Private Equity Firm Arby Partners Invests in Dental Service Orgainization Dr. Dental Management, LLC

Abry Partners has made an investment in Framingham, Massachusetts-based Dr. Dental Management, a dental management service organization. No financial terms were disclosed.

March 13, 2019
PRESS RELEASE
BOSTON–(BUSINESS WIRE)–Abry Partners (Abry), a Boston-based private equity firm, today announced that it has completed a strategic investment in Framingham, Mass.-based Dr. Dental Management, LLC (Dr. Dental), a dental management service organization that provides comprehensive management and administrative services to Dr. Dental-branded offices.

Dr. Dental has a unique playbook for growth, successfully scaling the company exclusively through new site openings to become one of the largest dental management service organizations in New England, with 100 active dentists treating over 250,000 patients a year. With this infusion of capital from Abry, Dr. Dental will continue to expand organically by opening new locations but will now also target strategic acquisitions of dental practices and groups throughout the Northeast.
Dr. Dental was founded in 2004 by the brother and sister team Alex Faigel, CEO, and Dr. Julia Faigel, DMD, clinical director, with the mission of providing quality dental care and great service at a lower cost in convenient neighborhood locations. The organization has grown from a single location to now 44 locations with 250 operatories throughout Massachusetts, Connecticut, New Hampshire and New Jersey.

The Dr. Dental management service organization supports its patient-care locations in all non-clinical aspects of dental practice, including staffing, patient scheduling, billing and collections, financial reporting and analysis, group purchasing, payroll, marketing, education and training. This suite of services enables affiliated dentists to focus exclusively on delivering high-quality patient care, making Dr. Dental one of the leading brands as measured by patient satisfaction in the Northeast.

“Abry’s investment in Dr. Dental is a true testament to our company and the dedication of our doctors and their loyal patients,” said Alex Faigel, Dr. Dental’s co-founder and CEO. “We’re excited to build on our recent growth with Abry Partners and look forward to all that we can achieve together. By combining our first-rate reputation and expertise in organic growth with Abry Partners’ resources and guidance for strategic acquisitions, we see Dr. Dental achieving record growth and rapidly expanding its footprint over the next few years.”

The funds will also be used to hire additional management and administration staff, and expand marketing and brand awareness for Dr. Dental and its affiliates. Dr. Julia Faigel and Alex Faigel will continue in their current management roles and run day-to-day operations.

“We see a very bright future for Dr. Dental,” said T.J. Rose of Abry Partners. “Alex, Julia and their team have built a strong business ripe for further growth. This investment perfectly aligns with Abry’s multi-site healthcare specialty platform – including dermatology, dental, autism and urgent care – and we look forward to leveraging our expertise to help accelerate growth organically by expanding with new locations and through acquisitions.”


About Dr. Dental Management
Headquartered in Framingham, Mass., Dr. Dental is a leading Dental Management Service Organization (“DSO”) in New England. Dr. Dental has 44 branded locations across four states (Connecticut, Massachusetts, New Hampshire and New Jersey). Dr. Dental is focused on providing quality and affordable care for all and has established itself as a leader in patient satisfaction. For more information, visit www.mydrdental.com.

About Abry Partners
Abry Partners is one of the most experienced media, communications, and information services sector-focused private equity firms in North America. Since its founding in 1989, the firm has completed over $80 billion of transactions, including leveraged buyouts, growth financings and recapitalizations. Currently, Abry manages over $12.0 billion of capital in its active funds.

Dr. Dental Locations 
Arby Partners Portfolio

Astroturfing by the Dental Support Organization Industry

Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net

“Astroturfing is the practice of masking the sponsors of a message or organization (e.g., political, advertising, religious or public relations) to make it appear as though it originates from and is supported by grassroots participant(s).”^1. -Wikipedia 
Introduction
It is imperative the so-called “dental support organization industry” (DSO industry) employ astroturfing techniques, as their entire business model is formulated on gross misrepresentations.^2-12 In order to obfuscate the rule of law relating to the unlicensed and unlawful practice of dentistry, these corporate entities must misrepresent themselves as only providing limited nonclinical support services for their chains of dental practices. This is patently false, and has been challenged by numbers of legal rulings and studies. In reality, DSOs either represent the true beneficial owners and clinical management for vast numbers of dental clinics, or they provide management for the private equity beneficial ownership. Doctors only serve in a limited role as facade nominee owners. The word “support” is intentionally designed to deceive. The lies go on.

