DSOs and mid-size dental groups have leverage single-location practices don’t. Most don’t use it — and it costs them millions.
A dental group with 5, 10, or 20 locations has structural advantages a single-location practice cannot access:
- Combined patient volume across geographies
- Multiple provider footprints in carrier networks
- Ability to selectively participate by location
- Negotiation leverage that scales with scale
Yet many mid-size groups end up with fragmented PPO structures, inherited contracts, and reimbursement that trails what their scale should command. Here’s what mid-size dental groups typically get wrong on the PPO side — and what the strongest ones do differently.
The inherited contract problem
Most mid-size groups grew through acquisition. Each acquired practice came with its own PPO contracts, some old, some poorly negotiated, some entirely unreviewed.
The mistake: leaving these contracts as-is because “they were part of the acquisition.”
The reality: acquisition contracts are one of the highest-leverage renegotiation opportunities in the DSO space. Carriers know the practice has changed hands. Aggregate volume has increased. The original contract terms are almost never optimized for the group’s new scale.
Fragmented fee schedules
Mid-size groups often have wildly different fee schedules for the same carrier across different locations. Some locations pay 92% of UCR. Others pay 78%. The difference isn’t always about market — sometimes it’s just about which acquisition happened when.
Consolidating (or intentionally differentiating) fee schedules based on strategy, not accident, is one of the highest-leverage moves a group can make.
Under-using volume leverage
A group with 20 locations and 40,000 active patients per year has different negotiation power than a solo practice. Some groups leverage this well. Many don’t — negotiating each location as if it were an isolated practice.
The strongest groups use volume leverage:
- In direct carrier negotiations
- In requiring uniform fee schedules across the group
- In demanding contract exclusions on network leasing
- In restructuring administrative provisions like audit and recoupment terms
- In carrier tier upgrades based on group size
Poor cross-location credentialing
Credentialing at scale is complex, and most mid-size groups underinvest in the function. The result:
- New providers not credentialed on time for new locations
- Providers moving between locations without carrier updates
- Recredentialing cycles missed at secondary locations
- Cross-location claim routing errors
Each of these leaks revenue. Scaled across many providers and locations, the leaks are substantial.
Selective participation isn’t fully used
A single-location practice has to make participation decisions that affect the whole practice. A multi-location group can be selective by location — participating with a carrier in markets where it makes sense and declining participation where it doesn’t.
Most mid-size groups treat participation as all-or-nothing. The strongest groups treat it as market-by-market strategy.
Reporting isn’t strategic
Mid-size groups usually have practice management data that could inform PPO strategy — but often don’t have it structured to actually surface strategic questions:
- Per-location reimbursement performance by carrier
- Per-provider reimbursement performance
- Contract compliance across the group
- Write-off percentages by acquisition source
- ROI on prior renegotiation efforts
Practices with three or more locations should have this reporting. Most don’t.
PPO strategy isn’t at the leadership table
The most common gap: PPO strategy is treated as an administrative function rather than a strategic one. Contracts get renewed by office managers. Renegotiations happen ad hoc. There’s no ownership at the executive level.
The strongest groups treat PPO strategy as an ongoing enterprise function, with:
- Named leadership responsibility
- Annual PPO strategy reviews
- Quarterly reporting on reimbursement performance
- Explicit budgeting for renegotiation work
What the strongest mid-size groups do
A few patterns:
- Consolidate PPO strategy under one leader
- Treat acquisition PPO contracts as immediate renegotiation targets
- Build enterprise-level negotiation strategy, not location-level
- Invest in credentialing infrastructure that scales
- Audit contracts and EOBs across the group systematically
- Treat scale as leverage, not just growth
Mid-size dental groups have the structural leverage to command reimbursement that single-location practices can’t. What most don’t have is the strategy to actually use that leverage.
The gap between what a well-managed 10-location group could earn and what most 10-location groups actually earn on PPO participation is measured in millions. Closing that gap is a strategic priority, not an administrative task.
A complimentary DSO PPO assessment maps your current structure and identifies where the leverage is being left on the table.
👉 Schedule your complimentary assessment: https://pponegotiationsolutions.com