Washington Dental Service, the state's largest dental insurer, has slashed payments to dentists for the first time in its history, saying it needs to make dental insurance more affordable for businesses. But dentists say the cuts may force compromises in patient care.

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Caring for your teeth costs more in Washington than just about anywhere else in the country, according to the state’s largest dental insurer, which recently slashed payments to dentists for the first time in more than 50 years.

Washington Dental Service (WDS), a nonprofit that insures about 1.5 million patients in Washington, says the $60 million it expects to save in cuts to dentists has allowed it to offer a more affordable plan to small businesses.

Angry and dismayed dentists, hit with cuts of up to 15 percent or more, warn that the drastic reductions will hurt patients, who have grown accustomed to dentists who take time to focus on prevention and options, instead of just waiting until something hurts or breaks.

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About 95 percent of the dentists in the state accept payments from WDS, but in the wake of the June 15 cuts, some have dropped the insurer, and many say they’re still considering doing so.

Dentists, most of whom own their own clinics, say they have no control over rising overhead costs and warn they likely will have to make drastic changes in their practices.

“Never in my 23 years in practice has there been a bigger threat to the way I take care of my patients,” said Dr. Chris Pickel, a Northgate-area dentist and immediate past president of the Seattle-King County Dental Society.

“This is a big tipping point right now,” Pickel said. “It forces dental practices to go to a volume-based system, where you see more patients per day,” limiting time for proactive, preventive care.

For example, he said, the volume-intensive “commodity-based” approach to a patient who has wear and breakage from teeth grinding might be to just repair, replace and offer a nightguard.

But with fair compensation, Pickel said, a dentist would spend time with the patient asking questions about possible causes of the problem, including workplace conditions, medical issues and medications, as well as checking the patient’s bite and doing tests.

So far, dozens of dentists have dropped WDS, but with new dentists coming in, the insurance panel is only 151 dentists down, said Jim Dwyer, WDS’s CEO — and that’s a small percentage of its network of nearly 4,000 dentists across the state.

Dentists who drop the insurer will still see patients insured by WDS, but they’ll get much-reduced reimbursements and will bill patients the difference.

Dwyer says he’s gotten an earful from angry dentists, and he sympathizes with them.

“They got to this position by expecting that their increasing expenses will always be met with an increase from Washington Dental Service — so we’re partly to blame in this.”

He said suppliers who serve dentists have continued to pass along double-digit cost increases to dentists. “They’ve been essentially immune to the recession,” with dentists paying their way.

“That process has to be arrested,” Dwyer said. “Otherwise, there will not be affordable oral health care for the citizens and businesses in Washington state.”

A WDS survey of reimbursements done earlier this year compared Washington to 14 “peer states” with similar market conditions.

Although patients have said for years that dental prices seemed high in Washington, this was the first time the insurer had conducted a “serious market survey,” Dwyer said.

It found that only a couple of other states on the East Coast were higher priced, he said.

“When we looked at this, we just said we have to make a course correction. In fairness, we should have addressed it earlier,” he said. Dentists argue that their costs of living and of dental supplies are higher here. They also say that the quality of dentistry, and patients’ expectations, are high here, in part because of the influence of the highly ranked University of Washington School of Dentistry.

Dwyer said the fee-reimbursement cuts average 5.5 percent, but dentists say many have received cuts from 15 to 22 percent. The cuts come after WDS froze fees for the last year or two.

Dwyer’s compensation — $1,098,333 in 2009 — has become an issue.

“Would he be willing to take a 50 percent pay cut as a percentage of take-home income as many dentists are being asked to accept?” asked Dr. John Weaver, an Olympia dentist, in an opinion column in the latest issue of the Washington State Dental Association’s WSDA News.

Dentists’ compensation varies widely, but median salary is $147,058 in the Seattle area and $127,138 in the Yakima area, according to salary.com.

Dwyer said WDS hires an independent party every year to analyze and benchmark compensation for its own employees.

“If we had been doing with the dentists what we do with ourselves every year, we wouldn’t be in this box,” he said. “That’s why I say we’re partly culpable.”

WDS, like most insurers, must pay attention to its customers: the businesses that buy insurance for workers. To keep its market share, it must offer affordable insurance.

Nationwide, nearly 10 million workers — many employed by small businesses — have lost their dental insurance in the past few years as companies cut back, Dwyer said.

Dwyer hopes that the premium reductions of 15-20 percent in the small-business plan, which will be open Oct. 1 for businesses with 10 to 99 workers, will encourage more small companies to buy dental insurance. Currently, there are about 30,000 businesses in that category statewide, WDS said.

For dentists trying to figure out what to do next, it’s a tough calculation.

“We’ve made ourselves lean and mean,” said Pickel, who said he and other dentists already have cut their own salaries.

“We have to make a choice: Do we stay with the network provider and completely change the care we deliver? Or do we stay with the type of care patients are used to, and bear the risk of WDS patients leaving?”

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com

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