Do you take my dental insurance? Nope and Here is Why!

Lately, I have been thinking a lot about the dental insurance industry and the public's expectations of it.  I am not a participating provider in any plans. 

Why, you ask?  Please read on.  

The definition of insurance: a practice or arrangement by which a company or government agency provides a guarantee of compensation for specified loss, damage, illness, or death in return for payment of a premium.

The key phrase with this definition is: "guarantee of compensation".  

Some examples:

If my home burns down, gets damaged by hail, or ruined by a flood, I expect that my homeowner's insurance will compensate me to rebuild my house and help to replace my belongings. Of course, after I pay my deductible.  I don't expect my homeowner's insurance to pay for my replacing air filters for the heater. I don't expect them to pay for caulking of my shower on a regular basis. I don't expect them to pay for the blowing out of my sprinklers or cleaning my air-ducts. 

If I get into a car accident, I expect that my auto insurance will compensate me to fix or replace my car and help with any injuries as a result of the accident. Again, after I pay my deductible.  I don't expect them to pay for my oil changes, my brakes, rotating of my tires or other preventative measures that I would take on a regular basis to keep the car running smoothly and safely. 

If I get sick, I expect my health insurance to cover for my medical bills after my deductible is met. I trust that my physician knows what is best specifically for the treatment of my medical problem and recommends things in my best interest.  I don't expect my plan to pay for my health club membership, healthy organic eating choices, vitamins or anything that would help me be more healthy proactively.  

Now let's look at dental insurance -

A typical dental insurance plan will pay a certain amount per year for your dental treatment in the range of $1,000-$2,500.  They pay a percentage of the procedures done and fix costs that your dentist can charge for these procedures.  In some states, they control the prices for procedures that they do not cover, but that is another story for another time. There may be a deductible to pay as well as the monthly premiums.  

Let's base these scenarios on the dental insurance model - 

If my home burns down, my insurance pays me $1,500 and I am responsible for paying everything else to rebuild my home, I am responsible for replacing my possessions lost in the fire.  There may or may not be a deductible. They may ask for a pre-estimate of the worth of my home and possessions but that but burned up in the fire and delay the payment accordingly.  Even though the maximum amount they will pay is $1,500.  Oh by the way, your deductible is $1,000... They don't care that you have been doing regular maintenance around the home on a regular basis.  They will question the use of certain pressure fire hoses to put out the fire saying that a garden hose would have been sufficient. Or they may have down-coded the use of a fire truck to a typical water pail passing line that was used in the 1,800's.   

If I get into a car accident, my insurance pays me $1,500 according to my plan, and I am responsible for the remainder of the damage, paying for any injuries, etc. Typically there is a deductible of $2  50-$1,000. I find out that they only pay for 50% to replace my tires.  They won't tell me 50% of what however.  I choose the same tires that I had on the car and they proceed to say that I was overcharged at the tire store that they recommended I go to.   I find myself questioning what benefit I am getting here as I add up my monthly premiums and the payout in my head...."Is this really worth the hassle?"

If I get sick and in the hospital, my insurance pays me my $1,500 while I am responsible for any blood work, x-rays, MRI's, surgeries, medications, ongoing therapies, etc....deductible? As an aside, I ask my physician how much each of these tests she is recommending are going to cost.  Blank stare...After an uncomfortable 60 seconds of silence I burst out, "Doc, I need to know how much this is going to cost me!"  She replies, "I don't know, I can have my office manager check what your benefits are and get back to you tomorrow"  

In any of these alternate scenarios, my financial responsibility would be catastrophic. 

Dental insurance is a misnomer.

It is not insurance.  It is a pre-paid benefit plan. It is in fact the opposite of insurance.  It covers the deductible and you cover the rest.

I think dental insurance is great for basic dentistry - cleanings, check-ups, x-rays, a filling here or there, etc.  If things get complicated with your treatment, your benefits will cover only what they cover based on the plan and nothing more.

What the benefit company isn't telling you - "We are great for basic dental care but don't expect us to be like homeowner's, auto or medical insurance.  Those insurance models cover you to prevent catastrophic loss.  We don't...Please set your expectations accordingly."

I choose to have a relationship based practice.  I take the time to get to know my patients and help them to discover and achieve their oral health goals.  Together my patients and I look at all the options with the pro's and con's of each.  Most of my patients have dental benefits and we do everything to help maximize those benefits for our patients.

As a result, I choose not to participate with these benefit plans.  I wish to have a relationship primarily with my patients.  A relationship that is not tethered by the restraints put on by an insurance company that has never met their subscribers. You are a number to them, a potential for them to pay out against their profits.  I view the relationship that I have with my patients as the most important aspect of my practice. I will only recommend treatment that is in my patient's best interest in achieving their goals for their teeth and smile.

By the way, if you don't have dental insurance, basic dentistry is fairly affordable and the cost of prevention is much cheaper than the cost of complicated dentistry caused by missing regular dental checkups!

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Dirty 30 race report

Well I have another ultramarathon under my belt.  As usual, it not only challenged me physically, but emotionally and spiritually too.

The Dirty 30  - a 50K in Golden Gate Canyon, CO.  It was actually 32 miles but I guess that doesn't make for a good name....

