Navigating Dental Insurance Podcast (SayNoToPPOs.com)
Navigating Dental Insurance Podcast (SayNoToPPOs.com)
This podcast.blog teaches the best practices for cash flow, recurring revenue, Membership plans, PPO Fee negotiation, insurance best practices, marketing, reducing your dependence on dental insurance and building a fee for service practice.
Blog By:
Jordon Comstock
Jordon Comstock

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The PPO Disease

The PPO Disease

8/12/2026 9:29:00 AM   |   Comments: 0   |   Views: 39

The PPO Disease

Why Seeing More Patients Can Actually Make Your Dental Practice Less Profitable

By Jordon Comstock

There is a strange disease spreading through dentistry.

The symptoms look surprisingly healthy.

A packed schedule.

A busy hygiene department.

Phones ringing.

More new patients.

Higher production.

A parking lot full of cars.

From the outside, the practice looks like it is crushing it.

Then the owner opens the financials and asks:

“Where did all the money go?”

Welcome to what I call the PPO Volume Trap.

It happens when a dental practice tries to compensate for discounted PPO fees by seeing more patients.

The logic sounds perfectly reasonable:

If we’re making less per patient, we’ll make it up with volume.

Except volume isn’t free.

More patients require more clinical time, more team members, more supplies, more sterilization, more scheduling, more billing, more claims, more collections, more operatories—and often more stress.

Production can climb while profitability barely moves.

In some situations, the practice can actually become busier, more complicated and less profitable at the same time.

That’s the trap.

And if we’re going to have an intelligent conversation about the future of dental insurance, we need to stop obsessing exclusively over production and start talking about the economics of each patient relationship.

The Most Dangerous Sentence in Dentistry

I hear variations of this constantly:

“We just need more patients.”

Maybe.

But before spending another dollar acquiring them, I would ask:

What happens financially when the next patient walks through the door?

That’s a very different question.

Imagine a restaurant losing money on every hamburger.

The owner walks into the kitchen and announces:

“Great news! Marketing figured out how to sell twice as many hamburgers.”

Nobody should celebrate.

Selling more of something with poor unit economics doesn’t automatically solve the problem.

Sometimes it accelerates it.

Dentistry is obviously more complex than hamburgers, but the economic principle still matters.

If a practice has poor economics on certain procedures or patient segments, simply adding volume may not create the profitability the owner expects.

Enter the PPO Discount

PPO participation can provide genuine value to a practice.

Networks can help practices attract patients.

Insurance can make dental care more accessible.

Many successful practices participate in PPOs strategically.

The problem isn’t necessarily participation.

The problem is failing to understand the economics behind it.

Suppose your usual fee for a procedure is $1,500.

Your contracted PPO fee is $1,050.

You’ve effectively accepted a $450 reduction from your standard fee.

That doesn’t automatically mean the patient is unprofitable. The PPO may have helped bring that patient into the practice, and there are many variables involved.

But here’s where dentists get into trouble:

The cost of delivering the procedure didn’t necessarily fall by 30% just because the reimbursement did.

Your assistant doesn’t suddenly cost 30% less.

Your supplies don’t become 30% cheaper.

Your rent doesn’t fall.

Your software companies don’t send you a sympathy discount.

Your lab probably didn’t call and say:

“Hey Doc, we heard Delta negotiated your fee down. We’ll take 30% off too.”

Wouldn’t that be nice?

The revenue side gets compressed while much of the cost structure remains stubbornly real.

That creates pressure.

And the most obvious response is:

Increase volume.

The PPO Volume Trap Begins

Here’s the cycle.

Your reimbursement per procedure falls.

So you need more production.

To produce more, you need more patients.

More patients require more hygiene capacity.

More hygiene requires more hygienists.

More clinical volume requires more assistants.

More employees increase payroll.

More procedures require more supplies.

More patients generate more insurance claims.

More claims require more administrative work.

More administrative work requires more team capacity.

The practice gets bigger.

The owner gets busier.

Revenue increases.

But so does the machine required to produce that revenue.

Pretty soon, the practice is sprinting just to maintain the economics it used to achieve while walking.

That’s the PPO Volume Trap.

Production Is Not Profit

This sounds obvious when written down.

But dentistry has developed an obsession with production.

“What did you produce last month?”

“What does your doctor produce per day?”

“What’s your hygiene production?”

“What are your collections?”

These are useful metrics.

But production can become a vanity metric if it isn’t connected to profitability.

Imagine two practices.

Practice A

Produces $200,000 per month and keeps $50,000 after operating expenses.

Practice B

Produces $300,000 per month and keeps $45,000.

Which practice would you rather own?

The $300,000 practice sounds more impressive at dinner.

The $200,000 practice puts more money in your bank account.

That’s why dentists need to distinguish between growth in activity and growth in economic value.

