Former DSO Owner and Executive Discusses a New Operations Decisioning Platform

DSOPro: Tell us about your background and how you got into the dental industry.

I was working on my MBA and planning to be an entrepreneur. A couple of friends (a dentist and a non-dentist) were working at a dental organization and I suggested that we open our own practice. Nine months later we did.

Over the next 5 years I became the sole owner of the DSO, which we had grown to six locations. In 2005, I sold the group to Great Expressions, who at the time had approximately 40 locations. I worked with them for 3 years as a VP of Operations for the New England region. By the time I left, the group had grown to about 70 locations.

After that, I took some time off, then in 2011 partnered with a couple of dentist friends in Florida. I moved to Florida, and we started with three new practices. In 28 months, we grew to 31 locations, and sold that DSO to a private equity firm. This DSO was #14 on the Inc. 500 list in 2014. After the transaction, I moved back to Massachusetts and started Maeva Dental Advisors.

DSOPro: How did that come about?

Around that time, some of my friends and I helped someone in the industry assemble a DSO conference. After attendees saw me speak at that conference and others, people started asking if I could help them grow. I decided I would do some consulting and see where it would lead. After getting an understanding of where the client wanted to be in 3 to 5 years, I would build a roadmap and walk them through it on weekly operations calls. One thing led to another. As they grew, they needed help getting their financials completed in a timely fashion, so we brought accounting into Maeva; they had HR issues, so we brought HR in; next, they wanted help with hygiene coaching, and we added coaches to the organization; then they needed some efficiencies on insurance verification, claims status, and posting checks, so we found a partner to do that for us, as well.

We’ve basically become what’s called a management service organization (MSO). We offer a la carte services based on where clients are in their journey. I learned through my own experience that as you grow, you need to bring in infrastructure to help manage the company. But when you have only three to five offices, it’s expensive to hire a $120,000 accountant, a $130,000 operations person, and a $100,000 HR person. We offer that as a fractionalized service so our clients can get all three for the cost of one.

In addition, we help institutional investors looking for opportunities to invest in dental with thesis development, management meetings, due diligence, and board of director roles. We have worked with large DSOs, private equity firms in North America, a client in Singapore, and recently completed a large project with Walmart Health. We predominantly work with smaller groups and create a customized roadmap to get them where they want to go over the next 3 to 5 years. In a number of situations, we partner with the leadership team/owner doctor(s). We always focus on creating a win-win solution, and this has been helpful with our client/partner relationships, many of which are still engaged since the day we opened.

DSOPro: What is driving the need for these services?

The trend in consolidation is driving the demand. Dentists want to own more practices and take advantage of the increase in the value that comes with a larger organization (in many cases the value of the practice can double), but they have never done it before. We’re basically giving them the roadmap, tool kit, and support to successfully get through the process.

Because I made so many mistakes myself over the last 25 years, I’ve experienced what they’re going through. At the end of the day, it’s a learning exercise. Now, the question is, do you want to pay for the education from someone who’s “been there done that” or do you want to pay for it through mistakes. When I started out, companies like Maeva didn’t exist so I was forced to learn the hard way. 

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When you get into buying practices, some of the mistakes can be very costly, stressful, and/or waste a lot of time. For instance, if a dentist decides to partner with the wrong person, they’ll spend months going through all the negative emotions that comes along with it. Often, this situation can be prevented.

When I started, I quickly learned—because I wasn’t a provider—that I needed to understand the numbers (key performance indicators) and had to have people on the team who knew more than I did. This led me to understand the important role the team plays in a practice and that the business of dentistry is a people business. Without good staff and without a cohesive team, you can’t grow. It comes down to managing and growing people. Few dentists have been educated on the many aspects of business ownership and management. For instance, not many know how to do a review or hold a manager accountable. Accountability is extremely important to successful people management.

Often team members are placed in an operations role or are working their way up because the dentists have put so much faith in them. They may have been very good in their previous position, but now they’re doing a poor job because of lack of experience or training. In addition, this puts undo pressure on them as they’re in over their heads. They know it but want to do it for the owner. This is a lose-lose situation, it affects the doctor’s pocketbook and the ability to grow others as well as the organization.

DSOPro: What are some of the best ways to grow your people and retain staff?

Communication. You need to have consistent team meetings. You must share information and help your team. If they weren’t part of building your mission and core values, learning those should be part of their onboarding program so they understand what it means to work at the practice. Those core values should be part of everyday living within the organization. 

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You need to create a good work environment, and you need to be flexible. People don’t just want to get paid; it goes beyond money. People are looking for connection and support. They want to know you care about them. That is what creates a place where people want to spend their time.

DSOPro: How do know when the time is right to open another practice?

I can’t tell you how many dentists are making a very good living so decide to buy another practice. This new practice is mediocre at best, and the dentist hasn’t done much to add value. Then they decide to buy a third practice. All the money from practice number one is going to practice numbers two and three, and they’re running around like a chicken with its head cut off, trying to keep everything together.

That’s not how you do it. You build one good practice, refine and operationalize it, put systems in place, and then bring that operational system to the next practice. You need a team that implements these systems. You need to understand you should have a well-trained associate/partner in your existing practice before you buy an additional one. Often doctors buy another practice and just plop a new graduate associate in there without mentoring them. That doesn’t generally work well. 

