pay for this and where this is going to go.  That got particularly intense this summer during the discussion.  We had to address the debt ceiling and what would be required, and I would expect that conversation to intensify, given that we’re heading into a national election next year.

I think what’s important to remember is that we actually have the slot on the books that it does currently point us in the direction of doing these things, and states are moving forward to do implementation.  Many states are moving forward in implementation, and for us, as people who have been working on this for many years, this is the best shot that our clients and people like them in other states and other communities have at getting their untreated health conditions actually treated.

So, our position is we need to continue to explore what could happen and to figure out how to broaden this conversation so that even if the Affordable Care Act doesn’t proceed as we all hope it will that we’ll have gained some ground in this conversation.  So, I offer that to you as a framing and acknowledgment that the political reality of the current situation, but we’re still very optimistic about this.  The rest of those presentation will be about why:  Why aren’t we optimistic?  Why aren’t we thinking this will make a difference?

So, a little bit of background, a little bit of epidemiology and numbers of people that we’re talking about.  First of all, this won’t be a surprise to anybody on this phone call, substance use disorders are nearly universal in the criminal justice system.  We know because of 30 years of research conducted by the Department of Justice, the National Institute of Justice, the National Institute of Drug Abuse, and many, many prominent national researchers that the criminal justice population include people who are both addicted to drugs and alcohol and people who abuse and misuse drugs and alcohol.  It may be in combination with a co-occurring mental health disorder.  It may be in combination with lots of other medical issues, but we know this is the consistently documented reality.

The National Institute on Justice’s research on jail inmates, they do quarterly testing in a number of cities around the country.  They consistently find that over 70% of jail inmates test positive for some illegal drug, and when you add alcohol into that mix, it goes up to nearly 100%.  So, this is a test within 3 days of arrest, and the prevalence is very, very high.  So, then, the next question we want to ask is what is the level of intensity and severity of those issues?  Are we talking mostly about people with risk use? Are we talking about people with ongoing problem use, or are we talking about people whose lives are like when the wheels come off the cart where their lives are run on their dependence on alcohol or illegal drugs or both?

The research on that shows that about 48% of prison inmates and about 44% of local jail inmates meet criteria for substance dependence, and that’s seven time greater than the general population.  So, we’re definitely looking at an area of concentrated, untreated addiction.  We are also looking at an area of untreated, risky use and abuse that has never been there.  So, both of these things can be addressed through healthcare reform.  Through the expansion of services, that’s possible through health care reforms in 2014.

Most of the remaining groups, the dependent group demonstrated significant substance abuse that has various consequences, obviously, including the legal consequences of their being in jail or in prison at the time.  When you think of how we manage this problem right now, we manage it by incarcerating people and putting them in community supervision, which can be expensive, especially the [10:08] Report and the public safety portfolio.  So, about 90% of the criminal justice dollars, corrections are actually spent on incarcerating people, and 10% is spent on all community supervision and other management population efforts that go on.  So, that’s really the big ticket item, and we have the opportunity to shift that a bit here.

Other chronic conditions in addition to substance abuse are very much more widespread than in the general population.  There are much higher rates of serious mental illness.  There was a very good study that was done by 1046 and other folks in the last couple of years that show the cross site analysis of jail populations consistently demonstrated serious and persistent mental illness.  So, schizophrenia, bipolar disorder, major depression, those are the ones that they looked at at over 15% of men, and about 30% of women who were in jail demonstrated that level of serious mental illness.  It’s also pretty high in the parole population, and it’s less high among the probation population.  So, that’s why I have over 10% on this slide.

There are higher rates of chronic medical conditions, including, we definitely see these in our patients, diabetes, heart disease, asthma, cancer, and HIV among the most prevalent ones.  There are also that only about 10% of these folks have insurance, whether that is Medicaid already through mental health or physical disability.  You have access to the All Kids Program. They call it something slightly different in other states, but it’s the subsidized Medicaid program for youth under 19.  Occasionally, folks have work and have private insurance, but because folks don’t have access to consistent health care, all their chronic conditions including their behavioral health conditions get treated episodically and get undertreated, essentially.  S

So, we see the effect of that in the behavioral health side with repeated cycling through problematic conditions, repeated arrests, but we also see the impact of that with chronic medical conditions.  So, undertreated diabetes and heart disease have much worse complications.  People are affected by those complications sooner, and they may die significantly younger as a result.  So, it’s a very large population group with a very high rate of untreated disease.

When we look at what this looks like in Illinois, this next slide is just a snapshot of the jails in Illinois.  In 2008, there were almost 367,000 jail booking.  We weren’t able to get an unduplicated number for those jail bookings, but if you just assume that, on average, everyone has two jail admissions, knowing that a lot of people have a lot more and some people have fewer.  I think it’s a conservative amount, about 180,000 in Illinois, and fewer of those jail admissions report to using drugs regularly.  So, two-thirds of the 180,000 would be about 120,000 unique people or 240,000 admissions.

So, about 14.5% have psychiatric disorders.  That’s 53,000 admissions, and of those, most have a co-occurring substance abuse as well.  With very highly variable lengths of stay and not a lot of organized re-entry services in jail, which are organized for people to come in and out of largely, it’s very difficult to coordinate care around case processing.  There’s not a lot of post-release care and a very high likelihood that people will return to jail if their behavioral health needs, in particular, are not addressed.

We also took a look at what are the numbers in probation across the four states at the area.  In Illinois, there were about 144,000 people in probation in 2009.  Indiana was a few less, 130,000.  Michigan, quite a few more at 175,000.  In Ohio, quite a few more at 260,000.  There are a number of very good, quite organized projects to link people on probation into substance use and mental health treatment programs.  They tend to be called like special probation supervision, specialty courts like drug courts and mental health courts, and certainly individual officers make a lot of referrals.

It’s a shame, I think, because Dental Protection and MDD US, they probably got billions invested in assets to underwrite what they do.  So, I think they should start paying out some sort of terminal bonus.  I think if you’ve been a customer of theirs and you retire, I think you should get a little bit of a share of the company back.  At the moment, they just go, “Thanks very much.  That’s the members’ money.  We’re putting it in, and we’re keeping it for the members.”

When you cease to become a member, I don’t see why you shouldn’t get a bit back, some sort of share.  They could do that and still maintain sufficient reserves, but at the moment, they’re saying, ”We have ways.  That’s going in the reserve.  We’ve had to put that into building the reserves.” I mean, how many billion pounds do you need?  They just save this money up for the sake of saving it.  It’s a bit addictive, I suppose, if you’re getting hundreds of millions of pounds in all the time.  When is enough, enough?  When do they say stop?

