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bigj1972

bigj1972

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It's striking that balance that is going to be hard due to a lot of harsh(er) realities that dental offices are facing. Patients' disposable income are shrinking with the cost of consumer goods going up, so less discretionary income is used for dental procedures. Insurances are lowering their reimbursements across the board in certain regions. The cost of dental supplies are going up (and so are other variable/fixed costs). There is definitely some pressure for dental offices to cut costs and one of them would be lab costs. I'm not going to say that dentists aren't greedy, but not all of them are. Some have always been penny pinching everywhere even before SHTF. I've cut my own salary just so that I can make sure that my staff's salary goes up in line with COL even though reimbursements haven't really caught up. However, I do still see the value in paying extra in a quality lab that reduces the risks of remakes, back and forths, and maintaining a good line of communication for more complex cases.... there's a big but in there though, but, at certain reimbursement rates for any work that requires a laboratory, there comes a point where we may be losing money per unit. I've heard in some states, medicaid reimburses as low as 250 dollars for a crown, and have onerous requirements such as HN PFM or excessive documentation that make it not worth doing the crown or accepting medicaid.

That gets us then to access to care and the care that people should be getting and the financial realities of delivering dentistry at a loss. There are some medicaid mills out there that do game the system and only do things that would result in a net gain (such as some places that only edentulate and slap on a halfass prosthetic).

I guess the point being is that the financial realities will lead to a demand for lower cost equivalancies, but not always because of greed. Although I'll admit there's a lot of greedy dentists out there, the market pressures on dentists will require us to seek lower cost alternatives. I think it's important to highlight that if you can prove that you are more approachable than a bigbox lab with people who actually know something about dental prosthetics, have a reasonable turnaround time, a fair price (not the cheapest, not the most expensive either),and things that "just fit" with minimal adjustments, then it is easy to sell yourself to dentists and say hey, we may not be the cheapest, but we'll provide good customer service, we're made domestically, we use good materials, and that the time they save from sending a case back (and quick cementation times),they'll come out ahead with a better patient experience, lab experience, and help their local economy too. However, the price premiums will definitely have to go down until the economy recovers.

Anyway, sorry for the long rant, I just feel like dentists are painted with such a broad brush stroke, but I think it's important to know why there might be a race to the bottom. I don't think all dentists are greedy, but some are, some are in a position/bind where they can't afford to go past their breakeven point in delivering a service due to geographical/insurance restrictions, and some will accept ****ty results and deliver whatever they get. Just as dentists are facing a new financial reality of delivering services at X cost, I believe labs may have to do so at some point without compromising on quality. I hope that dental materials manufacturers lower their price points, but with supply chain issues, I doubt that will happen (or just use it as an excuse to raise their price).
A couple of things dentists might not be considering in this dynamic.
1) The lab is not your employee, it is an independent business that's provides a service for a fee. Your financial difficulties do not influence it's operation. If you need to save money because of the contracts you entered into with insurance, you have the option of buying your own equipment, and staying over after hours or weekends and do your own lab work. Our position is not to make you profit, but to provide a service for you to resell.

2) There are over 200,000 licensed dentists in the US, and probably 6, 500 labs left after the pandemic began. It is not the Lab that is competing for your business, It is dentists who are competing to stay in a great Lab. If the cost of Lab fees are too high for you to be profitable, you should look inward at your own finances. Your lab fees are probably on the lower end of your costs. It is possible you may be unable to sell product X if your overhead is too much of a drain. You may even have to let someone go to offset the cost.
 
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Car 54

Car 54

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It's striking that balance that is going to be hard due to a lot of harsh(er) realities that dental offices are facing. Patients' disposable income are shrinking with the cost of consumer goods going up, so less discretionary income is used for dental procedures. Insurances are lowering their reimbursements across the board in certain regions. The cost of dental supplies are going up (and so are other variable/fixed costs). There is definitely some pressure for dental offices to cut costs and one of them would be lab costs. I'm not going to say that dentists aren't greedy, but not all of them are. Some have always been penny pinching everywhere even before SHTF. I've cut my own salary just so that I can make sure that my staff's salary goes up in line with COL even though reimbursements haven't really caught up. However, I do still see the value in paying extra in a quality lab that reduces the risks of remakes, back and forths, and maintaining a good line of communication for more complex cases.... there's a big but in there though, but, at certain reimbursement rates for any work that requires a laboratory, there comes a point where we may be losing money per unit. I've heard in some states, medicaid reimburses as low as 250 dollars for a crown, and have onerous requirements such as HN PFM or excessive documentation that make it not worth doing the crown or accepting medicaid.

