Lately, my technology conversations have started sounding strangely familiar. Different dental organizations, different roles, different challenges, yet the same concern keeps finding its way into the conversation.

There seems to be a growing lack of trust in software vendors across dental. Who to believe, where to spend the money, and whether ROI exists.

That runs through just about every category, from clinical to the back office. Tools and teams are being heavily scrutinized.

The topic that comes up most frequently is RCM, and for good reason.

For a single-doctor owner, it’s a no-brainer. You’re running a business. Every dollar matters, and every decision has to balance what’s best for your patients, your team, and your bottom line.

At scale, though, small misses stop being small. Spread them across twenty offices and it starts eating into collections and margin.

This has been my point for a while now. As M&A has slowed and buying EBITDA has become less of the growth strategy, the focus has shifted to same-store growth and revenue cycle sits in the center of this.

So my question is, if RCM is the number one problem, why are so many operators tired of hearing about the solutions?

Sixty Percent Then Scatter

There’s no shortage of promising RCM technology, from newer companies to more experienced partners. But when I ask RCM leaders how far the technology actually gets them, the answer is remarkably consistent

As one DSO executive put it to me at ADSO, we’re only about sixty percent there.

The rest is scatter. Teams chasing down what didn’t go through, and trying to piece together everything the technology didn’t solve.

Running a revenue cycle team isn’t something I’ve done myself, so my insights come from being an observer (see previous newsletter). What I can do from this seat is talk to the people who run these teams and implement the tech, without forgetting about the vendors selling to them.

My question to them was why they think there’s hesitation, and what they’re currently doing to tackle RCM challenges.

Worth noting, much of this mess is on the payers too, and that’s a conversation of its own. For now, let me stay on task with the question at hand.

For context, the early innovators in this space have always been exciting to me. New companies, and founders taking a swing at old problems with new perspectives are fun to talk to and follow. I’m always the guy rooting for the underdog, and sometimes the underdogs turn into the favorites (see my Buffalo Bills).

Part of what I try to do is give newer voices a place to be heard, while staying grounded in the companies that were once new themselves, and recognizing the impact the incumbents can have on moving the entire market forward.

So I called on a few from all sides, but mostly I listened to the operators living in the RCM mess every day. They’re the ones who know where the gaps really are.

So Many Tools, Rarely End to End

Here’s the pattern that seems to be wearing down people in leadership seats inside DSOs. The market is full of tools that each do one thing, and stitching them together is hard and time consuming.

Eligibility tool over here. Claims tool over there. Statements somewhere else.

Payments in this dashboard. Collections in another.

As I get ready for RCM Bootcamp this month, I’m reminded that Zentist was doing RCM automation in dental years ago, before the space got crowded, and a lot of the RCM leaders I talked to still speak well of what they built.

But what operators keep running into is the sameness underneath the names. As one RCM leader inside a large DSO put it, "They make it look shiny and new, but it's really just the same result."

The point was that almost everyone is scraping the same payer portals and filling the same gaps, because the clean data and the connections to insurance companies rarely exist.

One leader has been through enough of these to be direct about where it nets out as she said, “The majority of solutions out there are just a replica of everything else. Nothing is an actual end to end solution.”

Mike Baird has sat on both sides of this one. He ran Henry Schein One, and today he's CEO at Accelerate Dental, buying and living with these tools himself.

As he put it, pre-auth is cool, but then you go to post and you're back in a manual process, and jumping in and out of a vendor's workflow is where things get messy.

None of that means the these tools are bad. A good eligibility tool is a good eligibility tool, and that’s valuable.

The trouble is that a stack of point solutions doesn’t add up to a system, and a dependable system is exactly what teams want for their day-to-day.

The Leak Upstream

The instinct for many seems to be to fix the back end of the leak. Chase denials, work the aging, put more people on the phones, and the problem gets solved.

Most of the folks who run this process told me the real gains come way earlier than that.

One longtime DSO RCM executive, who has run revenue cycle across some of the biggest DSOs in the country, walked me through it.

The metric he watches is first-pass resolution, the claim that goes out clean and gets paid without anyone touching it again.

Even inside the PMS, the story is the same. Henry Schein One told me about an office that swore its new eligibility product was broken. Digging deeper, the real problem was the front desk not capturing clean names and dates of birth.

