Joel Idelson
CEO, Image Specialty Partners
There’s a phrase I hear tossed around in the world of DSOs like it’s gospel: “We’re centralizing for efficiency.” Sounds good. Makes you feel good. But here’s the uncomfortable truth: what we often call “efficiency” at the MSO level is just the rebranding of overhead…expensive overhead…disguised as progress.
I’m definitely not against centralization. I’m against bad centralization…the kind where we strip offices of responsibilities they used to manage quite well and move them into a call center, a billing hub, or a revenue cycle black box that’s supposed to run like a Swiss watch.
Take call centers. The idea is noble…ensure every call gets answered, follow up on leads, lighten the office load. But the moment you introduce “overflow,” you might as well call it “over it,” because that’s exactly what the office becomes. They stop picking up the phone. “Someone else will get it,” they think. And just like that, your answer rate plummets.
Same story with centralized RCM. We take billing and collections off the office’s plate, pat ourselves on the back, and then…collections drop and insurance denial rates spike. Billing isn’t just data entry. Sometimes it’s nuance. It’s knowing Mrs. Patterson’s kid had a retainer adjustment, and her new insurance just kicked in yesterday. That nuance dies on the assembly line.
Worse, once the responsibility is pulled from the office, so is the accountability. Suddenly, no one owns the outcome. Without proper communication and collaboration, you’re not solving a problem…you’re setting the stage for finger-pointing. And trust me, they’ll point. Because things will go wrong…and now no one on-site feels empowered (or responsible) to fix them.
Once you take something away from a local team, good luck giving it back. Offices adapt quickly to change…especially change that removes responsibility. Getting that responsibility back into the practice is like trying to put toothpaste back in the tube…messy, frustrating, and never quite the same
And let’s talk about cost. These centralized systems don’t come cheap. More headcount. More software. More management layers to manage the people managing the software. So now you’ve taken responsibilities away from the office, added expense to the MSO…and let’s not kid ourselves, you’re not slashing office pay just because they’re doing less. You’re still footing the same payroll, only now you’ve layered on new corporate costs without a single extra dollar of production, revenue, or EBITDA to show for it. That’s not a strategy…that’s a shell game.
I’ll say it again: I’m not against centralization. In fact, I’m all for it…when it’s appropriate, when it makes sense, when it’s communicated properly, when it’s done in collaboration and partnership with the office, when its effectiveness is measured and understood, and when it’s constantly scrutinized for improvement. That’s not just centralization…that’s leadership.
The bigger problem? Some do this without piloting. Without collaboration. They “roll it out” like it’s iOS 18 and expect practices to comply with a smile. But dental offices aren’t iPhones…they’re living, breathing, wildly variable ecosystems. You can’t dictate a system-level change and expect front-desk buy-in unless they’re in the room before you write the memo.
So what’s the play?
- Test and Learn. Pilot a new RCM or call strategy in a few offices. Let it fail. Let it breathe. Learn. Iterate.
- Involve the people who do the workand are at the practice. Ask them what works. Actually listen. Revise. Communicate.
- Set expectations. Is this permanent or a test? Say so. Transparency builds trust.
- Be ready to reverse course. There’s no shame in saying, “We tried it. It didn’t work.” Fail fast.
Because if you centralize without insight, communication, or buy-in, you’re not streamlining. You’re just centralizing the blame when it all breaks down.
And that’s not efficiency. That’s just expensive.