Centralize for efficiency or stay distributed for personal touch? That is the wrong question. Top-performing multi-location healthcare groups have moved beyond this binary choice to intelligent routing: systems that direct each call to the optimal handler based on call type, not geography. Here is the decision framework that reveals which model fits your group.
Table of Contents
- The Evolution from Binary to Intelligent Routing
- Understanding the Three Models
- The Centralization Decision Matrix
- When Centralization Works
- When Distributed Works
- The Hybrid Model: Intelligent Routing
- Total Cost of Ownership Comparison
- Common Centralization Mistakes
- Implementation Considerations
- Key Takeaways
The Evolution from Binary to Intelligent Routing
For years, multi-location healthcare groups faced a seemingly binary choice. Centralize intake for efficiency and consistency, or keep it distributed for local knowledge and personal touch.
Groups that centralized often found efficiency gains but lost something in the process. Patients who had been calling “their” office for years suddenly reached an unfamiliar voice. Complex questions that required local knowledge bounced between central and local staff. Staff at locations felt disconnected from the patients they served.
Groups that stayed distributed preserved relationships but struggled with consistency. Each location developed its own scripts, processes, and standards. Some locations excelled while others struggled. Visibility across the network remained limited.
The evolved approach recognizes that the right answer depends on the call, not the organizational chart. Intelligent routing asks: “What does this caller need, and who is best positioned to provide it?” Then it routes accordingly.
Understanding the Three Models
Model 1: Fully Centralized
All inbound calls route to a central call center, regardless of which location the patient is trying to reach.
Structure:
- Dedicated intake team in central location
- Single phone number or location numbers forwarding to central
- Standardized scripts and processes
- Central scheduling into all location calendars
Advantages:
- Consistent patient experience
- Specialized intake training
- Efficient staffing (no idle time at slow locations)
- Easy quality monitoring
- Simplified technology stack
Disadvantages:
- Loss of local knowledge and relationships
- Disconnect between intake and clinical teams
- Complex questions require escalation or callback
- Patients may feel they cannot reach “their” office
- Single point of failure if central has issues
Model 2: Fully Distributed
Each location handles its own calls with its own staff.
Structure:
- Local phone numbers ring at each location
- Front desk staff handle calls between patient interactions
- Location-specific processes and scripts
- Local scheduling and patient management
Advantages:
- Local knowledge and relationships
- Direct connection to clinical team
- Flexibility for location-specific needs
- Patient reaches familiar staff
- No dependency on central infrastructure
Disadvantages:
- Inconsistent experience across locations
- Coverage gaps (lunch, sick days, busy times)
- Difficult to monitor quality
- Each location reinvents the wheel
- Hard to share best practices
- Limited visibility for leadership
Model 3: Hybrid / Intelligent Routing
Calls route to different handlers based on call type, time of day, or availability.
Structure:
- Intelligent call routing based on defined rules
- Some calls go central, some go local
- Overflow and after-hours coverage from central
- Integrated systems share information
Advantages:
- Right call to right handler
- Local knowledge where it matters
- Efficiency where it helps
- Backup coverage for all locations
- Flexibility to adjust over time
Disadvantages:
- More complex to design and maintain
- Requires technology investment
- Staff need to understand routing rules
- Handoffs between central and local require process
- Can create confusion if not well-designed
The Centralization Decision Matrix
Use this matrix to assess which factors favor which model for your group:
| Factor | Favors Centralized | Favors Distributed | Your Assessment |
|---|---|---|---|
| Location count | 10+ locations | 3-5 locations | |
| Geographic spread | Multi-state/region | Single market | |
| Service complexity | Standardized services | Specialty-heavy | |
| Staff availability | Hard to hire locally | Strong local teams | |
| Technology | Integrated systems | Legacy/varied systems | |
| Growth rate | Rapid acquisition | Organic growth | |
| Patient expectations | Efficiency-focused | Relationship-focused | |
| Brand positioning | Regional/national brand | Community practices | |
| Current answer rate | Below 85% distributed | Above 90% distributed | |
| Leadership bandwidth | Limited oversight capacity | Strong local managers |
Scoring:
- 7+ factors favor centralized: Centralization likely appropriate
- 7+ factors favor distributed: Distribution likely appropriate
- Mixed results: Hybrid model likely optimal
When Centralization Works
Centralization succeeds under specific conditions:
High Location Count with Standard Services
Groups with 15+ locations offering similar services benefit most from centralization. The standardization overhead pays off when spread across many sites. A dental group where every location offers the same services is a good candidate. A specialty medical group where each location offers different services is not.