Chris Ritchie:      Well, they have to employ someone to count all the money, don’t they?  They’d have to sack people, presumably.  People would be made redundant.

Derek Watson:   Well, they can probably take on the people from the BDA then to help them count the money.

Chris Ritchie:      That is a very good idea.  What I’m more concerned about is the Scott advice, and he mentioned to me, some years ago, that he found out dental nurses, as you just told me, do not necessarily need indemnity insurance, but is the GDC still telling them that they do?

Derek Watson:   I think the GDC is pretty careful to steer clear of the argument.  Let me put it this way.  Dental nurses, I am pretty sure, and I’m looking for the reference here.  I think it’s fairly early on in the review that says that dental nurses are covered by NHS indemnity or their employer.

Now, a self-employed nurse would need indemnity, but there are very, very few of those.  The sort of people that need indemnity are hygienists, therapists, dental technicians, and stuff like that.

Now, if you’re a dental nurse and you’re worried, and you’ve been told, “Now, you’re already with the General Dental Council.  You may get reported to the General Dental Council.  You may have to appear before the General Dental Council,” then I can see why you might think you need some sort of insurance possibly to cover that and to pay for representation because you couldn’t pay for a barrister if you’re a dental nurse if you got a complaint.

For a while, people like Dental Protection said, “No, it’s not a problem.  If you’re a dental nurse working in the practice of a dentist who’s a member of the house, we’ll include in our scope of advice and care because basically it’s going to be the same complaint.  I mean, the complaint will probably reach to the dentist.  Then, they’ll name the nurse, but basically, we’ll be doing the paperwork anyway.  So, we might as well put your name down on the list of people that we are representing.”

This one organization in particular, the British Association of Dental Nurses, did come up with this scheme whereby they sold nurse’s indemnity insurance, and I’ve had many an argument with Pam Swain, their chief executive, about this, and underwriter, Sharon, who underwrote both Shield and Farras and I know underwrites the BDNA end scheme.

It’s money for them because they know damn well that the nurses aren’t going to get complained about, and they’re paying a premium, which £10 or £15 pounds a year, but even if it’s £2 a year, it’s £2 a year for not much.  The problem with this in the society in which we live is that this is seen as good business by some people, and there are an awful lot of nurses.  So, the numbers multiply.  There are profits to be made.  If 30,000 people pay £10, then you booked £300,000 haven’t you?  You don’t have to do much.  That’s good business.

I would say bad business.  Whenever our nurses have asked us if they need indemnity insurance, we’ve always told them no, but at the back of their mind, “Perhaps I’ll get it just to be on the safe side.  Perhaps I’ll get it just to be sure.”  Are you sure?  It’s always more difficult to say to someone, “No, you don’t need something,” than to say, “Yes, you do,” because you can’t prove it.  You can’t prove to them that they don’t need it.  All you can say is that you’ve looked at the Scott review, which most of them will never have heard of, let alone see, and say, “We’ve looked at it.  It’s our opinion. You don’t need it.”  I’m pleased to say, we’ve never regretted giving that advice.

Chris Ritchie:      Does the GDC have any knowledge of the Scott review?  According to the GDC website, “Once registered as a dental care professional, you must have professional indemnity to practice in the UK,” and they’ve helpfully blued out professional indemnity there.  So, you can follow the link.  If you click at that, “We’re sorry, we couldn’t find that page.”  I think it needs to spend a little bit of that new money it’s got on sorting its website out, perhaps.

Derek Watson:   Their website terrible.

Chris Ritchie:      Also, this advice is not right, is it?  It says you must have professional indemnity to practice in the UK, and as it turns out, that’s not exactly true.

Derek Watson:   Well, I’m on their indemnity page, and it says, “We expect you to have the appropriate arrangements in place in order for patients to seek any compensation, which they may be entitled to.”  Now, if you’re vicariously indemnified by your employer, then I would say that’s the end of it.

Chris Ritchie:      What about technicians?  Why should dental technicians need indemnity?  Would they?

Derek Watson:   Well, as I say, it’s really designed to protect you against financial claims, which arise out of claims for damage for loss as a result of negligence.  Now, how many times have technicians had claims of that nature?  It’s always the dentist isn’t it?  It’s always the dentist that gets sued.

Chris Ritchie:      It’s a big business, I think, built up around, and I think there’s a little bit of unscrupulous activity going on.  I think that it needs to be clearer.  I think who needs indemnity and who doesn’t should be made absolutely clear.

Derek Watson:   I wish I could find this thing in the Scott review.  Wait a second.  I got it.  Conclusions and recommendations number four.  It says, “My conclusions have taken into account that employees in the NHS and independent sector will be able to satisfy the condition of registration by dint of the corporate cover that arises from an employer’s vicarious liability for the acts or omissions of employees.”  Basically, that’s the employer’s support.  It’s like whatever goes wrong is my fault around here.  Whatever goes wrong with the nurse, it’s the nurse’s employer’s fault.

It says, “Personal cover, from a defense organization, trade union or other body, will not be required on relation to practice as an employee.” So, as an employee—

Chris Ritchie:      Completely covered.

Derek Watson:   “Personal cover will only be required in relation to self-employed practice.  In my judgment, this is the correct approach.”

Chris Ritchie:      So, this could be like the misspelling of PPI.  You know you get stung.

Derek Watson:   Oh, I haven’t thought about that.

Chris Ritchie:      You could get some recorded voice at the end of your phone, you know, saying, “Press 5 now and—

Derek Watson:   We were missold indemnity insurance by the PADN.  Holy cow.  Holy cow.

Chris Ritchie:      Yeah, that’s what it is.  This is what it boils down to.  This could be a PPI scandal in dentistry.

Derek Watson:   You know, it hadn’t occurred to me about that, and I’d been banging about this for years.

Chris Ritchie:      Well, you just need to talk to someone clever occasionally, that’s all.

Derek Watson:   You know, I think they’ll say that even if you are covered by vicarious liability, you might still need someone to represent your interest and help you handle the correspondence and everything, and that what we would do.

Oh well.  That seems like a fairly good note to end on.

Chris Ritchie:      We’ll be talking to Pam Swain next time, of course.

Derek Watson:   Pam Swain will be a guest on the next netcast, no doubt, explaining what she spent all the money on.

Chris Ritchie:      Buying Richard Leishman a new car, perhaps.

Derek Watson:   Right, we need to wind it up now because I think I’ll just have enough time to cover the list together.  As I said, the video’s working again this week.  That’s great.  We might have this up on YouTube as well, as a netcast, a podcast.

