Continued margin compression, outside people trying to get in between dental teams, and insurance companies denying care and delaying payments are a few of the burdens facing dental leaders.
Prioritizing alignment, culture and honesty with staff and patients is key to navigating these strains.
Three dentists and DSO executives recently connected with Becker’s to share some of the external pressures that are pushing the industry today.
Note: Responses were lightly edited for clarity and length.
Question: What external pressures in the dental industry concern you most today?
Matt Hendrick. Co-founder of Elevate Dental Partners (Denver): The external pressure that concerns me most in dentistry today is the growing influence of short-term capital combined with rising cost structures. As private equity has accelerated into the space, some models are built around compressed hold periods and aggressive growth targets. When those incentives are not aligned with doctors and long-term patient care, it creates cultural strain and operational instability.
At the same time, practices are facing significant wage inflation, supply cost increases and reimbursement rates that have not kept pace. That margin compression forces difficult decisions.
The groups that will succeed long term are those that prioritize alignment with clinicians, invest in leadership development and build sustainable, patient-first models rather than chasing near-term multiples.
Phillip Isaacman, DDS. Owner of Bluff City Dental (Memphis, Tenn.): I think when you refer to “external” pressures, you’re talking about money pressure from outside the office. The dentists and the teams are fine — for the dentists and the teams. Pressure comes from other people trying to get between the teams and the money. I own my practice, and maybe I can afford to lose 14% to a DSO, or private equity or whoever else wants some. But I can’t afford to have a bunch of bosses making sure I meet production levels so that they can meet production levels for their bosses.
Robert Trager, DDS. Dentist at JFK Airport (New York City): The pressures I have to deal with are called the three Ds instigated by the insurance companies: delays, denial and downcoding. All the insurance companies, in order to keep their float to collect interest and to protect their investments, are finding ways to deceive the providers as well as their insured clients. Whenever we send in for an EOB, we send the complete package; claim form with x-rays, narrative, periodontal charting and pictures of the patient’s oral cavity. The insurance company ultimately will approve one thing when multiple requests are sent in with all attachments needed for payment and or pre-authorization. All of this information is sent stapled together and when a follow up is done with the insurance company they will acknowledge receiving only part of what was sent as a complete package all stapled together and sent in one large envelope. Invariably they will delay and/or deny payment/approval asking for further information, which was sent with the original request, or they tell us that it’s pending or under review.
They use every excuse to delay or authorize the procedures performed or need to be performed. In most cases you end up speaking to an agent who is offshore and isn’t a licensed dentist. Who’s really making these decisions?
Therefore, we ask to be connected to a U.S. supervisor for verification. In many cases it’s helpful, but in the long run these insurance companies are using gimmicks and tactics that are causing many providers to commit insurance fraud to get their reimbursements. The insurance companies try to force you into accepting credit card and/or third-party payments in order to charge 2.5% to 3% commission. The ADA and state legislatures will have to come up with more stringent legislations to curb and to sway these insurance companies from their gimmicks and professional conducts. Be honest and ethical to your patients and don’t let these insurance companies control your destiny.