The tool was great however the the inputs were off.

When that happens, it turns into the Spider-Man meme. Everyone’s pointing fingers, and nobody wins.

The front end isn’t the whole problem, but it’s the first place I’d look. Get the data clean going in, and a lot of the back-end chasing quiets down on its own.

The Partner Question

Let’s talk about the PMS and partnerships for a minute, because perception and reality don’t always line up here.

Planet DDS is doing some interesting work in this area. From what I’ve seen, their soon-to-launch DentalOS gives partners a clearer place to live and helps customers better understand who does what and how the pieces fit together inside Denticon. More visibility into the ecosystem is a good thing.

Henry Schein One is interesting for a different reason. They’ve carried a reputation in parts of the market for “not playing nice with others,” but the more I’ve looked at what they’re actually doing, and talked with Ascend customers, the less that tells the whole story.

Their real-time eligibility is a good example. Instead of relying on a single vendor, Ascend can pull from several partners behind the scenes to find the best available eligibility response and surface it back to the office. The practice doesn’t have to think about which tool is doing what. They just get the answer.

That’s an important distinction. The partnership ecosystem can be doing quite a bit of work without the customer ever really seeing the complexity behind it.

And HS1 connects with more than 180 partners today. For a company that size, there’s always going to be a target on its back, and simple news like that doesn’t necessarily travel in a market driven heavily by word of mouth, events, and marketing campaigns.

There may be more partnership happening behind the scenes than the market gives them credit for.

In the world of PMS, there’s still a ton of tension around writing data back into the system. Even Open Dental, long considered the most open of the bunch, has tightened some policies lately.

Operators just want the work a tool does to land back in the PMS cleanly. Unfortunately, that still doesn’t happen nearly as often as it should.

So the frustration is justified, and it’s earned. One RCM leader described what happens when you start bolting vendor after vendor onto the workflow:

Every point solution that can’t write back accurately is one more thing an RCM leader has to deal with on top of a busy schedule.

Side note, how many times has a vendor said, “but it’s just another quick login and our dashboard is great”?

If that’s your pitch, just go get the PMS integration.

Build, Buy, Outsource, or Let the Agents Do It

Many DSOs of all sizes are beginning to chew on a new decision around AI agents in their workflows.

One executive had a clear read on building your own. Past a certain scale the math can work, but there’s a catch.

“Once you get into software development, you’re in software development.”

He pointed to a large group that built its own platform and is now getting back out of the software business, because maintaining, updating, and securing it proved too much.

There’s a third path, and it’s outsourcing the work. Plenty of groups run offshore RCM teams, and the loaded cost of those people can still come in below the technology sold to replace them, especially at scale and when platforms are priced as a percentage of collections.

It won’t hold everywhere, but right now, it holds more often than you might think.

Peter Qian, founder of a newer VC-backed agentic RCM company called Ventus, sees where things are heading.

Ventus has built extremely effective AI agent workflows that start on the front end, which loops right back to the clean-data point. Yet, the smartest agent in the world is still working with whatever you feed it.

Then there’s the point solution done so well, fixing something so important, that the people I talked to say it’s worth keeping around. One DSO RCM leader said to me,

“There’s a benefit to only doing a solution that touches a piece of it, because you can become an expert at that important piece.”

One name that came up was Pearly. They stay in their lane on standardizing patient billing, getting statements out by text and email with simple ways to pay.

It’s a narrow slice of the revenue cycle, and they’ve gotten very good at it.

The RCM leaders who’ve run the standalone tools still believe in them, as long as they’re fixing a very important problem.

Sometimes the best single piece beats the all-in-one.

Where Things Point

Humor me now as I get a little more theoretical.

The whole market seems to be pointing in a similar direction. Away from a pile of separate tools, toward one platform, where agents handle the routine work and people handle the exceptions.

What’s notable is that it’s coming from both sides. A newer vendor like Ventus describes that future, and the largest players in the PMS space like Denticon and HS1 say the same.

Barbi Elmore, Henry Schein One’s Sr. Director of Product Management over RCM, said this.

To me, when newer vendors and the biggest incumbent describe the same future, that’s a good tell.

Even the people building toward it will tell you it isn’t here yet. Kara Bean, who leads RCM at Henry Schein One, said.

