Dr. Troilo graduated from Creighton Dental School in 1978 and has been practicing dentistry in a solo practice in Rose Hill, Kansas, ever since. His five-operatory office employs nine full and part-time staff members who treat patients 29 hours per week. His practice’s productivity is considered to be in the top 1% of the nation’s dentists. He has been speaking with Dr. Joe Steven of Kisco Seminars over the last ten years, on the topics of staff relations and practice productivity. Mark has also been on the Dr. Woody Oakes seminar team for the last five years, providing high-tech seminars on topics such as intraoral cameras and filmless x-ray. He has also written articles published by several leading dental publications, including The Farran Report and The Profitable Dentist.

If you would like to have Dr. Troilo speak to your group, you may reach him at 316-776-2144, or call Kisco Seminars at 800-325-8649.

Managed care has attacked our office from every angle. It also has not managed to get much of a toehold in our door. The major reason for this is because of the quality of service and care we provide for our patients. We even have welfare patients who pay us cash to receive our services, so I know this is true.

Every time we get the opportunity to help a patient make a decision that has been set before them by their employers, we get into the act. If you sit by and idly let employers and employees be influenced by these insurance monsters, they are going to be swayed into making some poor decisions for themselves and for you. Unfortunately, because of the slanted way these plans are presented to companies and their employees, it is made to sound like a better deal for less money. Your job is to educate them.

We have written rather matter-of-fact letters presenting the facts and exposing the pitfalls of their managed care options. We mail these out to everyone employed with the particular company (this list should easily be obtained from your computer). Do not hit below the belt, no matter how tempting it may be, but just state the facts. I also know many of you are going to be very reluctant to send something out like this to your patients for the fear they won't like your attitude and will end up leaving your practice. Nothing could be further from the truth.

We have received more compliments from these letters, both in the mail and in person than I could have ever imagined. The responses are so encouraging, it will help keep you motivated in the fight against managed care in your own little neck of the woods. This is a constant battle, and you need to stay on constant guard against this ever present problem. I have included a recent copy of one of these letters sent to my salaried Boeing patients. You may copy and plagiarize any or as much of it as you would like for any particular situation. I know the hardest part of writing any letter is just sitting down and starting it, so this should be a good beginning for you if you'd like to pursue this matter in your own back yard.

If you happen to have a big company in or around your location that employs a large number of your patients, it can become a major economic issue with your practice. Apathy is pretty rampant among both doctors and patients alike on this issue, but it is apathy that will end up creating an environment that no one is going to like. I know your patients will appreciate the time it took you to write them and they will tell you so. How many people have the opportunity to affect their future like this? Good luck to you! It really doesn't take much effort and the rewards can be extremely gratifying.

Dear Valued Patient and Boeing Employee,

It has been brought to our attention that your employer, Boeing, has decided not to renew its contract with Aetna. They are attempting to set up some different options with Delta, but nothing has been set in stone at this point. Aetna is even attempting to get involved with a proposal it has sent out to the dentists. To my knowledge so far, most dentists I have talked to are not signing up for any of these plans.

Let's look at the two Delta proposals: One is a Capitation Plan and the other one is a PPO (or a DPO).

With the DPO, there is a new, reduced fee schedule which is considerably lower than most traditional insurance plans, so your out of pocket expenses will also be lower. If the dentist is a provider, they will have to accept the lower fee schedule in exchange for these new contracted patients. You may go to any dentist you wish to go to, but if that particular dentist is not a provider, Delta will reimburse him or her at a lower rate and you must pay the difference.

How about the Capitation Plan? This plan pays the dentist a set fee every month to take care of your family, regardless of whether you come in or not. The fee is very nominal and in no way can even come close to paying the dentist's overhead for treating you and your family. The reason it works is because the dentist realizes the only way he or she can be profitable is to sign up as many of these patients as possible, and hope that most of them will not call for appointments. Many patients who have been on these plans return to our office and tell us they could never get an appointment. I ask you, is this the kind of treatment you want?

As you know, at our dental practice, we encourage regular preventative visits and optimum treatment. We feel we take the necessary time that each patient requires to get them in the best state of oral health while maintaining a friendly, relaxed, and most of all, personal atmosphere. We truly care for every single patient, and your continued feedback, compliments, and referrals of friends and family always make us proud.

We strive to provide you with top quality comprehensive dental care at a reasonable fee. It is unfortunate that many of these cost-cutting insurance plans cannot allow us to do so. I personally would not ever feel comfortable practicing dentistry in this type of environment.

At this point, you still do not have to pay anything for your coverage, so it is better than paying for the whole thing yourself. But you need to understand that the benefits being proposed to you are at a considerable reduction. Why does Boeing want to do this?

Administrative costs traditionally average about 40% for these plans, which means this is money that Boeing puts out for you that goes into someone else's pocket (Boeing and patients lose). Don't kid yourself, Boeing knows exactly how much money it is going to put out on this benefit, no more, no less. The only thing it doesn't know is how it is going to be packaged.

There is another fairly new benefit plan out there that can cut Boeing's costs 25%-35%, called Direct Reimbursement (DR). The savings that DR can bring could be shared by both the company (Boeing wins) and the patient with better benefits (patient wins). The insurance lobby is strong and the only thing that is going to change this is if the employees start objecting to it. Force Boeing to look at this DR option by getting the word out and getting united on this deal. If you sign up for these plans that you are currently being offered, in the long run, it will be a major reduction in benefits for you. Insurance companies want you to think that dentistry is a commodity, like buying apples or oranges, and I think you people who are my patients realize that nothing could be further from the truth.

I have been trying for the last several years to get someone at Boeing to listen to me about Direct Reimbursement. No one will! But this I can promise you: If you raise enough ruckus in large enough numbers they will listen to you. I have the contacts in some national organizations and at some major companies (like Eli Lilly, a major pharmaceutical company that has employed this approach for 20 years). If you sit back and do nothing, you will be receiving a reduced benefit and it will cost Boeing more money to implement the plans. If you need informational brochures on DR, let me know; I'll get you as many as I can to spread around to other employees.

If you have any questions or concerns, please call and speak to our staff or to me personally. We would be glad to help you through this decision-making process. Hopefully, this letter will clear up some of the confusion many of you have had recently about these new plans your employer is presenting to you. Good luck with your decision, and if we can help, let us know.

Sincerely,

Dr. Mark Troilo

P.S. I have included the front page of the ADA News. Note that Mobile Oil and Energy, with 14,500 employees, has just switched to DR. This is a very viable and creative method for you to keep your benefits at the level you have been used to.

P.P.S. The other brochures I have included are for your information. Please feel free to pass them around or call me if you would like more.