Dental Practice Consulting

For independent dentists and solo practitioner offices, Black Ops Management Solutions provides innovative dental consulting services.

Our primary focus is on improving your practice's operational efficiency and market presence, and in so doing, increase the profitability and value of your practice.
Applying industry-proven practice management systems and techniques, Black Ops will implement operating policies and procedures designed to provide appropriate structure, generate growth within your existing patient base and surrounding community, and help your practice run like a true business.

Leveraging our relationships with vendors, Black Ops will reduce supply, lab, and other business costs by negotiating better rates than solo practices can do on their own. Lastly, Black Ops will create a dashboard system to measure and track key practice metrics, identify growth opportunities and loss risk, and manage team performance to promote excellence and drive greater profitability.

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Group Practice Consulting

For dental groups seeking to build their platform, acquire additional locations, and provide enduring opportunities for their partners, associates, and team members, Black Ops Management Solutions provides consulting services that support expanding group dental models for their successful growth trajectory.

Black Ops Management Solution’s philosophy is to maintain a doctor-owned, doctor-led model in which the clinicians set the standard of care and drive the pace of growth.

Black Ops Management Solutions helps identify, underwrite, and execute practice acquisitions and de novo construction to expand your group and advise on building the appropriate legal and organizational structure to accomplish your expansion goals.

The development of infrastructure – internal functional capabilities, administrative staff, and systems – is critical in the transition from solo to group practice to appropriately support the desired extent and pace of growth.  Black Ops Management Solutions will help build the necessary infrastructure to manage and operate a multi-location dental group effectively.

As the dental industry continues to evolve and consolidate, Black Ops Management Solutions can provide expert advice on the appropriate steps to take to achieve a premium valuation in the event that the best strategic course of action is to align with a larger platform.

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DSO Consulting

For emerging DSOs looking to build their platform further, increase their operating profitability, and ultimately monetize their platform and realize a premium valuation for the legacy they have built, Black Ops Management Solutions is uniquely qualified to assist emerging DSOs with their growth and transition processes.

Relying on our years of DSO executive experience, Black Ops Management Solutions can develop and implement your strategic plan to ensure that your platform is valued as an attractive investment opportunity for existing and potential future owners of your DSO platform. 

Using industry-proven organic growth techniques and cost reduction measures, Black Ops Management Solutions can significantly increase platform operating cash flow and enterprise value. Black Ops Management Solutions can make appropriate introductions to assist in raising capital to refinance debt, fund the development of your infrastructure, and perform acquisitions.

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Building a Dental Group and DSO Platform

When most dentists hear the phrase “building your platform,” they think of the physical plant of the office or perhaps the foundation of the building.

We refer to building the platform as a term meaning the systems, sets of policies and procedures, and the infrastructural capabilities required to operate a growing dental group or DSO properly. By this definition, the platform and its infrastructure consists of the key administrative functional areas that support, monitor, and drive the non-clinical operations of a dental enterprise, including:

Human Resources
Accounting & Finance
Revenue Cycle Management
Supply Chain / Vendor Management
Marketing
Information Technology
Call Center
Other central support functions depending on the business model

Most entrepreneurial dentists building a group or DSO have a vision that includes monetizing their business for a greater value than their investment at some point in the future. To achieve a premium valuation, buyers and investors in DSOs want to see a developed central operating platform that enables the business to run on a sustained basis without the day-to-day involvement of the owner(s). Without this platform, there is no true DSO structure – the dental group is just a collection of individually run and managed dental offices. And ultimately, without a platform or infrastructure in place, premium valuations are no longer being paid for aggregations of disparate offices without common policies, procedures, reporting structures, operating systems, or administrative support.

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Human Resources Support

Human Resources is an often-overlooked function as dental companies transform from a solo office or small group into a DSOs.

HR managers are an expensive investment for any growing company. However, no company can effectively manage employee relations, employee performance, recruitment and onboarding, benefits administration, or pay scale management without a structured human resources department. 