Gary and I pre-race

Start line

I sent my running partners Gary and John an email back in January telling them I was thinking about doing this race - any interest?  John didn't - he was done doing long races (I should probably follow his lead at some point!).  Gary liked the idea and the challenge.  We have adventured together for several years (Gary 20+, John 10+).  I don't ever look at the race details, just the pictures from the course.  Gary immediately looked at the race details and came up with a plan - we would have to run 19 minute miles, plan our nutrition and we will make the cut-offs.

We went to Golden Gate Canyon several times to recon the course.  It was usually snowy and cold.  We both got busy with life and didn't train or recon to the level that we should have.

This race was a bitch. No if's and's or but's.  It was a bitch!  It was one of the most challenging days I can remember.

For training, I did several mountain runs, however none more than 15 miles. I raced some snowshoe races this winter but they were only 10K.  The bottom line....I was under-prepared.

We decided to opt for the early start as we were going to need the extra time.  There were 50 +/- of us that opted to suffer more than the rest of the crowd.  The weather forecast looked favorable for a great race (low of 40, high 65, no rain).  The sun was just starting to rise, the nervous energy was palpable.  Most of the early starters were first time ultra competitors.  The race director, Megan, called them SISU's.

From the website, "Sisu is a Finnish word that cannot be properly translated into the English language, but is loosely defined as stoic determination, bravery, guts, resilience, perseverance and hardiness, expressing the historic self-identified Finnish National Character.  Sisu is about taking action against the odds and displaying courage and resoluteness in the face of adversity. Deciding on a course of action and then sticking to that decision against repeated failures is Sisu."

I admit, I was a little jealous of the attention that was bestowed upon the newbies.  I knew I was going to suffer today.  The question, "Would I be able to overcome the challenges ahead (and display the qualities of Sisu)?" loomed large.

Go!

I started out in 4th place (for about 100 yards - lol).  Over the course of the day, all but a few would pass me en route to the finish (500+).  For me, this was not a race against the other racers, this was a race against the trail, the conditions, the clock and most importantly, my brain.  My goal was to finish before the course closed.

My race strategy was to power hike all of the uphills, try to run the flats and downhills.  Drink water every 10 minutes or so, try to eat every 30 minutes.  I had a smorgasbord of food in my pack.  I try to eat real food early to keep my stomach happy. Then later, gels, bars, anything that I can tolerate. Over the years, I learned to have a good nutrition plan but be flexible as I never know how my body will respond on any given day.

I also used hiking poles.  They help me with the uphills and more importantly take 20-30% of the weight on the downhills creating less jarring to my knees and hips.  It engages my core and helps with balance - especially in the technical portions.  I did a lot of training at Orange Theory Fitness the past 1.5 years.  This has taught me focus (on the dreaded treadmill and rower), has given me some serious core strength, raised my aerobic capacity and anaerobic threshold.

Back to the race....

The word that best describes the first half of race for me - HUBRIS - I was full of it.  I kept thinking that this is going to be easier than other races/events that I have done - Grand Canyon, Leadville Marathon, Skyline to the Sea, Snowshoe marathons, etc.  Time goals started to creep into my head. "If I can do Leadville Marathon in under 7 hours, this should be easy!"

We were flowing through some nice non-technical singletrack. There were some climbs but nothing too difficult.   I always go out too fast, I always go out to fast, I always go out too fast.  Maybe one day, I will figure this out.  Gary was hanging back. He is much more disciplined than I.  I would get to the aid stations first and regroup while he steady paces his way in.  Today, I didn't realize that he was struggling with cramping and calf pain.

At around mile 9 the trail turned into a crazy technical rock skree field (elevation ~9500').  No running here.  I wondered if there was going to be a lot more of this.  It was totally un-runnable - up or down. The trail started to humble me.  The terrain reminded me of the top sections of Mt. Grey's and Torrey's.  I have climbed several 14-ers and it has proved to be great training for this - both mentally and physically. I was extremely glad for the hiking poles here! We then descended into aid station 2.

We left aid station 2, 40 minutes ahead of schedule still feeling pretty good.  12 miles done - 1/3 of the way there.  The trail out of aid 2 started to climb.  It was steep and long.  The negative thoughts started creeping in.  I ate some food but my stomach wasn't feeling that great.  I was forcing food and drink down. It was almost 5 miles to the next aid station.  It was 5 miles to the next bathroom.  It became clear that I would need it.  There was a sign that said 1 in 100 ultra runners poop their pants.  I was determined not to be that one....Though at times, it was getting close!

The trail descended for 2 miles with a 1000 foot elevation loss into aid station 3.  When the trail goes downhill, I think that I am the king of the world.  The trail flows and time flies. The hubris crept back in.

Aid 3 is 17.4 miles in.  WELL over half way!  There was a volunteer with a sign that that made me laugh so hard, I had to take a picture with her.