That gets us then to access to care and the care that people should be getting and the financial realities of delivering dentistry at a loss. There are some medicaid mills out there that do game the system and only do things that would result in a net gain (such as some places that only edentulate and slap on a halfass prosthetic).

I guess the point being is that the financial realities will lead to a demand for lower cost equivalancies, but not always because of greed. Although I'll admit there's a lot of greedy dentists out there, the market pressures on dentists will require us to seek lower cost alternatives. I think it's important to highlight that if you can prove that you are more approachable than a bigbox lab with people who actually know something about dental prosthetics, have a reasonable turnaround time, a fair price (not the cheapest, not the most expensive either),and things that "just fit" with minimal adjustments, then it is easy to sell yourself to dentists and say hey, we may not be the cheapest, but we'll provide good customer service, we're made domestically, we use good materials, and that the time they save from sending a case back (and quick cementation times),they'll come out ahead with a better patient experience, lab experience, and help their local economy too. However, the price premiums will definitely have to go down until the economy recovers.

Anyway, sorry for the long rant, I just feel like dentists are painted with such a broad brush stroke, but I think it's important to know why there might be a race to the bottom. I don't think all dentists are greedy, but some are, some are in a position/bind where they can't afford to go past their breakeven point in delivering a service due to geographical/insurance restrictions, and some will accept ****ty results and deliver whatever they get. Just as dentists are facing a new financial reality of delivering services at X cost, I believe labs may have to do so at some point without compromising on quality. I hope that dental materials manufacturers lower their price points, but with supply chain issues, I doubt that will happen (or just use it as an excuse to raise their price).

I understand up to a point of a Dr's overhead and the lack of insurance reimbursement, but how can an office not make it when they're charging the patient on average $1100 to 1200 for a crown and getting it from a lab anywhere from $80. to 160. per unit (speaking from the C&B side)? Is the greatest overhead $$ staff, and maybe having to many? How many really need to be at the front desk, or how many assistants? Is it hard to let staff, "family" go, so the Dr looks for other areas to cut back on, the first target being the lab/bill? I ask in sincerity, and not so much in jest, as you did bring up some good points in your post.

Patients who ask, or family members who've asked me, are always amazed at the disparity of what a Dr charges and what the lab fee is, but in a way, I do get the cost, overhead on your end.
 
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Car 54

Car 54

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Lab fees should be a separate invoice to the patient and not come from the Drs share.
Patients should have the option of deciding where they want work done .

Is it easier to work with one Dr who may be delinquent on his bill, even though it may be sizable, compared to trying to get paid from 100s of patients?
Is it something you do on CC, to help in that regard? I remember one of the overseas guru techs in Chicago years ago, doing a lecture for Ivoclar, showing us a check (blurred patient info) from a patient for big bucks for what he did, letting us know it is possible to get paid for that type of work, and from the patient directly.
 
rkm rdt

rkm rdt

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Is it easier to work with one Dr who may be delinquent on his bill, even though it may be sizable, compared to trying to get paid from 100s of patients?
Is it something you do on CC, to help in that regard? I remember one of the overseas guru techs in Chicago years ago, doing a lecture for Ivoclar, showing us a check (blurred patient info) from a patient for big bucks for what he did, letting us know it is possible to get paid for that type of work, and from the patient directly.
The lab bill is a separate line item on the invoice given by the dr.
Lab invoices the dr and not the pt directly however pt is always free to pay the lab directly as do most family and friends.
 
Car 54

Car 54

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The lab bill is a separate line item on the invoice given by the dr.
Lab invoices the dr and not the pt directly however pt is always free to pay the lab directly as do most family and friends.

Thanks rkm, that's what I was wondering, thinking.
 
bigj1972

bigj1972

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I understand up to a point of a Dr's overhead and the lack of insurance reimbursement, but how can an office not make it when they're charging the patient on average $1100 to 1200 for a crown and getting it from a lab anywhere from $80. to 160. per unit (speaking from the C&B side)? Is the greatest overhead $$ staff, and maybe having to many? How many really need to be at the front desk, or how many assistants? Is it hard to let staff, "family" go, so the Dr looks for other areas to cut back on, the first target being the lab/bill? I ask in sincerity, and not so much in jest, as you did bring up some good points in your post.

Patients who ask, or family members who've asked me, are always amazed at the disparity of what a Dr charges and what the lab fee is, but in a way, I do get the cost, overhead on your end.
I know its very expensive to own a dental office. But it's like a plastic surgeon doing boob implants. "I've got to use these Taiwan implants to cut costs."
When they are mis-sized, mis-shaped, and leaking, how is that gonna help their business?. Why don't they tell the patient how much the lab bill is and ask them if its too high?? We know why. 🤣 And now they want to justify spending even less on the lab fees.


