How One DSO Solved Patient Financing – And Boosted Financing Revenue By 5x
Darren Boggs, CEO of Altius Healthcare Management, discusses patient financing.
Jonathan Moffat discusses what drove him to create an investment-agnostic advisory company “Aligned” with dentists looking to own group practices or to step away from the chair.
DSOPro: Tell us about your background.
People always ask, “Why do you work with dentists, or why dentistry?” They think it’s kind of random. But my story is that my grandfather was a very successful orthodontist. Back in the ‘80s and ‘90s he had seven locations spanning from Los Angeles to San Diego before DSOs were even a thing and he would travel around practicing in all of them. He was a brilliant businessman.
However, the flip side is, my dad tells stories about hearing his father on the phone with CPAs, stockbrokers, or real estate investment firms and saying things like, “Yep, sounds good. Let’s put $200,000 there, $300,000 there, and $500,000 there.”
At one point, he was also co-owner of one of the largest privately held dairies in the country and went bankrupt two years later. He had a history of making bad financial decisions. He never had a plan; he was always just shooting from the hip.
My grandfather suffered a heart attack in 1994. It was severe and his third one, so he was forced to stop practicing. He and my dad didn’t know what to do with his practices. They didn’t try to sell them because they didn’t think they were worth anything. So, my grandparents lived the remainder of their lives on what little they had saved and Social Security. They had to sell their dream home and live in a tiny house. At age 79, my grandmother was teaching flute lessons just to pay the bills. I hated seeing them go through all that. They died within a few months of each other in 2003.
After college, I started working with my dad in financial services and we decided to specialize in helping dentists avoid making the mistakes my grandfather made. In 2010, I was working with our first dental client (who’s still a client today). He wanted to buy his building and I said, “That sounds like a great idea, let’s do it.” When we liquidated some stocks in his portfolio for a down payment, I got a call from my manager who was really upset with me.
He said I couldn’t tell the dentist to sell stocks, and that I could potentially get in trouble and even be penalized. I remember telling my dad, “I never want to be put in this situation again. If I can’t do what I feel is best for my clients, I’m not interested.” So, newly married, I told my wife I was starting a different career path.
When I started Aligned Advisors, I was determined not to sell any products, manage money, sell insurance, or be a wealth advisor. I decided we were going to be independent, completely non-biased, investment-agnostic, and focused on helping clients get really clear on their goals and achieve them. We would give them step-by-step action plans and coordinate their journey.
DSOPro: Why do some clients achieve their goals successfully and others struggle with that?
It boils down to three things: there is no plan, or if there is a plan, it’s not reviewed very frequently; there is no accountability for that; and there is no coordination of advice.
Think about it. You talk to your CPA, attorney, investment advisor, and financial advisor and they’re each giving you advice but not communicating with each other. We encourage—almost insist on—collaboration between all advisors. We get them all on a call before every client meeting. We cover legal issues, estate planning, taxes, insurance, business, personal insurance, everything. We talk about the client’s goals, ask for everyone’s recommendations, and analyze how they are working together to help the client move forward. We quarterback all the advice with the team and guide the client on the action steps necessary to achieve their goals. And we meet with them frequently to stay on top of that.
Clients trust us because we have nothing to sell them. That is the business model I created based on my grandfather’s experience and realizing there were aspects of the wealth management industry that I just didn’t like.
DSOPro: Tell us about your experience starting a DSO.
That first dental client told me he had tried opening additional practices twice and failed both times and asked if I would help him. So, we started a DSO called Launch Dental. We bought our first practice in October 2016 and our eighth in May 2020.
Having a successful practice, attempting to open multiple locations, and failing is common. It’s hard to be split between two or three places. We’ve seen a high success rate when we advise clients to first make sure they have a partner who can help them do it. So, I set up the business/management structure with all the systems and processes, then told the doctor, “You keep doing dentistry, and when we bring on new doctors, you train them and basically duplicate yourself.”
We learned a lot of lessons over the years, which was great because it allowed me to gain firsthand experience. Now, when I talk to clients, I can say we’re not just practice management consultants because I have a lot of personal experience I can share.
DSOPro: Describe your typical client. What are they seeking when they come to you?
Occasionally, we are approached by younger doctors, who we love working with. But our typical client has been in practice about 10 years. They feel like they’re on a hamster wheel—going to work, doing dentistry, dealing with all the day-to-day, but not really getting anywhere. They may be doing a million and a half plus and are looking to optimize their situation.
They usually need a wide variety of advice. They often don’t know if they have the appropriate amount of insurance to cover floods or fires or if they are taking every tax strategy available to them. They haven’t identified goals, optimized their savings, or know if they are on track to retire, what their practice is worth, or if they have an associate who wants to take ownership how to structure that.
People typically fall into three categories. The do-it-yourselfers who want the information, but ultimately will do it themselves, and the collaborators and the delegators. Our ideal clients are delegators, the doctors who say, “My time is best spent doing dentistry, building my practice, and training and mentoring. I’m making the biggest return on my dollar by delegating everything else to a team.”
We call our first discussion with individuals our “roadmap conversation.” Spouses and business partners are required to be there. We start by asking, “As you look down the road, what is a tangible goal you have that would require money and planning to achieve?”
That exercise helps us identify what their ideal life looks like and brainstorm what they would do with an extra 10 hours a week. Spend that time mentoring doctors, vacationing, exercising, or with family? There’s no wrong answer. We present ideas to see which ones resonate with them and help them devise a plan and implement it.
DSOPro: Tell us about your “Stepping Away” concept.
