Mobile Dental Systems Financing
a. How can we build financial sustainability?

A mobile clinic strives to fulfill its mission and achieve its goals, while operating and sustaining a business. Many times, the more inclusive a mobile clinic seeks to be in providing access, the greater its risk of operating in the red because of uncompensated care. By the same token, the more a mobile clinic limits uncompensated care, the greater its risk of limiting access to dental care for people with low-incomes and thus not fulfilling its intended mission. Creating a balance between these competing concerns is crucial to the success of the program.

Starting a new program assumes risk and the expectation that revenue will not cover 100% of expenses in the first years. It is critical that you have a plan for when revenues will equal expenses (the break-even point). If you dont, you will have raised awareness of the lack of resources and expectations for service, only to leave the community without care if you can no longer afford to operate. The Ronald McDonald Care Mobile program suggests developing a five-year budget and funding plan, and they counsel not to begin a program unless you are certain you can fund it for five years. A good study of the capital budgeting and long-term viability of one mobile dental program is included in the article by Arevalo and co-authors listed in the Resources tab.

Secure financial commitments before you order a mobile vehicle.

An organization's budget is a written plan to work toward its financial goals. Public programs and private non-profit agencies may differ in how they structure their budgets for a mobile clinic. Budgets are prospective tools for both the short-term and the long run. To maximize the usefulness of a budget, monitoring systems should be in place to assess the need for adjustment should things not go according to plan. A budget should tell the story of the mobile practice and reflect the scope of care defined for the program. The type of patients seen will have an impact on production, expenses and the revenue you can expect to generate.

There are basically five primary paths to take to finance the start-up of a mobile dental clinic (some of these could overlap):

Examples of financial lenders for mobile clinics include:

Most custom mobile health vehicle manufacturers can assist in arrangements for financing for buying or leasing (with option to buy) a mobile vehicle. Leasing is an option when limited funds are available up front. Leasing might allow a program time to continue fundraising and begin to generate patient care revenue while getting the mobile dental program launched.

Chapter 3 in the Safety Net Dental Clinic Manual provides comprehensive guidance about financial considerations for a fixed dental clinic; but many of the principles also apply to mobile clinics. Considerations also are included for fundraising and grantwriting.

Some cost ranges have been provided throughout this chapter, but  estimates from your own geographic area will be more useful. Some of the manufacturers will also help you with estimates to help you develop a draft budget.

Three examples of a business plan and associated spreadsheets for a specific mobile clinic that serves children are provided here for comparison of potential expenses and revenues. They are not meant to be budget recommendations for your program, but examples of factors and assumptions that can alter your budget and your bottom line.

Business Plan I Excel spreadsheet I
Business Plan II Excel spreadsheet II
Business Plan III Excel spreadsheet III

 You can substitute your own categories and estimates and use the interactive spreadsheets to create a first-year budget for your program.

Tips Related to Budgets for a Mobile Program

When determining revenue sources, consult with the various payers such as dental insurance companies and the dental consultant for the state Medicaid program to determine how reimbursement for services will be handled. Does each provider use a different provider number or is the mobile program assigned only one provider number? This may depend on your affiliation with a community health center or other parent organization.

Don't forget to calculate capital depreciation costs and report those in your budget each year. Depreciation measures how much of a tangible asset (such as your vehicle or computer) has been consumed. It is an allocation of a portion of the cost of capital equipment into each of the years of the item's expected life. Setting the depreciation amount aside in cash or investment each year will assure you have the funds available when it is time to replace items.

Once you have determined your first year operating budget, you may want to create a month- by- month breakout of that plan for the first 24-36 months of operation. As you do so, you will account for the termination of cash flow from start-up grants and the increase in cash flow from increasing numbers of patients and increased production. As your program progresses, you will want to compare, at least quarterly, real cash flow with projections. You will probably find it is necessary to make adjustments. If your revenue is not meeting expenses, then one of more changes in your operational plan may need to be made. Consider some of these options:

Partnering with others in the community is crucial for many mobile programs operated by government or non-profit organizations. Cost-sharing and leveraging resources through collaborative efforts are realities in today's public health environment. Programs that are extensions of Federally Qualified Health Centers (FQHC) can benefit from the multidisciplinary nature of some of the health centers as well as the funding and revenue-generating mechanisms.