Inside the DSO Revenue Gap

Vyne Dental’s Chief Product Officer Paul Bernard explores how leading DSOs identify, measure, and fix these gaps—and how you can too.

Many DSOs unknowingly lose thousands of dollars to inefficiencies hidden deep within their revenue workflows. From inaccurate coding to outdated collection processes, these “invisible leaks” can significantly impact the bottom line.

Whether you are running 50 offices or one, the RCM process is the same. However, the law of large numbers begins to affect DSOs as they grow.

“Every practice leaks, but these leaks really start showing up in a more magnified way the bigger you get,” Vyne Dental Chief Product Officer Paul Bernard says. “At the end of the day, if you see a patient and you expect to be paid $100, how much of that do you actually put in your pocket—and how much effort does it take to get those final pennies?”

Start with a Bigger Bucket
RCM starts long before billing a claim. The work you do up front to build a successful claim is part of the process. “People tend to want to bucket RCM too small. They think RCM is just billing the claims, which is just one piece. The whole process, from scheduling a patient to the patient making their final payment and everything in between, has aspects that significantly impact RCM,” Bernard explains.

By investing time on upfront processes in RCM, you can avoid spending energy on cleaning up mistakes. A process map can help you visualize that.

“Process mapping is not intuitive for a lot of people, but it’s no more complicated than examining what happens first, and then what happens next. You’ll start to see that prep work matters. It’s everything that happens before filing that makes that claim successful or not successful,” says Bernard.

Beyond mapping, narrowing your perspective on RCM can also limit your potential improvements.

Every practice leaks. The bigger you get, the louder it drips.

“For instance, some think scheduling has no impact on RCM. It absolutely does,” Bernard notes. “I want to be looking for things at scheduling that will help me submit a successful claim, such as asking if patients have changed employers. Is their insurance still the same? If they don’t know, go ahead and schedule but loop back before they show up to see if you’re in network.

“If you have a narrow view of RCM,” Bernard points out, “you are going to find narrow opportunities to improve. All the things that must happen before you even send a claim to a payer contribute to how much you will be paid.”

Mistakes You Can’t Afford

Incomplete or Delayed Credentialing
One way DSOs can miss out on or delay revenue is failing to properly contract and credential doctors. This can significantly impact how and when they are paid.

When DSOs acquire a practice, payers have to be re-contracted, which usually happens under a different tax ID.

“Payers will send payments to a tax ID, not a doctor who’s in a location. Knowingly or unknowingly, you changed where the money gets routed, and your processes in RCM have to adjust for that,” Bernard explains. “Those claims won’t get paid because the insurance company doesn’t know who this doctor is. You’ve billed a claim that isn’t getting paid, and you end up having to unwind problems, which will cause delays in payment or denial of payment.”

Not Mining EOBs
Explanations of benefits (EOBs) are a tremendous source of process data because they will tell you what claim got denied, what line on a claim got denied, and why. If you understand those reasons, then you can see where in your process flow you could have caught it.

Inevitably, a lot of errors are going to be at the point where you validate whether the eligibility and benefits are accurate and before you make an estimation and choose a fee schedule. Find and fix that error—and get paid.

“It does you no good if you have a good eligibility and benefit breakdown but you’re picking the wrong plan for that patient. You are never going to get the exact amount correct, so maintaining these plans and payer plans and fee schedules in your practice management system is critical if you want to bring those two together,” Bernard explains.

If your view of RCM is narrow, your results will be too.

Incomplete Claims
The ultimate goal is a clean claim with no receivables to manage. “You want to be collecting as much of what the patient owes up front as you can and then have some reasonable certainty that once you send that claim, it’s going to get paid whatever the insurance owes you,” notes Bernard.

“That’s a perfectly clean claim. That would mean that the level of effort that you must spend managing the receivable is zero because there is no receivable.”

Products like Vyne Trellis scrub claims before they get to the payer.

“It’s much better to try and put as much effort as you can up front to make sure that that claim is correct,” Bernard explains. “You can take 10 minutes now to fix it, or you can take two hours 30 or 60 days from now to try and figure out why you didn’t get paid. It’s a no-brainer—and yet somehow, we still allow these defects to escape the process.”

It’s All About Data
Don’t worry about making sure everyone is on the same practice management system.

“Why would you take a doctor who is unbelievably productive and generating revenue using whatever system they’ve been using and say, ‘Now that you’re part of a DSO, you need to switch.’?” Bernard asked. “Why would you rip out the wiring from somebody who is usually productive?”

The reality is that forcing a change often results in reduced productivity because staff are unfamiliar with the new system. It introduces unnecessary risk into the operation of a practice that was otherwise performing well.

Instead of focusing on uniformity of systems, DSOs should prioritize access to data. “Insist that the practice management systems give you your data,” he said. “Once you have it, you can bring that data into a centralized system and analyze it however you want. If you can free the data from those systems, you don’t need to change anything—and you reduce your operational risk.”

Once your data is accessible, you can measure performance across the organization without disrupting what Appointment Credentialing Claim Scrubbing Data Errors is already working. It’s not about the system itself—it’s about the visibility and control the data gives you.

Keep the Patient in the Loop
“You’ve got to think about the billing experience from the patient’s perspective,” says Bernard. “At Vyne Dental, we call it ‘patient in the loop.’”