Dentists need to view the lab like a utility service. Yes electricity is high and if you pay the bill it means less profit for you. But what are you gonna do work by candlelight? Put a generator in the supply closet? When it's the middle of winter or summer, you'll pay anything for the "Luxury" of electricity.. So there is no Right or Entitlement to lab work. You pay or do it yourself.
Dontknow
 
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Is it easier to work with one Dr who may be delinquent on his bill, even though it may be sizable, compared to trying to get paid from 100s of patients?
Is it something you do on CC, to help in that regard? I remember one of the overseas guru techs in Chicago years ago, doing a lecture for Ivoclar, showing us a check (blurred patient info) from a patient for big bucks for what he did, letting us know it is possible to get paid for that type of work, and from the patient directly.
Some fee for service doctors have been doing this for many years in the US. I regularly receive payment from patients. Only know one tech that regularly is paid in advance for his work. I like that idea, however I haven’t tried it myself.
 
rkm rdt

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I think the Dental Technology Act was passed in the '60s .
 
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2) There are over 1,000,000 licensed dentists in the US, and probably 6, 500 labs left after the pandemic began. It is not the Lab that is competing for your business, It is dentists who are competing to stay in a great Lab. If the cost of Lab fees are too high for you to be profitable, you should look inward at your own finances. Your lab fees are probably on the lower end of your costs. It is possible you may be unable to sell product X if your overhead is too much of a drain. You may even have to let someone go to offset the cost.


1,000,000 to 6,500
Huh. That’s a very large amount of work going to smart businessmen in the US and offshore peasants
 
sidesh0wb0b

sidesh0wb0b

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Lab fees should be a separate invoice to the patient and not come from the Drs share.
Patients should have the option of deciding where they want work done .
as the end users, patients do have the option of controlling where the products are made. most people sadly dont realize the dentist doesnt make them
 
rkm rdt

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as the end users, patients do have the option of controlling where the products are made. most people sadly dont realize the dentist doesnt make them
yet controls your fees.
 
bigj1972

bigj1972

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yet controls your fees.
They don't control our fees, although they wish they could. They just gripe like any other business customer.

Clerk: "Marlboro cigarettes? That'll be $7.50 please.

Customer: "These cigarettes are too exspensive. I can't afford it !"

Clerk: "You gonna quit smoking?"

Customer: "No, I'll just take my business elsewhere."

Clerk #2: "That'll be $8.00 please.

Customer: Bawling
 
doug

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200,000 dentists in the US in 2020...but I get what you're saying
 
bigj1972

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200,000 dentists in the US in 2020...but I get what you're saying
Your right. Corrected. Could have sworn 1mil in past article. I should have checked...Thanks.
 
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I understand up to a point of a Dr's overhead and the lack of insurance reimbursement, but how can an office not make it when they're charging the patient on average $1100 to 1200 for a crown and getting it from a lab anywhere from $80. to 160. per unit (speaking from the C&B side)? Is the greatest overhead $$ staff, and maybe having to many? How many really need to be at the front desk, or how many assistants? Is it hard to let staff, "family" go, so the Dr looks for other areas to cut back on, the first target being the lab/bill? I ask in sincerity, and not so much in jest, as you did bring up some good points in your post.

Patients who ask, or family members who've asked me, are always amazed at the disparity of what a Dr charges and what the lab fee is, but in a way, I do get the cost, overhead on your end.

I only wish I could consistently charge 1100-1200 a crown, then all this talk of lab fees wouldn't be a problem at all. The previous post wasn't meant to attack labs, but hopefully shed some light as to what could create market pressures to decrease lab fees. However, there is a trend to try and ditch insurances which may act as a boon for the middle-higher end of the dental lab price market. I learned early in my career not to go with the cheapest nor go with the most expensive either. There has to be that balance. When I first started as a dentist, there was this DSO that would ship the cases to China and OMG, it was the worst. The quality was not acceptable at all. I ended up leaving shortly due to so many issues (besides the really bad labwork returned).

One of the greatest overheads is definitely staff members. What's driving a lot of the costs of staff is a shortage of dental assistants/hygienists and increased cost of living. It's definitely not fair to the labs as well, as you guys have families to support too and labs aren't always an apple to apples comparison either. However, with decreasing insurance fees, would it then be fair to use a cheaper lab for cheaper insurances, creating a two-tier system for crowns? I don't think I could pay 300/crown on a 543 dollar/unit reimbursement given the other overhead factored into executing the crown procedure.

