The NextDDS Magazine – Fall 2015 – The Road to Integrated Care

The NEXTDDS – Click here for the full magazine pdf.

What is a DSO?

“DSO-supported dentistry is a growing professional career choice that would not exist if dentists didn’t want them or need them.”

— Dr. Quinn Dufurrena, Executive Director, Association of Dental Support Organizations (ADSO).

The Role of Dental Support Organizations

At their simplest, DSOs provide support services to dentists, with their services ranging from practice consulting to total practice management. While dentists are always responsible for patient care, clinical decision making, and patient records, DSOs can help streamline and/or consolidate certain administrative requirements of the practice in order to improve their efficiency and productivity.

Whether recent graduate or practicing dentist, ther are many who may benefit from practicing in a DSO environment. Those desiring flexible schedules, bearing the burden of significant student loan debt, or needing to build competency in a structured practice model are ideal for the practice supported by a DSO. New dentists who wish to learn from proven business systems rather than a traditional solo practitioner are also well suited for the DSO model. To this point, the ADA in 2010 reported that 6% of dentists surveyed had a practice supported by a DSO, and 15% of dentists who had practiced for fewer than 10 years were working for a DSO-supported practice.

Advantages of DSOs

Traditional dental practices commonly outsource nonclinical tasks such as billing, payroll, marketing, and human resources to third-party companies or consultants to manage aspects of the practice. The primary difference between practices utilizing a DSO model and those that do not is that a DSO consolidates these administrative tasks to a single source while traditional practices may use a number of consultants (CPAs, HR management, payroll services, etc.) for these services. Practices supported by DSOs benefit from economies of scale present in a network. They have greater buying power, may negotiate less expensive laboratory fees, better leases, insurance contracts, etc. They can also retain revenue in-house by creating their own specialist networks, for example, rather than referring patients out of the practice.

Professional Standards

Just like solo practitioners, dentists who partner with a DSO must maintain their own professional standards and take responsibility for their own clinical/ethical decisions, regardless of who handles the business activities. The dental laws in each state define what is clinical (i.e., matters of patient care reserved to dentists licensed in that state and regulated by its dental board) and nonclinical (i.e., operational tasks that can be performed by anyone). DSOs are able to provide only nonclinical services.

The PDS Institute Congratulates Dr. Tran

Pacific Dental Services

Congratulations, Dr. Tran!

Dr. Thanh Tran, PDS®-supported owner dentist, was recently elected to serve as President of the San Diego component chapter of the California Academy of General Dentistry (AGD) for 2016.

Dr. Tran served as Treasurer for the San Diego AGD component chapter for the past five years.

Please join me in congratulating Dr. Tran on this prestigious accomplishment and additional role!

Brad Guyton, DDS, MBA, MPH
Dean, PDS Institute®
Vice President of Clinician Development, PDS®

ADSO Announces Steve Thorne as President

Association of Dental Support Organizations Announces

Stephen E.  Thorne as President

Dr. Rick Workman to Serve as Vice President on the Executive Committee

November 17, 2015—The Association of Dental Support Organizations (ADSO) announced that Stephen E. Thorne, IV, Pacific Dental Services® Founder, President and CEO, has been elected to serve as President of ADSO. Dr. Rick Workman, ADSO Founding Member and CEO of Heartland Dental, is the immediate past President and will serve as Vice President of the Executive Committee.

“Rick has been a leader in our industry for years and has been nothing short of masterful as ADSO’s President the past two years,” said Thorne.  “We have been fortunate to have him at the helm and are grateful that he will remain in a leadership role for the association.   I look forward to building on Rick’s work in positioning ADSO as the preeminent organization for the DSO industry and its industry partners.”

Thorne began his work in the healthcare business arena in 1989 when his father, a dentist, offered him a job managing a struggling dental office. That first office became a big success, and Thorne continued to work with his father for several years before venturing out on his own and creating Pacific Dental Services (PDS®). PDS currently provides business and administrative services to nearly 500 supported practices throughout the country including California, Arizona, Nevada, Colorado, Idaho, Oregon, Washington, Texas, Utah, New Mexico, Missouri, Kansas, Georgia, Tennessee, and Minnesota.

Thorne was instrumental in forming ADSO, which is the largest association of dental support organizations in America and served as its President the first three years.   He graduated from the University of California Los Angeles with a major in Economics-Business, and  he earned his Master’s Degree in Health Administration from Chapman University.