If a patient leaves the doctor’s office, hears nothing for weeks, and then a surprise bill arrives, it can prompt confusion, doubt, and a timeconsuming call to the office. What if, instead, they were kept in the loop the whole time with clear, proactive updates? By the time the bill comes, they understand it, trust it, and are far more likely to pay it.

“There’s a direct correlation between time and payment,” Bernard explains. “The older that receivable gets, the less likely it is to be paid.”

When you build a billing process that moves efficiently, it not only benefits the patient but also strengthens the practice.

Prep work matters. It’s everything before the claim that makes it successful—or not.

Build Smarter, Scale Stronger
RCM isn’t just billing—it’s a living ecosystem. And like any complex system, it’s only as strong as its weakest link. From initial patient scheduling to the moment a claim hits the payer, every step in the process either protects revenue or puts it at risk.

The most successful DSOs aren’t the ones who work harder to chase revenue—they’re the ones who build smarter systems to prevent loss before it happens. They invest in automation. They map out their processes. They scrub claims early. And they never stop analyzing their EOBs for trends that can unlock even greater efficiency.

Because at the end of the day, your revenue isn’t what you bill—it’s what you keep.

Strengthen your pipeline. Protect your bottom line. Scale with confidence. Experience Vyne Trellis^®— the end-to-end revenue acceleration platform that gets you paid faster through streamlined claims submission and tracking, delivers batch and realtime eligibility checks, and keeps your communications secure.

Ready to Stop Revenue Leaks Before They Start?
Schedule your personalized demo today
at VyneDental.com.

Paul Bernard

Vyne Dental’s Chief Product Officer

 

A new generation of dentists is reshaping ownership, gender balance, and affiliations— with long-term consequences for the business of dentistry.

By: Rachel Morrissey and Marko Vujicic

What does it mean to be a “typical” dentist? Twenty years ago, the average dentist was likely in their 40s, midcareer, and the owner of a small practice. At that time, the profession was dominated by baby boomers who had graduated in the late 1970s and early 1980s, an era marked by a surge in dental school graduates.

Today, the picture looks quite different. Over the past several years, a generational shift in dentistry has been taking place, with more dentists at both the beginning and end of their careers. The large cohort of baby boomer dentists is now reaching their late 60s, with retirement on the horizon. At the same time, a growing number of young dentists are entering the field—a pattern that shows no signs of slowing.

The number of dental school grads in the U.S. has gone up since the early 2000s, following a large drop in graduates that began in the late 1980s. The introduction of more than a dozen new dental schools in the U.S. since 2000 contributed an additional 9,000 graduates to the
already rebounding workforce pipeline over the last two decades. Between 2014 and 2024, there were just under 70,000 dental school graduates.

Women now make up 56% of dental school graduates—a figure reshaping the entire profession.

Another major shift in today’s dental workforce is gender representation. In the early 1980s, women made up only about 20% of dental graduates. By the early 2000s, men still outnumbered women in predoctoral dental programs.

That trend has since reversed: Beginning in 2019, women comprised the majority of dental school graduates.

In fact, in 2024, 56% of dental school graduates were women. Women also made up more than half of the graduating classes of several advanced dental education disciplines in 2024, including pediatric dentistry, orthodontics, and general practice residency programs.

What does a younger, increasingly female dentist workforce mean for the future of the profession? One key implication lies with practice
modality. HPI has been closely tracking changes in dentist affiliation with DSOs as well as shifts in dental practice size, measured by the
number of affiliated locations within a practice. Both aspects of practice modality are changing, and the gender and age shift are major drivers.

There are major differences in practice modality depending on dentist career stage. Early career dentists are far more likely to practice in larger groups and to be affiliated with a DSO.

As of 2024, one-third of all dentists are in solo dental practice (34%) while less than one-fifth work for a large group practice with 10 or
more affiliated locations (17.4%). For younger dentists—those up to 10 years out of dental school—the reverse was true: 15% worked in solo practices compared to 29% in large group practices.

The share of dentists affiliated with a DSO has more than doubled in the last 10 years. In 2024, about one out of every six dentists overall was affiliated with a DSO. While this number has grown for all dentists, it is particularly robust for young dentists, with women even more likely to work at a DSO-affiliated practice. In 2024, close to one-third (32%) of female dentists up to five years out of dental school were in a DSO-affiliated setting.

Increased affiliation with DSOs is not likely to reverse any time soon. The American Dental Education Association’s 2024 Survey of Dental School Seniors showed that 32% of surveyed dental school seniors who plan to go into private practice following graduation intend to join a DSO-affiliated practice. Just five years ago, 18% of dental school seniors reported the same plans, a little more than half of today’s number.

An examination of practice ownership trends reveals a similar pattern of divergent career choices across age and gender cohorts. HPI analyzed data looking at practice ownership at different career stages for cohorts of dentists who graduated between 1991 and 2020. For dentists who graduated in 2010 or earlier, the majority were practice owners five to nine years after graduation. In sharp contrast, only about 20% of dentists who graduated between 2016 and 2020 were practice owners at the same point in their career. For women dentists in this cohort, the figure is 14% compared to 30% for men.

In 2024, nearly one-third of new female dentists joined DSO-affiliated practices.

The demographics of dentistry are shifting. More dentists are choosing career paths in larger group practices or DSO-affiliated settings over traditional solo ownership early in their careers. As this new generation grows, their preferences will continue to redefine what it means to be a dentist today.