I will hurt you, Delta Dental

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Permalink Reply by Darrell Pruitt on January 31, 2009 at 2:18pm

Part one: Easy PRey

If the name Ari Adler sounds familiar, he is the Public Relations professional quoted in Mughal’s article. “Dentists or patients…” presented in the Introduction to this thread, “I will hurt you Delta Dental.” Mr. Adler is employed by Delta. He heads its Corporate and Public Affairs division. He is also an adjunct journalism/PR instructor at MI State University (from Twitter).

Mr. Adler’s website says: “I'm available for hire as a professional speaker and trainer for company meetings, conferences, workshops, etc. Presentation topics include public relations, media relations, and new media/social media.”

I wonder how well he handles Search Engine Optimization. Let’s find out.

Adler’s latest comment “Hey, Big Brother, over here — the copy,” exposes the problem one must have maintaining personal transparency when one works for Big Brother as a day job, and runs a progressive blog at night. I can only imagine that it is difficult for traditional PR people to live in both worlds these days.

In the article, Adler asks this question shortly before requesting readers’ opinions about his social dilemma: “What should we be telling people looking to join us in the online universe? Is this like Big Brother watching everything we’re doing, only we’re some sort of insane masochists who volunteer to be watched?” I think the answer is, “Yes.” You didn’t volunteer, Ari Adler. You sold out. You are a hired gun.

Comparatively speaking, I am a free-lance amateur with wattage. It sort of makes me like the first shameless ham radio operator to show up in a polite, quiet, neighborhood - dressed in underwear and scratching.

I posted responses to three of his other questions below on his blog. Darrell
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http://aribadler.wordpress.com/2009/01/28/hey-big-brother-over-here...

You’re learning hard lessons fast in the PR business, Ari Adler.

“If I make a bad pun or a risque comment on Twitter, and it’s been known to happen, should that impact how people treat me at work?”
- Yes

“If a blog post I write is written specifically to provoke a discussion but someone who does business with my company disagrees, will that come back to haunt my employer?”
- Yes

“Please offer your opinions below — don’t make me write something provocative just to elicit a response. My boss might not like it.”
- No, your boss will not like this.

See: “I will hurt you, Delta Dental”
http://www.drbicuspid.com/forum/tm.aspx?m=646

Let’s you and I discuss your thoughts about Delta Dental. How about it, Ari Adler? What do you really think of transparency? Darrell K. Pruitt DDS

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Permalink Reply by Darrell Pruitt on February 1, 2009 at 1:58pm

Part two: Quality control and low bids

Delta Dental representative Ari Adler complains that it is unfair to his boss to have to mail payments to dentists out of network - even if they are dentists who Delta’s clients prefer over the providers Delta prefers. Delta customers’ preferences of out-of-network dentists are clearly understandable in a market that unfairly favors managed care dentistry like Delta Dental’s - performed by the lowest bidders without quality control. But now, Delta’s good ol’ boys can no longer ignore Adam Smith and basic principles of economics, even equipped with the best PR squad. And Ari Adler is not the best. He’s a part-timer.

Adler reasons that making payment convenient for their clients - who pay the insurance premiums - cheats Delta because dentists who refuse to sign a contract with Delta reap unfair benefits from Delta’s network without following cost guidelines and adhering to quality control measures - like those demanded of Delta’s preferred providers.

Such nonsense makes it surprising that Ari Adler’s alter-ego maintains a reasonable and progressive blog called 5Ws http://aribadler.wordpress.com/. That is why I find it stunning when the part-time Delta employee confidently says, "We put our dentists thorough a credentialing process and provide quality assurance.” I’ll get to Delta’s level of quality in a moment.

Adler blunders on: “That means if a dentist does a filling that should last a certain amount of time and it doesn't, they have to fix it without charging the network or the patients."

Please note that Mr. Adler does not offer exactly how long fillings should last. Delta Dental hires experts who do, though. They are called dental consultants.

Quality control - Is that why consumers buy dental insurance?

Some dentists think so, and they invariably belong to the American Association of Dental Consultants (AADC), and are hired by dentistry brokerage firms like Delta Dental and UnitedHealthcare Dental to maintain the highest quality in dentistry in the nation for the lowest possible price - and still maintain profits for those who sign their checks. Not an easy job.

I’ll introduce you to Dr. Robert S. Laurenzano, immediate past-president of the AADC later, and I’ll let him describe to you what he likes most about his job. But first, let us look at Delta’s success at promoting quality dentistry.

DR. Oogle and Delta’s dentists

Do you think continuity of care is important to dental patients’ health? If so, you have to agree that dentists’ popularity is the most important measure of quality available. Dental patients can sometimes recognize bad dentistry even as it is being performed.

In November of 2007, I performed a study of Delta Dental PPO participating dentists in Austin, Texas using DR. Oogle’s dentist popularity rankings on the Internet. http://austin.doctoroogle.com/dentist_ratings.cfm/pageID/2

From Delta’s PPO website, I chose 50 preferred dentists whose practices are located in or near the 78704 zip code in Austin, and simply compared the dentists’ DR. Oogle rankings with other dentists in the area.

SUMMARY

76% had no listing on DR. Oogle.
12% had no review.
12% were ranked, averaging a rank of 206 out of 297.

The study is so easy to repeat that I will not waste your time with my proof. The important result to note: Delta’s preferred providers were in the bottom third of patients’ preferences in Austin a little over a year ago. Is that quality?

Here is something more current: On November 9, 2008, I posted an article on PennWell titled “Transparency and managed care dental plans” which describes another study based on preferred providers and their popularity ranking on DR. Oogle. This time it was for Phoenix, Arizona.
http://community.pennwelldentalgroup.com/forum/topics/transparency-...