Rapid Acquisition Growth
PE-backed groups including DSOs acquiring multiple practices per year often lack the management bandwidth to develop local intake excellence at each new acquisition. Centralization provides immediate consistency for newly acquired practices without requiring local capability building.
Significant Coverage Gaps
If distributed locations are missing 25%+ of calls due to staffing gaps, centralization solves the coverage problem immediately. A central team can be sized for total call volume rather than peak volume at each individual location.
Weak Local Management
Some locations have strong managers who can develop excellent local intake. Others do not. Centralization removes location manager capability as a variable in intake quality.
Geographic Dispersion
Groups spread across multiple states face regulatory and labor market differences that make local staffing complex. Central teams in a single location simplify compliance and hiring. Front desk outsourcing can provide this centralized capability without building internal infrastructure.
When Distributed Works
Distribution succeeds under different conditions:
Strong Local Relationships
In community-based practices where patients have multi-generational relationships with staff, centralization disrupts something valuable. The patient who has been calling Mary at the front desk for 15 years will notice when a stranger answers.
Complex Clinical Services
Specialty practices where intake requires significant clinical knowledge benefit from having intake staff who work alongside clinical teams. A fertility clinic where intake staff need to understand treatment protocols is different from a general dental practice.
High Local Capability
Some groups have invested in building strong local teams with excellent intake performance. Centralizing would disrupt what is already working well.
Single Market Focus
Groups concentrated in a single metropolitan area have less to gain from centralization. Local staff can cover for each other across nearby locations. Labor markets are consistent. Community reputation matters.
Established Processes
Groups that have already developed and deployed consistent processes across locations can achieve standardization without centralization. The value of centralization is partly in forcing standardization; if standardization already exists, that benefit is reduced.
The Hybrid Model: Intelligent Routing
The hybrid model routes calls based on type rather than defaulting everything to central or local.
Call Types by Optimal Handler
| Call Type | Optimal Handler | Rationale |
|---|---|---|
| New patient scheduling | Central | Standardized conversion scripts, specialized training |
| Insurance verification | Central | Specialized expertise, efficiency of scale |
| Appointment changes/cancellations | Central | Simple transaction, no local knowledge needed |
| Existing patient with clinical question | Local | Provider knowledge, relationship continuity |
| Complex scheduling (multiple providers) | Local | Calendar knowledge, coordination |
| After-hours all types | Central | Coverage efficiency |
| Overflow during peak times | Central | Prevents missed calls |
| Complaints or concerns | Local (or dedicated) | Relationship repair requires authority |
Routing Logic Example
Step 1: Time-based routing
- Business hours: Proceed to Step 2
- After hours: Route to central
Step 2: Intent identification
- New patient: Route to central
- Insurance question: Route to central
- Appointment change: Route to central
- Clinical question: Route to local
- General inquiry: Route to central
Step 3: Availability check
- Local available: Route to local (for local-appropriate calls)
- Local busy/unavailable: Route to central overflow
Step 4: Escalation path
- Central cannot resolve: Transfer to local with context
- Local cannot resolve: Escalate to manager or clinical team
Technology Requirements for Hybrid
Hybrid models require technology investment:
- Intelligent IVR or AI routing: To identify call intent and route appropriately
- Unified phone system: Single platform across all locations
- Integrated scheduling: Central and local access to all calendars
- CRM or notes system: To pass context on transfers
- Queue management: To handle overflow routing
- Analytics: To measure performance by routing path
A specialized medical answering service can provide much of this technology and expertise, making hybrid implementation more accessible.
Total Cost of Ownership Comparison
Financial analysis should inform the decision, but beware of oversimplification.
