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Fee-for-Service vs. Capitation
restore centric relation stops on large occlusal posterior restorations cannot be ignored. It is not an easy ta sk w ith patien ts clam oring to be beautiful overnight and the lure of th e alm ighty buck. Drs. K eith and Glym an’s article, “Infratem poral space pathosis,” would m ake any d en tist who tre a ts TM J more a stu te in considering the differential diagnosis in these cases. It is im portant to note th a t some of the lesions they describe are not easy to pick up w ith even th e m ost up-to-date radiologic and im aging techniques. V icto r J . N itti, D.M.D. W ood R id ge, N .J. FEE-FOR-SERVICE VS. CAPITATION
I find th e article “Capitation: th e choice is yours” by Dr. Jam es Pride to be slanted editorially tow ard the author’s viewpoint of the advantages of fee-for-service compared to capitation. In my 21 years of practice, I have seen ab u n d an t pitfalls and abuses in all delivery systems. Some provider contracts for capitation plans are so poorly w ritten as to guarantee inferior p atien t care. I have also seen ram p a n t abuse from unchecked overutilization on fee-for-service program s. I agree w ith th e author th a t “th e choice is yours.” All practicing dentists can, to a degree, determ ine th eir practice philosophy. No d entist should feel forced by peer pressure to practice dentistry in a m anner in which they are uncom fort able. Those who enroll in 12
JADA, Vol. 123, January 1992
capitation plans because of a perceived economic th re a t and then take hostile feelings out subconsciously on the poor enrollees in the plan are doing nobody a favor. Nor are dentists well advised to en ter into m anagem ent contracts w ithout a full understanding of th e inherent underw riting risks atte n d an t w ith the contract and obligation to perform to the sam e stan d ard of care of the community, irrespective of the details of com pensation in the contract. I urge the author to seek out more “win-win” capitation practices, th en incorporate some of the solid m anagem ent principles from the m inds of owners of successful capitation practices into his m anagem ent sem inars. C apitation dentistry can be m anaged in a way where everyone cornés out a w inner, and the p atients receive good dentistry. I doubt th a t capitation will overshadow fee-for-service in popularity in my lifetime, b u t it does no service to anyone to continue to look a t the concept in such a negative light. A more positive contribution to the nationwide com m unity of dentists would be to help promote good sound practice m anagem ent advice which can be applied to all patients, irrespective of th e m ethod by which th eir services are being paid for. A lan M. G rant, D.D.S. L on g B ea ch , Calif. THE CHOICE IS YOURS
In “Capitation: the choice is yours,” Dr. Jam es Pride
presents a negative view of dental capitation plans. Some of Dr. P ride’s advice to the young dentist who wrote to him should be tem pered by the fact th a t not all capitation plans are alike. The adm inistrative structure, reim bursem ent and degree of tre a tm e n t coverage varies greatly between capitation plans. D entists need to thoroughly exam ine each plan before deciding w hether it m eets their criteria for participation. I personally participate in one capitated program . This program has increased its m onthly capitation fee annually. Additionally, th e plan fully capitates m inor restorative and preventive services and requires p atien t copayment for all other services a t approxim ately 70 per cent of standard fees. My participation has been profitable, and has caused no difficulties in in tegrating the enrolled patients into my practice. I have chosen not to participate in other capitation plans because no others have m et my criteria for my p articular practice and because I feel th a t capitation plans have a lim ited place in a traditional general dental practice. M ichael J . T u llm an , D.D.S. P h ila d e lp h ia NEW JADA FORMAT
I have ju s t completed reading th e November issue of JADA. I realize th a t the new form at started earlier b u t I didn’t realize how m uch easier it is to read and enjoy. The layout and design departm ent need to be commended.
I find th e article “Capitation: th e choice is yours” by Dr. Jam es Pride to be slanted editorially tow ard the author’s viewpoint of the advantages of fee-for-service compared to capitation. In my 21 years of practice, I have seen ab u n d an t pitfalls and abuses in all delivery systems. Some provider contracts for capitation plans are so poorly w ritten as to guarantee inferior p atien t care. I have also seen ram p a n t abuse from unchecked overutilization on fee-for-service program s. I agree w ith th e author th a t “th e choice is yours.” All practicing dentists can, to a degree, determ ine th eir practice philosophy. No d entist should feel forced by peer pressure to practice dentistry in a m anner in which they are uncom fort able. Those who enroll in 12
JADA, Vol. 123, January 1992
capitation plans because of a perceived economic th re a t and then take hostile feelings out subconsciously on the poor enrollees in the plan are doing nobody a favor. Nor are dentists well advised to en ter into m anagem ent contracts w ithout a full understanding of th e inherent underw riting risks atte n d an t w ith the contract and obligation to perform to the sam e stan d ard of care of the community, irrespective of the details of com pensation in the contract. I urge the author to seek out more “win-win” capitation practices, th en incorporate some of the solid m anagem ent principles from the m inds of owners of successful capitation practices into his m anagem ent sem inars. C apitation dentistry can be m anaged in a way where everyone cornés out a w inner, and the p atients receive good dentistry. I doubt th a t capitation will overshadow fee-for-service in popularity in my lifetime, b u t it does no service to anyone to continue to look a t the concept in such a negative light. A more positive contribution to the nationwide com m unity of dentists would be to help promote good sound practice m anagem ent advice which can be applied to all patients, irrespective of th e m ethod by which th eir services are being paid for. A lan M. G rant, D.D.S. L on g B ea ch , Calif. THE CHOICE IS YOURS
In “Capitation: the choice is yours,” Dr. Jam es Pride
presents a negative view of dental capitation plans. Some of Dr. P ride’s advice to the young dentist who wrote to him should be tem pered by the fact th a t not all capitation plans are alike. The adm inistrative structure, reim bursem ent and degree of tre a tm e n t coverage varies greatly between capitation plans. D entists need to thoroughly exam ine each plan before deciding w hether it m eets their criteria for participation. I personally participate in one capitated program . This program has increased its m onthly capitation fee annually. Additionally, th e plan fully capitates m inor restorative and preventive services and requires p atien t copayment for all other services a t approxim ately 70 per cent of standard fees. My participation has been profitable, and has caused no difficulties in in tegrating the enrolled patients into my practice. I have chosen not to participate in other capitation plans because no others have m et my criteria for my p articular practice and because I feel th a t capitation plans have a lim ited place in a traditional general dental practice. M ichael J . T u llm an , D.D.S. P h ila d e lp h ia NEW JADA FORMAT
I have ju s t completed reading th e November issue of JADA. I realize th a t the new form at started earlier b u t I didn’t realize how m uch easier it is to read and enjoy. The layout and design departm ent need to be commended.