In all fairness, I must reveal that according to the grading system I designed, of the twenty most common discount dental plans available in Phoenix a few months ago, Delta’s Premier was the managed care plan most likely to be accepted by a popular dentist, as rated by DR. Oogle. Even so, Delta’s plan still only scored a 5.5 on a scale of 0 - 10, so the chances of picking out an unpopular dentist was about the same, with or without Delta’s list. Is that quality? Yes. That is average quality, and the best that Phoenix has to offer in managed care dental plans. Surprised?

Here is something else I learned about the dental market in Phoenix: From the data available for UnitedHealthcare, if one purchased their plan, he or she would be much more likely to be sent to a dentist in the bottom 4% of popularity than in the top 4%.

Did I mention that UnitedHealthcare, also the owner of Ingenix, is the largest contributor to the American Association of Dental Consultants? The AADC will be meeting again in Scottsdale, Arizona this spring - not far from Phoenix.

I wonder if Gordon Christiansen will be addressing the group this year like he did last May. The crowd fits in well with his repeated criticism of dentistry in the US, doesn’t it? They soak it up. D. Kellus Pruitt DDS

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Permalink Reply by Darrell Pruitt on February 2, 2009 at 12:03pm

Part three: Progress Report

This thread, “Delta I will hurt you,” including its civil version that is being simulpost on Medical Executive-Post, are gaining significant popular momentum on the Internet according to a couple of indicators I follow. Believe it when I tell you that a crowd is gathering regardless if one invites friends to witness the public lynching of sleazy businesses.

At the risk of causing a riot against calculated tyranny that has been kept hidden up until now, I must say that this thread could prove to be the tipping point to the introduction of accountability in the managed dental care industry. It has already been shown in this thread that Delta deceives its clients as business policy. The lies that Delta tells in order to expand its network hurt their clients by breaking up dental homes. Let me allow a Delta representative to help me explain the harm:

Common sense tells us that if patients are comfortable with the dental teams of their choice, they are not only more likely to have cleanings and check-ups regularly, but they are also more likely to keep better care of their teeth at home. That seems so logical, doesn’t it? So what does this mean for patients who are limited to dentists on preferred provider lists which run for only 12 month periods? Someone with access to vast sources of longitudinal dental claims data could confirm the benefit of a dental home very quickly and easily. I think someone should have done the simple study long, long ago. Well, finally the investigation has been accomplished. It is incredible that it was a Delta Dental representative who broke the news that will bring certain harm to Delta Dental - possibly by accident.

I was in the audience of about a hundred dentists and dental industry representatives on the morning of August 15, the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago (“Road Trip IV”). I heard Delta Dental Plans Association (DDPA) representative Maxwell H. Anderson DDS admit: “The greatest hazard to teeth is changing dentists.” That quote was not reported in the ADA News article about the conference, so if you were not there, and you didn’t read “Managed Care or Dental Homes - You can’t have both” (September 30, 2008), you missed it.
http://community.pennwelldentalgroup.com/forum/topics/2013420:Topic...

Dr. Anderson said that by data mining their “proprietary” dental claims over 11 years, Delta uncovered evidence-based information revealing that clients who change dentists regularly are likely to receive more fillings than those who enjoy long-term consistent care from dental homes. Note: It took Delta 11 years to mine this valuable information from their “proprietary” data. When challenged about their inaccessible information, a Delta rep replied that business pressure forces Delta to keep claims data secret from competitors. Forget about the dental patients.

By this point in the adventure, it should be obvious to everyone that Delta Dental not only lies to its clients about quality control, but Delta also disregards its own research that shows that their business model causes expensive harm to their clients. That is why it is against the morals described in the Hippocratic Oath for dentists to enter into contracts with Delta Dental representatives.

Delta Dental, a traditionally sleazy company, will continue to cause harm regardless what I do. That is why it all depends on what you do with the information I provide… or not. D. Kellus Pruitt DDS

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Permalink Reply by Darrell Pruitt on February 2, 2009 at 9:49pm

Part four: Parasites and stoic individualism

In contrast to the health insurance industry’s attractive corporate successes with micro-management of physicians’ careers - causing physicians to no longer encourage their children to follow in their paths - only a few CEOs seek to control dentistry. Of those fifty or so, I bet not a single executive in the nation grasps why dentists have traditionally proven to be unusually difficult to domesticate. And if Ari Adler is the best PR person Delta Dental can muster, my goal of bringing Delta’s good ol’ boys down a notch or two for my readers’ entertainment (for starters) could be easier than I thought it would be. From Delta’s silence, I learned long ago that the sleazy company is aware that its business model is defenseless. Otherwise someone might have attempted to defend the honor of Delta Dental. And that, of course, would mean that we would have us some real fun, friends.

Here is something that would-be healthcare parasites will forever stumble over: 85% of dentists in the nation are sole proprietors of solo dental practices. That means that there are well over 150,000 different characters in 150,000 separate offices, completely independent of each other - especially in personalities. For those who are up for the world’s most difficult management challenge, they should know that each dentist represents a brand new unpredictable battle in a resilient, quiet neighborhood. Yea. Too quiet.

Even though the profession may consist of an exceedingly vast assortment of über-individuals, I know of one characteristic that seems to be common among my colleagues who have also endured dental school. When it comes to public forums, dentists are stoically quiet from their freshman year forward in life. Almost every one of us learns to be reticent like those outside the profession would never believe. I am an anomaly at the extreme end of a long tail of a bell curve.

