For many months, the Massachusetts Dental Society (MDS) and Dental Service of Massachusetts (also known as Delta Dental of Massachusetts) have been in a heated dispute over proposed fee reductions for dental services. Dental Service of Massachusetts is a nonprofit 501c company that holds the lion’s share of dental insurance contracts in the Commonwealth of Massachusetts. Subordinate to this nonprofit company are numbers of for-profit companies that operate outside of state regulation.
A newly established for-profit PPO product of Delta Dental is called Total Choice. It represents a 20% to 30% reduction in dental service fees from the company’s currently offered Delta Dental Premier. Proposed fee reductions for Delta Dental Premier are in the range of 9% to 10%. The MDS leadership has signed off on these fee reductions after negotiations.
Dentists have to swallow “a less bitter pill,” said David Lustbader, DDS, immediate past president of the MDS, about the Delta fee schedule reduction.
“I’m not happy about it. But 10% is better than 30% fee reduction,” Lustbader said.1
After negotiations with Delta Dental concluded, Lustbader wrote an interesting letter to the president of Delta Dental of Massachusetts on July 18, 2018. It’s clear in the letter’s wording that Lustbader’s negotiation style is very non-confrontational. He requests (not insists) on an unrelated issue, “As a matter of goodwill, the MDS urges Delta Dental to join the other major dental benefits corporations and allow patients to assign benefits to nonparticipating providers.”
The apparent humble tone of the letter reflected that of a subordinate party.
“The MDS Board of Trustees’ decision (decided) to support Delta Dental’s proposed fee methodology and to testify on its behalf. This was not an easy decision for the MDS to make, but the proposal offers a better alternative to the Chapter 175 PPO product (Total Choice with 20-30% fee reduction) and ensures Division of Insurance (DOI) oversight on any future fee changes,” the letter said.
The MDS seemingly not only surrendered to Delta Dental, but was forced to say “uncle.”
In reaching this agreement between the MDS and Delta Dental, Lustbader is quoted in the Boston Globe as saying, “If you stop yelling at each other and start talking, it’s amazing what you can accomplish.”2
“This proposed methodology is the result of candid, productive conversations that we’ve had over the past year with dentists, the Massachusetts Dental Society, state lawmakers, employers and business groups about the important role that the dental community must take in addressing health care cost containment,” said Dennis Leonard, president of Delta Dental.2
Battle Continues with Rank-and-File Doctors
The earlier referenced ADA News article cited an unnamed group of dentists: “In addition, a group of Massachusetts dentists unaffiliated with the Massachusetts Dental Society filed a petition last June asking the state attorney general to investigate Delta Dental’s insurance practices.”1 That unnamed group of dentists is the Massachusetts Dentists Alliance for Quality Care (MDAQC).3-5
On July 12, 2018, the MDAQC, independent doctors, and the public met for a hearing with the Massachusetts Commonwealth’s Division of Insurance (DOI) to deliver testimony and counter alleged misrepresentations proffered by Delta Dental. The group also presented a petition with more than 1,100 signatures in support of their positions.6
Subsequent to the agreement between the MDS and Delta Dental, numbers of rank-and-file Massachusetts dentists openly expressed their displeasure with Lustbader and other leadership within the MDS on social media.
“I am so glad we went to the DOI meeting. At this meeting it was clear that DOI had no idea what this new methodology is about,” wrote Jenny Chang, DMD, DMSc, a prosthodontist specialist in Natick, in an open letter to Lustbader.
“The committee member stated and reassured us that there was no decision made already and this plan was not ever heard or approved. You were the only dentist there who voiced support of this plan. All the other dentists are opposing this plan,” Chang continued.
“While as President of MDS, You decided to operate in secrecy. You did not disclose any information to its members in a candid honest way. Instead, you chose to align yourself with Delta,” Chang wrote, concluding her letter by addressing “sabotage of the dental profession,” “corruption with Delta Dental,” and “arrogance.”
MDAQC director Jill Tanzi, DDS, presented open testimony for the public record.
“I ask all of you, with the cuts we have made to physicians salaries in the past, has healthcare become more affordable? No, it has not, and prices seem to escalate each year. Healthcare premiums are completely out of control and we see our middle class workers struggling to afford their premiums as well as paying extremely high deductibles. In addition, there are too many middle men between the patient and the doctor creating increased costs and less value,” Tanzi said.
