While Everyone Else Raised Their Fees, He Lowered His
At every lecture he attended early in his career, Dr. Rick Kushner heard the same refrains from the dental profession’s most celebrated voices. Don’t take that insurance. Don’t be in that neighborhood. You don’t want that kind of patient anyway. He kept listening. And he kept thinking the same thing. “I’m looking around and I’m thinking, I think I’ll lower my fees,” Kushner recalls. “It makes a difference.”
It’s a line that sounds almost comically simple against the backdrop of decades of elite dental practice philosophy. But that simplicity, deliberate, principled, and relentlessly executed, is precisely what has made Comfort Dental one of the most consequential organizations in the history of American dentistry. The organization is approaching half a billion dollars in annual collections, has close to 500 partner-owners across more than 150 locations, and operates in underserved communities that most of the profession has never bothered to enter.
The Problem With “The Right Kind of Patient”
Kushner’s fee philosophy didn’t emerge from contrarianism. It emerged from a moral objection to the way the profession was stratifying access to care. As he describes it, the mainstream dental model has always been structured around affluence: higher fees, shorter schedules, fewer patients, more selective insurance acceptance. The patients left behind by that model, the middle-income, the lower-income, the uninsured, the Medicaid recipients, weren’t going somewhere better. They were going without.
“I would go so far as to say it’s worse now than it ever was,” Kushner says. “There are more middle income and below percentage-wise in the population than there was in the ’70s and ’80s. It’s worse than ever.”
Comfort Dental’s response was structural, not charitable. Kushner didn’t build a nonprofit. He built an efficient, high-volume, low-overhead franchise model that could afford to charge less because it was engineered to operate leaner. Where the average dental practice runs overhead at or above 80%, Comfort Dental averages under 50%. That gap is what makes lower fees sustainable and, in fact, profitable.
How the Economics Actually Work
The elite practice model depends on a specific patient: one with comprehensive insurance, a large treatment plan, and the financial means to proceed quickly. When those patients show up reliably, the math works. When they don’t, the practice waits. Kushner watched that waiting turn into playing video games between patients. He watched 80% overhead structures invite the private equity firms that would eventually consolidate the profession into DSOs, a development he predicted publicly on tape decades before it happened.
His model works differently. Lower fees bring higher patient volume. Higher patient volume generates clinical reps, which builds clinical speed and confidence, two of the characteristics Kushner has identified as most predictive of success in his model. More patients also means more predictable revenue, less dependence on any single large case, and a practice that isn’t structurally dependent on excluding anyone.
“We don’t discuss caliber of patient,” Kushner says. “This one, the average case is gonna be $850. This one, it’s gonna be $2,800. We’ll have to see three more patients. They all work. It all works.”
Ninety-eight percent of Comfort Dental practices accept Medicaid. They take plans, as one of Kushner’s colleagues puts it, that nobody else wants to take. They work hours nobody else wants to work. And they produce at a level most of the profession doesn’t believe is possible until they see the numbers.
What “Taking Everyone” Actually Looks Like in Practice
Kushner’s open-door philosophy goes beyond fee schedules. It shapes every patient interaction, from the initial interview to the treatment plan to the follow-up care call. The Comfort Dental model is built around meeting patients where they are, financially and clinically. If a patient can’t afford a full treatment plan, the practice finds a partial one. If all they can manage is an emergency visit, that visit happens.
“Send me the patient, any patient, all patients,” Kushner says. “I’ll work with her. See if we can find a way to move forward, even if it’s just a partial treatment plan or a simple emergency visit. Send me everything.”
That philosophy, applied consistently across hundreds of locations and decades of practice, has created something unusual in American healthcare: a large-scale dental organization that is both financially successful and genuinely accessible to the patients most providers turn away.
The Profession Still Hasn’t Caught Up
Kushner has spent 50 years being told he’s wrong. The profession’s elite have questioned his fees, his patient mix, his model, and his claim that volume-based dentistry can produce excellent clinical outcomes. The results keep answering back.
Comfort Dental’s top producers are earning seven figures. Its overhead remains well below the industry average. Its partner-owners are paying off dental school debt early. And the communities it serves are getting care that would otherwise be out of reach. Lower fees, it turns out, make a difference.
Take the Concept Back to Your Practice
Whether you’re a dental professional rethinking your model or a practice owner wondering whether a different approach to fees and patient access could work for you, Comfort Dental‘s story offers a compelling case study. The math is real. The outcomes are documented. The only question is whether you’re willing to do what most of the profession still won’t.