Dental organizations are being squeezed from multiple angles, as reimbursement continues to trail inflation and pressure builds on public coverage.
Through August 2026, the reimbursement rate index rose 1.5% while inflation rose 2.3%, according to the American Dental Association Health Policy Institute’s latest dental economy update. Since the start of 2021, reimbursement has climbed 19% compared with 27% inflation.
On the public side, states including Massachusetts and Idaho have weighed capping or eliminating adult Medicaid dental benefits as federal cuts tied to H.R. 1 strain state budgets.
Rather than simply cutting costs, some organizations are building flexibility into their operations now, through cross-trained staff, new workforce models and in-house services.
Two dental leaders discussed how they’re building business models that can absorb economic volatility at Becker’s 5th Annual Future of Dentistry Roundtable in Chicago.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: With reimbursement rates stagnant, how do you build a business model that can absorb economic volatility without just asking practices to cut costs, and how do you create flexibility before you truly need it?
Manu Chaudhry, DDS. President of Capitol Dental Care (Salem, Ore.): We contract with 455 dental providers throughout the state, and about 300 to 350 of them are part of our DSO network. From a payer perspective, sharing in the managed care mentality of value-based care has really driven greater innovation and productivity across the entire system. Since 2020, we’ve nearly doubled utilization. Not all of that comes from capitated contracts; much of it comes from workforce innovation. In 2021, we helped pass legislation allowing expanded practice dental hygienists to perform interim therapeutic restorations in the field. We also helped establish dental therapists in the state, and we’re one of the sponsors of Oregon’s first dental therapy program, which starts its first cohort this year. We’re also piloting a program with a community health center in Southern Oregon to train dental assistants to give injections, which is allowed in Oregon. We’re looking at how we can take what we have, redesign it and optimize it to increase capacity and productivity, and to provide the right care at the right time. In that one pilot, we were able to see two more patients per day. Imagine what that can do across the entire system: A doctor who might be comfortable with 2,500 patients a year could see 10% to 15% more.
Everything comes back to establishing trust and rapport with our patients. It’s also important to partner with state and regional dental associations to see whether colleagues are interested in developing these kinds of programs.
Anna Pelak, DDS. Board Member and Owner of TotalDentistry (Palatine, Ill.): Part of it is having cross-trained staff so you can cover different areas of the practice when you need to. Another way to add flexibility is the total-care approach, whether that’s being a super general practitioner or adding specialties to your practice. Scheduling efficiently is also very important. A lot of practices schedule linearly rather than staggering. Map out dental assistant time versus doctor time so your schedules are more efficient. AI is also a big win right now, whether it’s training your front desk or training your team to read X-rays. Then look at your costs. In-house labs help. You can also train your staff in other areas of dentistry, such as orthodontics and Invisalign. You can add a lot of flexibility to a general practice by seeing what your doctors and staff want down the road and by looking at how to help patients pay for care through options like third-party financing.
You also have to look at the type of practice you have and what your patients are comfortable with. If you have more of a boutique practice, you’re not going to have staff take on certain tasks because of the nature of the practice. If your patients are used to one-on-one time with their hygienist for 30 years and you switch them over to dental assistants, that’s a fine line. I’ve seen increased productivity from having other staff members take on certain responsibilities where the state allows it, but is that truly the nature of your practice? We have to tread carefully so we don’t lose the quality behind the practice, and so we keep patients happy.
