The Scale Dilemma: The Cost of Disconnected Tech

David McNeil, Chief Revenue Officer at Weave

Over the past two years, I’ve had the opportunity to sit across the table from dozens of Dental Service Organization (DSO) and group practice operators. What has stood out to me is just how different their experiences are right now.

Some groups are continuing to grow and expand. Others have seen the economic environment bring acquisitions and expansion to a near standstill. There isn’t one simple story that captures what every operator is experiencing.

When you step back from the current environment, however, the broader direction is clear.

According to the ADA’s Health Policy Institute, the share of U.S. dentists affiliated with a DSO has more than doubled since 2015, reaching 16% in 2024. Roughly two in three dentists now practice in a group setting, and among dentists who graduated in the past ten years, one in four are already affiliated with a DSO.

Whatever happens in the economy this year, it’s clear that the multi-location model will continue to shape the future of dentistry for many owners and practitioners.

In my role as Chief Revenue Officer at Weave, I spend a lot of time listening to industry experts, practitioners, team members, and patients. We also regularly conduct original research to better understand what practices are experiencing. Most recently, we commissioned a new survey and a series of in-depth interviews focused on multi-location healthcare organizations.

Three themes stood out to me:

1. The front desk continues to make or break healthcare organizations of every size.
2. The people buying technology and the people using it often have very different views of whether it is working.
3. Standardizing a practice’s technology stack has become essential, especially for organizations that want to benefit from AI.

Theme 1: The front desk can make or break the practice

For a long time, scale was viewed as the key to unlocking operational efficiency. There is certainly truth to that, but scale can also magnify the challenges already present inside a practice.

As organizations add locations, the pressure on the front desk often grows with them.

Among organizations with 50 or more locations, 74% described repetitive administrative work as a major operational problem. Another 63% said they are losing measurable revenue to no-shows, last-minute cancellations, and gaps in the schedule. More than half said insurance claims and communication across disconnected systems are consuming valuable staff time.

One group leader said it plainly: “Insurance claim denials delay payments and hurt cash flow badly. Staff waste hours reworking denied claims instead of helping patients directly.”

That last part matters. Every hour spent correcting a claim, tracking down information, or moving between systems is an hour someone cannot spend helping a patient.

The front desk is where the patient experience, the team experience, and the financial performance of the practice all come together. When the front desk is overwhelmed, everyone feels it.

Theme 2: The people buying technology and the people using it often experience two different practices

When we asked people how satisfied they were with the technology already in place, owners and partners were overwhelmingly positive. Frontline team members told a very different story.

The gap was significant:

• Two-way patient texting: 95% of owners were satisfied, compared with 50% of non-owners.
• Email and text marketing: 95% compared with 32%.
• Call center and phone-tree tools: 93% compared with 35%.
• Insurance verification and preauthorization: 82% compared with 30%.

We saw the same pattern across nearly every category we measured.

It also showed up when we asked about operational pain. Repetitive administrative work was a problem for 65% of non-owners, compared with only 36% of owners.

The people closest to the work feel the friction most. The people signing the contracts often feel it the least.

This helps explain why so many well-intentioned technology decisions fall short. If an owner believes the current technology is working, leaving it alone feels like the rational choice. When a problem becomes too large to ignore, the response is often to add another point solution.

But neither approach necessarily solves what the frontline team is experiencing every day.

Before choosing new technology, leaders need to spend time with the people answering the phones, filling the schedule, verifying insurance, collecting payments, and helping frustrated patients. Their experience should be part of the buying decision from the very beginning.

Theme 3: Technology standardization matters more than ever

Among survey respondents with fewer than 50 locations, 72% said their practices are running more than one software solution. Nearly half of the organizations with more than 50 locations reported the same thing.

One decision-maker described the problem simply: “Our PMS, telecommunication devices, and patient communication tools do not share data.”

That is the heart of the issue. Many of these systems do not work together.

Among large networks, 85% identified a lack of integration with their PMS or EHR as their biggest obstacle. Nearly 80% are concerned about the downtime involved in migrating patient records to a more integrated system. Another 70% worry that introducing a new system will disrupt daily operations and create even more work for the staff it is supposed to help.

The desire for better technology is there. The hesitation comes from the very real risk of implementing it.

In fact, 87% of multi-location practices said they plan to adopt new scheduling, communication, billing, or payments technology within the next year or two. They are not holding back because they lack interest. They are holding back because they have seen how painful change can be when systems do not integrate, and implementation is not handled well.

How AI fits into the conversation

Among the large practices we surveyed, 96% said they are using AI more than they were a year ago. Two-thirds of leaders described their organizations as innovators or early adopters.

Perhaps most telling, 67% said they are comfortable using AI in patient-facing interactions, as long as a team member can step in when needed.

That condition is important. The goal of AI should not be to remove the human element from healthcare. It should be to give people more time to be human where it matters most.

When we asked large groups where they want to use AI next, the biggest gaps between interest and current adoption were all connected to revenue:

• Insurance claims management: 67% want to use AI, while only 7% do today.
• Re-engaging inactive patients: 63% want to use it, while 15% do today.
• Outbound payment collection: 48% want to use it, while 19% do today.

AI is also closely connected to the staffing challenge. Roughly 62% of dentists told the ADA’s Health Policy Institute that staffing shortages were the single biggest challenge facing their practices.

Many practices cannot continue adding people every time they want to add capacity. They need a way to grow without placing even more pressure on teams that are already stretched thin.

That is where I believe AI can make a meaningful difference. It can take on the repetitive, rules-based work that consumes a team’s day, while allowing people to focus on conversations, decisions, and patient needs that require empathy and judgment.

Looking ahead

If there is one idea I would want operators to take away from this research, it is that the right solution depends less on how many locations you have and more on how your organization actually operates.

The frontline capacity problem is nearly universal, but it shows up differently depending on the practice. Understanding the specific problem you are trying to solve should come before evaluating a single vendor.

For an owner-operator, the biggest constraint may be cash flow. Denied claims, slow collections, and long billing cycles can create enormous pressure. Yet 66% of these leaders said staff well-being is their top priority. Removing administrative friction does more than improve the numbers. It gives people time and energy back.

For a practice manager or operations leader, the challenge is making it through the daily rush. Confirmations, waitlist backfill, missed calls, and hours of manual phone work can quickly consume the day. For these leaders, the question is practical: How many hours will this give back to my team? Two-thirds of operational leaders identified time saved as their most important measure of success.

For an enterprise DSO, the challenge is consistency and visibility across a much larger organization. Acquired locations may use different systems, follow different processes, and deliver very different patient experiences. These organizations need unified oversight, strong integrations, and the ability to write information back into the systems their teams already use. At that scale, saving staff time becomes even more important. It was cited as a requirement by 96% of enterprise buyers.

The underlying challenge is the same, but it takes a very different shape depending on the organization.

After years of conversations, hundreds of reports, and feedback from thousands of people, I keep coming back to three things:

1. Understand the specific shape of your capacity problem before you start shopping for a solution.
2. Ask the people at the front desk what they are actually experiencing every day.
3. Make sure anything you add works with the systems and workflows your team already relies on.

The operators who pull ahead over the next few years will not be the ones who simply bought the most technology. They will be the ones who understood their practices well enough to make thoughtful decisions.

They will listen to the people doing the work, choose technology that fits the problem they are trying to solve, and protect the human connection that patients and team members need.

The technology has caught up. The real opportunity now is to use it thoughtfully, giving healthcare teams more time to care for patients and helping practices grow without asking already stretched teams to carry even more.