Over the last three or four decades that began with the seemingly benign arrival of dental insurance, followed by progressively worse interference in the dentist-patient relationships by dental consultants hired to save insurers money, it was easy for lots of people to temporarily forget who rightfully should be in charge of dental care in the nation. Until universal healthcare is forced onto dentistry - and as long as American small businesses can thrive in a free-market economy where competition controls quality efficiently - it will from this time forward be informed consumers who determine dental treatment in the land of the free - not dental consultants like Dr. Robert S. Laurenzano, the immediate past-president of the American Association of Dental Consultants (AADC).

On March 5, 2007, Dr. Laurenzano shared with ADA members not only the reasons that he likes his job working for dental insurance companies as a dental consultant, but also his desire to be welcomed as part of the dental team. The title of the article he posted as a “ViewPoint” on the ADA News Online pleads “Is collegiality between dentists and benefit consultants possible?”
http://www.ada.org/prof/resources/pubs/adanews/adanewsarticle.asp?a...

Personally, I don’t give collegiality much chance on ethical grounds. But don’t take my word for it, please read Dr. Laurenzano’s plea for respect and judge for yourself. I could be unfairly biased against dental consultants. Perhaps they have been more honest with other dentists’ patients than they have been with mine.

I studied the viewpoint. From what I determined, here is the list of dental consultants’ obligations according to UnitedHealthcare’s AADC as mentioned by the organization’s former President, Dr. Robert Laurenzano:

- Validate the appropriateness of treatment or improve quality of care (mentioned 2 times)
- Reduce fraud (4 times)
- Increase profit for dentists (1)
- Increase trust from patients (1)
- Assure ethics (6)
- Prevent mistakes (1)
- Save money on healthcare (1)
- Assure professional ideals and preserve the reputation of dentistry (4)
- Assure Evidence-based and otherwise science-based dentistry (7)
- Assure best practices (3)
- Improve record keeping (2)
- Improve accessibility (1)
- Improve globalization of dentistry (1) [(?)]

So how involved is the ADA? Dr. Laurenzano writes, “Last year [2006] the AADC invited Dr. James Bramson, ADA executive director, to speak at one of our meetings. He called for cooperative action by and between the ADA and the AADC in his keynote speech, and the AADC welcomes the opportunity to do just that.”

From the number of times Dr. Laurenzano mentions his desire to enforce other dentists’ ethics (6), it is obvious what he likes about his job. My question is who is enforcing Dr. Laurenzano’s ethics? UnitedHealthcare?

But look what dental consultants like most. “Assure Evidence-based and otherwise science-based dentistry.” He makes Evidence-Based Dentistry sound like it favors Delta Dental, like his ethics perhaps? D. Kellus Pruitt DDS

(To be continued)

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Permalink Reply by Darrell Pruitt on February 4, 2009 at 12:35pm

Part five: Ari Adler’s PRoblem

I think education is important for the health of the neighborhood, and truth in advertising the foundation of ethics in the marketplace. That is why I consider it my civic duty to help big-city salespeople learn that slick, traditional PR tricks work poorly on the Internet. When salespeople representing fat, insensitive dinosaurs like Delta Dental attempt to intimidate dentists these days with ’cause-I-said-so sales pitches that once worked swell, they fail to make necessary adjustments for pervasive gossip, and occasional pranksters. That is when good ol’ boys become first trapped, and later, top billing in neighborhood entertainment for an indefinite period of time.

On January 30, “Dentists or patients: Who should get the insurance check?” was posted on DrBicuspid.com
http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=di...
The article by Rabia Mughal describes how Delta Dental intends to shamelessly grow its network using its clients as pawns - destroying dental homes for the sake of their network and the common good.

On January 28, two days before Rabia Mughal’s article appeared, Ari Adler described a modern social dilemma for today’s PR professionals on his 5Ws blog titled, “Hey, Big Brother, over here — the copy.”
http://aribadler.wordpress.com/2009/01/28/hey-big-brother-over-here...

Here is Adler’s opening paragraph: “I’ve had the topic of personal vs. professional online activity come up in Twitter discussions and during presentations to folks wanting to explore social media. It seems that whether we’ve been at this for a while or it’s a strange new playground, none of us are really very comfortable making a decisive argument about how your personal and professional life should or shouldn’t collide via your online activities. (I wonder how George Costanza would survive the Internet!?!)”

I have sympathy for the stress Adler must be feeling today. Maintaining the credibility of one’s Internet brand - as well as a progressive blog - while working PR for a sleazy company like Delta Dental must be painful to one’s soul.

It was through Mughal’s article that Ari Adler gave naive consumers information that demands clarification. As mentioned previously, after reading what Adler said about Delta on DrBicuspid, I posted a comment on his blog, warning him about this thread. Fair is fair.

Adler mentioned my warning on his blog the next day. I presented his response as an introduction to the comment I left yesterday. We are still awaiting a response. This is far from over. D. Kellus Pruitt
-------------------------------------
http://aribadler.wordpress.com/2009/01/28/hey-big-brother-over-here...

Comment number 8, Posted 2/4/09

“On the other hand, as Dr. Pruitt points out above, [transparency] can work in the opposite direction, too — with who your employer is or what they do bouncing back and affecting your personal life.” - Ari Adler 2/1/09

Mr. Adler, I am a general dentist with in a solo practice in Fort Worth, Texas. Like you, every day I strive to provide my bosses with my very best work. If you think about it, dentistry is not an easy job. It is intricate work performed in mouths of unpredictable humans. Regardless of the time and attention I pour into my small custom pieces of durable art, sometimes my patients take care of their fillings, and sometimes they don’t.