We’re going to the BDTA.  Now, I’ve got a problem because Farida is stuck in Iran.  My staff is stuck in foreign acclaims and therefore, cannot man personnel, workforce, whatever the word is, stand.

So, I don’t know what I’m going to do.  Ask me on the next podcast how it goes because 2 three-day exhibitions, and there’s nobody to help me.

Chris Ritchie:      Aw, diddums.

Derek Watson:   So, by the time people listen to this, the exhibition’s going to be over anyway.  So, they don’t care.

Chris Ritchie:      Does anyone care?

Derek Watson:   But if you do, if you’re listening to this in the two or three days before the BDTA.  It’s the 17^th and 19^th of October.  We’re on stand R and J [55:06].  Now, the next netcase is going to be on Monday, the fourth of November.  That’s they day for a bonfire date, and as usual, just either e-mail us at info@dentalfusion.org or go to the website dentalfusion.org.

If you’re a member, you’ll be able to get in.  If you’re not a member, there’s still some stuff there for you, including the address to the podcasts and stuff like that.  Please do consider joining because we have, for many years, relied on the support of the profession to keep going.  Unlike the British Dental Association, we don’t have much of the way or reserves, and we do need your help and support more than ever.  So, go and have a look.  See what we offer.  If you think it’s worth what we’re charging for it, then sign up, and try us out.

So, I think that’s it.  Anything else?

Chris Ritchie:      No.  I was just going to suggest, as it’s the day before Bonfire Night, we could have a mass burning of all the indemnity certificates.

Derek Watson:   Yes, there’s going to be a mass burning of Leishman unless we find out that he’s got a bloody excuse for not being on this week, but as you said, I think he did mention that he wasn’t going to be around one week.

Chris Ritchie:      This is that one week.

Derek Watson:   Possibly, he’s taken his blood £81,000 Mercedes abroad, and he’s gone on a driving holiday hasn’t he?

Chris Ritchie:      Probably.  That man seems to take holiday every week.  I just don’t know what’s going on.  Shocking.  We have to work for a living.  He’s some sort of playboy, gallivanting around Europe.  I don’t know.

Derek Watson:   First of all, can I just say, if you’re going to be a presenter on this podcast and you don’t turn up, expect the piss to be taken off you mercilessly.  That is one of the conditions.  If I ever miss one of these, and Chris has certainly missed these in the past, that is just a condition of joining in.

Chris Ritchie:      Yeah, that’s fair.

Derek Watson:   Secondly, read rule one.

Chris Ritchie:      Thirdly, I’m hungry.  Thanks very much.

Derek Watson:   Alright Chris.  Talk to you next time.

Chris Ritchie:      Buh bye.

Derek Watson:   Bye.

Talking about selling your practice for a million, the NHS practices continue to attract more, in terms of money, and I think in a way this is related because someone who’s a corporate, he’s going to want a practice with a contract attached because there’s some certainty about that.  There’s some guarantee of income, providing you can negotiate the transfer of the contract, of course, but you’re far more like, let’s say if a surgery has a turnover of £1 million or something.  If you buy it, you’re far more likely to realize a similar turnover if it’s contract-based rather than if it’s a private practice, and all of the turnover was associated with the former boss who may want to work for you or may not.  He may take his million and a half somewhere else, and you’re left trying to build up what is literally a practice where the private practitioner’s gone AWOL.

Chris Ritchie:      Yeah.  Going back to Oasis, they can’t have a monopoly, can they?  You’re not allowed to have a monopoly so it could end up that we have more corporates popping up, smaller corporates.  I think you’re going to give Oasis and IDH, being the big ones.  A supermarket may well launch its own branch chain.  I think that’s definitely the way it’s going, isn’t it?

Derek Watson:   Well, when you say you can’t have a monopoly, I think you’re right in that you can’t prevent other companies coming in and stocking up, but you can get into a situation where you’re dominant in the market.  When you look at the spectacle sector, for example, you can count on the fingers in one hand, the major players in the spectacle sector in the main division, Division Express, Optical Express, SpecSavers, Dollan’s, perhaps.  I don’t know if you could think of any others. Then, you’ve got the really, really small guys, but the big ones are dominant.

I think they all continue the same way in dentistry.  I think they’re expecting it to go the same way in dentistry.  I think Oasis and IDH don’t expect to cancel each other out, but I think they do expect to be two of the three or four major players.  They’ll dominate because they’ll pick up 80% of the market, and 80% of £7 billion, for them, is a lot of Dutch.  Perhaps, it’s worth investing in Stuart Rose to get 80% of that particular pie.  That’s a lot of money, isn’t it?

Chris Ritchie:      Yeah.  It’s a good time to be buying shares in any of the corporates, but that thing you do currently have close to big ones in dentistry.  So, there’s room for two or three more, and it’d be interesting to see where they come from.

Derek Watson:   Now, winding up, the last story I’ve got here on the schedule to have a chat about is the Dental Defense Union, and for those people that are not familiar with the insurance and so on, this is medical indemnity insurance we’re talking about now, which is compulsory insurance in case you do something that is later decided to be negligent and which causes harm, which then causes a loss.  That loss is then paid for by your indemnity insurance.  For example, if you dropped your [36:38] down someone’s throat.  That always used to be a good example, although there’s no excuse for that now.  They probably wouldn’t pay for that because you’re not supposed to be working in a way that would allow that to happen.

There are three major players that are UK or London-based.  I think there’s two in London:  The Dental Protection and Medical Defense Unit in London.  Then there’s Medical and Dental Defense Unit in Scotland.  So, there are three.  There are others.

They all used to be mutual.  In other words, the members paid into a central fund, and then, they would, if they needed to, put a claim in and claim against the fund, and providing it got agreed, it would be paid.  All the expenses for the lawyers and everything would be paid out of the fund.

Then, a years ago, around year 2000 or so, the Dental Defense Union suddenly said, “No, we’re going to an insurance policy-based approach.  So, there’s going to be no mutual fund anymore.  We are going to pay at premium to Lloyds, and Lloyds is going to underwrite everybody.  It’s a marvelous scheme because you all have a policy.  So, you know exactly what is covered and what isn’t covered, and there’ll be none of these ambiguities there is with mutual associations.”

Are you going to be covered or not?  It’s discretionary.  So, it’s discretion, and they banged on about this for years and years.  It turned into a massive band fight between Rupert Hoppenbrouwers, the Dental Defense Union, and Kevin Lewis of Dental Protection with MDD on their side about what was the best way of doing things.

I think the answer is that they were both reasonably good ways of doing things, possibly.  The problem with the insurance-based model is that more of the members’ money leaked out into the shareholders, and the insurance people who underwrote the insurance then the mutual where, obviously, all stayed in hell.

