When it comes to growth and centralization, COO Kellie Cernobyl discusses the need to be transparent about what you want to accomplish and expect from your team.
DSOPro: Tell us about your background.
I’ve been with Freedom Dental Management for 12 years. Before that, I worked in single family home construction. When we went through the housing bubble and subsequent break in 2008/2009, I found myself without a job. When I began looking for a new one, I did not see the dental industry as an option since I thought it would be very boring and nothing exciting would ever happen. I couldn’t have been more wrong!
At the time of my interview, we had two dental offices in northern Delaware. My boss was the general manager, and he needed an administrative assistant to run payroll, handle accounts payable, and monitor the systems and teams that were in the practices. I joined in 2010 and we soon found ourselves growing rapidly. We opened our third office in Millsboro, DE, and managed that project through three build outs. Later, we opened other offices in Dover and Wilmington. We opened our most recent office in Middletown.
DSOPro: How did Freedom Dental Management come about?
In 2014, our owners decided that we would benefit from some economies of scale by bringing together some of our back-of-the-house functions and forming Freedom Dental Management as it is now. First, we consolidated our in-house revenue cycle management (RCM) by moving our billing manager and three billing team members from their local offices into one central location.
At that point, I became the operations director. I was still doing my day-to-day managing of the bank accounts, issuing payroll, making 401K deposits, and paying vendors. About a year and a half later, we decided to move our marketing in-house. We were spending too much and not seeing the results from outsourcing. We subsequently grew the marketing team to three in-house team members. Next, we moved human resources from the office level over to Freedom, centralizing HR and recruiting. Most recently, training and development was centralized into Freedom.
I was promoted to chief operations officer (COO) in May 2022. I visit all our dental practice locations monthly and meet with the location leadership. We discuss key performance indicators (KPIs), production, collections, staffing opportunities, and general practice operations. My leadership team at Freedom and I work hand-in-hand to accomplish our goals. In addition to practice leadership, I also oversee the managers of the following areas: sedation, orthodontics, RCM, HR, revenue and finance, and marketing.
In 2017, it became apparent that my workload was not sustainable for one person. So, I hired a fantastic accounting assistant who, as a result of our rapid growth, hired her own assistant at the end of 2022. The entire platform has taken time to build. Each initiative to grow our group was timely and evaluated for efficiencies and strategic leverage. We recently closed on our sixth office location and support about 135 team members, doctors, and specialists.
DSOPro: Tell us more about the structure of Freedom Dental Management.
Freedom Dental Management is owned by the doctors who originally owned the separate dental practices. The board of directors consists of five dentist partners. Around the time we got to the third/fourth office range and learned more about the DSO space, they decided centralizing functions under one umbrella would enable us to handle things more efficiently.
Delaware is very close-knit state. We have 300+ practicing dentists and specialists in the state. We’re fortunate to work with dentists who have some entrepreneurial experience and want to expand their groups.
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DSOPro: What kind of concerns do emerging groups have and what are their operations priorities when they are initially expanding?
The first concern is what to centralize. How do you bring those positions under your umbrella that makes the most sense at the practice level and achieves those economies of scale? You want to leverage your buying power as you add offices. You know that your suppliers, insurance companies, and dental labs are willing to negotiate. So, bringing your billing/collections team in-house is really the first step. We usually choose people from the practice level, someone who has a fantastic work ethic and is willing to grow and learn. You need to have a strong shared vision and cultural alignment with your board of directors so that you know what their goals are for the business.
As you get to five to eight practices, the things that worked fine for practices one through four may no longer work. Growth periods involve reinventing systems to better fit your company. It can be stressful, and it’s not easy. You don’t know things are no longer working well until they break down. Cloud-based practice management systems are almost necessary when it comes to measuring your analytics across practices in different locations. Measuring people’s performance is a challenge when you can’t be in six places at once. Getting your systems in place and realizing it’s not a “set-n-forget” situation is important. Consistent monitoring and communication ensure all systems are in alignment.