With larger sized groups we are seeing a movement towards more partnership models where the DSO is providing services to younger dentist owners who are not planning on retiring anytime soon. In these situations, the DSO is providing capital and back-office support for the partner dentist to scale their current successful practice by increasing the number of providers and adding additional locations.

DSOPro: At what stage do people try to find some help? When they first start out or not until they have a problem?

From our experience, the clients or doctors who have come to us proactively, who have one practice and want to add, or two and are starting to feel some pressure, or 10 and understand they are at another stage that may be a bit beyond them, have had very good success and many stay with us for a long time. These people see the situation and are self-aware enough to get help before major problems are created. 

We also have many folks who come to us after they have made commitments that are negatively impacting their success. In these situations, the process takes longer because we must “unwind and reset.”  The “reset” requires commitment to the process and in many instances bold change and patience. This is where we see some hurdles. Sometimes only 70% of the plan is committed to, or the decision is dragged out because of fear that people will leave. 

So, the answer is the sooner the better, so the practice can start implementing quickly versus a reset that involves many changes.

DSOPro: In your experience, what are the most common operations issues that recur?

Having the wrong people in a position. You need to have the right people in the right seats. And you must communicate, grow your team, and be a leader. You need goals that are trackable and are tracked on a daily, weekly, monthly, and annual basis. 

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DSOPRo: Tell us about the new digital platform you are launching soon.

We’ve built a digital dental operations decisioning platform. This platform is based on business-process automation and business-rules management, which will provide advanced analytics. It’s a way of compiling and analyzing the data dental practices are gathering but is housed in multiple technologies. 

Today’s practice management software (PMS) collects all patient, treatment, and ledger data. You can view data by running reports from the PMS or installing a dashboard that pulls data out of the PMS and organizes it in different ways for you to interpret. However, to make informed decisions, you must look at PMS data points along with data from other parts of the practice/organization. For instance, your financial data, and data on patient communication, payroll, human resources, marketing, phone data, clinical data, etc. We’re going to be bringing data from more than 10 different technologies all into one, analyze it, and tell you where problems lie and potential solutions.

For example, with this technology, we’ll run analytics from the VOIP system and be able to analyze that on average you receive 450 calls a week. If that drops, a red flag goes up and it will automatically check data sources that could impact call volume, such as marketing or internet connection. Maybe your internet was down for 2 hours and calls weren’t coming through, or maybe your credit card expired and Google was not able to charge for your pay-per-click, so your on-line marketing was not live for four days. Or the system identifies that while the overall periodontal percentage for hygienists may be achieving goal, 4 out of your 30 hygienists are below average. Or seven employees are missing CE credits, and one doctor’s NPI number has expired. Or that this month it cost $2,000 to hire a dental assistant and it took 3 months to fill the position.

In addition, we have proprietary tools such as an automated doctor compensation tool. The software will pull data from the PMS, your accounting software, and payroll to automatically calculate your provider compensation. Today many groups are doing this manually on Excel sheets but with our software, it’s all automated.

We’re developing this platform because dental groups are experiencing more and more add-on technologies that all have data that needs to be analyzed against other data within the practice. It’s just too much information for anyone to process and analyze manually on a consistent basis. 

DSOPro: When will the technology be available?

We are beta testing in several offices and expect to go live in Q4. We are open to adding a couple more beta test sites. If anyone is interested, we’re happy to talk with them about it. I can be reached at vin@maevaadvisory.com.

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About Vincent Cardillo 

Vincent Cardillo is a proven industry leader with 25+ years of experience in leadership/partner roles growing DSOs. He has a successful track record of structuring, growing, and positioning dental groups for rapid growth. Vincent’s latest ranked #14 on the INC 500 list of fastest growing private companies with growth of 12,896%. His ability to successfully build and manage teams, create and execute strategic vision, and identify and drive key metrics has led to substantially increased shareholder value in each company. 

Vincent is the founder of Maeva Dental Advisors, which provides outsourced C-Suite services to dental groups and single offices that have the intention of growing. Maeva positions its clients for long-term growth by strengthening their operational systems and infrastructure. Vincent also provides his expertise in operations, strategy, and financing to private equity firms and other financial institutions nationally and internationally looking to make an investment in a DSO. 

Vincent earned a BA from SUNY Potsdam, an MBA from Clarkson University, and Executive Degrees in Managed Care and AI in Healthcare from the University of Connecticut and MIT respectively. Vincent also serves on the Board of Directors of the Baystate Health Foundation.

About Maeva Dental Advisors

Maeva Dental Advisors is a recognized and trusted industry leader providing dentists and dental practice owners who are interested in growing their practice or DSO with enhanced management advice, solutions based on best practices, and proven industry experience. Maeva Dental Advisors also powers dental practices who seek to grow without selling or merging their practice by delivering the power of strategic “DSO” business operations services.

We take professional and personal pride in putting our experience and expertise to work to help our dental practice clients grow and succeed. Through all stages of your practice growth, we offer a comprehensive selection of practice management and growth services and targeted business solutions designed to make your business soar.