I paid a visit to the outhouse to drop some weight.  Now all was well in my world.  Lower bowels were empty and I still had a spring in my step.  I had a drop bag to replenish my food.  I changed socks, wet my head and I was ready to tackle the second half of the race.  Unfortunately Gary dropped at this point. He was cramping really bad.  He didn't think he would make it to the cut off in time to continue on in his current physical state. He called it a good training day and dropped out. There were a lot of people dropping at this point.  Seeds were planted in my brain, though I didn't know it at the time.

The temperature was much hotter than the forecasted 60 degrees - I cursed at the weather man for giving me unrealistic expectations.  It was probably 80 degrees in the sun.  I exited aid station 3 to a grinding 2.5 mile (1200') climb.  I was starting to cramp.  I took several breaks along the way.  The flats and downhills now became shuffles instead of runs.  I was breaking down.  This section was 8 miles to the next aid station.  It was very technical.  I was alone for most of it.  There were a half dozen or so of us suffering, passing, resting, leapfrogging each other.  I felt my attitude plummeting faster than I could run downhill.

I got it into my mind that I would drop at the next aid station as I thought I would only have 50 minutes to make the cut-off from aid 4 to Windy Peak. - the last obstacle of the race.  I thought that distance was 5 miles.  I was now shuffe-walking - visualize Marty Feldman's Igor in "Young Frankenstien" (walk this way).  That was my running gate.

I arrived at Aid 4 (mile 25) and accepted my fate.  My hubris had turned to humiliation. I was defeated. I rationalized that 8 hours, 25 miles was still a good day. It had been a long time since I didn't finish a race - maybe I was due?  My cramping was fierce at this point. I was quite dehydrated.  I sat down in the shade.  I told them I didn't think I would make the 5 miles in 50 minutes.  They immediately started questioning my logic.  It was only 1 mile to the 3:00 cut off.  I had plenty of time.  Fuck, Fuck Fuck! I guess I didn't really have an excuse anymore.

This aid station was probably the best aid station in the history of aid stations.  I ate fresh fried pirogies, boiled sweet and white potatoes dipped in salt, avocados, chips, watermelon and popsicles. Yes - Pirogies and Popsicles how much better could life be!?!  I must have sat and ate for 15 minutes straight.  I accepted that I couldn't use the "I'm too slow excuse" and I was resigned to gut out the remainder of the race.  I refilled my water bladder and set out to finish.   I also took a lifeshotz vitamin boost.  It couldn't have come at a better time. I knew my wife Gina would be proud! I felt awesome!

The rest and food really energized me. My "Igor" gallop turned again into good running form and I was going as fast as I had a the beginning of the race.  I was back in the flow.  Again, I was pretty much alone as almost everyone in the race has passed me by now.... I knew that this rejuvenation wouldn't be long lived, but I would ride it out as long as I can.  I was at the cut off in 8 minutes as it was all downhill.

I turned into a steep downhill single track in the woods. there were several familiar faces coming up looking really tired.  Ominous warning.  I am cruising along and I start to feel something dripping down the back of my legs.  I thought, "Is it water or blood?" Thankfully it was water.  I must not have secured shut my water pouch.  I pulled it out of the pack and there were several hole in it.  Fuck, Fuck, FUCK!   How does this happen?  And what timing!!

 A random hiker offered to lend me her bladder, I politely declined.  The lowest holes were about 2" from the bottom of the bladder.  I could keep about 16 oz of water in the bladder.  I knew that wouldn't last long.  I still had 8 miles, and the hardest part of the course was looming large ahead of me.

The climb to Windy Peak was 2.5 miles and 1200'.  Alone, it wouldn't have been too difficult.  It was now mile 26, exposed in the hot sun and 8.5 hours of running thus far.  I was still able to run the flats and the short downhills.  The uphills started to become more technical and steep.  I was able to maintain with several breaks.  My legs were starting to cramp again.  I took some salt tablets and took a big pull from my water hose.  About 5 minutes later, the cramping got real.  I felt like I was on the edge of full tonic-clonic seizure.  I drank the remainder of my water.  I thought I was close to the top, but I was very wrong.  I took it easy, modified my gait to minimize the cramping.  I was in trouble.  I sat along the side of the trail and massaged my calves and thighs to to try to flush out some of the lactic acid.

I started asking other runners for water.  I had salt deposits all over my clothes, face and hat.  I was pale and my heart rate wouldn't come down.  The other runners let me take pulls off their water hoses.  One trail angel named Charles had a spare bottle in his pack that he gave to me.  This guy saved my race (and most likely, my life!)  I drank a good bit of it quickly, took more salt pills and marched forward.  I summited about 20 minutes later.  I took a picture at the top.  Sat down for a few minutes and drank the remainder of my water.

Top of Windy Peak Mile 28 - Cue the butterfly!

I heard the volunteers talking about me that I was out of water, not looking so good.  There was some chatter on their walkie talkies about sweeping the course.  However, the only way to safety would be to finish.  I needed to go about a mile downhill to get some more water.  I better get moving.  I didn't want to DNF at this point!

I was back to my "Igor shuffle".  All downhill from here (except for the uphills...).  I started to reflect on my life.  My mom is not doing well with her health and her situation weighed heavy on my at this section.  The emotions were strong at this point.  I decided to turn on some music.  Foo Fighters - "Times like These" started playing.  Couldn't have been more appropriate.

