The Tool Desk
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What counts as a new healthcare market?
A new market is not necessarily a new address. It can be a different geographic area, a different care setting, or a different way of delivering care. A practice might add a physical location in another community, coordinate dental services with medical care, work with a Federally Qualified Health Center (FQHC), or use virtual visits to reach patients who face travel or access barriers.
The American Dental Association (ADA) describes several practice arrangements, but no model is automatically permitted or suitable everywhere. Before choosing one, define the patient population and services you intend to serve, the role you want to retain in ownership and clinical decisions, and the local resources patients will need for in-person care.
Compare expansion models before choosing a location
| Model | How it works | Questions to resolve |
|---|---|---|
| Additional owner-operated location | The practice extends its existing operating model to another physical site. | Can you recruit and support staff at both locations? What are the local patient base, insurance mix, and payer-enrollment requirements? |
| Dentist group or shared-services cooperative | Dentists may retain practice ownership while sharing or centralizing nonclinical functions, depending on the arrangement. | Which functions are shared, who controls clinical decisions, and how are costs, records, staffing, and administrative responsibilities handled? |
| Medical-dental model or health-system integration | Dental and physician practices may coordinate care through referrals, shared records, or health-system employment. | What services and records can be coordinated, who employs the clinicians, and how do referral and follow-up workflows operate? |
| FQHC or other safety-net setting | Dental services are provided within or alongside a safety-net organization; FQHCs are often integrated medical facilities with a shared patient chart. | How does the organization serve its patient population, and what clinical, staffing, records, and operational arrangements apply? |
| Teledentistry-supported care | Live video or asynchronous store-and-forward workflows can extend access or support follow-up, with in-person care arranged when needed. | Can the remote information support the intended clinical decision? Are licensure, scope, privacy, billing, and local follow-up addressed? |
These are broad descriptions, not legal or financial recommendations. Compare options against ownership and control, clinical integration, access to the intended patients, workforce capacity, administration, payer mix, and regulatory feasibility.
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Build the market case around patient need and operating capacity
Define the patients and services
Specify the communities you want to serve, the care they need, and whether your plan depends on local appointments, remote triage or follow-up, medical referrals, or a combination. Consider geography, insurance mix, underserved populations, and whether patients can reach an appropriate dental resource when a virtual interaction is not enough.
Test workforce and workflow capacity
Map the people and processes the model requires: recruitment, supervision, staff roles, training, benefits, scheduling, documentation, billing, and coordination across sites or with medical partners. For a virtual workflow, account for staff training and for how appointments, visits, follow-up, and claims fit into existing operations.
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Build a target-specific financial model
Estimate investment, operating costs, reimbursement, payer mix, enrollment work, and expected volume using assumptions for the actual location and service mix. The sources available here do not establish a broadly applicable cost, revenue, payback period, or market-size figure for dental-practice expansion. Treat any projection as specific to your own operating assumptions rather than a general industry benchmark.
What does a teledentistry workflow need?
Teledentistry can extend a practice’s reach, but it is not simply a video call added to the schedule. The U.S. Department of Health and Human Services (HHS) describes both synchronous live video and asynchronous store-and-forward approaches. Choose the method based on the care need, the information required, and the rules that apply where the patient is located.
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Technology and workflow considerations
HHS identifies secure video-conferencing software, capable computer hardware, tablets or smartphones, and integration with electronic health records (EHRs) as possible components. A handheld intraoral camera may help capture detailed images for remote examinations. These are options to evaluate, not a universal equipment list. Consider image quality, clinical need, system compatibility, security, connectivity, and whether the workflow works for patients and staff.
- Set up secure communication and appropriate security controls.
- Plan for unreliable connectivity and establish a contingency process.
- Explain the virtual process to patients and train staff on the tools.
- Build scheduling, documentation, follow-up, and billing into the workflow.
- Identify local dental resources for patients who need in-person examination or treatment.