I was intrigued by your statements on the DrBicuspid website recently about Delta Dental’s ideas for dentistry. You were quoted in an article by Rabia Mughal titled “Dentists or patients: Who should get the insurance check?”
http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=di...

Here is a promise you made about Delta Dental that in all fairness simply demands more explanation: "We put our dentists thorough a credentialing process and provide quality assurance. That means if a dentist does a filling that should last a certain amount of time and it doesn't, they have to fix it without charging the network or the patients."

Did you intend to tell potential purchasers of Delta Dental plans that Delta guarantees its preferred providers’ work? Did Delta actually approve that sales pitch?

If that is indeed Delta’s revolutionary new policy, you did your job. But since you brought it up, in the name of accountability, you owe it to naïve dental benefits purchasers to either explain how Delta dentists are credentialed or give me the name of someone who can. That is not all. I will demand, yes demand, that you or another Delta representative to explain to consumers how long fillings should last. If you remain silent about these sales points that have already used to lure purchasers to Delta, you will have committed fraud on behalf of your boss. I think you are more stand-up than that.

From reading your other works, it appears to me that Delta Dental has sacrificed your hard work at an Internet reputation. Are you a company man now?

Nobody would blame you for denouncing Delta Dental. Everyone knows it is a sleazy company anyway. You can do better, Ari Adler. D. Kellus Pruitt DDS

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Permalink Reply by Darrell Pruitt on February 8, 2009 at 1:35pm

Part six: Fraud and Delta Dental

"We put our dentists thorough a credentialing process and provide quality assurance. That means if a dentist does a filling that should last a certain amount of time and it doesn't, they have to fix it without charging the network or the patients." - Ari Adler, representing Delta Dental, his employer.
http://www.drbicuspid.com/forum/tm.aspx?m=646&mpage=1&key=&...

How many new clients has Delta Dental already attracted with their bold guarantee of dentists’ work? As the numbers mount, I think there could soon be a class-action lawsuit spurred by angry, misled Delta Dental clients unless someone retracts Ari Adler’s sales pitch.

As you could probably guess, for my part, I intend to spread the word about the first guarantee in dental care from a discount dentistry broker in the history of the nation. I find this an exciting frontier, especially since law enforcement lags in controlling the avarice of slow-moving opportunists. Lynchings happen. We don’ need no stinkeen’ badges.

I can confidently say that very few dentists respect Delta Dental. Delta has been sleazy a long, long time.

A year ago, while walking through the exhibit hall at the Southwest Dental Conference in Dallas, I noticed National Provider Identifier (NP) application forms prominently displayed at the Delta Dental booth. The Delta saleswoman who covers the east side of Fort Worth, my neighborhood, pushed me hard to fill out an application. “You don’t want to wait until the last minute. May 23rd is the [final] deadline.” (The deadline had been delayed a few times because of countless CMS blunders).

I already knew by then that the ten-digit identifying number does nothing to improve dental care, and that once a dentist applies, one cannot back out. By Jan. 2008, I also knew that foul-ups concerning the NPI had already delayed physicians’ payments for almost a year. That means that the number which was meant to “speed” payments, doesn’t - causing harm to dentists’ patients by needlessly increasing the cost of care. Anyone can see that it is counter to the Hippocratic Oath to even listen to Delta Dental representatives.

When I resisted applying, she and other Delta employees emphatically agreed that the NPI number will soon become a licensure requirement for all Texas dentists anyway. I later checked. She lied.

This comment will also be submitted to Ari Adler to be posted on his blog, 5Ws. This will not end well for anyone associated with Delta Dental. I promise.

Here is my advice: Retract the guarantee or defend it. A retraction would cut Delta’s losses, while defense from Delta would make for some swell entertainment. D. Kellus Pruitt DDS

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Permalink Reply by Darrell Pruitt on February 19, 2009 at 12:35pm

An open letter to Delta Dental Plans
________________________________________
From: pruittdarrell [mailto:pruittdarrell@sbcglobal.net]
Sent: Thursday, February 19, 2009 12:30 PM
To: 'kgerlesits@deltadental.com'
Cc: 'angelafeig@meyocks.com'
Subject: Delta's guarantee

An open letter to Delta Dental Plans regarding guaranteed dental work.
-------------------------------------
Dear Kate Gerlesits of Delta Dental:

On January 30, Delta Dental employee Ari Adler announced that Delta guarantees its preferred providers’ work in an article that was posted on DrBicuspid.com.

“We put our dentists thorough a credentialing process and provide quality assurance. That means if a dentist does a filling that should last a certain amount of time and it doesn’t, they have to fix it without charging the network or the patients.”
http://www.drbicuspid.com/forum/tm.aspx?m=646&mpage=1&key=&...

In the last two weeks, both Dr. David Edward Marcinko, Publisher-in-Chief of Medical Executive-Post, and I have requested an explanation from Ari Adler and Delta Dental. So far, our requests have been ignored.

Did Delta Dental authorize Ari Adler to roll out the news of Delta’s guarantee, or was the sales pitch a product of Adler’s own initiative to attract new clients for Delta?

Please respond promptly. D. Kellus Pruitt DDS

Kate Gerlesits
Delta Dental Plans Association
630 574-6994
kgerlesits@deltadental.com

Angela Feig
The Meyocks Group
515 327-3425
angelafeig@meyocks.com

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Permalink Reply by Darrell Pruitt on April 2, 2009 at 5:48pm

Part seven: Blindsiding Delta Dental

Delta Dental sends more easy prey my way.