They’re not the same thing.

The $1 Million Practice That Feels Broke

This is one of the strangest experiences in entrepreneurship.

Your company grows.

Revenue goes up.

Your team gets larger.

Everything looks more successful.

Yet somehow you feel poorer.

Dentists experience this too.

A doctor builds a million-dollar practice.

Then $1.5 million.

Then $2 million.

But every increase in revenue requires additional infrastructure.

More people.

More space.

More technology.

More management.

More working capital.

Eventually the dentist realizes:

“I didn’t build a more profitable practice. I built a larger machine.”

Large practices can obviously be tremendously profitable.

The point isn’t that scale is bad.

The point is that scale without healthy economics is dangerous.

Start Measuring Profit Per Chair Hour

Here’s a metric I think deserves far more attention:

Profit per chair hour.

Not just production per hour.

Profit.

How much economic value is actually being created during the time that an operatory, doctor and team are occupied?

Think about two patients requiring similar amounts of clinical time.

One produces significantly higher net collections because of the practice’s fee structure.

The other generates substantially lower collections because of contractual adjustments.

The clinical work may be identical.

The labor requirement may be nearly identical.

The operatory time may be identical.

The economic outcome isn’t.

Multiply that difference across thousands of appointments every year and suddenly PPO participation isn’t merely an insurance question.

It’s a capacity allocation question.

Your practice has a finite number of chair hours.

Those hours are inventory.

Once Tuesday at 10:00 a.m. is gone, you can never sell it again.

So the question becomes:

What is the economic return on that hour?

Your Schedule Has a Maximum Capacity

Dentistry is constrained by something software companies aren’t:

Time.

A software company can theoretically sell the same product to another thousand customers without hiring a thousand additional programmers.

A dentist can’t perform a crown on 1,000 people simultaneously.

Every additional patient consumes capacity.

Doctor time.

Hygiene time.

Assistant time.

Operatory time.

That’s why discounted pricing becomes particularly important in a capacity-constrained business.

When your schedule has excess capacity, filling an empty chair can make tremendous sense.

But what happens when the schedule is already full?

Now every discounted appointment may be competing with another use of that limited capacity.

At that point, the question changes from:

“Can PPOs bring us patients?”

to:

“Which patients and procedures should occupy our limited clinical capacity?”

That’s a much more sophisticated business question.

The Full-Schedule Illusion

This is why a full schedule can be misleading.

Dentists naturally associate busyness with success.

Empty chairs feel terrible.

Full chairs feel great.

But a full schedule tells you only one thing:

Your capacity is being used.

It doesn’t tell you whether that capacity is being used profitably.

Airlines understand this incredibly well.

They don’t merely track whether the plane is full.

They obsess over revenue per available seat.

Hotels don’t simply celebrate 100% occupancy.

They track revenue per available room.

Dental practices should develop the same discipline.

Don’t just ask:

“Are our chairs full?”

Ask:

“What are our chairs producing economically?”

The Hidden Cost: Complexity

There’s another cost of volume that doesn’t show up neatly on a financial statement.

Complexity.

Every additional patient creates operational work.

Phone calls.

Scheduling.

Rescheduling.

Eligibility verification.

Claims.

Explanations of benefits.

Collections.

Recall.

Treatment plans.

Questions.

Emails.

Text messages.

Documentation.

None of those things are inherently bad.

They’re simply part of running a practice.

But complexity has a cost.

Eventually you need another front-desk employee.

Then another manager.

Then more systems.

Then meetings to coordinate the systems.

Then software to manage the meetings about the systems.

Congratulations.

You’ve invented corporate America.

The more volume you push through a business, the more carefully you need to evaluate whether that volume creates enough economic value to justify the complexity it produces.

Then Comes Burnout

There is also a human cost.

When reimbursement pressure leads to increased volume, doctors and teams can feel forced to move faster.

More patients.

Shorter appointments.

More procedures.

More handoffs.

More pressure to stay on schedule.

A dentist may look successful on paper while privately wondering:

“How long can I keep doing this?”

The goal of owning a dental practice shouldn’t be to create the world’s most sophisticated treadmill.

Growth should create freedom.

Not eliminate it.

Don’t Drop Every PPO Monday Morning

Whenever I talk about PPO economics, I want to make this clear:

This is not an argument for recklessly dropping every insurance contract.

That can be disastrous.

A practice with heavy dependence on one PPO could experience substantial patient attrition after terminating participation.

Every market is different.

Every patient base is different.

Every contract is different.

The answer isn’t emotion.

It’s analysis.

Before changing participation, understand what each PPO actually contributes to your business.

Rank Your PPOs

I’d encourage practices to create what I call a PPO Scorecard.

List every PPO.

Then evaluate each one across several dimensions:

Revenue

How much does the plan actually contribute?

Contractual adjustments

How much production is being written off?