“Before you consider this new fee methodology for Delta Dental, a non-profit corporation, ask yourself if this will indeed make care more affordable for our residents or will it serve to fatten the salaries of insurance company executives. In 2016, Dental Service of MA had $25M in net income and $588M in net assets, even after paying insurance executives hefty salaries. Imagine how much more care they could be providing for our residents. Why are they holding so much money in a non-profit corporation when their purpose is ‘to improve health care for all’?” Tanzi asked.
“I believe the 176E non-profit corporation (non-profit incorporation charter) was conceived in the spirit of providing high quality dental care to patients, not as a vehicle for tax avoidance and profiteering. Let the consumer decide if this product should be in the marketplace, not an insurance company,” Tanzi continued.
Pediatric specialist Kristine Grazioso, DMD, also delivered impassioned testimony.
“The executives of Delta Dental would have you believe this is for the benefit of employers and their employees. I argue that this is not true. The truth is that premiums on dental benefit products for employers and employees in our state are already quite low and even insignificant in the total amounts spent on healthcare,” Grazioso said.
“What does Delta Dental actually do? They serve as a third party administrator, a paper pusher, for lack of a more sophisticated term. And it turns out that only 20% of their business is in the dental benefit sector—80% of what they do is in claims processing. So how can they claim that they will go bankrupt if they continue to sell the premium product when it accounts for a small part of their actual business?” Grazioso asked.
“It is the dentists and the employees of dentists who provide the care to our patients. It is the dentists who form a caring relationship with their patients, who provide both prevention of disease and surgical intervention to the citizens of this state. It is the dentists who put the needs of their patients first and do not have the sole focus of making money,” she said.
“I cannot help but notice that all Delta Dental talks about is money. They have hired economists to look at every angle from an economic viewpoint. They have hired a multitude of attorneys and business people, all to find a way to make more money for their company. Dentists, on the other hand, primarily form relationships and provide necessary healthcare to others,” Grazioso said.
Grazioso concluded her testimony with examples in the failing medical healthcare model, dominated by allegedly uncaring corporate healthcare and big-business insurance companies. Costs are going to ridiculous heights, as quality falls precipitously, she said. Both doctors and patients are the losers, she added, while big-business interests soundly prosper.
Prosthodontic specialist Virginia Shahinian, DMD, of Hingham, also testified for the DOI record.
“Delta claims that they have to cut costs to become more competitive. That just does not make any sense. Delta Dental pretty much has a monopoly on dental insurance in this state. The CEOs of Delta do not need to make millions of dollars that should belong to the dentists and their staffs who go to work every day to deliver the care. Many practices will not survive and the ones that do will be forced to cut corners,” Shahinian said.
Conclusion
The Massachusetts DOI has not yet come to a decision on the determination for potential fee reductions on payments for dental services with Delta Premier. Other for-profit insurance vehicles such as Delta Dental PPO are outside the authority of state regulators. Delta Dental of MA and the MDS stand firm that their alleged compromise agreement was fair and should prevail. Others disagree.
“It does not take a majority to prevail… but rather an irate, tireless minority, keen on setting brushfires of freedom in the minds of men,” — Samuel Adams
References
- Burger D. Delta proposes new fee methodology in Massachusetts. ADA News Jun 27, 2018. https://www.ada.org/en/publications/ada-news/2018-archive/june/delta-proposes-new-fee-methodology-in-massachusetts
- McClusky PD. Delta Dental, dentists find common ground on payment rates. Boston Globe Jun 7, 2018. https://www.bostonglobe.com/business/2018/06/17/delta-dental-dentists-find-common-ground-payment-rates/G1CxBJzo3zcH201DHfluGJ/story.html
- MA Dentists Alliance for Quality Care. Facebook site 2018. https://www.facebook.com/MADentistsAlliance/
- State House News Service. Dentists Critical of Delta Dental Plan. Worchester Business Journal Oct 31, 2017. http://www.wbjournal.com/article/20171031/NEWS01/171039989/dentists-critical-of-delta-dental-plan
- Davis MW. Emerging Advocacy Groups Support Small Business Dentistry. Dentistry Today News Apr 20, 2018. http://www.dentistrytoday.com/news/todays-dental-news/item/3191-emerging-advocacy-groups-support-small-business-dentistry
- Tanzi J. Stop Delta Dental’s New Payment Methodology. iPetition 2018. https://www.ipetitions.com/petition/stop-new-payment-methodology
Dr. Davis practices general dentistry in Santa Fe, NM. He assists as an expert witness in dental fraud and malpractice legal cases. He currently chairs the Santa Fe District Dental Society Peer-Review Committee and serves as a state dental association member to its house of delegates. He extensively writes and lectures on related matters. He may be reached at mwdavisdds@comcast.net or smilesofsantafe.com.
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