When it comes to blindsiding witless PR departments, what good is Schadenfreude if it can’t be shared for the entertainment of my large collection of quirky, unshaven sports fans - a special class of readers who would stick around to watch the sequelae of an ignited paper bag on a front porch… even if from a safe distance.

The rumor is, watching PR professionals silently vanish from the Internet is becoming a popular spectator sport - especially when it’s the more expensive hacks for sleazy discount dental companies like Delta Dental. I intend to show you that when someone writes really nasty things about their most devoted employees - employees who publicly donate their name and reputation to Internet branding for the interests of Delta Dental - Delta Dental will still not come to their defense. (No wagering, please). The devoted and abandoned, whose objectives in life are to take hits for some team, make easy prey.

Remember Ari Adler? He heads Delta’s Corporate and Public Affairs division, and was quoted in DrBicuspid Assistant Editor Rabia Mughal’s article, “Dentists or patients: Who should get the insurance check?” http://www.drbicuspid.com/index.aspx?d=1&sec=sup&sub=pmt&am...

It was on DrBicuspid that Adler broke the news to the nation that Delta Dental now guarantees the fillings done by their preferred providers. When confronted by a special bastard to explain Delta’s unprecedented sales pitch, Adler immediately sat his butt down and shut up. (See “I will hurt you Delta Dental”)
http://community.pennwelldentalgroup.com/forum/topics/i-will-hurt-y...

That was two months ago, and Adler still hasn’t uttered another peep on behalf of Delta Dental. Now doesn’t that make the air in the land of the free just a little more pleasant?

Yesterday, Rabia Mughal posted another article illustrating managed dare dentistry’s level of ethics titled “Study: Insurers' market power lowers dentists' income.”
http://www.drbicuspid.com/index.aspx?sec=sup&sub=pmt&pag=di...

Mughal describes the findings of a study titled “The effects of insurance carrier market power on dentists and patients” that appeared in the January edition of the JADA. Here is the abstract of the study:
-------------------------------------------
http://jada.ada.org/cgi/content/abstract/140/1/90
The effects of insurance carrier market power on dentists and patients

L. Jackson Brown, DDS, PhD, Albert H. Guay, DMD and Donald R. House, PhD

Background.
Market power among dental insurance carriers is a carrier’s ability to reimburse dentists at rates below what would exist in more competitive areas. Competition among carriers for dentists’ participation in their networks protects dentists from highly discounted fees. The authors examined the extent to which dental insurance carriers facing less competition increase fee discounts.

Methods.
The authors selected a sample of dentists from listings of general practitioners. They identified 219 metropolitan areas and contacted 11,542 dentists in those areas by mail, telephone or both. A total of 8,017 dentists completed surveys (a response rate of 69.46 percent). The authors’ key focus was the possible relationship between carrier market power and the size of the fee discount. The authors compared discounts across metropolitan areas with their differing levels of insurance coverage and carrier market shares.

Results.
Carrier market power was directly related to the sizes of fee discounts. The larger discounts were found where there was significant dental insurance coverage and few carriers providing this coverage. Dentists’ net incomes were significantly less in areas with larger fee discounts.

Conclusions and Practice Implications.
Dental insurance carrier market power leads to increased fee discounts. These higher discounts reduce dentists’ earnings. Although the larger discounts may result in lower overall patient costs, this patient benefit is temporary. Ultimately, the number of practicing dentists in these communities will decrease as dentists seek improved practicing conditions elsewhere. This reduction will lead to overall fee increases until the earning potential of dentists is restored.

Key Words: Insurance; insurer concentration; market power; fee discounts; reimbursement; provider networks

Abbreviations: IPAs: Independent practice associations. • PPO: Preferred provider organization. • UCR: Usual, customary and reasonable.
----------------------------------------------

As one can imagine, Delta Dental, the largest dental discount service in America, did not like what both the ADA study and Mughal had to say about discount dentistry brokers. This time though, instead of sending Ari Adler into the wide open spaces once more, Delta sacrificed a new, unsuspecting traditional-type of PR executive whose feelings have never been hurt. Her name is Janis Oshensky, and she is the vice president of professional relations for Delta Dental Plans Association.

Ms. Oshensky confidently said that it is her opinion that the study is flawed. Here is what Ms. Oshensky told Mughal: "The study speculates that dentists will leave markets dominated by a few large carriers, which would lead to higher fees for uninsured patients and reduced access to care. In fact, the miniscule effect of concentration on the fees paid to dentists -- as they are reported in the study -- is unlikely to trigger a mass exodus of dentists from concentrated areas."

Ms. Oshensky further states - on dentists’ behalf - that we actually realize that discounts do not necessarily mean less pay, and that network participation increases dental visits (for the same pay). Now that woman deserves a company wristwatch!

To show you how devoted Oshensky is to Delta Dental, her act almost fooled me into believing that she believes the NPI number makes sense. That’s no joke. Look at what she posted on the Delta Dental Website celebrating Delta’s success, and you will see what I mean:

“Thanks to all of the dentists and health professionals who have applied for NPIs and who have notified us of their new identifiers. While we’re not ready to completely replace the current identifiers with NPIs, we’re making great progress and will work to keep dentists and their office staff informed about our NPI readiness.”
http://www.deltadentalnj.com/npi/PrepareToAccept.shtml

Now that’s talent. I would imagine that she probably charges more than Adler ever will. Her name is all over the Internet on behalf of Delta Dental, and she sounds even more enthusiastic about the NPI number than Patrick Cannady of the ADA Department of Dental Informatics did a couple of years ago when his department was still telling ADA members to quickly volunteer for the ten digit identifier. You know, come to think of it, Delta Dental’s Website closely resembles the ADA’s. How do you think that happened?

