60 : Advocacy, Regulatory Pressure, and the Fight Over How DSOs Are Allowed to Operate

One state dental board passed a rule that would have changed who gets to own dental equipment and hold office leases, and the DSO industry went to court to stop it. Andrew Smith, CEO of the ADSO, walks through what happened in Colorado and what it signals for the rest of the country.

Adrian Lefler sits down with Andrew Smith, CEO of the Association of Dental Support Organizations, the group representing roughly half the DSO market and about 19 billion dollars in revenue. Smith sums up the mandate in three words: protect, promote, and position the DSO model. Roughly 65 to 70 percent of that work is government relations, with lobbyists in more than 30 states watching legislation and dental board activity week by week.

Then they get into Colorado. The rule came from the dental board, not the legislature. It would have forced supported dentists to take over leases and equipment the DSO had been holding, added variable fee restrictions, and opened up records demands. The ADSO sued on the grounds the board reached past the authority the legislature actually gave it. The board then voted unanimously to stay the rule while the case plays out. Smith thinks the board underestimated the operational damage rather than set out to attack the model, but he places it inside a wider anti-corporate mood showing up in state politics on both sides of the aisle.

The back half covers insurance. Smith names the wins that have actually landed at the state level, explains why the industry still has weak negotiating leverage, and makes the case that consolidation is the thing that changes that. He also compares the rise of DSOs to what ride sharing did to taxi medallions, and explains where that comparison holds and where it falls apart.

1. What does a dental industry association actually do for practices that owners never see?

Most of the work is government relations. The ADSO keeps lobbyists in more than 30 states monitoring every dental bill, sunset act, and dental board agenda, then decides which items have real momentum. Roughly 65 to 70 percent of the organization's effort goes there, because a single adverse rule can reshape how practices legally operate.

2. Can a state dental board change how a dental practice structures its business?

Only within the authority the legislature granted it. Dental boards exist for licensee discipline and patient protection. When a board writes rules on leases, equipment ownership, or fee structures without statutory backing, it can be challenged in court as overreach, which is exactly what happened in Colorado.

3. What should a practice do when a new state rule threatens its operating structure?

Engage before the rule is final. Submit comments, request meetings, and show regulators the concrete operational impact. Boards often do not understand what a rule costs on the ground. In Colorado, that engagement plus litigation produced a unanimous vote to stay the rule pending the outcome.

4. What dental insurance reforms have actually passed at the state level?

Several states banned virtual credit card payments, which let insurers pay providers by card and skim roughly 3 percent as a transaction fee. Others changed assignment of benefits rules so the practice is not chasing patients for reimbursement checks. Network leasing and retroactive denials are the next targets.

5. How much of dentistry is now practiced under the DSO model?

Close to 35 percent of dentists practice in a DSO-supported setting, and about 40 percent of graduating dental students go straight into one. Rising school debt and the economics of buying a practice drive most of that. Meanwhile 50 percent of Americans still do not see a dentist annually.

Andrew Smith is the CEO of the Association of Dental Support Organizations, a role he has held since 2021. Before dentistry he worked in Washington as a multi-client consultant and lobbyist, with earlier stops in political and government offices. At the ADSO he leads advocacy across state legislatures, dental boards, and insurance regulators, and hosts the association's podcast, Thank You for Flossing.

Guest: Andrew Smith

Website: https://www.theadso.org

LinkedIn: https://www.linkedin.com/in/andrewmulherinsmith/

Instagram: @theadso

Host: Adrian Lefler

Website: https://mysocialpractice.com

LinkedIn: https://www.linkedin.com/in/adrianlefler/

Book Adrian to speak: https://mysocialpractice.com/dental-marketing-expert/

Dental Marketing Services: https://mysocialpractice.com/dental-marketing-services/

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