In addition to Thorne being named President and Workman being named Vice President, the Executive Committee added three new Board members: John Cline, CEO STX Healthcare Management; Steve Spellman, CEO Midwest Dental; and Ken Cooper, CEO, North American Dental Group.

DSOs provide administrative non-clinical support to dental practices, enabling supported dentists to focus on their patients and expand access to oral healthcare while maintaining the highest in industry standards.   ADSO supports its members through research, education and advocacy; enabling them to foster innovation, collaboration and a vibrant market where DSO-supported dentists can provide quality oral health care.


Wisconsin The Next State To Consider Protectionist Bill That Cuts Access To Care, Hikes Costs


Since Republicans took control of the Wisconsin Legislature in 2010, they have enacted an impressive slate of pro-growth, free market reforms. These legislative accomplishments include income tax reductions, entitlement reform, prevailing wage reform, and a Right to Work law that makes Wisconsin the 25th state where workers cannot be forced to join a union as a condition of employment.

However, protectionist legislation currently pending in the Wisconsin Assembly, which will be heard in committee this week, would reduce access to dental care in the Badger State and drive up costs. It would be an uncharacteristic bill for Wisconsin’s Republican-controlled legislature to approve.

The bill in question, Assembly Bill 368, would grant the Wisconsin Dentistry Examining Board unnecessary and inappropriate powers to regulate Dental Service Organizations (DSOs), despite the fact that DSOs do not practice dentistry. Dentists contract with DSOs to handle non-clinical, administrative functions, such as bookkeeping, payroll, and marketing. The DSO-model is similar to those employed by a number of medical professionals, such as oncologists, emergency room managers, optometrists, and other doctors.

Dr. Tim Quirt, a Wausau, Wis.-based dentist, explains how the DSO model assists caregivers:

“Running a dental office has many non-clinical aspects like managing supply procurement, facility maintenance, and bookkeeping, to name a few. I turned to a well-established practice of working with a dental support organization, or DSOs. DSOs first came on the scene in the 1970s and have been a boon to patients across the country by working with individual dentists to solve the unique problems of their practice. In my case, the non-clinical tasks of a large practice combined with providing the dental care meant I was working seven days a week and losing the passion and fire necessary for a caring profession.”

The DSO model is advantageous because it frees dentists up to focus on patient care. This model is also attractive for new dental school graduates, who are beginning their careers in an industry with significant startup costs. Any legislation that could hinder the DSO model, such as the misguided bill being considered in Wisconsin this week, would have negative consequences for consumers.

Underscoring the importance of this issue, the MacIver Institute, a Madison-based free market think tank, recently joined with two national conservative organizations – Americans for Tax Reform & the National Taxpayers Union – in sending a joint letter to Wisconsin legislators outlining the unintended negative consequences of making it more difficult for dentists to contract with DSOs:

On behalf of our supporters across the state, we write today to express concern and raise questions about Assembly Bill 368, legislation…that would grant the Wisconsin Dentistry Examining Board onerous and unnecessary new regulatory powers. The proposal takes aim at Dental Support Organizations and would restrict the ability of dentists in Wisconsin to run their practices more efficiently and cost-effectively by contracting with management companies to handle administrative and other non-clinical duties. Impeding the ability of a dentist to run his or her practice as needed will harm consumers and taxpayers across Wisconsin by limiting access to care, increasing costs, eliminating jobs, and discouraging in-state investment.”

Wisconsin is not the first state where protectionist, anti-DSO legislation has been introduced. A bill was introduced in North Carolina in 2012 that would’ve effectively prohibited dentists from contracting with DSOs. Passage of that bill would have reduced access to care in a state that already ranks as one of the worst states in the nation when it came to access to dental care.

When that bill was being debated in the North Carolina legislature, the John Locke Foundation, a Raleigh-based non-partisan think tank, pointed out that instead of infringing on dentists’ ability to contract with DSOs, state lawmakers “should be looking at ways to expand dental care…not restrict it. If a management company is interested in assuming purchasing, billing and administrative duties and a dentist wants to spend more time on patient care, they ought to be allowed to work out whatever arrangement works best for them.”

North Carolina lawmakers were right to vote down that protectionist, anti-DSO bill three years ago, and Wisconsin lawmakers would serve their constituents well by doing likewise this week.

Patrick Gleason is director of state affairs at Americans for Tax Reform and a senior fellow at the Nashville-based Beacon Center of Tennessee.