About half way down, four high school boys were coming up the trail  They asked me if I saw a guy with a white hat on.  They were bringing up water for him.  I wished it was for me, but I knew I could get water fairly soon and didn't want to take it away from someone who "really" needed it.  I told them somewhat sarcastically that there were hundreds of runners with white hats.  I had a tan hat on.  They kept going up, I kept going down.

I come up to aid 5.  One of the volunteers asked me if I got the water that they sent up for me?  Fuck, Fuck, FUCK!!!  I told her that I didn't think it was for me as the boys specifically said a guy in a white hat.  We both had a laugh.  I sat and drank water and tailwind electrolyte replacement.  2.6 miles to go.  I got up and headed for some more downhill.

I could hear the cheering at the finish line but I couldn't see it.  The last mile seemed like it took forever.  There was a prize for "last ass off the pass".  I was thinking that I had a good shot a winning some money.  I slowed my pace a bit to come in 5 minutes before the official cut off.  Turns out there were a handful of people still behind me.  No prize....

I finished with some people at the finish line but not the crowd I felt I deserved - lol.  Gary was there to support.  He guided me towards the food and we exchanged stories from the battles that were fought today.  Lot's of emotions.  As we were talking, I realized that I had to really had to dig deep to finish.  I was in awe that I finished.  It was a definite character builder!

Thank you Megan and all the volunteers on the course.  There were supporters dressed as clowns, sunflowers, I think I saw cookie monster, and a sadistic sexy police woman in fishnet stockings (she sent the water for me). The aid stations were well stocked with great food, supportive volunteers and great energy.  The views form the trail were absolutely spectacular and the pictures on the website don't do it justice.  A great time was had by all!

http://dirty30.org/golden-gate/course-info/

At the finish.  Full of salt!

I have to thank all those that support me along the way.  Especially my wife Gina, my kids and all my family and friends near and far.  I thought of so many of you on my run while in solitude for almost 11 hours today.  I feel blessed to have the life I have and the people in it.  Gary - always my partner in these crazy adventures.  You will get it next time. And John, you would have loved this race.

 My favorite quote from a sign today:

I am definitely a "special kind of idiot!"

I Try Not to Get Political - But....

"I Have a Dream" - the MLK Step at the Lincoln Memorial at sunrise

Once again, I was honored to have been chosen as part of a delegation to represent Colorado dentists and attend the Washington Leadership Conference put on by the American Dental Association. It is an opportunity for leaders in dentistry to meet with our national legislators to educate and advocate best practices and trends that we are seeing.  In a time of such flux with the delivery of healthcare, we offer perspective that hopefully will help shape health care and ensure that we can best serve our communities.

It was an interesting social and political time in the area.  A man named Freddie Gray was killed while in police custody shortly after being arrested.  Sadly, a much too common occurrence not just limited to Baltimore, but across the nation. The protests began peacefully but soon turned violent.

I was Baltimore to attend the Orioles game on Saturday evening. There was a palpable energy inside and around the stadium due to a strong police presence. At the game’s conclusion, the fans were not allowed to leave for their own safety until the riots had calmed.  

As time marched on, the riots continued. Buildings were damaged and looting ensued.  People were injured.  The National Guard was called in, and a curfew was instituted. CNN and Fox News were having a paparazzi feeding frenzy with a countdown to the mandated curfew. There were several more arrests and a public outcry….The entire situation was sad to witness.

Order was not restored quickly.  It wasn’t safe to be in the area.  The following day the Orioles game was cancelled.  Oddly, the next day’s game was played to an empty stadium.  Never before has a Major League baseball game been played in an empty stadium.

Pictures from the game which no one watched

Back in DC,  we dentists were meeting with our legislators.  Several of our legislators mentioned that they were invited to various “State”events (dinners, lunches, etc) with the President, who was hosting the Japanese Prime Minister. 

The Japanese Prime Minister (Shinzo Abe) must have been wondering about how the free speech thingy (1st Amendment) is working for us….I am sure that President Obama was thinking the same thing.  At a press conference to introduce the PM, POTUS took a few minutes to address the rioting. 

He recognized first that the rioters who were committing unlawful acts were not helping the situation.  They were no better than criminals and thugs taking advantage of an opportunity to be destructive. 

He then balanced his displeasure at the fact that some police officers/departments are not doing what is mandated that they do -"to protect and to serve”.  They too needed to reform and be held accountable.  

He continued to address the core issue with some of the most profound and inspiring words I ever heard him say.

"Without making any excuses for criminal activities that take place in these communities, what we also know is that if you have impoverished communities that have been stripped away of opportunity, where children are born into abject poverty, they’ve got parents often because of substance abuse problems or incarceration or lack of education themselves can’t do right by their kids, if it’s more likely that those kids end up in jail or dead that they go to college, in communities where there are no fathers who can provide guidance to the young men, communities where there’s no investment and manufacturing’s been stripped away and drugs have flooded the communitiy and the drug industry ends up being the primary employer for a whole lot of folks… In those environments, if we think that we’re just gonna send the police to do the dirty work of containing the problems that arise there without as a nation asking what we can do to change those communities, to help lift up those communities and give those kids opportunities, then we’re not going to solve this problem.

