Social coupons

Ethics Social coupons Background.—One way that people cope with the stresses of the current economic downturn is through the use of social coupons to obtain services and goods at discounted prices. Businesses use these coupons to get people to purchase their services or goods with the hope that they will grow their customer base. Social coupon companies have set up programs whereby dentists specify the treatment or service to be offered and then the company markets it for them. Usually the service or treatment is offered at a discount of at least 50% from the usual fee, with the company keeping about 40% and the remainder sent to the service provider. The dentist receives the money up front and is paid whether or not the patient uses the coupon. The legal and ethical issues that arise with this approach are many and should be addressed before proceeding with this marketing tool. Legal and Ethical Concerns.—Making an arrangement with a social coupon company might be seen as fee splitting, especially if the company collects the fee and keeps some of the money. Some states have laws that would be violated by this arrangement, and the federal ‘‘Stark Law’’ can become an issue if the dentist treats patients who receive Medicaid or Medicare and does not offer them the same benefits as other patients of the practice. The American Dental Association Advisory Opinion 4.E, Rebates and Split Fees, bears directly on this matter, prohibiting such activities. The problem may be overcome if fees paid by the patient go directly to the dentist, who pays the company a fee for promoting the coupon. Some insurance reimbursements are set based on the provider’s average fee for a procedure, so offering and performing the service for a reduced fee may lead to lower reimbursement from the insurance company. If some coupon-holding patients have dental insurance and the insurance company is billed for the dentist’s full fee instead of the actual amount paid by the patient, there could be a charge of insurance fraud or misrepresenting fees charged. Copayments by patients must also be considered when there are third-party payers. Problems may arise if the dentist keeps the fee but does not perform the service because the coupon holder does not redeem the coupon. Consultation with the practice attorney regarding state

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Dental Abstracts

and federal laws that may apply to social coupon usage is advised. Sometimes people who purchase coupons already have a dental home but want take advantage of the low price for services. This could encourage patients to abandon their dental home and shop for the best deal for treatments instead. This alters the dentist’s ability to perform in a professional role for these patients and can hinder continuity of care. This kind of risk could be a violation of the ethical duty to do no harm as well. Other Issues.—Another important consideration is whether the person who purchased the coupon actually needs the service being discounted. To avoid this problem, the dentist may need to perform services such as dental examinations and radiographs before the service for which the coupon is good is done. The coupon holder may feel that the coupon is a bait-and-switch tactic in these cases, where he or she has to pay for services before using the coupon. This is appropriate dental care, but should probably be disclosed in the description of the deal being offered. The dentist should specify that other procedures not covered by the coupon may be needed before the coupon can be redeemed. Offering discounted services may create the perception that the reduced fee is more important than the quality and safety of the procedure being done. This is a disservice to patients but also to the dental profession.

Clinical Significance.—Although social coupons can offer a valuable marketing tool for dentists, this approach is not free of complications. Dentists should proceed cautiously in this area to avoid compromising patient care and to maintain a practice free of ethical and legal issues.

Rosato R: What are the ethical implications of using social coupons to expand my patient base? J Am Dent Assoc 143:1035-1037, 2012 Reprints not available