Now, someone might say, why do you take insurance if they pay so poorly? A FFS office isn't always practical in every part of the country. Some regions are dominated by companies that provide a specific insurance - with dwindling disposable incomes, patients are trying to utilize in-network benefits more than out of network benefits to maximize what they receive in terms of treatment. The tradeoff with accepting insurance is having a larger volume of patients to keep your office sustainable v. a FFS office that may not necessarily have the patient flow to be sustainable. I don't take every insurance, but I do take a fair amount of insurances that actually pay what they promise, and there's a breakeven point that needs to be met to not lose money on a procedure with all costs taken into consideration. However, I don't think any of us really works towards the breakeven point, because then it means that our labor is worth zero; that applies to everyone, dentists and lab owners alike. We work to make a profit, but then the question is how much is enough and how much is too much?
 
bigj1972

bigj1972

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I only wish I could consistently charge 1100-1200 a crown, then all this talk of lab fees wouldn't be a problem at all. The previous post wasn't meant to attack labs, but hopefully shed some light as to what could create market pressures to decrease lab fees. However, there is a trend to try and ditch insurances which may act as a boon for the middle-higher end of the dental lab price market. I learned early in my career not to go with the cheapest nor go with the most expensive either. There has to be that balance. When I first started as a dentist, there was this DSO that would ship the cases to China and OMG, it was the worst. The quality was not acceptable at all. I ended up leaving shortly due to so many issues (besides the really bad labwork returned).

One of the greatest overheads is definitely staff members. What's driving a lot of the costs of staff is a shortage of dental assistants/hygienists and increased cost of living. It's definitely not fair to the labs as well, as you guys have families to support too and labs aren't always an apple to apples comparison either. However, with decreasing insurance fees, would it then be fair to use a cheaper lab for cheaper insurances, creating a two-tier system for crowns? I don't think I could pay 300/crown on a 543 dollar/unit reimbursement given the other overhead factored into executing the crown procedure.

Now, someone might say, why do you take insurance if they pay so poorly? A FFS office isn't always practical in every part of the country. Some regions are dominated by companies that provide a specific insurance - with dwindling disposable incomes, patients are trying to utilize in-network benefits more than out of network benefits to maximize what they receive in terms of treatment. The tradeoff with accepting insurance is having a larger volume of patients to keep your office sustainable v. a FFS office that may not necessarily have the patient flow to be sustainable. I don't take every insurance, but I do take a fair amount of insurances that actually pay what they promise, and there's a breakeven point that needs to be met to not lose money on a procedure with all costs taken into consideration. However, I don't think any of us really works towards the breakeven point, because then it means that our labor is worth zero; that applies to everyone, dentists and lab owners alike. We work to make a profit, but then the question is how much is enough and how much is too much?
My reply is not an attack on dentists as well. And I also think that you are sincere. Dental insurance has not only ruined the dental office but has contributed to the problems of the dental lab as well, for reasons that should be self-explanatory. A two tier system? I don't think that is an issue. Some of my clients do it with my blessing. The debate of whether you are an in-network dentist is within your own realm. You have to decide if you're willing to sell your labor, for 50% off. The lab didn't sign that contract. And while we are clinical partners that work on cases together, sometimes we forget that there is a separation of entities. Labs must and will remain profitable. We do not have a some money is better than no money mentality, nor would I think any successful businessman adapts that philosophy. And should downward price pressures reduce profit to a certain point, we will simply just close the lab, and start a new business or career. Which BTW is what's been happening the last 20 years. At that time there were over 15,000 labs in the United States.
Unfortunately, dentist are getting squeezed. The insurance companies are gangsters, and general public does have finance issues. That being said I see a lot of people who say they couldn't afford that $1,200 crown eating out at the restaurants every weekend and driving around a nice late model car on the way to their 2,800 sqft home. But that's a different discussion.
I am sympathetic to dentists. It's not the greatest of businesses to be in. And you'll have to decide whether the desire to help people for less profit is rewarding enough, or whether you go full FFS for your own benefit. The lab is not the crooks. In fact we are the only ones who have a vested interest to see you be successful. The crooks are the Universities who sell you a $250,000 education to then worry about paying an office lease, and the insurance companies, who through no practical experience, dictate that your time is only worth half the money.
I do applaud you for your empathy of the less fortunate. And see no problem with you using low cost labs to see that through. My position is the Lab cannot be used to subsidize discount dentistry. You want to give them a break, it'll have to come out of your end.

Oh the how much is enough??? There is never too much, and the enough is the enough to make me want to stay in this business, or close and start a different one.
Capitalism...love it or hate it.
 
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