“Anybody who says you’re never going to have to lift a finger, that’s a sales pitch. It just doesn’t exist in our industry right now.”

Rohit Chaparala, co-founder of Newton, is taking a broader swing at the problem. Newton has built an AI-powered VoIP platform that starts with the phones but extends across the entire patient communication workflow. Rohit agrees:

“I don’t think the solution is to automate RCM teams with AI voice agents. There are more realistic ways to reduce human error, like organizing the data in a clean interface and having AI connect the dots.”

What Newton is after isn’t just an agent. It’s clean, organized data in a platform so good people who can act on it.

There’s a newer breed worth watching too, PMS platforms built AI-native from the start.

Twelve is the clearest example I’ve seen. The PMS, the CRM, and the revenue cycle sit on a single AI backbone, with the agents built into the system from the start. The whole approach is closer to a business in a box for dentistry than a PMS with a few features bolted on.

A few others are starting to build this way, which is a change from where most of the market sits today.

How you price something like that for a large group is still an open question for me. Do you add services? Do you charge per token usage?

Lots of questions still to answer, but something to watch.

For the Operators, For the Vendors

If you run a DSO, define the problem first. Let me say that again. Define the problem first.

Find where the money is leaking in this RCM bucket, and get your ops and RCM teams on the same page, not siloed.

Then price the ROI together with your vendor. That’s a win for both sides.

When I was chatting with Mike Baird, he explained the vendor side better than I could. He said:

His challenge back to the builders was that they haven't defined the problem any better than the operators have.

For the vendors, keep working to to understand dental’s complicated workflows. Stop overselling what the product does today. Open up the API connections, and make write-back work.

And don’t just say you’re a partner, really be a partner. Partner where it serves the customer, not just your revenue model.

For those frustrated with the incumbents, realize their size can move the industry forward and they’re made up of great people, working hard to solve problems every day.

As I mentioned earlier, most of the data problem starts with the payers, and no single office or vendor has the weight to change that.

A PMS with real market share does. So do the largest DSOs. When they push the payers together, everyone benefits.

One DSO executive said to me,

“Until the insurance carriers all fix their systems and offer API connections and all the data, we’re going to have trouble winning this battle.”

That’s the fight a company the size of Henry Schein One, or a group of DSOs aligned on the same mission, can help move.

The front-end leak everyone keeps pointing to often starts at the carrier level. Getting the payers to open up takes real size behind it, and that’s a push only the biggest players can make.

Define the Problem First

So back to the question I started with. If RCM is the number one problem, why the hesitation to hear about the potential solutions?

The skepticism is understandable.

It isn’t that the technology is bad. It’s that undefined problems keep meeting oversold solutions, poorly deployed, across teams that already have a hard job.

Add in a mix of venture-backed companies saying things that may or may not end up being true, and the hesitation makes sense.

So here’s where I land on the reluctancy in the market. There are great tools but the way out isn’t another tool. It’s getting clear on the exact problem you’re solving, cleaning up the data feeding it, and getting your people aligned before you buy anything.

Do that, and the tech has a real shot at closing the gap. Skip it, and the best platform in the world still leaves you at sixty percent.

The tech I see each week is exciting, from the new names to the more experienced ones.

The operators who see the most success deploying these tools will know exactly what problem they’re trying to solve and approach the vendor as a partner in solving it.

I’m speaking at RCM Boot Camp later this month, and I’m looking forward to hearing how the RCM leaders in that room see all of this.

If you’re going, reach out and let’s connect. If you’re thinking about it and want the details, just contact me.

Schedule some time with me regardless even if you’re not attending at this link here.

The DSO Technology Show

Brian Colao and I sat down solo and talked through the success of this years Dykema Conference. We had some fun back and forth regarding some criticism he had for my latest LinkedIn article regarding my conference observations. The conversation is one to check out!

👉 Watch the episode here

DSO Compass Off Script

Clayton Russell and I had a great conversation on trends reshaping the dental market half way through the year. From AI underperforming in dental use cases to shifting DSO priorities, this episode explains what’s changing and how smart leaders are adapting.

👉 Listen on Spotify, Youtube & Apple Music

Truly appreciate you being here and making it to the end. Have ideas, questions, or tech you want me to explore? Just reply to this or book some time with me to discuss.

- Matt