My hat goes off to author Rabia Mughal. How he can successfully lure another Delta Dental slow-mover into the open following the ambush of Ari Adler is pure genius in a mis-match of wits.

So here we go again, sports fans.

Come on out, Janis Oshensky, I can make you famous. Please bring everything you know about the NPI number with you as well because I have a few questions to ask…. or not.

Schadenfreude macht Freude.

D. Kellus Pruitt

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Permalink Reply by Darrell Pruitt on April 3, 2009 at 5:48pm

Part eight: Sending PR types on down the road

Delta Dental PR expert Janis Oshensky, who likes the NPI number, has no place to hide. I only hope Oshensky is a pen-name she chose… Yea. I see what you mean. Probably not very likely. I found Oshensky today in a PR piece from a few days ago where she served up committee-approved talking points about Delta Dental. I submitted the following comment, but it might not be posted on the Life & Health Website because of Delta’s advertising dollars.

It is my passion to keep PennWell readers as informed, and as entertained as I keep myself. We’re at the edge of healthcare history, friends. Our hope is transparency. But most importantly, let’s have some fun! Darrell
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http://www.lifeandhealthinsurancenews.com/News/2009/3/Pages/Associa...

Truth about Delta Dental

When I hear Delta Dental PR specialist Janis Oshensky brag about their lobbying efforts to decrease regulation of discount dentistry brokers, the Hippocratic Oath compels me to expose her deception to protect my patients from harm.

As I look at the prominent and expensive ad space which Delta Dental Plans Association (DDPA) rents on this insurance industry Website, I can easily understand why leaders of Life & Health National Underwriter might decide not to post the comment I offer in response to their PR piece (no byline) titled, “Association Lobbies For Dental Benefits” - which was also paid for by DDPA. The Website’s inescapable conflict of interest due to significant ad revenue is why I also submitted this to the Medical-Executive Post as a follow-up to a comment titled “Blindsiding Delta Dental” - where DDPA vice president Janis Oshensky, who is featured in the Life & Health article, collided with me less than a day ago. She lost.
http://healthcarefinancials.wordpress.com/2009/04/03/blindsiding-de...

To show your readers, and perhaps your executives, how fast traditional PR careers can vanish these days, if one searches “Janis Oshensky” on Google, “Blindsiding Delta Dental” is her number 4 hit. It looks like it will be on her first page for a long time because sports fans seem to enjoy it.

Janis Oshensky’s career in dental insurance PR is over because she carelessly trusted her reputation to a sleazy company that will not come to her defense. Oshensky should hold her boss accountable. They used her up, and the leaders could not care less.

Let me ask you, Life & Health editor, whatever your name is. Do you occasionally like life on the edge? Are you a sporting type? Here is a challenge in transparency if you have the confidence to step out into the open with me: You will tell me how much Delta Dental pays you for ad space each year, and I will tell you how many children’s dental check-ups that would purchase at a price that is fair to both the dentist and patient. You can’t get better than that in the land of the free.

When you posted the DDPA article, did you realize that the link you were provided for an “educational Website” uses the tragic story of the 12 year old Maryland child who died from an infected tooth to convince lawmakers to increase their “flexibility”? (“Flexibility” is a fresh euphemism for “Tyranny.”) I’m sure that most editors who are not anonymous find Delta’s consistent lack of compassion repugnant. I assure you that dentists do.
http://www.advanceoralhealth.com/?page_id=2

How important are happy dental homes anyway?

I am a dentist, and over the last couple of decades, thousands of my patients have been lured away from my practice by Delta Dental discount dentistry plans that were not their choice. Does it cause harm to force a patient from the provider they prefer? Of course it does. What’s more, if the patient’s boss pays premiums to Delta, and the insured cannot find anyone they like on a preferred provider list, who profits the most from the healthcare dollars when the patient never goes to the dentist? Delta Dental clearly has a disincentive to hire popular dentists. How good is that?

In “Who Killed Health Care?” by Regina Herzlinger, a widely-respected authority on the healthcare industry and Harvard Business School professor, she said that for prevention to have a chance in healthcare, medical homes are so important that annual limits to contracts should be eliminated for multi-year contracts only. I assure you that in dentistry, continuity of care is especially important to whole-body health. Sometimes it can take a couple of years of regular cleanings for a patient to finally grasp the habits he or she needs to prevent diseases of the teeth and gums. Talk about a money-saver! The vast majority of dental work is to correct damage caused by poor oral hygiene. Not the absence of a preferred provider list - as Janis Oshensky would like lawmakers to believe.

I think most people would suspect that when a dental patient has to leave the provider of their choice, there is a good chance that “new cavities” will be unexpectedly discovered by the new dentist - especially if it is a discount provider who cannot raise fees to cover increasing overhead. Here is a fact: Ethics are not free.

I know it is also a fact that Delta Dental has known for at least 8 months that their business model causes damage to their clients. I was in the audience on the morning of August 15, when I heard DDPA representative Maxwell H. Anderson DDS admit to over a hundred attendees: “The greatest hazard to teeth is changing dentists.” It was the first day of the 2008 National Dental Benefits Conference in ADA Headquarters in Chicago. Dr. Anderson was describing the results of an-house and still unpublished study of Delta’s claims information accumulated over the last 11 years. Shortly afterwards, he was asked to share his data with research institutions. Maxwell replied that Delta could not share their data because it is proprietary. He explained that if such information were released, it could give BCBS an unfair advantage in a very competitive dental benefits market. Did I mention that Delta Dental has no compassion for its own employees either?