America, the land of opportunity - has no opportunities to thrive. 

Without opportunity, there is no hope to dream. Frustration ensues and more riots are going to occur. 

We must return to our roots- the ideals that serve as our country’s foundation - life, liberty and the pursuit of happiness.  

We need to take back our freedom.

We must accept that to right the ship, there are no simple answers.

We all are going to need to sacrifice for the betterment of the whole.

The finger pointing needs to end now.  

We need to work together to figure out solutions that spur opportunities for everyone to contribute. Americans have always had the creativity combined with the spirit to make this happen.  

We real solutions, not more riots…

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Who is John Galt? How Corporate Dental Offices are Disrupting the Status Quo.

Who is John Galt?

Disruptors in Dentistry

By Brett Kessler, D.D.S., CDA President

"I started my life with a single absolute
That the world was mine to shape in the image of my highest values
And never to be given up to a lesser standard, no matter how long or hard the struggle" Ayn Rand, Atlas Shrugged

Disruptors are innovators.  They are businesses that shift a mindset of how consumers think, purchase, etc. – thereby challenging established businesses.

Harvard Business School professor and disruption guru Clayton Christensen says that a disruptor displaces an existing market, industry, or technology, and produces something new and more efficient and worthwhile. It is both destructive and creative.

Some examples of disruptors are companies like Apple, Netflix, Amazon, and Uber.

I identify Apple not for the computers that it builds, but for another niche that it took over – music and listening device sales.  iPods, iPhones and iTunes have changed how we buy and listen to music. There are hardly any CD stores remaining other than those that sell used discs.  When I grew up, I would buy records.  The cover art would attract me to give new bands a listen.  I judged the band by entire albums that it recorded.  Today, we buy songs, not albums. They are instantly downloaded onto our computers.  No waiting in lines; no browsing through tedious shelves of records/CD’s.

We create playlists with the drag of a mouse.  We use auto shuffle and the “genius” feature to create our own personal radio stations. They connect to our cars, our phones, our tablets and all are stored on our computers.  CD players are becoming a thing of the past.  Music is stored on hard drives, flash drives, iPods, etc.

Netflix took how we rent movies to a new level.  For a low monthly fee, we can have unlimited movies shipped to our house – hassle free – or immediately available to view on our computer or smart TV’s through an internet connection.  Blockbuster used to charge late fees, “you-didn’t-rewind-the-VHS” fees, etc.  I dreaded having to pay this fine. The buying experience was a hassle and expensive.  Netflix is easy, customized to my preferences and instant. Are there even any Blockbuster stores left?

Amazon capitalized on the fact that a book is still readable after it had been read, music is still listenable after it had been listened to, and anything should be able to be purchased on the internet easily!  They created a personalized buying experience based on your browsing and buying habits.  It greatly affected the big chain bookstores like Borders or Barnes & Noble.  It also helps you find the lowest price for a commodity and they deliver it right to your door.  If it wasn’t exactly what you were looking for, ship it back.  Hassle-free!

Lastly, Uber is putting a huge dent in the taxi business. With Uber, you can press a button on your phone app and a nice clean car will be at your location within 15 minutes. Taxi’s get to you when they get to you and the entire cab experience pretty much stinks!

All of these disruptors have innovated, streamlined and penetrated market share. They have challenged and even ruined wildly successful businesses, while reinventing the delivery of these services.  They have changed the consumer’s mindset and changed the paradigm on how these services should be purchased, used and consumed.  The consumer experience is exactly the way the consumer prefers.  We (the consumers) wouldn’t have it any other way.

Another commonality of these disruptors is that they didn’t just enter the marketplace and were welcomed with opened arms.  The status quo or “established” business model was not happy and tried to stop them.

In reality, the status quo was asleep at the wheel. They were lazy and arrogant. They felt they were too big to fail. Those established business models that survived disruption evolved their business models to better serve their consumers.

The question, “Who is John Galt?” comes to mind from Ayn Rand’s book “Atlas Shrugged.” John Galt represents creativeness and innovation.  In the book, the status quo was constantly putting up barriers to protect its own interests in how things always have been done.

The status quo must constantly channel its inner John Galt if it wishes to remain relevant to the people it serves.

There are disruptors popping up in every niche of business, and dentistry is definitely not immune. 

Large Group Practices, better known as Dental Support Organizations, are delivering dental services cheaper, quicker and more efficient than the typical private practice. A Dental Support Organization takes care of all of the business aspects for the dentist – the billing, HR, marketing, equipment, materials, etc. 

They are aggressively growing around the country.  They are aggressively hiring new dentists.  They are aggressively advertising their services.  They have created a niche for themselves and continue to attract patients.  Some may say that they haven’t perfected the consistent customer experience yet, but at some point, this too will change.

As in private practice there are good practitioners and those who could use a little nudge to “up their game.”  The reality with the Dental Support Organizations is that they are being judged by the lowest common denominator.  For every bad patient experience, the entire organization’s reputation takes a hit. If these companies are going to take their disruption to the next level, they need to shore up some of the weaker links in their organizations.  Trust me; they are aggressively evolving their internal practices to do just this. 

