Dental cost Q-and-A

Redmond dentist explains pricing philosophy

Anne Aurand / The Bulletin /

Published Nov 29, 2012 at 04:00AM

The variable costs of dental work have many patients confused, wondering why some dentists charge more or less for the same procedure.

Many factors go into any individual dentist's prices, from overhead costs to different insurance plans. Dentists are developing new and different ways to accept payment, too, such as membership models of care.

One local dentist has made a mission of lower-priced care. James Row is a Redmond dentist whose goal is general and implant dentistry for the “smart consumer” at a “whole lot less,” he said. Here, he explains his pricing philosophy and how technology and experience have allowed lower prices.

Row says he can charge less because he has, over time, invested in technology that makes his practice more efficient, and because he's willing to sacrifice some profit.

Row started doing dentistry in Hillsboro in 1999. Six years ago he opened an office in Madras. When he opened an office in Redmond in August, he advertised low kick-off deals, such as $599 for a ceramic crown and $475 for an anterior tooth root canal. The promotional deals will gradually wane until Jan. 1, when, for example, those prices will increase to $799 and $582, respectively, which he says are still less than many dentists in the region charge.

Q: Why do you want to charge less?

A: We need to control medical costs.

Most dentistry is done by solo practitioners. We don't answer to stockholders or a board of directors. So if a dentist makes enough money for what he wants to do with his life he can charge whatever he wants. I can keep my schedule full by dropping my fees. It keeps me busy and I make enough to be happy.

Q: How different are your rates than other dentists?

A: Even after my initial promotional prices go up, my goal is to keep my prices in the lower 50th percentile of what others in the region are charging.

Q: How do you know what others in the region charge?

A: I have worked with consulting firms that do surveys. They rank fees by percentile.

Q: When did you adopt the mission of charging less?

A: When I was surrounded by Intel employees in the Hillsboro area, they all had great insurance and it didn't matter as much. But when I moved my office to Madras in 2006, I found many people didn't have insurance or had some that wasn't as good. I started thinking about how to use technology to bring down the cost of what I do. I can do my work easier and faster and at a lower cost, and I can pass that on.

Q: Explain how the high-tech equipment you have allows you to perform certain procedures for a lower fee.

A: The first is a CAD/CAM unit, (computer aided design, computer aided manufacturing). A laser camera on a wand sweeps through the patient's mouth, creating three-dimensional virtual impressions of teeth that appear on a computer screen. On the screen, I can design the veneers that improve the cosmetic look of teeth, or the crowns that fix durability and structural problems. Onlays and inlays are also done using the equipment.

I can then send the picture to the mill, a machine in a different room here that shapes a crown out of a chunk of lithium disilicate, a type of ceramic.

This eliminates lab fees. Many dental offices have to send off such designs to labs where veneers or crowns are created. I have my own lab and my own firing oven. It only costs me the price of the block of ceramic, which is about $30. So I can cut $170 off the cost of a crown for patients. That gives me a lot of latitude in my fee schedule. I can still make some profit. It doesn't take too long to pay for the $100,000 CAD/CAM equipment, and I have years of investment into my equipment.

I also custom stain my own crowns, instead of sending that work to another lab. I don't charge for shade adjustments because I can just do it in a few minutes. For all these things, we don't pay a middleman, another place that has rent and staff and heating bills.

The other piece of equipment I have is all paid off. It's a 3-D CT scanner, which is used when people need implants (an artificial root that holds in a replaced tooth or bridge). I bought it when I was working in Hillsboro. I took a leap and invested in this technology.

Using the CT scanner, a 3-D rendering shows roots and bones from different angles, to diagnose problems that might not otherwise have shown up until you're well into a procedure. It makes it faster for me and safer for the patient. You're eliminating any surprises.

CT scans can cost $350, but I can charge less because my machine is already paid for. Right now, our implant consultations are free, and that comes with a scan. It gives people a reason to come to us.

Q: How can you guarantee that your quality is equal to another dentists?

A: The crown material I use is the same as what's used in a lab. Most everyone uses high-quality materials. Some send crowns off to get made in China or Mexico, but most of the dentists around here don't. I don't think materials are an issue. It comes down to abilities. I'm experienced and I've been doing this for a while.

Q: What are the “combined skill sets” mentioned on your website (www.drrow .com) that you say allow for a “lower profit margin?”

A: In addition to general dentistry, I can do an implant and a crown so I don't have to refer those jobs out. If someone gets an implant done by an oral surgeon, he has his profit margin. The restorative dentist has his profit margin. A lab has its profit margin. If I do the implant, I design and make the crown, I've consolidated that down into one profit margin.

Q: You suggest on your website that you earn less than other dentists in the region. What makes you think that?

A: You know from experience what it costs to do this kind of stuff. You have a good idea of what it costs others to be in business. Everyone has to make a profit. I make as much money as I need, doing what I like, the way I like to do it.

Q: Does higher cost ever represent higher quality in dentistry?

A: Sometimes. A great example of this is when a patient has been taking Fosamax, a drug for osteoporosis. I'll send them to an oral surgeon to get a tooth extraction in case they have complications with their bones. It would be better to pay more to have an oral surgeon manage that.

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