Patient volume

How many active patients are associated with the plan?

Procedure mix

What type of dentistry are those patients receiving?

Administrative burden

How difficult is the plan to work with?

Effective reimbursement

What are you actually collecting relative to your standard fees?

Capacity impact

How much valuable chair time does this population consume?

Now rank them.

You may discover something surprising.

Your biggest PPO may not be your best PPO.

High volume can disguise weak economics.

Build the Safety Net Before You Jump

This is where I believe membership plans become extremely powerful.

A practice shouldn’t necessarily drop a PPO and then desperately try to replace the revenue.

Reverse the order.

Build the replacement first.

Create a membership plan.

Identify uninsured patients.

Enroll appropriate patients.

Build recurring revenue.

Strengthen patient loyalty.

Improve the economics of the patient base.

Then evaluate your weakest PPO.

This is less dramatic.

It’s also much smarter.

I call it building the financial safety net.

Membership Changes the Math

Imagine building 500 membership patients paying an average of $45 per month.

That’s:

$22,500 per month in gross recurring membership revenue.

Or:

$270,000 per year.

That’s not automatically $270,000 of profit—the practice still provides the included services and incurs costs.

But economically, something important has changed.

The practice now has a meaningful stream of predictable revenue generated through direct patient relationships.

Now imagine 1,000 members.

At the same hypothetical average:

$45,000 per month.

$540,000 per year.

Suddenly the owner approaches PPO decisions differently.

Not because insurance became evil overnight.

Because the practice has options.

We’ve Seen This at BoomCloud

Some practices using BoomCloud have taken membership far beyond the traditional “discount plan” sitting forgotten in a filing cabinet.

Wood River Dental has built a membership population numbering around a thousand patients and generated substantial monthly recurring membership revenue.

Other multi-location organizations using BoomCloud have grown membership populations into the thousands.

These examples aren’t promises of what every practice will achieve.

They demonstrate what’s possible when membership becomes a genuine business strategy rather than a brochure at the front desk.

The practices that succeed don’t simply create a plan.

They operationalize it.

The clinical team understands it.

The front desk understands it.

Patients hear about it.

Growth is measured.

Recurring revenue is tracked.

Membership becomes part of the practice’s culture.

Use BoomCloud to Build Before You Reduce

BoomCloud was built to help practices create, manage, automate and grow dental membership programs.

Practices can use the platform to build plans, enroll patients, automate recurring payments and renewals, monitor membership performance and track recurring revenue.

The strategic idea is simple:

Don’t remove revenue before you’ve built something to replace it.

If your long-term goal is reducing PPO dependence, membership can become part of the bridge.

Grow the plan.

Build the recurring revenue.

Strengthen direct patient relationships.

Then make insurance decisions based on data rather than frustration.

What If You Didn’t Need More Patients?

This may be the most provocative question of all.

What if your practice doesn’t actually need more patients?

What if it needs better economics from the patients it already has?

Maybe the answer isn’t another $10,000 in advertising.

Maybe it’s improving treatment acceptance.

Reactivating overdue patients.

Growing membership.

Increasing retention.

Reviewing fees.

Ranking PPO contracts.

Reducing unnecessary write-offs.

Improving revenue per chair hour.

Suddenly growth looks very different.

Instead of:

More. More. More.

It becomes:

Better. Better. Better.

Growth Should Make Your Practice Easier to Own

This is my favorite test of a business model.

As the business grows, does owning it become better?

Or worse?

Does growth create:

More profit?

More predictability?

More freedom?

More enterprise value?

Or does it simply create:

More employees?

More patients?

More headaches?

More hours?

More revenue without proportionally more profit?

Those are fundamentally different versions of growth.

Escape the PPO Volume Trap

The PPO Volume Trap doesn’t happen because dentists are bad business owners.

It happens because the traditional solution to declining reimbursement has been:

Produce more.

But eventually there are only so many hours in the day.

You cannot outrun bad economics forever.

At some point, the answer isn’t increasing the speed of the treadmill.

It’s stepping off long enough to examine the machine.

Calculate your contractual adjustments.

Rank your PPOs.

Measure profitability—not just production.

Understand the value of your chair time.

Build recurring revenue.

Create a membership safety net.

Then gradually make decisions that improve the economics of your practice.

Because the goal shouldn’t be to see the most patients.

The goal should be to create an incredible clinical experience while building a financially healthy practice.

A practice that pays your team well.

A practice that invests in technology.

A practice that takes care of patients.

A practice that creates wealth for its owner.

And perhaps most importantly:

A practice you actually enjoy owning.

So the next time someone tells you:

“You just need more patients.”

Ask one question first:

“Do I need more patients—or do I need better economics?”

The answer could completely change the future of your practice.

Start, manage and grow a patient membership plan and stop the PPO Disease!
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