Giving OHP a Second Look

It is common for dentists and their teams to not want to accept patients from the Oregon Health Plan (OHP).  But is that the best course of action, especially since there are over 600,000 OHP patients—a number that is expected to grow even larger.

To make the best decision for your dental practice, you need to consider how many OHP patients you have in your area.  If you draw a two or three mile circle around your practice, you may encounter a significant pocket of patients receiving state help.  Can you afford to exclude this population?

A valid point made by many dentists is that OHP reimbursement is so low they cannot make a profit.  If you participate in a non-capitated plan administered by ODS, Capital, or Advantage, you bill out a fee schedule that is approximately 25 – 30% of your normal fees for some procedures.

Dentists who have made this work in their practice have retooled their approach, which includes minimizing their chair-side time, double-booking patients, and using dental assistants to their fullest capacity.  There is no question this approach is challenging.  But if you have empty chairs and/or you want to add additional days, OHP could be something to consider for your practice.  And it’s a great service for the community.

In addition, if there is a large enough OHP patient base in your area, you may qualify for a capitated plan through Advantage.  A capitated plan pays you a set amount each month based on the number of OHP patients assigned to you.  You have to bill out approximately what you receive in capitation payments, using a fee schedule that is competitive with many PPO plans.  The discount you take is a lot less than with a non-capitated plan.

There are many points to consider before adding OHP to your practice.  Before you simply toss the idea out the window, however, I encourage you to go through the analysis.  Considering the number of people who currently receive state help, adding OHP may make more sense than you think.

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