As far as the insurance went, they cost about the same, and they did about the same job, but then, two years, this guy called Finlay Scott was asked to review the requirement to have indemnity insurance because there was a debate. New dentists need to be indemnified.  New doctors need to be indemnified, but then, there was a worry that, possibly, nurses need to be indemnified as well.

He came up, and I’m a bit cynical about the way these things happen.  He came up with this recommendation, which is that no nurses were find, especially if they’re working in the health service.  They’ll be covered by the health service insurance, and if they’re working as employees, then, basically, they’re pretty unlikely to be sued anyway because employees benefit from something called vicarious liability, which means that if they do something negligent, it’s assumed that it’s their boss’s fault.  Their bosses either didn’t train them properly or didn’t supervise them properly or didn’t give them the right equipment.  So, the boss is in trouble.

Finlay Scott came up with this dependent policy review, and he said, basically, nurses don’t need it.  Nobody who’s employed needs it.  Nobody who’s working for the health service needs it.  Now, one offshoot of that is he was asked to look at this question of whether mutual insurance or insurance policy-based insurance is better.  Is one of them better than the other?  He said, “Look, I’ve had chat with officials by which we presume.  We don’t care.  It’s the same.  It doesn’t make any difference to us,” because that that point, there was still dots and dinges.  One was bought.  It wasn’t compulsory.  It’s only been recently compulsory, and it still causes a problem if the dentist moves abroad.

Chris Dean from Dental Old Partnernership is leading a campaign to try and force these indemnifiers to face up to their responsibilities when the dentist goes abroad and leaves and effectively leaves the patient without any recourse to indemnity even though they may be indemnified and there might be a policy that may pay out.  But the patient can’t find out from the dentist who the insurer is.  So, no liability arises.

Finlay Scott decided that there was pretty much no difference, and then, Dental Defense said, “That’s it.  He was our last best hope.”  Dental Defense was hoping that the government would turn around to the discretionary insurers and say, “No, this needs to be insurance based,” and it would have been a leveled playing field.  Seeing that they couldn’t play on a leveled playing field anymore, I think the Dental Defense Union said, “We give in, and we’re going to go back to discretionary occurrence basis,” funded by us.  So, now, it’s all gone back in the house.

Chris Ritchie:      But it doesn’t ultimately make any difference if you were customer, does it?

Derek Watson:   No, I don’t think so because at the end of the day, you still pay your money and make a choice.  You know, you got the cover.  The cover’s pretty similar.  The premium’s pretty similar.  I’m a great fan of the DFO, a mutual organization.  I’m a great fan of mutual associations whether it’s for pension provision or investments or providence societies, friendly societies.

Certainly, income protection would say to any young dentist out there, if you’ve got a commercial firm where you’re paying premium and you’re going to get a certain amount of income protection versus paying to a mutual, you may find that the commercial firms pay more, and they pay it quickly.  They probably won’t pay it for long, but they’ll pay it quicker and probably give you slightly more.

That’s pretty attractive, but in fact, if you pay into a mutual, then you may have to wait longer for the money.  You may get slightly less, but you do, when you’re 50-something, get a great massive lump sum, which is equivalent to getting all your premiums back, pretty much.  I can say this because I’m not an independent financial advisor. You know, I’m not getting paid for this advice.

I mean, if I’m completely wrong, it’s a shame Chris is not here because he would tell me.  I mean, but I always relied on mutual for my income protection because I knew that I was only lending them the money.  With a commercial organization, you’re giving them the money, but for mutual, you’re lending them.

The way it looks to a dentist is you are going to get the same or no more than you got, but you’re going to be expected to pay for it, £800, at least, and if you want all this practice and testing stuff done, then we’re going to charge you £1100.  What you have to do, the extra £300 is only what I would spend in an inspection test, and it combines the package anyway.

So, I haven’t lost anything because I can cancel my subscription to my compliance people, but if you think of Adobe now, Adobe makes computer programs that creative people who do writing and make websites and movies and audio and stuff like that.  They went from a system where you bought a product, and after 2 or 3 years, you upgrade it to now, you rent the programs, and you rent them all.  You pay £20, £40, £50 a month, and that gets you access to all the programs.

Now, what that means for us is we get access to the latest version of the two or three programs we use, but we also get access to the latest 17 programs that we’re never going to touch in our life because I’m not going to go into cinematic production or post-production or produce flash movies.  So, from a fairly human point-of-view, I think to myself, “I’m paying for all this stuff that I’m not going to need”.

I could see why the dentists are looking at the BDA and saying, “Okay, I’ve got a conference ticket,” and Janey Pinder made this point on GDP UK, “Okay, so you’ve given me a free conference ticket, and you’ve given me two free conference tickets for two members of the staff.  So, that’s three hotel rooms unless you get very lucky, in which case, it might be one, but three hotel rooms over three days.  So, that’s six nights, possibly nine nights in a hotel and travel and subsistence, and that’s not canceling the opportunity cost of not being in the practice.”  So, you’re looking at £1500 for your free ticket minimum.

Chris Ritchie:      Hello.

Derek Watson:   Yeah, I’m here.

Chris Ritchie:      Sorry, you dropped out completely there.

Derek Watson:   So when analyzed in that way, it doesn’t look to be quite a good bargain, doesn’t it?

Chris Ritchie:      No, well I wouldn’t have said it quite like a bargain at all, but as said earlier, you already got to pay your money to the GDC.  When they put their fees up, they did put their fees up by 33%, and you’ve got this huge price hike.   I think, as you said, at the start, there’s actually no demonstration yet that the services improved over at the GDC certainly.

What has improved?  Is there any sign, even now, that that money has been put to good use?  The BDA has made a decision.  Maybe it will pay off, maybe it won’t, but I think the majority of people, when they see now that they’ve got to pay double what they did before, are going to really ask the question.  I think will say, “Do we really need this?  What does the BDA do for me apart from put loads of paper on my lap every month?”

Derek Watson:   Well, I think it’s a shame because there is a place for membership association and the intangible things they can do for members, not based upon inspection and testing and compliance but things like even emotional support and encouragement, networking and all those sorts of things.  So, I do hope that dentists don’t stop joining membership associations whether it’s the BDA or the DFO.

Now, let’s go on to the second story.  I think we’ve done that one to death, and that one’s on Oasis Healthcare.  Now Oasis Healthcare is in the hands of a French capitalist as most corporate dentist bodies are, and they needed a chairman.  Who have they gone to?  Who would be a high profile trophy appointment for that sort of job?