Centralized Cost Model
Fixed costs:
- Central facility (if physical)
- Technology infrastructure
- Management overhead
Variable costs:
- Intake staff (scaled to volume)
- Training and quality
- Telecommunications
Hidden costs:
- Escalation handling when central cannot resolve
- Patient satisfaction impact if poorly implemented
- Local staff time handling transfers from central
Distributed Cost Model
Fixed costs:
- Technology at each location
- Local training programs
Variable costs:
- Front desk time allocated to phones
- Coverage for gaps (temp staff, overtime)
Hidden costs:
- Missed calls during coverage gaps
- Inconsistent conversion rates
- Management time addressing location variation
Hybrid Cost Model
Fixed costs:
- Technology for intelligent routing
- Central team (smaller than full centralization)
- Local coordination processes
Variable costs:
- Central staff (scaled to assigned call types)
- Local staff phone time (reduced)
Hidden costs:
- Complexity of routing maintenance
- Training on routing rules
- Handoff process overhead
Comparative Analysis
For a 15-location dental group with 3,000 monthly calls:
| Model | Estimated Monthly Cost | Answer Rate | Conversion Rate |
|---|---|---|---|
| Distributed (current) | $45,000 | 78% | 62% |
| Fully Centralized | $38,000 | 94% | 68% |
| Hybrid | $42,000 | 95% | 72% |
In this example, hybrid has higher cost than centralized but delivers better conversion due to appropriate routing of complex calls. Distributed has highest cost when accounting for coverage gaps and missed call revenue impact.
Common Centralization Mistakes
Groups that fail at centralization often make predictable errors:
Mistake 1: Centralizing Everything at Once
The “big bang” approach disrupts patients, overwhelms the central team, and leaves no fallback if problems arise.
Better approach: Centralize one call type at a time. Start with after-hours, then new patient calls, then overflow. Build capability progressively.
Mistake 2: Underinvesting in Training
Central staff need to understand multiple locations, providers, and services. Generic training produces generic results.
Better approach: Invest in location-specific training modules. Central staff should know each location’s providers, specialties, and quirks.
Mistake 3: Eliminating Local Phone Access
Patients who cannot reach their location directly feel abandoned. Provider teams who cannot reach their own front desk are frustrated.
Better approach: Maintain local direct lines for appropriate use while routing main numbers through central. Give providers internal direct access.
Mistake 4: Ignoring Escalation Design
When central cannot answer a question, what happens? Without clear escalation paths, callers get stuck.
Better approach: Design specific escalation paths for each call type. Central staff should know exactly who to transfer to and how to pass context.
Mistake 5: Not Measuring the Right Things
Measuring only efficiency metrics (calls per hour, handle time) while ignoring effectiveness metrics (conversion, satisfaction) leads to fast but poor intake.
Better approach: Balance efficiency and effectiveness metrics. Track both call handling speed and outcomes like conversion and patient satisfaction.
Implementation Considerations
For Centralization
Timeline: 6-12 months for full implementation
Key milestones:
- Technology selection and implementation (2-3 months)
- Staff hiring and training (2-3 months)
- Pilot with 2-3 locations (2 months)
- Phased rollout to remaining locations (3-4 months)
- Optimization (ongoing)
Critical success factors:
- Executive sponsorship and communication
- Investment in training
- Clear escalation paths
- Metrics that balance efficiency and quality
For Hybrid
Timeline: 4-8 months for initial implementation
Key milestones:
- Call type analysis and routing design (1 month)
- Technology implementation (2-3 months)
- Central team development for assigned call types (2 months)
- Routing activation and testing (1-2 months)
- Iteration and optimization (ongoing)
Critical success factors:
- Clear call type definitions
- Reliable intent identification
- Seamless handoffs between central and local
- Continuous routing optimization based on data
Key Takeaways
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Move beyond binary thinking. The centralized vs. distributed debate is outdated. The real question is which call types benefit from which handling approach.
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Use the decision matrix. Ten factors determine which model fits your group. Score yourself honestly to guide the decision.
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Recognize when centralization works. High location count, standard services, rapid acquisition, and coverage gaps all favor centralization.
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Recognize when distributed works. Strong local relationships, complex clinical services, high local capability, and single market focus favor distribution.
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Consider hybrid as the evolved approach. Intelligent routing sends each call to the optimal handler based on call type, not geography.
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Calculate true cost of ownership. Include hidden costs like missed calls, escalation handling, and satisfaction impact in financial analysis.
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Avoid common centralization mistakes. Do not centralize everything at once, underinvest in training, eliminate local access, ignore escalation design, or measure only efficiency.
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Plan implementation carefully. Both centralization and hybrid require 4-12 months for proper implementation with clear milestones and success factors.
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