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Each dentist, or any other professional, develops a system for applying fees that will cover all the costs involved in delivering such a service. Then additionally allow some incentive, profit margin that will finance relatively normal life expenses like mortgage payments, food etc. Traditionally this profit is modest and governed by laws of morality. The profit will provide an adequate incentive to the professional to continue their demanding career where they are otherwise constantly putting their patient's interest first.
As the owner of the dental practice (and therefore also the beneficiaries of any profit) is also the principle 'hands-on" clinicians, their relationships with the patients are notoriously close and personal. So fee consideration is often a little conflicting and difficult for the dentist. But reality has to kick in. Bills have to be paid. So a simple but fair system to apply fees has to be worked out and applied with discipline.
A recent development is that corporations are owning medical and dental practices. Corporations are governed by the requirement of maximum profits pretty much alone. This profit drive is policed by the CEO and accountants of the corporation. There is often no personal relationship with the patient between the people determining the fees and the patient. So things are often different there.
It is up to the practice owners to determine a fair and simple way to allow their patients to pay fees that will cover the practice costs and modestly reward the dentist. The convention is generally to evaluate each treatment, considering the time and resources used to perform the procedure, and list a fee accordingly on a fee schedule. Additionally adding a weight factor for the complexity of the procedure, including any inherent risk of time consuming complications that a procedure may bring and may have to be dealt with.
To be more specific, generally procedures are given an A, B or C rating. "A" being a simple, uncomplicated procedure like a scale and clean appointment. "C" procedures are quite difficult and run a risk of complication. eg complicated tooth extractions. The most difficult of procedures, you can call them "D", are usually carried out by specialists in a field. As specialists limit their equipment and training to their restricted field, they often work very quickly and efficiently at their specialty and hopefully do not have to raise a fee too much higher than the GP practitioner.
There are a number of ways for a health professional to calculate a fair fee for service subsequent to an appointment.
1. Rigidly adhere to a prepared scale of fees . eg each one surface filling is a fixed fee, the same fee being raised irrespective of whether the procedure is long or short, resource consuming or not, simple or difficult.
2. Do not use scheduled fees but hourly rates set for the 3 difficulty levels.
3. Use a scale of fees as per 1. above but with adjustments reductions (we call them efficiency discounts or sometimes "time factor" discounts). These adjustments are applied for procedures that turn out to be simpler than the average version of the procedures.
Now I feel the third technique is the fairest, in that patients who consume more resources will pay the fixed fee, as a maximum. Those that, by their procedures being simple or undemanding, will instead be charged a reduced fee based on an appropriate hourly rate.
So fixed fee schedules are used by myself, at our clinic, so we are able to determine and issue cost estimates and provide a published fee where that is required. Hourly rates are then used to enable the dentist, e.g. myself, to adjust the estimated or published fee so that fee to fairly represent the level of resources used for a particular procedure.
It is worth stating here that I am not comfortable with the technique of applying a fixed fee to a procedure irrespective of its time requirement. If we did, patients who have simple procedures compensate or balance for those that have difficult versions of the same procedure. This specifically is what we are not comfortable with. We believe an ultimate fee should cover what resources you as a patient consume during your appointment, measured in time and complexity, any laboratory fees and materials used.
The hourly rates we defer to are as follows
A... simple routine procedure $540 ph examples Scale and clean, examinations.
single small fillings,
simple tooth extractions
B... moderately difficult procedures $700 ph Multiple simple filling, procedures multi-tasked
standard level extractions
C... demanding and complicated procedures $800 ph Molar root canal therapy, difficult extractions,
or cosmetic critical filling.
I hope this all isn't too confusing but I am passionate about the fairness of the system of applying fees even if that means it is a little complicated to describe and apply.
Dr Adrian Longworth
90 Parkin Street Rockingham WA 6168