Break-even analysis of Medicaid versus fee for service in orthodontic practice: North Carolina as a case study

The purpose of this study was to examine the potential profitability of treating patients covered by Medicaid in NC orthodontic practices using the break-even analysis. Questionnaires were mailed to 154 orthodontists in active practice in NC. Respondents were categorized into 4 groups based upon the number of 2005 Medicaid case starts. On a per case basis, assuming the break-even point had not been reached, three groups realized a potential profit for each Medicaid case treated. For each of the groups analyzed the inclusion of 5% Medicaid cases in the treatment pool did not substantially increase the practice break-even point. Assuming the break-point had been reached, all groups realized per case profits for each Medicaid case treated. Once the break-even point is reached, the inclusion of a small percentage of Medicaid patients can increase practice profitability while helping to address the current challenges with improving access to care for underserved populations.