Our business is based on the “family office” model. That’s how the wealthiest people in the world—think Bill Gates, Elon Musk, people who are worth billions of dollars—do business. When they want to buy a sports franchise or a mansion in the Bahamas, they don’t pick up the phone and call about it. They have a team that figures out the most effective way to do that for them.
Our model is based on that, but we call it a “fractional family office” because you get the same benefit and value of having all those advisors working for your team individually. Our most common feedback from clients is that they have been looking for support like this their entire lives.
The idea for Stepping Away came from an experience I had with Henry Schein. I am on the faculty of the Henry Schein Dental Business Institute. When the pandemic started in 2020, they approached me about doing an online educational platform. So, I looked back at every roadmap we had done in the last 10 years. It was interesting, but not surprising, that the number one question dentists had was, “How can I be unchained from the chair?” A common phrase was, “I want to practice, not because I have to, but because I want to. If I don’t feel like going into the office, I don’t want my financial situation to be impacted by that decision.” Or maybe they want to take a four-week vacation, which most can’t do because they only make money when they’re doing dentistry. Stepping away didn’t mean leaving dentistry or retiring, but continuing to practice or be involved on their terms. So, I created the Stepping Away course and still follow it today.
I know that after workshops many people rarely look back at their notes much less implement anything. So, I decided that this course would be different. I teach attendees how to create an action plan they will actually follow and how to build a team they can delegate to. When you delegate, there’s a much higher probability things will get done. They also create follow-up accountability for the action list.
The last 90 minutes of the meeting is phones off, computers off, and pen to paper while we walk through creating a 90-day action plan. Then, we say, “Pull out your phones and start emailing those team members their action items. Start delegating right now, so when you get home, you’ve already started the process.”
They give us a copy of their action plans, and we follow up with them over the 90 days to ensure they’re making progress. That’s unique—no one has ever been to an event structured like that.
DSOPro: What are some sample action items?
That depends on the individual. It can include anything or everything from the doctors to the front office staff.
For example, one of our speakers, Dr. Chao, has not been hit by the staffing shortage. In fact, people call every week looking for a job. He made and posted a video on his website about why employees love working at his office. So, one action item might be creating a video that attracts people you would want to hire. Another could be deciding whether to network with different insurance companies or just one.
Another speaker, Dr. Bahia, describes leaving dentistry and buying the building his practice was in. He now owns and operates a portfolio of over $250 million in real estate. So, an action plan might be looking at buildings for sale in your area or reviewing the length of your lease because you want to own your building.
Other items include how to keep associates, deciding when to sell, bringing on a partner or figuring out how to share profits or create incentives.
DSOPro: Tell us what makes Aligned Advisors different and why dentists would benefit from working with you.
We’re basically personal strategists. We create the plan, bring in the team to implement the plan, and then oversee implementation. We are very boutique and very hands-on. Each team can handle about 50 clients to the level that we work with clients. We have 19 employees, and a team is typically made up of about seven “subject matter experts” (SMEs).
I’m the head strategist, but if clients want to know specifically what to do for this or that, we have our SMEs. They include an attorney who also covers tax issues and strategies, a money manager SME who knows about 401ks and IRAs, and a financial planning SME who puts together all the strategies and reports we provide to clients. We also have SMEs on personal insurance, professional insurance, tax accounting, and alternative investments.
DSOPro: Tell us about your upcoming programs.
My goal is to offer a workshop every three months. We held our first two-day live event in February with about 60 attendees. Attendees said this was the first time they’d heard this type of information and every topic was on point. The October 14-15 meeting is in Newport Beach, CA. We’re covering a range of topics, including how to create dental systems that scale and how to attract talent.
These workshops give us a chance to share ideas that worked for us. Every speaker has achieved their goal of stepping away. Some are as young as 38 and some are in their 70s. They have all done it a little differently, and that’s the beauty of it. There’s not just one way to do this—you can explore what’s best for you.
More information on courses and featured speakers is available at https://www.stepawaytoday.com/. Use discount code “GDN” to save $500.
Final Words
When I speak to audiences, I always point out that dentists don’t usually have anyone whose job it is to make sure they have a plan and are on track with it. When you can say, “My team’s only job is to ensure our clients are organized and achieving their goals” it changes the narrative and I can sleep at night because I know I don’t have to wake up every morning and wonder, “What am I going to sell my clients today?”
Jonathan Moffat, Founder and CEO of Aligned Advisors, saw his grandfather enjoy great business as a successful orthodontist, and later, lose virtually all his wealth due to poorly coordinated advice. This experience sparked Jonathan’s passion for helping dentists avoid the same pitfalls. Jonathan’s broad and continuing education spans both finance and business at institutions including University of California – Irvine and Brigham Young University, and an Executive Education program (in Investment and Retirement Strategies) at the Wharton School of Business, University of Pennsylvania. Jonathan has taught about estate, tax, and retirement planning at various colleges and universities. He enjoys travel and community involvement through Rotary and coaching his children’s soccer teams. He and his wife Deborah have four children.
Aligned Advisors
Aligned Advisors was founded on the basis of "think differently to get different results." Clients of Aligned Advisors not only get a step-by-step action plan to achieve their goals, they also get access to a complete team of subject matter experts to oversee the implementation of the plan, giving clients a higher probability of achieving their goals. This unique approach is what really sets Aligned Advisors apart and is one of the keys to their rapid growth and success.
To register for the Stepping Away event, October 14-15, visit https://www.stepawaytoday.com/.
Darren Boggs, CEO of Altius Healthcare Management, discusses patient financing.
Daniela Coughlin discusses her methods of talent recruitment and retention for Select Dental’s 38+ locations.
Paul Gruensfelder, Vice President of marketing for Select Dental Management, on making practices stand out locally, tools for attracting and...