Same-Store Growth, Reframed – Lessons From the Field

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Very often, dental groups and DSOs spend big to acquire new patients, hoping to boost their enterprise value.  They revamp office space, add chairs and specialties, and spend a fortune on ads. Unfortunately, this doesn’t always work. New patient acquisition strategies work only when they are built on top of a strong foundation of operational best practices designed to create lasting value. 

I was always of the opinion that same-store growth is under-rated by practices, a sentiment that until now did not have any objective data-driven backing. So when CareStack invited me to help design and interpret a benchmark study on same-store growth in US Dentistry, I jumped in with both feet. The project analyzed operational data from 123 CareStack practices and captured candid interviews with owners, clinicians, and managers. Distilling that information, we can see five habits that every consistent grower shares. In this article, I have tried to capture a field-level take on each habit, with just enough data to show the pattern and plenty of narrative to explain why it matters.

1. Guard the Brand, Grow the Reputation

Walk into a top-performing practice and you feel the brand before you see the signage. Colors match the promise, the scent at reception is intentional, and the team uses the same language online and in person. That coherence spills onto Google: high-growth offices routinely collect dozens of fresh reviews each month and hold ratings north of 4.6 stars.

But the data only tells half the story. Operators who win at reputation management design moments for praise. Hygienists mention the review request while patients are still reclined. The business team follows up with a text before the parking-lot engine starts. And crucially, someone answers every single review. That public dialogue validates the clinical promise and boosts local search; it also reminds the team that real people are on the receiving end of their work.

Five-star proof converts better than five-figure ad budgets.

“Patient experience is not a nicety anymore. In a fiercely competitive healthcare marketplace, it’s a necessity.” – Katie Post, CEO Northwest Dental Group

2. Build a Patient-Centered Culture

Long before the first ad impression, practice growth lives – and dies – in the micro-choices staff make every day: greeting a nervous parent, explaining insurance in plain English, celebrating a child’s cavity-free visit. The study shows that practices able to hold no-show rates near the “unicorn” 4 percent mark do so by weaving empathy into hiring, training, and recognition. Leaders coach against burnout, spotlight success stories, and give employees permission to solve problems on the spot.

We’ve watched these cultures in action. In one Midwestern group, assistants keep a small “comfort kit” at every chair, that includes lip balm, tissues and noise-canceling earbuds. Why? Because someone once noticed a patient’s discomfort and made a change that stuck. Small gestures like these snowball into remarkable loyalty, and loyalty underwrites growth.

3. Treat Sales as a Team Sport

Great businesses have great stories to tell. The study’s stand-outs see phones, consult rooms, and follow-up texts as chapters in the same narrative. Front-office teams handle inquiries with scripted warmth, then hand off seamlessly to treatment coordinators who have rehearsed answers to financing fears. Clinicians reinforce the value, not the price. Nothing feels “salesy” because everything feels aligned.

Dr. Tarun Aggarwal, Owner of 3D Dentists at Raleigh, NC captures this perfectly: “If you want to grow consistently, you need more than just good dentistry. You need a team that knows how to attract, present, and close high-value cases by working together.” That togetherness is amplified by technology, including AI call recording and real-time coaching dashboards. But the heartbeat is still human. When a patient hears the same respectful confidence from receptionist to doctor, case acceptance improves almost automatically.

4. Don’t Chase Cash. Let it Flow In.

Few topics drain an operator’s energy faster than revenue cycle management, yet the winners we interviewed talk about cash flow with genuine enthusiasm. Their secret is automation tempered with curiosity. They automate insurance verification and posting, yes, but they also review denials weekly, looking for broken processes they can eliminate. Patient statements go out digitally, balances can be cleared with one tap, and cards kept on file mean questions get answered before a balance turns into bad debt.

We’ve seen groups shave weeks off Days Sales Outstanding simply by agreeing on a single definition of “clean claim” and refusing to let exceptions slide. The relief is palpable: fewer collection calls, steadier payroll, happier associates. Cash flow is culture, too.

5. Simplify the Tech Stack and Aim Early at AI

Every operator loves a new app, until thirty log-ins later, nothing talks to anything else. Rather counter-intutively, high-growth practices take the opposite approach: fewer platforms, deeper adoption, tighter data loops. Many of them choose a cloud PMS that already speaks native RCM, tie in enterprise VOIP that supports their staff, and feed everything into a single analytics layer. The up-front change management can feel brutal, but the payoff is real: lighter subscription spend, reduced data fragmentation and errors, and more time for patient-facing work.

Early AI projects look to be the cherry on top. Radiographic analysis that flags early bone loss, call-scoring bots that highlight missed booking cues, voice-scribe tools that free up charting time are some of the popular AI projects being undertaken by good performers. While none of these fully replace people, they create room for people to do the irreplaceable labor of empathy and persuasion.

Scott Kalniz, Chief Dental Officer at Beam Dental, described his evaluation criteria this way: Does the tool integrate cleanly, exchange data without limits, and avoid piling work elsewhere? If it clears those three bars, he’s in. If not, he moves on. 

Pulling It All Together

Across states and business models, the same pattern repeats:

1. Brand & Reputation create magnetic pull.
2. Patient-Centered Culture turns that pull into retention.
3. Unified Sales Teams transform interest into accepted care.
4. Streamlined Revenue Cycles protect every earned dollar.
5. Integrated, AI-Aware Tech keeps the engine humming with less friction.
   

None of these levers works in isolation, and none requires a nine-figure budget. What they demand is leader attention, process discipline, and a willingness to think long, beyond the next acquisition and into the future value of each operatory already on the P&L.

The full report from the CareStack study, The State of Same-Store Growth in 2025, breaks down the benchmarks and offers practical checklists for each habit outlined in this article. We hope it helps your organization move from owning more practices to getting more out of the practices you already steward.

Access the full study here and start
charting your own same-store success story.

Written by Emily Ryba. Emily is the Co-Founder and CEO of OSDental and ProDent Financial Partners. She has been in the Dental / DSO space for over 10 years. During her time in the industry, she has worked with over 50 DSOs in public accounting. Most recently, she was Vice President of Accounting for a large DSO with over $100 million in revenue.