DSOPro: What are some of your tips for success when you’re trying to prioritize and centralize?
The best thing I’ve learned so far is to never lose sight of who you are as a leader. Don’t forget where you came from and the people who are making you successful because every one of them provides a piece that makes the entire engine work well.
You must have regular communication. You need to be transparent about what you expect from your team. Giving your teams the “why” behind the “what” helps generate buy-in and acceptance of new processes and/or policies. Explanation of the overall business goals and the pathway to achieve them make for a clearer understanding for everyone.
Understand and share the values of your organization. Be in alignment with your board of directors or whoever you report to. Be completely transparent about what you are trying to accomplish. I’ve learned firsthand that cultural and personality fit, and work ethic are the things you want to watch for most when building that executive team.
Also, celebrate your wins. Recognize, appreciate, and encourage your team. When you hit a goal or a milestone, celebrate it with the partners and team that made it happen. That’s crucial. People love to be appreciated and understand how they contribute to the success of the business model.
Take care of your professional development and stay on top of what’s happening in the industry. This industry is constantly evolving. Invest the time and effort to be ahead of the curve and know what’s coming. That’s your job as operations leader. You need a strategic mindset.
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DSOPro: What kinds of trends are you seeing? Anything you might be planning ahead for?
Delaware may be the last state that still requires a state board exam for licensure as a dentist. This exam is offered only twice a year, there are only 18 seats, and it is pass/fail.
That’s why competition for associates, even in the larger markets, is so big right now. The dentists who are licensed to work in Delaware are extremely valuable. Dentists here can earn a much higher income due to our reimbursement rates from insurances being extremely competitive. Even reimbursement for Delaware Medicaid for children’s dental health is one of the highest reimbursement rates in the nation.
Recruiting for us starts in dental school and we follow the students through their year-long general practice residency at a hospital and then through their board exam. If you’ve practiced outside the state for 3 years or more, you may receive reciprocity on the residency requirements, but you still must take the Delaware Board Exam.
One of the things we offer to associates transferring from other states is a team that will help them through the board exams and line up patients for the day of the exam. Associates are our magical unicorns. We do our best to make their transfer into Delaware to practice dentistry as smooth as possible. Once they are here and working within our group, they love it!
DSOPro: What other staffing challenges are you dealing with?
The expectations of the team and the staff are so much different than they were pre-COVID. Employees are now valuing a true work-life balance. They value time off more than substantial increases. They don’t want overtime, they want four-day weeks. Everybody had a big perspective shift during COVID, and they are saying, “Look, this is not what really matters to me in my life. My family, my time, my mental health, and my well-being are things that I’m focusing on and I’m going to need you to accommodate that schedule.”
Finding the talent with the skillset you need and working with their availability and their needs is challenging. Recognizing your people’s wants and what motivates them now is completely different than it was before. Staffing shortages for licensed professionals are a problem everywhere. Dental hygienists are just as hard to find as doctors.
We have had to get aggressive with recruiting and think outside the box. I don’t want to give away our secrets, but you must be creative with your efforts and offers to attract talent in this market.
We also had to do pay scale adjustments when we came out of COVID and then again in early 2022 due to the increase in inflation rates in the first quarter. We presented a cost-of-living increase based on inflation to the board of directors for the entire team to make our pay scales more competitive in the market. Now, we also offer signing bonuses, retention bonuses, and employee referral bonuses. That’s how we’re combating some of the shortages that we’re seeing.
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DSOPro: What types of technologies are you using to help with centralization, organization, and communication?
We have been using Eaglesoft for at least 12 years at all our locations. We stopped using their eClaims service and their clearing house and went to Vyne and they have been phenomenal. They are incredibly affordable and super easy to work with. My billing and collections team has reduced their days outstanding from 35 to less than 10. Our collections ratios have been incredible, and we continue to see ease of use with the Vyne platform.
We are still reviewing platforms for cloud-based practice management. We have reviewed about a half dozen platforms to determine the best fit.
