What goes into a dental fee?

What goes into a dental fee?

In evaluating the cost of dentistry it’s important to understand what goes into creating that dental fee.  The cost of a dental procedure is typically determined by a number of variables, many of which differ from region to region across the country.  The biggest determiner of a fee for a service in business (and the business of healthcare) is the overhead, or cost of providing the service to the client.  One major factor that influences overhead is the cost of the medical equipment used to provide care to patients.  For example, the sensor used to capture the image of a digital x-ray can cost in excess of $15,000.00.  A cone beam CT scan used for digital imaging can cost $250,000.00. Although the cost of computers tends to decline over time, the cost of the software designed to run equipment only seems to go up.  It goes without saying that in a modern dental practice that uses current and cutting edge technologies the cost of equipment can be very high.  Practices that don’t regularly upgrade and maintain their equipment can certainly reduce overhead costs.  One needs to ask though if offices that cut costs in this manner can deliver the same quality of care on a consistent basis as compared to those practices committed to using technically advanced machinery and maintaining this equipment rigorously.

After considering the cost of the medical equipment needed to operate a dental clinic, the next biggest overhead cost in dentistry is the cost of staffing.  Dental auxiliary team members in Alberta make on average approximately 25% more than their counter-parts in British Columbia.  In general terms, the team members that support and keep an office running in Alberta are paid at a rate higher than elsewhere in our country.  This discrepancy among salaries of dental auxiliaries can be more pronounced when one considers regions outside of Canada.  Again, it is worth mentioning that exceptional staff members are also compensated financially for their expertise (as they should be) and as such, more highly trained and skilled health care providers will be paid more and subsequently will cause the overhead in a practice to increase.   Consider also that convenience comes at a cost.  In an office that directly bills insurance companies for services that are provided, a team member is often dedicated to keeping track of the accounts receivable generated from outstanding insurance claims.  Although directly billing insurance companies is more convenient for many, it increases staff requirements and subsequently overhead costs.  In discussing regional wage discrepancies, one must also consider regional differences in cost of living both within our province and inter-provincially.  A haircut, parking, houses and rent, groceries, gas, all have various differing costs when compared across the province and beyond, and also have an impact on what people get paid and how far a dollar can stretch.  When a living wage (income needed to meet basic needs) in a specific area like Calgary is higher than in other urban or rural areas the salary in more highly skilled jobs is also proportionally higher.  This in turn affects the cost of operating a business.  Curiously, the increase in the cost of dentistry at Southport Dental Care over the past 10 years  has been below the average wage and cost increase in health care services as reported by the Alberta Government in their Health Care Cost Drivers report.

Rent, parking, material costs, equipment costs, office supplies, sterilization costs, the cost to create the environment within the office,the cost of continuing education (required to provide ongoing exceptional care) and business and property taxes all contribute to overhead expenses and can vary dramatically within a city, throughout the province, and from province to province.  Because many products are purchased from companies outside of Canada, the exchange rate of our Canadian dollar, import tariffs/duty and shipping costs impact the cost of supplies as well.  Alberta recently instituted new sterilization protocols which mandate more rigorous monitoring and documentation of sterilization equipment for Alberta dentists and the incorporation of more single use disposable supplies, gowns and surgical drapes.  All of these measures are good, and have been put in place to ensure the highest level of care and safety for patients being treated in dental clinics.  Of note is that the sterilization protocols required by the Alberta government and enforced by the Alberta Dental Association and College are not optional, and are not mandated outside of our Province.  All of these measures however increase operating costs.  All of these variables need to be considered when determining what it costs to deliver care to a patient.

The level of competence and experience that a practitioner has is a determining factor in establishing a fee for a service.  This is not to suggest that inexperienced dentists are not competent, but rather to point out that dentists with a greater level of education and clinical experience often will be compensated more for their commitment to higher learning and their broader and more refined skill sets.  The complexity of a procedure that a health care provider can do, the time it takes them to do this procedure (how efficient they are), and the quality of the equipment being used to complete the procedure are all variables that influence the cost of a dental service provided to a patient.

When we look at comparing a fee guide from a given province (like the ones published in BC or Ontario) to surveyed fees from a region in Alberta we’re not actually comparing the same measurables.  A fee guide is simply a guideline that a dentist uses in order to determine what an insurance company will pay them for a service and be a benchmark for what they can in turn expect to be compensated for by an insurance company if they direct bill.  In provinces where fee guides are published, dentists are still free to charge what they want based on what they feel the quality of the service they are providing is worth compared to the average fee.  Dentists in areas that have published fee guides who practice in high density regions with higher costs of living (like Vancouver or Toronto) will charge rates above the recommended fee published by their college because their overhead costs (and thus the cost of delivering care to their patients) are higher than those in more rural or suburban settings.  A more accurate way to compare fees across different regions would be to first and foremost compare areas with similar demographics, and then compare actual fees from clinics rather than a published fee guide with actual fees.

Finally, in assessing a fee we need to confirm what exactly what service is either being provided (in the case of the dental team) or being received (in the case of the patient).  When a patient has a unit of scaling during a hygiene re-care visit are ultrasonic hand instruments and lasers being used to more thoroughly and predictably remove bacteria and enhance regeneration of lost periodontal attachment, or is the health care provider simply scaling the tooth with basic hand instrumentation?  Is an x-ray truly just an x-ray?  Is the dentist using digital images or computer tomography to reduce radiation exposure, enhance diagnostic abilities and reduce the environmental impact associated with chemicals used to develop and fix the images, or are the older xray slide films being used in a standard fixing solution and developer?  Is the material that the dentist is using to restore the tooth an inexpensive yet clinically acceptable material, or is it a highly esthetic and technically more challenging material to work with that will provide a longer lasting and better looking restoration?  Is the dentist spending time in a recall examination to review a person’s medical history, to screen for cancer, to evaluate all hard and soft tissues, to examine any potentially inflamed muscles and evaluate each tooth appropriately, or is the recall simply providing a cursory overview of the patients general dental health?  Again, are we comparing the same measurables?

What goes into establishing a fee for a service in dentistry, like any other business, is a complicated matter and not simply about how much money a dentist or dental team member wants to make.  Establishing a fee involves delicately balancing many variables in challenging economic times recognizing both the need to provide a basic level of health care to the general population while simultaneously holding oneself accountable to that same population to provide them with the best level of health care possible using the most current techniques with the best materials and equipment possible.