Dentists Comment About DMO Problems & Request for Proposals

Since our recent stories about the new dental RFP for Medicaid and DentaQuest’s capitation payment move, TDMR has received several emails from dental providers about their concerns over the RFP choices and provider lack of power against such large companies.

Comments from dental providers

Number of DMOs – “We need 3-4 DMOs so dentists can refuse to accept DMOs that are run unfairly.  If one is only 20 percent of their business instead of 50 percent that is better. I believe bad DMOs are eliminated in time through attrition if there is adequate competition. Dentists committed to Medicaid have to take all DMOs unless there are numerous options. I believe this is one current argument to increase the number of DMOs in the future dental pool,”

Redistribution of patients –   “What is this anyway? A rep from MCNA said they did that to be “fair” for all providers. My opinion is someone should be sued over this unless somewhere in the paperwork for Medicaid it states that all Medicaid patients belong to the state. Goodwill is all there is of value in a practice when it comes time to sell, besides the fact that the effort of internal marketing and cost of external marketing is completely negated when an outside force can just give your patients to someone else.”

Redefining dental terminology –  “Does anyone else run into this? They seem to actually think they can change dental terms…I had filed a Class V mesial/facial/distal and they told me to have a Class V with a mesial or distal there had to be an interproximal component…so a Class V has to be a Class III? DQ is on this “imminent” phase for exfoliation of teeth. I spoke with the dentist on a peer to peer and got the basic runaround…that DentaQuest is applying the money somewhere else if there is “only some pain”… What?”

Legislative involvement – “As a body,  we need to do what we did when they threatened fee reductions… get the state on board and politicians to promote a stakeholder meeting for the new dental RFP’s.”

DentaQuest Capitation Payment Plan

DentaQuest’s capitation payment model may not be dead.  We sent an email to DentaQuest representative Brenda Walker a week or so ago asking if the RFP release has derailed the capitation payment option roll out.   No response was received.

Providers we have talked to, both big and small,  said they found this plan unworkable.  The fear from smaller providers is that they would lose patients that would be given to a handful of larger providers to make capitation work.  The fear from larger providers is that capitation can’t work for them with Medicaid populations but that DentaQuest will force them into it anyway because the company will transfer patients to other providers who agree to it if they don’t.

TDMR reached out to Dr. Jose Cazares, Past President of the Texas Dental Association, about this capitation model.  He provided us with this response:

“As for TDA having a formal position on any specific delivery model, I do not believe that there is any such position.  But, I do feel that there are shortcomings to the capitation model.  I feel that fee-for-service is the best delivery model, whether in Medicaid or not.”

No forum for providers to discuss problems

One provider who reached out to TDMR lamented that there was no forum anywhere in which Medicaid dentists could get together to discuss mutual problems with DMOs.

TDMR has since found out that Google Groups can provide a secure online forum that is private and members need to be approved to join.  Aliases can be used within the group to help maintain anonymity as well if that is necessary.

We want to find out if this interest is more widespread.  So we have put together a short survey for dental providers. Please answer it if you are a dental Medicaid provider.

Survey on having a dental online forum

Create your own user feedback survey

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