I recently attended a forum on Dental Support Organizations. DSO’s are growing 15-20% per year with over 7000 dentists employed, it was illustrated that the trend in healthcare is moving toward consolidation.  Consolidation breeds efficiency, in theory.  If you look around, there are very few privately owned pharmacies; there are very few private physician offices.  They have all been engulfed by corporate entities that manage the business side of the practices. Has it improved healthcare? I’ll leave that for the reader to decide. 

Many of us in private practice (the status quo) are complaining.  Of course, it’s only natural.  The realities are, however, if the private practitioners aren’t evolving their games, they will soon be wondering where their patients have gone. Maybe some of us already are!

Graduating dental students are being hired in droves by these practices.  I asked a recent graduate who was working for a Dental Support Organization what his favorite part was about working in this environment?  He answered that he has mentorship and professional networking instantly available to him.  He admitted he gives up some of his autonomy, but implied that no job is 100% perfect.  I would agree with that statement in private practice too.  There are parts of my day that I don’t look forward to doing (usually administrative) as well. 

Most of these dentists are not joining organized dentistry.  Why?  The most common response: they are made to feel “less than” for working for those companies. 

This must stop.  We (organized dentistry) are being judged by this fact, just as some may be judging those who work for entities different than private practice. The Colorado Dental Association is charged with advancing oral health in our state.  The DSO’s in Colorado are helping us achieve this.  They are just doing it differently than the “status quo”.

We need to be much better at welcoming our colleagues.  They are working the best that they can with the opportunities that are presented to them.  I always remind young dentists to keep the patient’s best interest as their main focus.  We have a must maintain our code of ethics as a profession.

The Association of Dental Support Organizations (www.theadso.org) has emerged to help set standards for it’s members and is looking to ensure that ethical practices are in place.

Evolution is the survival of the fittest.  Those who can adapt and create change will evolve into the new paradigm, and address the needs and desires of the consumers.

The status quo does not exist indefinitely.  It will constantly be challenged.

“Who is John Galt?”

Disclaimer: I am not passing judgment on these disruptors mentioned in this article.  I am just sharing my observations and thoughts.  I may or may not subscribe philosophically with various paradigm shifts occurring in the dental marketplace.  Each serves a niche that is attractive to various people.  That is why they are growing/gaining the market share and shifting the perceptions of the consumers. When I mention “organized dentistry” I mean ADA, state associations and its components.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Inalienable Rights

The Statue of Liberty stands proudly in New York Harbor. It stands as the universal symbol of freedom and democracy. This symbol stands for what makes our country great.

I love the practice of dentistry. I love the freedom that it offers us.

We have the freedom to cooperatively treat our patients, helping them achieve their goals in a predictable and satisfying manner. Patients are free to choose to go to any dentist they like. Dentists are free to choose to treat anyone they like and do any procedures that they like and vice- versa. As a result of these freedoms, we are an example of a free-market healthcare system that works.

Our professional autonomy (freedom), however, isn’t free. Eleanor Roosevelt said, “Freedom makes a huge requirement of every human being. With freedom comes responsibility.” The values of the profession must be actively upheld by us — the practicing dentists. If we are not diligent and stand for what is best for our patients, our profession will no longer be autonomous.

Author Peter Drucker said in the ’70s, “Those that are content to rise with the rising tide will also fall with it.” And when it falls, if we did nothing to better and preserve our work, we have no right to complain. In other words, if we are passively riding the waves, we will have no choice but to accept our fate when the wave crashes.

We are responsible to serve the needs of our communities. We have an obligation to stand up for the individuality of our practice philosophies. Our uniqueness is what makes our practices special and attractive to our patients. We cannot let outside entities influence our standards, our ethics and our decisions. We do what is best for our patients because it is in their best interest.

This past year, Colorado has introduced an adult Medicaid benefit to our state. They have allocated over $100 million to provide these services to those who are eligible. It is estimated that over 300,000 adults are now eligible for this benefit. The CDA worked closely with legislators and the governor’s office to create this benefit. As dentists, we directly witness the impact that dentistry has on those who need it.

We improve oral and overall health, we restore function, and we provide smiles.

We continue to fight hard to shape the benefits and make sure that our communities have access to our finest care. Our communities need Medic- aid providers to serve this need. We understand that the system is a work in progress, and are working daily on your behalf to address concerns to help the system run much smoother in coming weeks and months.

At the same time, we have the responsibility to provide care to Medicaid patients. Currently, there is extensive discussion among policy- makers and the public regarding gaps in Colorado’s dental health. If we are to make the case to the public that qualified dentists are the answer to access concerns, then it is incumbent on our profession to step up to the plate.

The fate of our profession is in our hands. “With freedom comes responsibility.”

Author Jim Collins wrote, “No matter how much the world changes, people still have a fundamental need for guiding values and sense of purpose that give their life and work meaning. They have a fundamental need for connection to other people, sharing with them the common bond of beliefs and aspirations. They have a desperate need for a guiding philosophy. More than any time in the past, people will demand operating autonomy - freedom plus responsibility - and will simultaneously demand that the organizations of which they are a part of stand for something.” We take this statement seriously.