The answer is Sir Stuart Rose, formerly of Marks and Spencers, widely accepted to be a retail god.  He’s now chairman of Oasis Healthcare.  Now, I know it’s only one of the things he’s doing, but I’m sure he’s not doing it for the crack.  You know, I’m sure he’s going to be looking quite closely at how Oasis is developing, and I’m sure he doesn’t come for £10 an hour and for bacon and sandwich either.

Chris Ritchie:      Or crack.  I didn’t know anyone did that sort of job for crack, but thank you for bringing that to my attention.

Derek Watson:   He’s going to be a force, isn’t he, in dental corporates?  He’s a sign that the whole battle between corporates is heating up now.  They’re bringing in the big generals, aren’t they?

Chris Ritchie:      Well, it’s just the way it’s going, isn’t it?  The corporates have to expand.  They have to keep going, just like any capitalist venture has to keep on going like where I live, there’s Walton Bridge.  It’s a very famous bridge, and there’s been two replacement bridges over the last 50 years or so.  They finally decided to build a new permanent bridge, but I’m sure it can’t be permanent because at some point, there will be a need for a contractor to come in and build another bridge.  It never stops, but all of these things go, and that’s how I view anything that happens in business.  You appoint someone, you create a new product, and it’s all generally the same stuff recycled that was happening 20, 30 years ago.

In terms of what is means for dentistry, I’m not sure if it means a hell of a lot.  I think it means that it’s just a company expanding and expanding and expanding until one day, it will rule the world.  They think it’s a big deal.

Derek Watson:   Do you think it’ll win, or do you think it’ll expand until they turn into selling cross and blood?

Chris Ritchie:      No, well, there’s a danger that you’ve got a bad egg somewhere, but the difference is if you’ve got a bad egg at the top of an organization, then that drip feeds down.  It’s like an oil that then covers everyone underneath, but this chap is not (well, I don’t know him personally), someone with his track record doesn’t appear to do business in a cloak and dagger way.

So, it would appear to be a very good appointment, certainly from the point-of-view of Oasis and not its competitors.  You know, what’s next, or will Richard Branson get involved?  Something like that.

Derek Watson:   Well, I think Bridgepoint Capital looks like Stuart Rose is on the board of Fat Face.  If I remember, Bridgepoint owned Fat Face.  So, it may be just that they him on a retainer, advise them across all of their purchases.

Chris Ritchie:      Yeah, and he’s the right man of the job, isn’t he?  Going from what he’s been doing, it certainly appears to be a very, very shrewd acquisition.

Derek Watson:   Okay, well, I’m not quite with you on that.  I think it’s pretty significant.  I mean dentistry, you’re always used to dentistry being second division, possibly third division in everything, and the day that a dental company gets Stuart Rose as its chairman, I think, is pretty significant.  It shows that we’ve been promoted somewhere.  I’m not quite sure where, maybe in terms of the amount of profit they think we can produce or the amount of capital they think they can realize on the sale of the group or something, but I think he’s a Premiere League player.  To see him in charge of dentistry is quite good fun than just to see where that goes.

Chris Ritchie:      You know, dentistry is going through big changes, Tesco now opening up practices in there, aren’t they?  And offering NHS and private so you can go and do your shopping, and then, you can go in and have a few implants, and Boots were involved a few years ago, weren’t they?

You know, there have always been efforts to combine retail and dentistry, and this is just another sign of that.  I’m not disagreeing with you.  I think this is a very, very interesting development, but where can they take it?  It’s not like they can do anything more than what dentistry is.  They can’t change dentistry.  Dentistry is dentistry.

Derek Watson:   Yes, I suppose dentistry has changed quite a bit.  Now, I’m thinking more about the fact about Tesco.  That was integrated dental.  So, on the one hand, we’ve got integrated dentals going into with Tesco, which already is a massive chain.   Oasis.  Perhaps there’s room for both of them.  I think it’s an escalation in the battle for market domination.

You can look at it from one of two ways.  You can say, “Well, the small guys will get squeezed out of this,” which they almost certainly will.  We’re talking about the medium-sized practices, not the one where the BDA’s giving free conference tickets to, one dentist, two nurses, or one dentist, one nurse, and one receptionist.  I’m talking about the guys who, perhaps, have the bigger building near the city center and possibly for dentist work, and they have six dentists or something like that.  These are the guys that are being bought out.

You’ll still be able to go into dentistry small and make a reasonable living, probably not brilliant, but I don’t think you’ll be squeeze out.  Perhaps, the guys in the middle tail will be squeeze out, but they won’t be bought out.  They’ll retire with at least a million, a million and a half.  He won’t care, and it’ll be up to the companies to make these millions of large sums a success, which they’ll probably do to economize the scale.

Nine times out of ten, the patients will say, “Yeah, I like it.  I noticed that you do things a little big faster.  So, you had to put the fees up after a few years.  I understand that,” but the BDA have done it the wrong around haven’t they?  They’ve put their fees up.  I can’t remember exactly what they were charging before.  It was in the order of 500 or something, before, and now, members had to two choices to pay more, which is to pay nearly £800, £795, or to pay nearly £1,100, or drop down to £295, but that’s just to use the website.  It’s a hands off approach, and don’t ring us, don’t e-mail us.  It’s a self-service BDA, if you like, and I can see how they’ve stratified it.

What they’ve done to try to justify the increase in cost, they’ve included a lot of things that they really don’t want or most of them probably don’t want such as things like the three day conference passes because if you’re an extra member (£795), you’ve got a three day conference pass to a conference you may not go to.

Chris Ritchie:      Yeah.  Well, it strikes me that you already pay your GDC money, and that’s an organization that you really can’t get a straight answer out of quickly.  So, you might as well not go with the essential package.  The extra package seems a lot more, and I don’t understand the job really.  Like you said, who’s to say everyone’s going to go to this conference?

Derek Watson:   I think the extras are really targeted at associates and just the way people think about this, an extra is just as such.  An expert is principles, and they’re coming into so much pressure from other organizations that are doing the member support role, you can argue how much is due to this failure to impose their policy direction on the profession nationally.  So much of what dentists want now is simple check box ticking approach.

You know, we’ve got the inspector coming in.  Is there a series approach called for this?  Can we buy the protocols and stick them on the shelves so that when the inspector comes in, you can say, “If you want to see the blah policy, there it is.  It’s all up there on the shelf.”

Now, I’m sure the BDA does some of that, but I think they’re getting into people like Smarlon and people like Simmi Shamran [12:30].  They’re probably doing it better given the choice, and obviously, we’re facing the same problem as the BDA in that respect but nobody wants to join the association on principle really nowadays.  They want to know how it’s going to help them in their workplace.