Compliance with these critical activities becomes more stringent as the practice continues to add employees -- under the Affordable Care Act, once the 50 employee threshold is reached, the game changes entirely, and the provision of health insurance for all full-time staff members becomes a requirement. 

Black Ops Management Solutions will assess your current and anticipated future human resource needs and work with you to optimize an HR strategy. This could range from outsourcing HR functions to a fractional HR professional, contracting with a PEO (professional employment organization) and cost-effectively leveraging a vendor’s HR platform, hiring a full-time HR manager, and staffing a department as needed.

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Accounting and Finance

When surveying entrepreneurial dentists who have successfully built and sold their groups and DSOs, they consistently answer that the first and most critical hire they made was an experienced CFO.

The platform's Accounting and Finance functions are key foundational areas in building infrastructure and having continuous insight into company performance. Understanding the platform's operating results and financial position is essential for the proper management of any business. 

Because you cannot manage what you cannot measure, all dental operations, from solo practices to DSOs, must have the capability to generate accurate and timely financial reporting every month to track trends in production, contractual adjustments, supply and lab costs, labor and operating expenses. This will also help identify exceptions that may indicate issues that are often overlooked in day-to-day operations. 

As dental businesses grow in size and complexity, accounting and finance become an essential capability to manage the group's revenue cycle, track and forecast weekly cash flows and compile periodic balance sheets as well as monthly income statements to make capital investment decisions and obtain outside financing from banks or other capital sources to fund future growth opportunities.

Black Ops Management Solutions can work with groups on enhancing their existing Accounting and Finance functions, from recruitment of professionals to augmenting their business intelligence capabilities.

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Revenue Cycle Management Support

As group practices mature and the administrative services are centralized, Revenue Cycle Management becomes a mission critical platform capability.

Revenue cycle management (RCM) encompasses all functions related to billing and collecting revenue from patients and insurance payors, including credentialing providers with payors, maintaining updated fee schedules, fully capturing billing codes for services performed, billing and collecting co-payments on the desk from patients, billing and collecting charges from payors, posting payments and adjustments, managing accounts receivable and credit balances, and addressing claim denials. 

RCM is the proverbial canary in the coal mine, indicating the overall effectiveness of a dental operation.  Issues with correctly billing out and collecting for services rendered will starve a dental practice of cash needed to cover its expenses, aggravate providers paid on collections, upset patients with unexpected charges, and delay necessary capital investment in the business.

While RCM is essential for solo practitioners and larger organizations, the financial stakes become greater as dental operations increase in size and revenue volume. Larger groups should strongly consider centralizing RCM capabilities as part of their platform infrastructure in order to manage these processes and free up office administrators to focus more directly on patient service.

Black Ops Management Solutions can assist groups with analyzing every aspect of their RCM processes and work to resolve issues to improve the functioning of this operational cycle.

Legal Structure

The Legal Structure of a dental company enables a group practice to fully evolve into a true DSO.

A dental group practice ordinarily operates with one or multiple dentist owners of a PC (or multiple PCs depending on the state). It raises capital through personal investment from the dentist owners and bank debt. 

As a dental organization grows in size and complexity, however, successful groups will reach a point where achieving further growth and operational excellence requires the infusion of more capital than the owners can invest or borrow. The managerial needs demand the addition of professional expertise in-house.

Suppose equity capital is raised from outside sources (typically private equity investment firms). In that case, it is likely that a new legal structure will have to be created to permit non-dentist owners to invest in the business. Also, professional managers (typically non-dentist business professionals) will want a means for sharing in the growth and profitability that they have a hand in driving on behalf of the group.

For these reasons, the DSO structure was developed, with a separate Management Company formed to enable non-dentist owners to invest in the business and provide a vehicle for equity incentive compensation for the executive team and at the same time comply with state laws reserving the clinical ownership and management of the dental practice to the dentist owner(s) at the PC level. The newly formed Management Company and the PC combine to create the DSO structure through crossing service agreements that contractually obligate the Management Company to provide administrative services to the practice(s) and obligate the PC to provide clinical services to the Management Company.  

