Who Else Wants Dentists Targeted for Tooth Tax?

tooth taxDo you think dental services should be taxed?

Apparently Vermont’s Governor Peter Shumlin believes so.

A $24 million new tax package was recently approved by the Vermont House Ways and Means Committee. They voted 7-1 on a package intended to help make up a $176 million projected shortfall in their state.

Fortunately for dentists and patients residing in Vermont, the package did not include Gov. Peter Shumlin’s plan to expand the provider tax to include dental services.

His “tooth tax” initiative would have imposed a 3% tax on the gross receipts of dental services.

Dentists in Vermont were outraged, and more than 4,500 people signed a petition with the VSDS opposing the 3% tax.

The Vermont State Dental Society vehemently opposed the tax, stating, “We believe it makes much more sense to tax items that hinder oral health like candy, soda and tobacco. Taxing health care to pay for health care is a math problem that just doesn’t add up.” The group called for dentists and patients alike to sign the petition through the VSDS website.

The controversial expansion of the provider tax to include dentists that would have raised another $3 million in revenue for the state.

Even though the increased tax would have increased Medicaid payments, dentists still believe a tax on dental services is the wrong way for the state to raise funds.

Should dental services be taxed? If you were in Vermont, would you have signed the petition?

For more on this story, see the Bennington Banner.

Dental Marketing: Direct Mail Marketing Seems Old-fashioned (video)

Direct Mail Marketing Seems Old-fashioned

Popular daily-deal sites such as Google Offers, Groupon and Living Social have exploded on to the Internet dental marketing scene. These sites make many dentists wonder if tried-and-true methods of marketing — like direct mail — still work for internal marketing.

Why wouldn’t they?

Dentists spend great sums of money to acquire new patients, and not continuing to market to proven buyers is truly a mistake. Regular patient mailings are one of the proven methods for dentists to stay in touch with their patients.

The Wealthy Dentist conducted a survey of dentists to find out if they regularly mail their patient base. A California dentist was quick to respond, “It’s a complete waste of time. Patients ask not to send them any more junk mail. This is not the 1970’s.”

Click on Play to see what the dentists have to say about direct mail marketing

Are you still doing direct mail marketing? Tell us your story in our comments.

Dentists: Are Dental Hygienists Worth Their Weight in Gold?(video)

Dentists: Are Dental Hygienists Worth Their Weight in Gold?(video)In our story, Dental Hygienists Among the Fastest Growing Occupations in the U.S. we revealed that the U.S. Bureau of Labor Statistics Occupational Outlook for 2008-2018 expects the demand to hire more hygienists to perform preventive dental care will continue to grow.

According to the ADA, independent dentists reported paying full-time dental hygienists $33.90 per hour in 2008.

Considering the current economic environment The Wealthy Dentist decided to conduct a survey asking dentists if they pay their hygienists an hourly wage or if compensation is based on commission.

It seems most dentists still pay their dental hygienists an hourly wage, but some feel paying on commission is more fair. Said one dentist, “Hygienists are worth their weight in gold!” Another dentist disagreed saying, “Practices couldn’t run without them, but the current economics barely breaks even at best … hygienists seem to think they are cash cows for the office and fail to recognize the support and facilities the utilize.”

It’s an interesting economic issue. Click on Play to hear more of what dentists say about paying hygienists —

How do you pay the hygienist in your practice?

Private Equity Dental Management Companies Come Under Fire

Private Equity Dental Management Companies Come Under FirePrivate Equity dental management companies are at the center of a U.S. Senate inquiry, audits, investigations and civil actions in six states over allegations of unnecessary procedures, low-quality treatment and the unlicensed practice of dentistry, according to a report released by Bloomberg News.

Federal lawmakers and state regulators are trying to determine whether a popular dental practice model funded by Wall Street is having a destructive influence on dentistry in the U.S.

The private equity dental companies only account for about 12,000, or 8%, of U.S. dental practices, according to Thomas A. Climo, a Las Vegas dental consultant.

In 2010, The Wealthy Dentist reported that All Smiles Dental Center Inc., a management company owned by Chicago-based Valor Equity Partners, filed for bankruptcy protection after a Texas Medicaid action cut off reimbursement payments because of their exorbitant amounts of orthodontic care at the expense of Texas taxpayers.

All Smiles was part of a state audit that discovered 90% of the Medicaid claims for orthodontic braces weren’t medically needed.

After years of criticism that the poor were being deprived of dental care under Medicaid, class-action lawsuits and public pressure forced Medicaid to change their health care reimbursements. As reported by The Wealthy Dentist in our story, Taxpayers Footing the Bill for Braces in Texas, some Texas’ dental practices went on to bill Medicaid $184 million for Medicaid orthodontics — more than the rest of the United States combined.