On the practice management side, we have had to get real savvy with our credit card processing, increasing our ability to do things virtually and online. Patients want to be able to tap and go or do it through a link on their phone, which we’re able to do now through Stax Pay.
This year we added cone-beam technology at one of our offices. We have found that the doctors coming out of school are expecting newer technology like CBCT, digital x-rays, and different types of platforms and tools that they became familiar with during school and practical experience.
We are also looking at AI platforms. We have reviewed Overjet and Pearl at this point. Our Director of Clinical Compliance and Practice Development and partner doctors are looking at those platforms and determining if either is a good fit for our business.
Phone technology is important for portability of numbers and having all the offices connected. So, if you’re not on VoIP, take care of that.
We are also beginning to implement LightScalpel, a laser used for tongue ties and frenectomies. Our pediatric specialists now have this available to help expand our offerings to our patients.
DSOPro: Any advice you would like to add?
Don’t forget who you are. Don’t forget where you came from and don’t forget the people who helped you build what you’re looking at today. Keep pushing forward. There are tons of networks out there that will help you achieve your goals. I love what I do. I want to continue doing this for the rest of my career and I couldn’t do it without the team that I have!
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Kellie Cernobyl has been working with the same dental group since 2010, when it was only two practices. She became Director of Operations in 2014 when Freedom Dental Management was formed. Her role as COO was established in 2022.
Kellie is a Pennsylvania native and was raised in Lancaster County. She moved to Delaware in 1997 to attend Goldey-Beacom College, a small business school in Wilmington, and graduated in 2002. She has been married to her amazing husband for 20 years and has three awesome children, ages 4, 8, and 10. She attributes her success to the support she has at home and strives to set a good example for her children, demonstrating that through hard work and dedication you can achieve anything you set your mind to. In her spare time, she enjoys vacationing at the beach, reading, and listening to podcasts.
Freedom Dental Management, LLC, & The Sleepy Tooth Group of Dental Practices
Freedom Dental Management, LLC, is a fully integrated DSO serving as the management entity for The Sleepy Tooth Group, an affiliation of dental practices in Delaware. The Sleepy Tooth Group is presently comprised of six general dental offices, all of which offer sedation, and several of which offer orthodontics and pedodontics from in-house specialists.
The group currently has five founding dentist partners, and several additional partners with smaller equity interests. There are presently 16 dentists providing general dentistry, including 3 orthodontists, 2 pediatric specialists, and 1 dentist anesthesiologist. Additionally, two of the dentists are permitted for conscious sedation, and the group also contracts with a group of physician anesthesiologists. The Sleepy Tooth Group is able to offer the full range of dental services to all ages, with the added ability to serve phobic and special needs patients. Several in the group are on staff within the local hospital network.
Freedom Dental Management was formed in 2015 to provide administrative support for the two affiliated practices at that time, Bear-Glasgow Dental in Newark, and Peninsula Dental in Millsboro. Since then, the group acquired an established practice in Dover, opened de novo offices in north Wilmington and in Middletown, and most recently acquired an established practice near Newark. Freedom’s CEO, who has been with the organization for 23 years, oversees a Chief Operations Officer, a Director of Clinical Compliance, an HR Director, a Marketing Director, a recruiting specialist, a billing and collection team, a finance and revenue manager, and a Director of RCM. Most Freedom employees have been with the company over 10 years, with several serving 15 years or more.
The practice began as a solo practice in Newark in the 1950s, with some of the first patients still being seen today. From those beginnings, the group has evolved into a state-of-the-art network of group practices, with an emphasis on high standards and modern techniques. Delaware is a unique environment for dental practices, with rapid population growth, new housing, and many affluent communities. At the same time, the Delaware Medicaid program is widely considered the best in the country, offering the highest reimbursement of any state. Freedom Dental Management is adept at working with third-party payors, from insurance to state and Federal government, as well as individual patients to accomplish treatment.
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