Here is the scariest line in the PR piece: “The Delta Dental Plans Association is promoting the importance of including dental benefits in health reform efforts.”

If you don’t drop it, Delta, I’ll drop you, - one hack at a time. Please send out another’n.

D. Kellus Pruitt DDS
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Permalink Reply by Darrell Pruitt on April 7, 2009 at 1:07pm

Attention sports fans!

I cornered another huge dinosaur. Sit back and watch me carve off chunks of credibility, live, and whenever it pleases me. (Wear old shoes).

Today I discovered that Delta Dental Plans Association has launched a Web site “to educate the public, regulators, lawmakers and policymakers about the importance of including dental benefits in health care reform.”

Nothing is mentioned about discussing their reform plans with dentists, because Delta's leaders think they are so huge in the marketplace that they don’t have to talk to dentists at all. It’s called “command-and-control” and is obsolete in dentistry. Nevertheless, unrealistic Delta leaders continue to underestimate the marketplace penetration of healthcare free forums like this, as well as the power of sports fans’ social networks. We are the viciously ubiquitous.

I pledge to be merciless as I show readers that DDPA is easy prey - precisely because of its size. Delta is a fat, slow-moving dinosaur with a committee for a central nervous system. Committees haven’t a chance against me, or others who are sure to follow when they see how easy this is - as well as fun. Old school is so lame.

I posted this letter on Delta Dental’s new “Advance Oral Health” Web site.
http://www.advanceoralhealth.com/

I can do this for years. Darrell

------------------------------------------------
Dear Delta Dental Supervisor:

You should probably get your boss.

My name is D. Kellus Pruitt DDS, and it is my opinion that Delta Dental’s business model is harmful to dental patients. As public service to my neighborhood, I intend to stand in your way, Delta. And I am the special bastard who can do it. Look what Jeff Jarvis did to Dell Computers a few years ago, when he brought transparency to Dell’s poor business ethics. They call it “Dell Hell.” Jarvis, who is much more profane than I am, made Dell Computer clean up their act. Now Dell is more consumer-friendly. If the leaders of Dell had accepted the trainloads of clues sooner, it Dell Hell would not have harmed the company at all.

I learned a lot from Jarvis, and several others who have caused incredible change using social network platforms. Who have you got? PR geniuses Ari Adler and Janis Oshensky? You’ve got nobody.

You, Delta Dental Plans Association, are defenseless. Your position in the market is so untenable that I can silence your crew simply by publicly picking you apart (between checking hygiene patients) with straightforward questions about dentistry that you cannot answer without sounding absurd. Let me show you what I mean:

Question 1. I have noticed on several Internet venues that Janis Oshensky, vice president of dental relations and public policy for Delta, encourages dentists to sign up for the NPI number. But I have yet to hear a good reason to do so. On the contrary, I have watched physicians’ payments delayed for months because of crosswalk problems with NPPES. Who needs that? Why should I volunteer for an NPI number?

See what I mean? If Janis Oshensky or the next in line would like to take a shot at answering my questions, this letter to you is simulposted on the PennWell forum as part of a long thread titled “I will hurt you, Delta Dental.” And I will.
http://community.pennwelldentalgroup.com/forum/topics/i-will-hurt-y...

Got guts?

Question 2. I have noticed your efforts to lobby for lawmakers to lessen the regulation of your company so that you can more effectively and economically regulate dentists. In the last couple of weeks your PR department has been very busy justifying your discount dentistry brokerage service to Congress - bragging about your plan being accepted in 75% of dentists’ offices. It sounds to me like you have too much power already. Why do you talk with lawmakers, but refuse to talk to dentists on the PennWell forum?

I assume that PennWell sports fans will never hear squat from you. Prove me wrong. I dare you.

More questions to follow. I know for a fact that lawmakers, as well as employers, consumers and dentists, are watching. You have a large audience now.

D. Kellus Pruitt DDS

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Permalink Reply by Darrell Pruitt on April 26, 2009 at 2:22pm

Hey, Ari Adler: Tweet this

Good afternoon, sports fans. Remember Ari Adler, the Delta Dental PR specialist and adjunct marketing professor who made fantastic promises about Delta Dental’s quality control in an article on DrBicuspid? To refresh your memory, starting on January 31, I covered his alleged deception in this PennWell thread, “I will hurt you, Delta Dental.”

Months ago in the DrBicuspid piece titled, “Dentists or patients: Who should get the insurance check?” assistant editor Rabia Mughal quotes Adler: "We [Delta Dental] put our dentists through a credentialing process and provide quality assurance. That means if a dentist does a filling that should last a certain amount of time and it doesn't, they have to fix it without charging the network or the patients."

When I failed to receive a clarification from Mr. Adler about what appears to be an unprecedented guarantee of dentists work by an insurance company, I asked Kate Gerlesits of DDPA and Angela Feig of the Meyocks Group the obvious and important legal question: “Did Delta Dental authorize Ari Adler to roll out the news of Delta’s guarantee, or was the sales pitch a product of Adler’s own initiative to attract new clients for Delta?” It’s been six weeks now, and nobody from Delta Dental has answered my question. This morning, however, I discovered that selectively silent Ari Adler is actually a well-recognized songbird on Twitter, begging for dissection.

For a special bastard like me, Twitter opens a vast new arena of opportunities. Let’s explore one of them together today.

Ari Adler became popular on Twitter quickly. He already has attracted over a thousand followers, in fact, according to his latest Tweet, he found an application to help him manage his popularity. That’s impressive. In comparison to Adler’s posse, I have two, and I think one of them is a nosy cousin who follows everyone.