Black Ops Management Services can assist with identifying attorneys with specialized practices that understand the state and federal regulations governing such arrangements and are highly experienced in creating these structures.

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Vendor Management and Purchasing Support

Supply Chain / Vendor Management refers to the centralized purchasing segment of the dental company.

Monitoring expenses and purchasing is a critical component to maintaining profitability and controlling costs for a group or DSO. The larger the company gets, the more buying power it holds to leverage best pricing with vendors. In a well-run DSO, dental supplies and lab combined should account for no more 9% of revenue (depending on the amount of crown and bridge, orthodontics, implants, etc.) DSO’s and groups will work with their supply companies to develop a formulary which narrows down a list of items to order and best pricing can be received on that new list of items. The Clinical Director will select a short list of the best laboratories that will provide competitive pricing and support that the dentists can utilize for their lab work. Of course, the procurement of goods and services for dental companies spans more than the just supplies and labs – these are typically the two largest buckets when looking at COGS. Less sophisticated groups have failed to capitalize on these economies of scale through leveraged purchasing and give up significant value when looking to monetize their business.

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Marketing Support

In today’s dental market, the days of relying on a generic website with stock photos, supported by a handful of patient reviews, and paid search positioning to generate new patient flow are coming to an end.

Regardless of the dental organization's size, a multi-faceted marketing program has become an essential function to generate new and continuous patient flows.  As dental groups grow in size and build out their infrastructure platform, developing a robust marketing capability to drive patient flows to each of their offices becomes an increasingly important, expensive, and time-consuming function.

Marketing has moved from reliance on word of mouth references, local ads, websites, and social media presence.  In today's digital economy, these actions that worked in the past are simply the rudimentary beginnings of a comprehensive marketing strategic plan.  Websites must be compelling, with video, actual office photos, and refreshed proprietary content.  Fully operable mobile apps are now accessed by virtually all patients, including many Baby Boomers.  The continuous posting of recent 5-star Google reviews provides potential new patients with a degree of assurance that the office and providers are quality.  

Managing a robust online presence with search engine optimization and management (SEO and SEM), creating a constant stream of propriety content in blog posts, newsletters and social media postings, sending out periodic mailers and organizing major media campaigns requires a centralized marketing function that focuses on these activities and tracks the success of its efforts to optimize the costs of new patient acquisition from each marketing tactic.

The age-old question of "To brand or not to brand?" is more relevant today than ever when forming a group or DSO. Both branded and unbranded models compete successfully in the same markets and even exist alongside each other within some of the larger DSOs. 

Black Ops Management Solutions can assist groups with the process of determining the preferences of their providers and of their patients in the geographic markets in which they operate as well as the risks and rewards associated with branding before making a strategic decision on this fundamental question.

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Information Technology Support

The IT platform is an arcane but absolutely critical component governing the proper function of every dental operation.

The IT platform, consisting principally of workstation and server hardware, practice management software systems, business intelligence applications, networking and security capabilities, and IT support services, is the nerve center for all dental enterprises regardless of size.

As dental groups and DSOs grow through acquisition, the organization's IT function becomes more challenging to manage because newly acquired practices will have different system components, and selling dentists typically will have underinvested in this aspect of their practices. 

A common challenge for groups and DSOs expanding through acquisition, then, becomes how best to manage its IT platform, which can quickly become an aggregation of disparate technologies which do not interface well with the existing platform and likely requires additional capital investment for connectivity, HIPAA compliance and security concerns (practice valuations rarely will have taken these additional investment requirements into account).  Depending on the group's size, the demands for capital, and the tolerance for short-term operational issues, a decision will have to be made whether to convert newly acquired practices to a common practice management platform or to operate with disparate systems with different reporting formats and training requirements.

Black Ops Management Solutions recommends working with a trusted IT vendor to perform an initial systems assessment to issues and upgrade requirements to minimize the operational disruptions and staff frustrations.

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