The Smilebuilderz business model is a rarity in an industry dominated by solo practitioners — but that might be changing.
The American Dental Association calls large-group practices "a rapidly expanding career option," with its Health Policy Resources Center reporting in 2012 that the number of large dental group practices grew 25 percent in just two years. In 2008, solo practices represented 92 percent of all dental practices; as of 2010, only 69 percent of dentists were solo practitioners.
"We seem to be still in growing mode," says Smilebuilderz CEO Dr. Anthony Skiadas, who started the Manheim Township-based company in 2006. "This could be, honestly, a billion-dollar company; there's no reason why it couldn't. It improves dentistry, it improves patient convenience."
Smilebuilderz offers "99 percent of what a typical family might need," Skiadas says. It offers extended hours, and it accepts many insurances, including Medicaid. And although the still-evolving main campus is the heart of the business, the urgent care office in East Hempfield Township and one to come in Ephrata Township are also key to its success.
"They create additional referrals," Skiadas says. A lot of people don't have a dentist, he says, but they may come if they knock out a tooth playing sports or have severe tooth pain, and that gives the urgent-care staff an opportunity to remind them of the value of regular care. Smilebuilderz also has its own dental plan that offers services at a discount.
"We're the people's dentist," Skiadas says. He thinks the trend away from solo practices will continue, and he sees parallels in a similar industry.
"The medical field integrated medicine back in the 1800s," he says, referencing how health systems now aggregate specialists of all kinds. "That's certainly become the standard of how medicine practices. Dentistry isn't much different; a lot of the treatments we provide for patients require a lot of different treatments, different subspecialties. In a case like ours, I think integrating the care makes it a lot easier."
His business model also provides economies of scale, Skiadas says, including the fact that facilities and equipment can be in use 70 to 80 hours a week, and it gives dentists professional growth opportunities they typically wouldn't have if they spent 20 years running their own business and doing one specific, narrow job.
"Somebody like that comes along and says, 'This is a great opportunity to be part of something big,'" Skiadas says.
Then there's the changing dental landscape. According to the ADA, people have been going to the dentist less frequently since about 2003, and since about 2006 the inflation-adjusted net income of independent general practitioners has been dropping an average of 3 percent a year. Skiadas also says reimbursements have been going down; on both issues, having a broader customer base is an asset.
Being large also helps on the insurance front. Skiadas says Lancaster County was a place "where not many providers accepted insurance for a long time," and the ADA found in 2012 that on average only 18.2 percent of dentists accepted new Medicaid patients. The numbers are slightly higher for non-solo practices, but still there's a sizable underserved population that Smilebuilderz is reaching out to, and that will only grow if Pennsylvania eventually expands Medicaid.
Then there is the issue of location.
"I don't know how he figures out where the hospitals are building urgent cares, but he sets up near them," says Vido DeCamillo, director of Fastcare at Lancaster General Hospital. Skiadas has a collaborative relationship of sorts with LGH, as some emergency department visits belong more properly in a dentist's office.
It's not a huge number of people; LGH says in the first six months of 2016, 561 patients came to the emergency department with chiefly dental issues — about 1.4 percent of the total ED population. Most have messy mouths that demonstrate the danger of going without dental care. Some people with dental emergencies may choose to go to a Smilebuilderz Urgent Dental Care center if informed of them, but for many people, even a minimal cost is a deterrent.
"What it comes down to is money," DeCamillo says. "People come to the emergency department and know that they don't have to pay any money."
That dynamic underscores the fact that even the populist, patient-hungry Smilebuilderz model won't close all service gaps. But, Skiadas says, it's helping.