Adler is arguably one of the best bloggers around. And I’m arguably no slouch, but from my encounters with him, Adler has proven to be a formidable player for a part-time good ol’ boy. I’m not ashamed to admit that I have tried again and again - using my best Search Engine Optimization (SEO) tricks, to push any one of several challenging comments onto Adler’s first page in a search, and each time I have failed… so far. Adler continues to be out of my reach because of the googlejuice he’s justifiably amassed. Too bad the Dark Side has him in its cold-blooded clutches. As is often the case in the decision to lower one’s standards, I have to think money is at the bottom of Adler’s need to compromise his reputation, and probably his career by doing work for Delta Dental.

As a sporting salute to Ari Adler, I should point out that as far back as October of 2006, I successfully nailed a harsh comment to HHS Secretary Michael Leavitt’s first page that stayed a week. It is an article posted on WTN about electronic health records titled, “Careful with that electronic health record, Mr. Leavitt.” Here’s more: Even though I could not come close to helping Adler expose his true brand, a couple of months ago, I was able to overcome Allscripts CEO Glen Tullman’s googlejuice and nail two unflattering comments on his first page, even though they also remained for only a short time. Finally, allow me to point out that even more recently, and closer to home for Ari Adler, I overwhelmed a weak PR specialist named Janis Oshensky. Today, “I will hurt you Delta Dental” is her number one hit, and Delta Dental refuses to publicly defend the reputation of their faithful employee. They’ll let her bleed out. They don’t care about what happens to Ari Adler’s reputation either, even though he easily out-classes Oshensky. That is the employees’ side of tragedy in this real-time drama.

Wear old shoes. This could splatter.

This morning, Ari Adler tweeted: “Lots of new followers in past 2 days. Hello, and good morning everyone, except for the spammer who has tried to follow me with 6 accounts :(“

My question is, why has Ari Adler attracted the attention of a spammer with even more energy than I have? I smell the stench of Delta.

Too bad Adler is associated with such a sleazy discount dental business. To illustrate how the company one keeps can become a burden in a PR career quicker now than ever before, let me show you how Twitter inadvertently offers special bastards a new dissection tool for leveraging that allows one to take advantage of weakly reinforced purchase points.

Here is the tweet I sent Ari Adler.

“@aribadler Does Delta dental guarantee fillings done by its preferred providers?
about 5 hours ago from web in reply to aribadler”

I’m a baaad boy. D. Kellus Pruitt

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Permalink Reply by Darrell Pruitt on May 17, 2009 at 1:31pm

A grin for Ari Adler

Anyone who goes to my Twitter page (Proots) can readily see that one of the 11 accounts I follow is Ari Adler’s, who I already described as possibly misrepresenting the business policy of his boss, Delta Dental. Adler says that Delta Dental guarantees its providers’ fillings. I don’t believe it, but I cannot get an explanation from either Adler or Kate Gerlesits of DDPA (kgerlesits@deltadental.com). I follow Gerlesits’ Twitter account as well, but she is not active at all. She also does not respond to emails. How good is that?

I have said before that it is next to impossible to be half-way transparent on a social network like Twitter. These days, working for The Man makes one’s reputation especially vulnerable if The Man is a sleazy monster like Delta Dental. For example, Delta’s part-time PR rep, Ari Adler, is trapped, and his future as a credible PR professional hangs in the balance. By now I am certain that Adler knows that as part of his PR deal, he mortgaged his reputation to Delta. I think he also knows that now he cannot escape. To make matters worse for his career, Delta Dental has little concern about the reputations of their expendable PR employees.

I am certain that Ari Adler will bounce back because he is sharp and writes good stuff. Today he posted a well-considered comment on Ari Herzog’s AriWriter blog - which provides “strategies and tips on: social media & online marketing.”

I happen to agree with everything Adler said against having information-only sites on Twitter, and I posted the following article on Adler’s friend’s blog, which even looks friendly on the surface. For those who have been following me, this is a variation of the trick I pulled a few days ago when I posted a comment on David Politis’ blog after I discovered that he and Trajan King, the CEO of Intelligent Dental Marketing, are possibly buddies who live in the same town.. The difference is, I didn’t mention Trajan’s name to Politis. In today’s trick, on the other hand, I snuggled up right next to Delta employee Ari Adler with my complimentary comment. You can imagine that when I grinned at him, I showed him some teeth, and snarled just under my breath. Darrell
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http://ariwriter.com/2009/05/2-years-1-month-and-10-days-later/comm...

I tend to agree with Ari Adler. As a read-only news source, I think Twitter makes for a poor information control tool which can possibly draw viewership away from one’s website - especially if it is successful. Otherwise, having more than one responsive Twitter account just does not make sense. In addition, unresponsive accounts sometimes attract unwanted, public responses which cannot be easily handled from the designated non-interactive account. It could create a PR mess, in my opinion.

I also think that employing a simple news-flash page of some kind on one’s website is much more attractive because it can offer immediate content not limited to 140 characters, less a link - and a click. I think to improve one’s brand, one would do better to concentrate on providing good, first-hand and real-time content - with or without links - and strive to be responsive to one’s audience regardless of the size. Personally, I think finding a manageable niche on the “long-tail” rather than marketing to everyone makes more sense. But then, I’m an amateur.

As Adler says, Twitter is conversational. Right now, the currency of “followers” reminds me of a CB radio fad from a few decades ago. I am optimistic. As Twitter settles into its useful place in social networking, more and more incredible, interactive tools will surely emerge - breaking down even more silo walls with implied transparency.

D. Kellus Pruitt

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