M. Alec Parker, executive director of the North Carolina Dental Society told Bloomberg News that the private equity industry stepped up its investments in dental management over the last 5 years partly because health care was one of the few areas that grew through the recession.

According to the Bloomberg report, Christine Ellis, a Dallas orthodontist, who testified before Congress in April of this year reported that the “flagrancy of the fraud” she found in audits she performed for Texas Medicaid “is truly unbelievable,” with only 10% of the paid claims she reviewed actually qualifying for Medicaid coverage.

Ellis told the U.S. House Committee on Oversight and Government Reform that Texas “has gained a lot of fraudulent orthodontic providers, including many private equity owned dental clinics engaged in the illegal practice of dentistry.”

Medicaid's Dental Boom - Bloomberg News

This May North Carolina is considering legislation that would subject agreements between dentists and the companies to state approval over concerns brought about by the the practices of private equity dental practices.

The Wealthy Dentist twice reported on the North Carolina Senate Bill 655 that would require the North Carolina Board of Dental Examiners to examine all business contracts entered into by dental practices in their state.

Our first article, Dentists Beware: The Government May Want To Tell You How To Manage Your Practice detailed information concerning inclusive authority over how dentists manage their business.

The second The Wealthy Dentist article, Dental Practice Management: North Carolina Senate Bill Wants Dentists To Do It Themselves discussed dentist responses to the impact this bill could have on their dental practices.

The measure has already passed the state Senate and has moved on to the House, where leaders have appointed a special interim committee to study the bill and its potential repercussions to dentists.

Reports have surfaced that the legislative proposal likely to be heard this month. The basics of the bill is intended to restrict contracts dentists can build with dental service organizations and give the Dental Board control of how dentists in North Carolina run their practices.

The North Carolina Dental Society supports the bill, stating that dental management companies often bill dental patients for unneeded care and opponents insist that passage of the bill will only drive up dental care costs.

What are your thoughts on private equity dental management practices?

For more on this story see: Dental Abuse Seen Driven by Private Equity Investments

Dental Associates vs. Hygienists: Who’s More Profitable?

Examine the Bottom Line When Considering a Hygienist and/or Associate
Editorial by Jim Du Molin

Have you ever wondered what your real profit is on your hygienists or dental associates? Have you ever wondered whether a hygienist can be more profitable to you than an associate? If you have an extra operatory available, would it be more profitable to hire a dental associate or another hygienist?

In last week’s column, I explained how you can earn a profit of $493 per day from a hygienist who produces $962. How much would an associate have to produce to yield the same profit? Here again, the Comparative Value Analysis is helpful.

Comparative Value of One Day’s Production

Provider: — Hygienists — Associate
Mary Tim Goal Equiv.
(Commission) (Salary) (Per op)
Production $700 $700 $962 $1,176
Collections (96%) 672 672 924 1,129
Less…variable costs (9%) – 63 – 63 – 87 – 106
…commission (41%) – 288 n/a – 482
…salary n/a – 288 – 313 n/a
…employer taxes (10%) – 29 – 29 – 31 – 48
Profit $292 $292 $493 $493

Let’s assume that you would pay the dental associate 41% of his or her production. (In reality, we normally recommend that the associate be paid a percentage of his collections. However, we will keep things simple here.)

Further assume that the associate would pay his or her own lab fees and assistant, and that you would not have to add any front desk staff to handle the associate’s patients and scheduling.

Your net profit rate on the associate would be as follows:

Net Profit Rate on Associate

Collections 96%
Less: variable costs – 9%
Less: commission – 41%
Less: payroll taxes – 10%
Profit 36%

The associate would have to produce $1,176 per operatory used to give you the same profit as a hygienist. If the dental associate used two operatories, he or she would have to produce $2,352 per day to be as profitable as hygiene would be in those same operatories.

In our experience, it is easier to bring hygiene production up to $960 per day than it is to find a dental associate capable of consistently producing $1,176 in each operatory, or $2,352 in two operatories. Also, the associate must have a sufficient flow of patients to make this production level possible.

When structuring both hygiene and associate compensation, we advise that you compare what the hygienist or associate is earning on the relationship, compared to what the senior dentist is earning. The relative compensation levels should reflect a fair distribution based on the parties’ investments of time, energy, and financial risk.

For help in increasing hygiene production, a key element to increasing doctor profitability, contact J.P. Consultants or Advance Hygiene Concepts.

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