Clinical quality and responsibility
The ADA’s teledentistry policy, updated in 2020, says examinations and interventions should be consistent with in-person care and based on enough information to support diagnosis and treatment planning. The dentist remains responsible for quality and documentation, should provide a service summary, and should know what local dental resources are available for follow-up. The policy also says teledentistry does not expand the scope of practice permitted for auxiliary personnel.
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Check licensure and scope rules for every patient location
For remote care, the patient’s location can determine which state’s rules apply. The ADA policy states, “The delivery of services via teledentistry must comply with the state’s scope of practice laws, regulations or rules.” HHS’s general cross-state telehealth guidance, last updated April 30, 2025, describes possible pathways for healthcare providers, including a full license, temporary-practice or reciprocity provisions, a compact, or telehealth registration where available. Those general pathways do not establish that a particular pathway applies to dentistry in a particular state.
Before offering services across a state line, confirm the dental-board requirements, scope-of-practice rules, and any applicable registration or compact conditions in the state where the patient is located. HHS also advises verifying the patient’s location and obtaining consent before the appointment.
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Compact participation is time-sensitive. An ADA Health Policy Institute article from April 2026 reported that 12 states had passed legislation to join the dentist and dental-hygienist licensure compact, with legislation pending in eight more states at that time. That is a dated legislative snapshot, not confirmation of current availability or of an individual dentist’s eligibility. Check the compact and relevant state dental boards for current status.
Verify billing and Medicaid operations before launch
Do not assume that a service covered in one state or by one plan will be reimbursed the same way elsewhere. HHS’s oral-health telehealth guide, last updated August 6, 2024, says Medicaid teledentistry policies vary by state and advises practices to check private-plan rules with the patient’s insurer. Confirm the applicable codes and modifiers, documentation standards, claim-submission requirements, and processes for tracking and addressing denials with the relevant payer.
The ADA’s policy calls for dental benefit plans and public and private payers to cover covered teledentistry services to the same extent and level as in-person services when the policy’s conditions are met. That is the ADA’s policy position; it is not a guarantee of payment or a uniform legal entitlement under a state program, insurance contract, or individual plan.
Plan for Medicaid enrollment and participation
Medicaid entry involves administration as well as reimbursement. A June 2026 ADA summary of a two-year pilot begun in 2023 across Maryland, Nebraska, Ohio, Pennsylvania, Rhode Island, and South Dakota reported that four of the six participating states increased dentist participation in Medicaid and expanded dental-service utilization. That result describes the named pilot, not a predicted success rate for another market.
The summary highlights provider outreach and education, enrollment assistance, simpler administrative processes, stakeholder collaboration, and reliable data. Its report authors noted: “Reimbursement increases should be paired with provider outreach and education to help combat outdated information or long-held beliefs about participating in the program.” For a new market, assess which of these operational supports are available and how you will track enrollment, participation, utilization, and claims performance.
Quick Recap
Use a staged market-entry checklist
- Define the market: Identify the target geography or care setting, patient population, services, and access problem you intend to address.
- Select a model: Compare a second location, group or shared-services structure, medical-dental integration, safety-net setting, and teledentistry-supported care against your ownership goals and operating capacity.
- Validate state requirements: For each state involved, confirm dental licensure, scope, supervision, telehealth, and patient-location requirements with the relevant dental board and applicable authorities.
- Confirm payer terms: Check Medicaid and private-plan enrollment, covered services, codes, modifiers, documentation, claims processes, and reimbursement directly with the applicable program or insurer.
- Design clinical and technical operations: Specify in-person and remote workflows, records, secure communication, staff training, patient education, follow-up resources, and contingencies.
- Model the economics: Use target-market data and practice-specific assumptions for investment, staffing, payer mix, reimbursement, and administrative burden; do not rely on a generic payback or revenue figure.
- Set measures and review them: Decide what data will show whether the new market is reaching patients and operating as intended, then use it to adjust staffing, workflow, and partnerships.
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