FQHC Dental Startups: Getting Off on the Right Foot

DF2 Uncategorized

Dr. Mark J. Doherty
DMD MPH CCHP

Proper planning is the most effective path to success for new FQHC dental programs. Many FQHC executives might say, “Well, planning is easier said than done,” but we do not agree. After many years of dental practice consulting to health centers, we have developed a tried and true process that minimizes the uncertainty and reduces the risk associated with dental startups. Every new FQHC dental program should start with a systematic plan that includes a number of basic principles and strategies.

Fundamental to a successful plan is a thorough environmental scan, which includes:
  1. The socio-demographics of the health center’s service area;
  2. Oral health status indicators: access to care barriers;
  3. Workforce availability;
  4. Inventory of other local safety net dental and social service organizations (which may serve as potential collaborators and/or competitors to the new program);
  5. Public school enrollment, and;
  6. Medicaid enrollment and utilization, covered services and reimbursement amounts.

With that information in hand, define what success should look like in the areas of ACCESS, FINANCE and OUTCOMES. Understanding the important benchmarks for FQHC dental programs, which also contribute to the creation of practical, realistic and achievable goals.

Then, define what access and capacity should look like for the new program.  Access is defined in large part by program capacity as determined by structure- days and hours of operation, number of dental operatories, type and number of providers and support staff. Capacity is what the practice’s actual productivity could be assuming realistic and achievable encounter rates.

Access also includes priority populations for care (i.e. patients for whom we need to ensure access to care), as well as the metrics that will be used to measure success (HINT: think about more than just encounters).

Next, the financial plan must include realistic projections related to patient mix, payer mix, program expenses and all revenue sources- including grants- with a clear delineation of program goals, individual staff productivity goals (encounters, revenue and services provided), staffing models and detailed job descriptions. When planned correctly, finance supports care and care leads to financial sustainability.

Outcomes should be both meaningful and measurable. For example, in addition to the required HRSA sealant measure, completion of Phase I treatment plans is an important outcome that has the added benefit of helping programs determine the number of new patients that can be accommodated without disrupting the care of existing patients. Other potential outcome measures can be found on the Dental Quality Alliance website here:

Dental programs that have started and failed or that have started and become a burden to the overall health center often began without a clear and informed understanding of what needed to be accomplished to guarantee success. Conversely, a thorough startup plan that includes the areas identified above will give health centers the greatest likelihood of getting off on the right foot and not having to circle back and redesign the program in response to unforeseen circumstances or challenges.

When executed correctly and supported by data and experience, a sound dental startup plan leads to success. When planning is incomplete, programs often fail to achieve the results they target and that their communities need.

Take the time get the data, get the outsight and prepare well. It is worth it.