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

  1. The Evolution from Binary to Intelligent Routing
  2. Understanding the Three Models
  3. The Centralization Decision Matrix
  4. When Centralization Works
  5. When Distributed Works
  6. The Hybrid Model: Intelligent Routing
  7. Total Cost of Ownership Comparison
  8. Common Centralization Mistakes
  9. Implementation Considerations
  10. 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:

Advantages:

Disadvantages:

Model 2: Fully Distributed

Each location handles its own calls with its own staff.

Structure:

Advantages:

Disadvantages:

Model 3: Hybrid / Intelligent Routing

Calls route to different handlers based on call type, time of day, or availability.

Structure:

Advantages:

Disadvantages:

The Centralization Decision Matrix

Use this matrix to assess which factors favor which model for your group:

FactorFavors CentralizedFavors DistributedYour Assessment
Location count10+ locations3-5 locations
Geographic spreadMulti-state/regionSingle market
Service complexityStandardized servicesSpecialty-heavy
Staff availabilityHard to hire locallyStrong local teams
TechnologyIntegrated systemsLegacy/varied systems
Growth rateRapid acquisitionOrganic growth
Patient expectationsEfficiency-focusedRelationship-focused
Brand positioningRegional/national brandCommunity practices
Current answer rateBelow 85% distributedAbove 90% distributed
Leadership bandwidthLimited oversight capacityStrong local managers

Scoring:

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 TypeOptimal HandlerRationale
New patient schedulingCentralStandardized conversion scripts, specialized training
Insurance verificationCentralSpecialized expertise, efficiency of scale
Appointment changes/cancellationsCentralSimple transaction, no local knowledge needed
Existing patient with clinical questionLocalProvider knowledge, relationship continuity
Complex scheduling (multiple providers)LocalCalendar knowledge, coordination
After-hours all typesCentralCoverage efficiency
Overflow during peak timesCentralPrevents missed calls
Complaints or concernsLocal (or dedicated)Relationship repair requires authority

Routing Logic Example

Step 1: Time-based routing

Step 2: Intent identification

Step 3: Availability check

Step 4: Escalation path

Technology Requirements for Hybrid

Hybrid models require technology investment:

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:

Variable costs:

Hidden costs:

Distributed Cost Model

Fixed costs:

Variable costs:

Hidden costs:

Hybrid Cost Model

Fixed costs:

Variable costs:

Hidden costs:

Comparative Analysis

For a 15-location dental group with 3,000 monthly calls:

ModelEstimated Monthly CostAnswer RateConversion Rate
Distributed (current)$45,00078%62%
Fully Centralized$38,00094%68%
Hybrid$42,00095%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:

Critical success factors:

For Hybrid

Timeline: 4-8 months for initial implementation

Key milestones:

Critical success factors:

Key Takeaways

Not sure which model fits your group? Schedule a consultation for a custom intake architecture assessment.