So, inspection, testing, and compliance has become such a big part of the dentist that the question, really, for principle is why would you want to have to pay for an inspection testing and compliance package and then join the British Dental Association, on top of that, however much of a trade union they say they are, however much they say “Yes, you can borrow a book from the BDA library.”  I mean, who the hell borrows books from a post lending library anymore?  Hello, the internet’s come along and the British Dental Journal, which is such a dyre magazine.

When I was a BDA member, which I think I was for a few years, I don’t think it even got on the racks.  It got stacked.  I’ve been in very many dental surgeries where you go to the dentist’s office, and you’ll see a great pile of British Dental Journal stacked in the corner because they’re very heavy.  They have to stack them in the corner; otherwise, after a few years, they fall over and kill you.

You say, “What are they.”  Oh, that’s the British Dental Journal.  I must get around to reading those one day, and you think, well, you need a fairly hefty spell in prison to have enough time to be able to read that all.

Chris Ritchie:      It’s a very academic leaning for that journal, isn’t it?  It’s not a magazine in that sense, and it’s very text heavy.  I’d say I probably couldn’t get through a page of it without falling asleep at least three times.  I think it also comes out, in frequency, is it bimonthly or monthly?  I don’t know.  I can’t remember.

Derek Watson:   I think it’s monthly.

Chris Ritchie:      It does offer CPD, and it’s very easy CPD.  You don’t even have to get the question right to get the credit.  So, people join the BDA because they come out for dental school, and certainly, for years and year, it was a done thing wasn’t it?  You come out of dental school, you join the BDA.  You’re a part of the union. They take care of everything else, but as you say, the times have changed.  What exactly do you get from the BDA now apart from the CPD, the BDJ that you won’t read? I mean, what else is there?

Derek Watson:   Well, I’ll tell you what I’ve got, and it’s literary.  I got a card this morning because so many have resigned because they didn’t want to pay what they effectively say is more for the same level of service that they’re talking about figures of 10% of the membership lost.  That means that they’re going to have to recruit an awful lot more people onto their lower tier, which is the £295 tier.

They’ve got 24 copies of the BDJ.  This is what they get.  So, it must be two a month.  Two copies of BDA News, a way of recording CPD online, 5000 pages on the website, discounts on books, trade union membership, borrowing right at Europe’s largest dental library.  Actually, I would pay good money not to have those.  An associate contract checking service downloaded over 170 books.

I’m not saying there is not any value there, but from my experience, basically, people are pretty good at solving their own problems.  If they want a book, they’ll find a book, but what they want from a membership organization is to be able to ring out and talk to another dentist and say, “This patient is driving me mad.  How do I handle it?”  They value this sort of personal service that we’ve always provided one-to-one tailored problem solving approach.

The British Dental Association was bad enough before this change when they used to ring up, and you wouldn’t talk to a dentist.  You may talk to someone who may have had this sort of training in the problem that you’ve got, but it wouldn’t be a dentist.  So, they really wouldn’t understand where you’re coming from, either, perhaps emotionally as well as technically.

One of the side effects of this 10% reduction in their budget is they’ve got to be making 20% of their stuff redundant.  So, it’s going to be interesting how they’re going to argue that the increased expense, the £1100 they’re expecting you to pay, which is already pretty much all of what you did before. How are you going to get a better service for that if you got only 8% of the staff, and Eddie Crouch just resigned from the principal execute committee.

They’re looking at a £3 million loss.  Now, they’ll say, “We’ll be back in profit again next year,” and they probably will because it is a license to print money in British Dental Association.  I just always had this suspicion that the British Dental Association exists to support the British Dental Association and not necessarily the members.

Chris Ritchie:      There’s two things here, as you said.  You’re not disputing that there’s value, but most of the things that you listed off that card are literature.  It’s a lot of reading that they’re offering for £1100.  You can read all this, and again, the internet is there.

Dentists do not have time to do all that reading.  They’re staring into the abyss of the mouth all day long, and they come out.  The last thing they’re going to want to do is read 5000 pages online and two magazines a month.  That’s just too much.

So, £1100, there’s value, but it’s value if you want to bore yourself stupid, reading and reading and reading every evening, which you don’t.  Also, one has to wonder why this price difference thing has come up.  What’s the reason for putting a package together for £1100?  Any ideas?

Derek Watson:   Well, I don’t know, but running a membership association as we do, I think what happens is a very small proportion of your members tend to use up most of your resources.  Very many people just get the magazine.  You never hear from them until they retired, in which case, they’ve resigned.

A lot of people cost a lot of money, and it’s tempting to say, “Well, perhaps we could charge them more.”  You never think, “Oh, we’ll just charge the majority less,” but think perhaps you could charge more to the people who use more.  They’re under a lot of pressure, I think, from everybody to be everything.

So, people don’t want to spend money on dental vinyls or whatever they can avoid, but the British Dental Association did everything and probably can’t forcefully say, “You’re our association.  I think you should be providing XYZ or compliance.”  What they’ve done, I think, is very similar to what Dental Protection did about 10, 15 years ago, which is have a risk based approach to subscriptions, and DPL went from charging everybody one price to say, “If you have a claim, you go up a tier.  If you have two or three claims, you go up a few tiers,” to the point where we could take any type of member and say or they’re taken as a group (a group within a group if you like) they’re self-supporting.  So, the high maintenance people are self-supporting.  The low maintenance people are also self-supporting.

The whole idea is if theoretically that works, then everything is still self-supporting, but I think they’ve forgotten that dentists love gaming systems, as the politicians keep telling us.  So, from a personal level, I think that they didn’t really pilot it, another lesson that could be learned from another body.  They didn’t look at an account as to how dentists are going to look at this proposition.

http://www.youtube.com/watch?v=A1IO408dv0o

Derek Watson:   So what episode is this? Is this 46?

Chris Ritchie:       Forty-something.  Does it matter?

Derek Watson:   Well not really. Well, it will do when we get into a thousand. We want to know where we are, 1000, 1001, or we’re still only 999. So, we might as well keep track. If we don’t keep track now then, we’ll never know, will we?

Chris Ritchie:       That’s a very good point. Okay.

Derek Watson:   So, welcome to the Dental Fusion Podcast.  We found a lead to the video camera.  So, we have got some video, and if I press that button, I’ve got a screen recorder going.  So, we’re surrounded by technology, and on the line, I’ve got Chris Ritchie, freelance journalist and author.  No Richard Leishman this week.  We think he’s abroad, don’t we, Chris? 

Chris Ritchie:       Yeah.  He might be in prison.  He might have had to turn himself in or–

Derek Watson:   He’s got a foreign dialing code on this phone, or his phone may have been stolen and ended up in Romania.