What does the Colorado Dental Association stand for? The CDA is advancing oral healthcare to our communities — in the best way possible. It is here to support its members so we can provide the best, most appropriate dentistry to our patients.

Recently, the Colorado Dental Political Action Committee (CODPAC) met with 40 state legislators and candidates individually. It was an extensive task that involved hundreds of volunteer hours and immense coordination. The purpose of this endeavor was to further our relationships with key influencers, educate the legislators on our issues, and then strategize our legislative agenda.

We sent them information about key legislative priorities and our objective to make it as easy as possible for dentists to deliver the best possible care to our communities. We dialogued about possible solutions regarding these subjects: increasing Medicaid reimbursements, improving student loan forgiveness programs, dental insurance reform and preventing the introduction of a new mid- level dental provider in our state.

The legislators seemed genuinely impressed with our ideas, our passion and our mission.

The hard work that we have been doing over the past several years resulted in several congratulatory statements of support by the legislators. Respect for our profession has greatly improved. Today legislators look at us as experts to help guide and shape policy around oral health and oral health care delivery. But if we don’t fulfill our obligations, our influence will be gone.

Thank you to our CODPAC colleagues representing us. Thank you to our members for contributing to CODPAC and the American Dental Political Action Committee (ADPAC). These dollars are the best investment that you can make to preserve the freedom that we have. Please tell your communities how important it is to get involved either with monetary or voluntary contributions. Remember, we all must do our part in giving to the profession.

On the west coast there is a proposal to build another statue. This one is being called the statue of responsibility (http://statueofresponsibility.com).

It will symbolize this notion that freedom isn’t free. We are responsible for setting the standard and delivering the finest oral healthcare in this state. We take this seriously and by our actions, we will continue to enjoy our freedoms.

If you would like to make a donation to CODPAC/ADPAC please contact the CDA at info@cdaonline.org or 303-740- 6900 or 800-343-3010.

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can contact us  the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK

Advocacy in Dentistry - ADA Storms Capitol Hill - Washington, DC

United States Capitol at Sunrise

I was honored to be part of a delegation that went to Washington DC to provide dental care advocacy on behalf of the Colorado Dental Association and the American Dental Association.  We had a chance to meet with most of our Colorado legislators in person and if they were unable to meet with us personally, they had their health care staff expert meet with us.

This year we had three issues to bring forth.  The first was a reform on student loans hoping to get a reduction in interest and an increased tax deduction.  This is for everyone with student loans, not just dentists.  An interesting stat - Americans collectively owe $1.1 trillion dollars in student loans, much of it subsidized by the government.  It is quickly approaching the amount of money that we owe China ($1.4 trillion).   Congressman Paul Gozar, DDS (R-AZ) calls this a bandaid, a good start - but not a comprehensive solution.  The cost to go to college/graduate school must evolve as it is unsustainable.  Dentistry is the costliest of the professions to train and it is not unheard of for a dental student to finish with a $500,000 student loan debt.  This is a 30 year mortgage, not a student loan.

The second issue we discussed was an ask for grant money to help start initiatives that will serve those in need.  These grants will help states with initiatives such as "Give Kids a Smile", "Missions of Mercy" and community coordinators that will help people find a dentist via emergency room referrals, nursing homes, schools, etc.  The legislators asked where is the money going to come from.  We call this designated grant money an investment, not a cost.

For example, in Colorado - we have an event called Colorado Mission of Mercy (COMOM). COMOM is a 2 day event where dental professionals set up a temporary dental clinic in a big way.  Over a thousand patients are treated for free over the course of the event.  All of us bring our own dental tools and supplies and treat what is needed.  The cost to put on a COMOM is $160,000.  The amount of dentistry given to the community over a $1,000,000. This is money that won't have to come from government benefits such as medicaid.  The next COMOM is in October in Henderson, CO.

The third issue was a letter initiated by Rep. Paul Gosar, DDS (R-AZ) that we want our legislators to join in and sign.  This letter asked the Center for Medicaid and Medicare services to improve the fairness and transparency of Medicaid recovery auditors and their review process.  We believe that audits of medicaid providers should be done to catch providers trying to beat the system, but not on those that are doing their best to serve those in the community in need.

Currently, in some states, the process is "guilty until proven innocent" with very little opportunity for the provider to have any recourse to defend him/herself. It is difficult for dentists to want to join up to become medicaid providers when these type of audits are in place.

We also had a variety of speakers give us the current state of the political climate in Washington.  There is less than 40 legislative days left in session and due to stalemate political party posturing, they predict that very little legislation of any significance will get done.  Sad that this is the case.....

One of the best speakers was Rep. Peter Roskam (R-IL).  He was preaching to the choir when he said that the Affordable Care Act cannot put a price tag on caring for our patients.  He predicts that the "commoditization of health care" is going to drive down the opportunity for us to truly care about our patients.  I am doing everything in my practice to not let this happen.  I hope my colleagues will too.

A big revelation was how important our political action committees (PAC's) are.  Both ADPAC (national) and CODPAC (Colorado) raise funds to advocate to keep dentistry a profession of relevance.  This year alone, these PAC's have allowed us to spend time with our legislators to explain our needs so we can provide the best dentistry and services to our communities that we serve.

