One of the questions we received recently came from a health center operating three dental locations where more than half of their patients are uninsured. Their question was straightforward:
How do we operate our dental program effectively while maintaining financial stability?
The answer can get complicated quickly. Every health center is different, and there isn't a one-size-fits-all approach to building a successful dental program. But before talking about staffing models, scheduling, reimbursement, or productivity, I always recommend taking a step back and starting with a simple exercise: a SWOT analysis.
Looking at your Strengths, Weaknesses, Opportunities, and Threats provides a framework for evaluating your program and identifying where your biggest opportunities—and challenges—may lie.
While every health center's SWOT analysis will be unique, there are several themes that we see over and over again.
Strengths
Alignment with your mission
Adding or expanding dental services supports a health center's mission of providing integrated care to underserved communities. Dental isn't simply another service line—it's an important part of comprehensive patient care.
An established patient base
Health centers already have relationships with thousands of patients. That existing medical patient population can provide a strong referral source for a dental practice.
Medicaid reimbursement
Many health center patients are covered by Medicaid. Because private dental reimbursement is often low, many private dentists choose not to participate in Medicaid. Health centers, however, generally receive a significantly higher PPS rate for dental visits.
If your state also allows reimbursement for same-day medical and dental visits, that's an additional advantage.
Pediatric patients
Many state Medicaid programs provide extensive dental benefits for children while offering limited coverage for adults. Health centers serving a large pediatric population may have additional opportunities to build a sustainable dental practice.
Weaknesses
Recruitment and retention
Dentists and hygienists remain in high demand, making recruiting and retaining qualified staff an ongoing challenge.
High capital costs
Dental programs require significant investment in equipment and facilities. Large private practices often have greater financial resources to absorb those startup costs.
Productivity
Scheduling inefficiencies and high no-show rates frequently result in productivity levels well below those seen in private practice.
Serving a low-income population
Health centers care for many uninsured patients and are required to offer services on a sliding fee scale. While this fulfills the mission, it can also create significant financial pressure.
Advanced dental conditions
Many patients have gone years without access to affordable dental care. As a result, health centers often care for adults with extensive treatment needs, creating both operational and financial challenges.
Opportunities
Significant unmet need
Nearly every health center serves communities with substantial unmet dental needs. Organizations that develop a productive model with a sustainable payer mix have the opportunity to become the leading dental provider in their communities.
Integrated care
Health centers are uniquely positioned to provide truly integrated medical, dental, and behavioral health services. A strong dental program can strengthen the entire organization by attracting patients to additional service lines.
School-based and mobile clinics
When implemented well, these programs can expand access while bringing more pediatric patients into the practice.
Grant funding and philanthropy
Dental programs have benefited from HRSA funding, state grant opportunities, and philanthropic support. Over the years, many health centers—including my own—have secured significant funding to expand dental services.
Threats
Difficulty recruiting quality staff
Health centers continue to compete with private practices that often offer higher compensation.
Sustained low productivity
Without strong scheduling, patient flow, and operational oversight, productivity can remain below the level needed to support the program financially.
Poor or inadequate management
Managing a dental practice is very different from managing a medical practice. Health centers sometimes underestimate the level of leadership and operational oversight required for a successful dental program.
Resistance from private practices
I've always found it interesting that dentists who don't typically serve Medicaid patients sometimes object when health centers step in to meet community needs. In some states, dental boards have also been openly hostile toward health center dentistry.
High no-show rates
No-shows continue to be one of the biggest operational challenges.
Decades ago, my own health center began requiring deposits from patients with repeated no-shows. For a period of time, we actually collected more revenue from non-Medicaid patients who missed appointments than we did from providing services.
Federal and state Medicaid cuts
Potential reductions in Medicaid eligibility and covered services could create additional financial pressure for health center dental programs in the years ahead.
The Bottom Line
As you can see, there are many factors that influence whether a health center dental program will succeed financially and operationally. A thoughtful SWOT analysis helps leadership understand where their organization has advantages, where risks exist, and where investments are likely to have the greatest impact.
About the Author
Steven D. Weinman, MBA, Principal at FQHC Associates
During his time as a management and IT consultant for Coopers & Lybrand (now PwC), Steve became proficient in designing and programming complex business software systems. In 1984 he was recruited by a small Community Health Center (CHC) in Southwest Florida to revive it’s failed first attempt at automation. After creating and implementing a Practice Management (PM) system, he advanced from IT director to CFO, where he grew the $3 million, single site FQHC into a more than $30 million program. When Mr. Weinman retired in 2013 to devote his full time to a growing consultancy, he was serving as Executive VP/COO with over 300 employees (all except the CEO), 13 sites, a Ronald McDonald Care Mobile, a dental residency program and a wholly owned Medicaid Health Plan.
In addition to his employment, Mr. Weinman has been actively involved in the national CHC movement since 1988. He brings extensive experience in board training, strategic planning, IT, grant writing, staff development and a host of other services to CHCs and Primary Care Associations (PCAs) across the country. As a noted expert in topics including finance, operations, managed care, IT and governance, Mr. Weinman is in great demand as a speaker at national CHC and state PCA conferences. In addition, he has authored numerous articles, issue briefs and blog posts. Mr. Weinman is particularly well known for his work with FQHC Medicare/Medicaid policy and strategy, the 340B Drug Program and development of FQHC focused integrated delivery systems.
To read blog posts by Steven, click here.
To contact Steven, send him an email at SDWeinman@FQHC.org.