Chris Ritchie:       He might have bought his new car, if you were listening last time.  He might have driven it off a cliff somewhere.

Derek Watson:   Sorry, he’s not here because after we went off the air last time, we both found out that car cost about £81,000, didn’t we?  That’s before you start putting in the video and the seatbacks and the antique collision radar. 

Chris Ritchie:       The machine guns, as well, at the front.  Torpedoes.

Derek Watson:   Just to clarify with Ritchie Rich how much he spent on it because I don’t think he mentioned it last week, did he?  Surprisingly quiet on that.

Chris Ritchie:       It must have been at least the suggested retail price.  So yeah, someone is paying him far too much, and considering he’s at the top of the tree, he’s paying himself far too much.

Derek Watson:   Well, it may be a company car, you see.  That’s the other.  I mean, it may be a company car, and working in money, he may have contacts.  These money people have contacts that know how to get money.  I know he knows people who know how to get money.  I know that.

Chris Ritchie:       That’s in Russia, you mean?

Derek Watson:   I’m thinking more contacts in car leasing who can get him a very good deal, not just a very good deal, a very, very good deal. 

Chris Ritchie:       So, not that mafia.  That’s not what you’re saying?

Derek Watson:   Maybe not the mafia.  I don’t know.  I’ve never bought a car.  No, I did buy a new car once, I think.  It was a Ford Sierra Ghia.  I’ll tell you how far ago that was, and I drove it for 13 months.  Then, I totaled it.  I crashed it in the snow, and I wrote it off.  So, I vowed never to buy a new car again because it depreciated so much in the 13 months that I had it.  Always bought second hand cars.

                              Typically, I buy a car when it’s got 30,000 miles on the clock, which is about the time that they trade it in.  They’re still in reasonably good condition then, and then, I drive it until it’s got about 100,000 on the clock.  Then, I think about buying another one with 30,000 on it.  What do you do?

Chris Ritchie:       Well, I wouldn’t know about that, but I apply the same logic to how I choose women.  I’ll just go with that.

Derek Watson:   You wait until they’re 30?

Chris Ritchie:       No, I wait until they’ve don’t 30,000 miles.   That’s all.

Derek Watson:   Then, you get rid of them when they turn 100. 

Chris Ritchie:       I don’t really mind how old they get to.  Yeah. I was going to say that the rapid depreciation of your gear was probably due to you totaling it in the snow.  That can have an effect on the value of the car.

Derek Watson:   You know, I haven’t discussed it with anyone ever since.  It was a very traumatic period in my life. 

Chris Ritchie:       Let’s keep talking about that, then. 

Derek Watson:   I remember going to look at it when it was towed away, obviously, and I had to go to the scrap heap and get a few bits out of the car, which they had taken out.  I stood there, looking at it, and it was T-boned.  Someone was coming down the hill in the snow, and couldn’t stop and T-boned the car on the passenger side, much to the surprise of my wife who was sitting in the passenger side at the time. 

                              I escaped, I’m pleased to say, mainly by managing to skid the car so that the passenger side was the side that got the largest impact, but I was looking at it in the scrap yard.  I remember saying to the guy, you know, because it was one of the relatively new models.  It was written off, and I said to him, “That’s a lovely car, and if you’re thinking of buying a new car, it’s a lovely car.”  He took one look at it.  “Yeah, it was.”

                              Cruel, cruel.  Too harsh. You know, I just lost the car.  I mean, you don’t have to rub it in that badly. 

Chris Ritchie:       Yeah, you lost your dignity, as well, that day, then.

Derek Watson:   I’ll tell you what I did.  I lost my love for cars that day.  My love affair with cars died with that car because it just came across to me that cars were for getting from point A to point B, and as long as I had a radio and a heater, I didn’t really care, which is a sham because Richard’s a car nut.  Tony Reid, who I’m hoping to speak to, is a car nut.  They’re vintage enthusiasts.   They call themselves car nuts, too, and my brother-in-law owns and drives a Ferrari, and I don’t think he had to sell his Lotus when he bought it.  So, you can imagine what he’s like with cars.

Chris Ritchie:       It’s very difficult to drive two of them, isn’t it?

Derek Watson:   And I can’t to any of these people.  It’s a bit like, I was in a taxi the other day, and I just asked the taxi driver who won the World Cup qualify match.  He said, “You’re talking to the wrong block, mate.  I heard about that Steven Gerrard for an hour and a half, and I didn’t know who he was.  For an hour and a half, we spoke about weather, the state of the economy,” he said, “but not about football.  He must have thought I was the best taxi driver in the world, not bothering about football.”  He couldn’t talk to me about football.  He thought I was a football nut, and he apologized. 

Now, when I go to a party and bump into my brother-in-law and we stand there just looking around because all he can talk about is cars, and he knows that what I know about cars is really not worth bringing up.

Chris Ritchie:       Well, considering how little you know about cars, we spent the last 25 minutes talking about them. 

Derek Watson:   You mean talking about the fact that I don’t know anything about them?  So, let’s move on something dental because the thing I think is probably most relevant, perhaps, to the audience of the podcast at the moment is one of the changes going on in the British Dental Association, and they’re now having a bit of a crisis, aren’t they, the BDA?

Chris Ritchie:       Well, the old pizza war, lalala, I’m not listening crisis was good.

Derek Watson:   Oh, god.  That was funny wasn’t it?

[Infomercial]

Lalalalalala. 

Is it zero or not?

No, I’m not going to do this if you’re going to try to trap me.

I’m not trying to trap you.  You told me that there was no mercury vapor, at least, from an amalgam filling. 

I’m not doing this.

You’re not doing what?  Answering the questions that we told we were going to ask you?

No, you didn’t tell me you were going to do it that way.

Chris Ritchie:       Well, what’s going on here is this membership levels thing, which is confusing everybody isn’t it?

Derek Watson:   Well, I think they’ve made a classic mistake here which is when you make a private conversion, which I think is analogous to what they’re doing, what you do is if you want to do it wrong, you put the fees up and say to people, “Don’t worry.  It’s going to be fantastic.  You’re going to love it.  It’s going to be so wonderful afterwards.  You won’t care about the fact that you’re paying more,” and of course, people think, “All I know is that the fees are going up, and I haven’t experienced the service that you’re promising.”

So, on the one hand, you’ve got a known, which is a known increase in fees.  On the other hand, you’ve got a possible increase in quality of service.  So, if you’re trying to do a private conversion like that, as a dentist, you will fail.  What you have to do is you have to put up the quality of the service first.  You have to deliver on everything that you want to and possibly run a loss.