25 Things About Me

As my 46th birthday approaches, I decided to take a different approach to my usual rants here on my blog.

This was a facebook thing several years ago.  I retrieved my list from 2008 and updated it. It was a good reflection exercise for me.


Here are 25 things about me in no particular order -

1. I used to alter my mind with substances but found that it didn’t agree with my present or future plans…

2. I am inspired by positive changes in people, places and things...

3. Someone from my high school told me once that I when I grow up, I wouldn’t listen to heavy metal anymore….”F@%k -you old friend, I still do!”

4. My kids are exactly like my wife and I, and it is scary! We are raising our children Jewish…however, sometimes Sunday school interferes with our ski weekends and my mountain running “problem”…Sorry Rabbi Mo!

5. I love to run, bike, triathlon, snowshoe etc.… my favorite running partners over the years have been Gina, my Dad, my brothers and sisters, Gary Benson, Charlie Perez, Maggie Close, Liza Gualandi, John Stevens, Conrad LaPorte, Steven Griffith, Dave Lindeman, Brian Reick, all my Team-in-Training groups, my dog Kida and now Crosby.  Thinking back, Gary Benson has been sharing adventures with me for close to 25 years.

6. I love to run/play in the mountains. In fact, last fall I ran the Grand Canyon, South Rim to North Rim and back to the South Rim in less than 18 hours.  Other notable athletic accomplishments – Leadville 50 mile mountain bike race, mountain biked from Telluride to Moab, multiple marathons, trail marathons, and snowshoe marathons. (yes you read that right SNOWSHOE marathons)

Which segues nicely into….

7. My life is an adventure, just ask anyone!

8. I am a deeply spiritual person. I try to improve my faith every day. Sometimes I falter and my intentions don't align with my actions. I am human and there are lessons to be learned everyday….There is spirituality in imperfection.

9. I am excited to see so many friends that are on similar paths as I. I am proud to walk this path with all of you! You give me strength and hope when I cannot see it for myself.

10. I have an awesome dental practice, and an amazing team of people that I work with. (employees, patients, consultants, referring doctors, specialists, etc). I am proud of the lives that we impact through our dentistry. . I love being a dentist. I believe that the smile is the window to the soul. I do everything that I can to help my patients’ soul shine through.

11. Progressive music genre: “Complicated music for complicated people” – I think that Geoff Tate of Queensryche was speaking to me when he said that!

12. I would play guitar for a living if I thought it would support my lifestyle.

13. Two friends (Mike Ford and Pat Gibbons) died recently from complications of the flu.  Their lives were cut short, but their impact on the world was huge and their spirits carry on in so many lives that they touched.

14. My wife is a saint to put up with me on a daily basis!

15. I am glad to have reconnected with so many friends from the past on social media.  I am so happy for all of you who choose to share about your lives.  I hope to reconnect in person with you in our various travels.

16. The economy may not have a bright immediate future. However, our attitudes do, if we choose accordingly.

17. In October, 2007, I testified before the United States Congress on behalf of the American Dental Association. I was to explain to them about the ravages of methamphetamines on oral health. My true message was that there is a solution to the disease of addiction. Treatment works. Sometimes it may take a few times but it is the best solution going. And, it saves lives!

18. I am about to become the President of the Colorado Dental Association – I am nervous, excited, and amazed that any group of people would choose me to lead an organization.   I hope to leave the organization better than when I took it over.  I work with an amazing board and CDA staff that keep this train rolling in the right direction!

19. The best thing about being a father is that I get to live my childhood again through them. I am blessed to have a loving family to share their experience on how to do this thing! It is easy to father a child, it is an accomplishment to be a father.

20. Religious people are afraid to go to hell in the afterlife. Spiritual people have been to hell (here on earth) and don’t want to go back!

21. I have had many mentors in my life to which I am most grateful. They saw things in me that I couldn’t see in myself and then encouraged me to grow those gifts.  I try to pay it forward by mentoring others. Thanks to all of you, especially mom and dad....

22. My wife thinks that social media is weird but she is starting to warm up.

23. My dream house is in the mountains near a rolling, open meadow strewn with wildflowers and a stream running through it.

24. I played basketball in high school.  As a rebellious teenager, I began to hate it at the time. Looking back regretfully, I could have played at a higher level if I put the effort in.  Basketball has so many life lessons in it.  I took my son Max to the Coach K basketball camp two of the past three years.  Last spring, I reached out to my old basketball coach from high school (Ken Sartini). Over dinner we caught up on what had been going on in our lives the past 20 plus years.  I thanked him for being a great teacher and mentor to me.  I still talk to him often, what a gift!

25. One more….Chicago Cub’s, next year is now! Come on already!

If you like this blog post, I would love to hear about it.  Please comment or share it on Google+, Facebook, Linked in, Twitter, etc.  If you are looking for a dentist in the Denver area, we are always looking for new patients.  Please visit our website http://www.tcdodenver.com/ or like our facebook page,  https://www.facebook.com/TCDOdenver.  Or you can do it the old fashion way - call us at 303-321-4445.

Thanks for reading!  BK