Then, go to the patient and say, “Look, as you probably noticed, we’ve completely redeveloped the surgery.  We’ve taken on new staff.  We’ve got waiting times down.  We’re using [9:21] now instead of silver, and as you can appreciate, it is costing us more.  We’re going to have to pass some of that cost on to you, but now, we think that now you’ve experienced the new, improved whatever.  You’ll agree with us that it still represents good value for money.”

I’m a very private person and don’t like to talk much about my life. But the positive dental experience I had with Dr. Vinograd deserves to be mentioned. I’ve never heard a good story about a dentist, so I’m telling my story so there will be at least be one!

The very first time I visited the office, Dr. V stuck his head around into the room while I was still filling out my paperwork and told me who he was. I immediately saw a big smile and could sense the warm and welcoming personality that I would learn more about later. That was a great way to start since I was nervous. Breaking the ice was really helpful.

When I got to the exam room, Dr. V was the first person to come in — not a nurse or tech or someone else. He started out by asking a lot of questions, learning about me and what I had experienced in the past. That was all before he put his hands in my mouth.

After he examined me, he told me that I had three cavities. I was astounded — not because I had some cavities but because my previous dentist had told me I had 10 cavities! I thought I was only there for a second opinion before I had my 10 cavities filled, but I immediately knew he was much different from my other dentist. I has thought 10 cavities was a lot, and that’s why I wanted a second opinion. I really do brush my teeth, so I thought the other dentist must be exaggerating to get more money or something. For some reason, the other guy just didn’t seem trustworthy to me — and it turned out he wasn’t.

Dr. V told me that I could go ahead and have them filled right away even though I was six months pregnant. He said that since these wouldn’t require drugs or painkillers, it would be okay. My first thought was HELL NO! Fillings without numbing? Not gonna happen for me.

But he explained that he uses a different kind of drill that runs at a very low RPM that generates very little heat and no pain. I didn’t really believe him, if I’m honest, but I needed the fillings and didn’t want to wait three or four months before the baby was born.

To my surprise, it didn’t really hurt at all. Twice it was slightly uncomfortable, but I put up my hand like he told me to do and he stopped, let me recover a bit and then continued when I was ready. In about 40 minutes, it was all done, I wasn’t numb so I could eat right away and everything was fine. And the other seven teeth didn’t need fillings yet, so he’s just going to watch those over the coming months and years — and I know which areas to pay special attention to when cleaning my teeth.

And the prices were better than the other place too. Since I don’t have insurance, that’s important to me.

When I went back for a cleaning, everything went smoothly and I even got a discount since I didn’t need much done. I was shocked at the discount and very surprised how gently and careful they were around me since I was still pregnant.

Maybe this review is too long, but people never say nice things about dentists. But Dr. Vinograd is great. He’s a good guy, a good dentist and I’ll keep going to him as long as he’ll have me.

In January 1997, PPI was referred to physicians at Southwest Orthopedic Institute (SOI). SOI, a twenty-four physician orthopedic group, had been affiliated with a multispecialty physician practice management company, Allied Physicians of DFW, P.A. that by January of 1997 was on the brink of bankruptcy. SOI retained PPI to provide guidance with regard to strategic alternatives. However, within one week, Allied filed for bankruptcy taking all of SOI’s accounts receivable and terminating all billing functions, accounting, payroll, benefits and all other business processes. Immediately, PPI arranged for a $1 million line of credit with a local bank so that SOI could meet payroll and other expenses. PPI immediately established new payroll and accounting functions, established employee benefits, hired and re-established billing and collection functions, and implemented all new practice management systems. From a strategic perspective, PPI ultimately repositioned the physicians into a new group practice and renamed the group Orthopedic Specialists and reformulated the group’s governance and compensation structure. The results of PPI’s efforts yielded an economically improved group including a 20% reduction in the group overhead ratio and a collection rate far in excess of historical averages.

“We retained Practice Performance when our practice was involved with the failure of a large multispecialty group. During that period, PPI identified our problems, proposed solutions, and moved ahead to solve all of our problems and improve our group practice. Their knowledge on the business aspects of medicine is superb. Since we began working with PPI, our profitability has increased by at least 20 to 30%.

In my opinion, the best decision I have made in 15 years of practice is to hire Practice Performance.” Jim Montgomery, M.D., Orthopedic Specialist, PLLC.

“We needed a turnaround agent and Practice Performance was terrific. They stepped in immediately and helped us address our problems and re-established all of our managed care business. As advisors, they have provided us with exceptional strategic vision that has improved our market position.”

Kevin Gill, M.D., Orthopedic Specialists, PLLC.

Improving PPI billing and collections requires accurate information, timely data and considerable operational expertise. PPI offers health systems and physicians a full range of professional billing and collection services designed to optimize revenue using a PPI calculator. Results are measured against our financial summary reports for continuous performance evaluation and improvement.

PPI’s customized reporting provides physicians and practice managers with clear, concise financial measures and statistics. Among the indicators tracked are revenue, accounts receivable, denial rate, collection rate, carrier performance and write-offs. These reports provide the ability to track performance against improvements in order to evaluate the need further initiatives.

PPI will customize services to meet the needs of each customer; however, billing and collection service arrangements generally follow either a “Batch Billing” or Billing + ASP model. In both models, PPI performs billing and collection functions including preparation and submission of bills, pre-collection contacts, forwarding of unpaid balances to collection services as set forth on practice protocols, recording of payments, adjustments to accounts, and reporting.

Top five Five reasons you should let PPI handle your billing and collections:

1. Improve Cash Flow and Collections: If we are able to increase your office’s collection rate a few percentage points, the improved performance will pay for themselves.
2. Change the Fixed Costs of Billing to a Variable Cost: This lowers your business risk. If collections decrease because of lower patient volumes or periods of absence due to vacation, your billing expense also decreases.
3. We are Vested with You: Because we are paid on a percentage of collections, we are vested in maximizing your cash flow and collections. From checking your charges to ensure that they are above your payor negotiated rates eligibles to following up on down -coded claims or communicating with your front office staff to decrease denials, we are partners with your business office staff.
4. You Do Not Pay Us Until You Collect: Because every denial is a cost to us, you pay us only when you collect on a claim. Moreover, because we are paid based on a percentage of collections (not charges), we cover all of your overhead costs (staff payrolls, postage, forms, etc.) upfront. Therefore, if your practice grows or you are a physician starting a new practice, using our service helps to finance your start up.
5. Checks and Balances: By outsourcing your billing and collections, you have better checks and balances on the running of your business office. You have an external perspective on best practice office work flow procedures and overall practice performance.

We will optimize collections using a PPI calculator so you can focus on delivering stellar healthcare.