Forms of DSO Astroturfing
There are four basic designs of astroturfing utilized by the DSO industry. At the most basic level is DSOs placing bogus positive patient reviews with online rating services or their website. The next astroturfing technique involves individual dentists who openly advocate for the DSO industry. The third method employs hired public relations and public advocacy specialists. The final level, and often most challenging to prove, is hired lobbyists who direct public policy through directly influencing government agencies and government elected officials. 

Bogus online Patient Reviews
Although this form of deceptive advertising is unlawful, violators are rarely discovered or sanctioned.¹³ The DSO utilizes existing employees or a retained service to generate positive patient reviews for dental services with online review sites, and/or their own website. Often the specific language utilized in the review is a tip-off, that the bogus reviewer is truly not a clinical dental patient, but working in the dental field. Certain DSOs have such a disturbingly high degree of employee turnover and negative staff retention rates, they now resort to posting bogus positive reviews of current or former employees on employment websites such as Glassdoor.com and Indeed.com. One will generally see multiple low rated “one-star” reviews, intermixed with over-the-top glowing “five-star” reviews. Obviously, corporate astroturfing is in play. 

Individual Dentists Espousing the DSO Agenda
On occasion, state legislatures will take up the cause of regulating and restricting the DSO industry to benefit the public interest. Bills will be presented to establish enhanced transparency in true beneficial clinic ownership. Clarification will be added to protect the doctor/patient relationship (contract), and patient rights such as the informed consent process, and always holding the patient’s interests paramount in clinical decisions. Truth in advertising and lending will be advocated. Mechanisms for bait-and-switch schemes will be discouraged.

DSO Business Model Includes Violating State Labor Laws

 
Dr. Michael W. Davis maintains a general dental practice in Santa Fe, NM. He serves as chairperson for Santa Fe District Dental Society Peer-Review. Dr. Davis also provides a fair amount of dental expert legal work for attorneys. He may be contacted via email: MWDavisDDS@comcast.net.





David Sohn is the principal attorney at SOHN LEGAL GROUP, P.C., which prosecutes and defends employment and business disputes on behalf of individuals, small businesses, and non-profit organizations.  Prior to starting his own law firm, David worked at several prominent national law firms in San Francisco.  He received his bachelor’s degree in Economics from Stanford University and his law degree from Harvard Law School.  Due to the successful results he has achieved for his clients, David has been recognized as a Northern California Super Lawyer by Super Lawyers Magazine. David can be reached at 415-421-1300 and david@sohnlegal.com.
 
INTRODUCTION
David Sohn is an attorney in San Francisco specializing in employment litigation matters. Last year, he represented a dentist in his wage and hour lawsuit against Western Dental Services, Inc. (“Western Dental”) for misclassifying him as an exempt employee and not paying him overtime wages and providing proper meal and rest breaks, among other things. Mr. Sohn tried this case in San Francisco Superior Court against an army of big law firm lawyers hired by Western Dental – and prevailed. As a result of his trial victory, the overwhelming majority of dentists in California are now misclassified. They should be receiving overtime wages, proper meal and rest breaks, and all of the benefits and protections of California’s employment laws.
The case is entitled Nanda v. Western Dental Services, Inc . (Case No. CGC-13-529601).

Dr. Davis: Mr. Sohn, I sincerely thank you for taking the time and effort to address matters of this case. I understand much of your legal work involves labor workplace rights. The public may not appreciate how even a licensed dentist may have their rights violated in the workplace. Could you give our readers an overview of the merits of this case and how your client was damaged? 

Mr. Sohn: Thank you, Michael, for giving me an opportunity to discuss with you and your readers my trial victory against Western Dental. This is a very important, game-changing case that all dentists and to-be-dentists need to know about so that they understand what their workplace rights are.

When I decided to take on this case back in 2013, I didn’t know anything about the dental industry. I took it on because I saw a very interesting legal question. That question was: are dentists employed by Western Dental compensated in the form of a “salary?” Western Dental compensates its dentists by a fixed daily rate and/or a percentage of their production. They are not guaranteed in advance a minimum weekly or monthly amount of compensation.

This legal question is important because in order for dentists and other licensed professionals to be exempt from all of the benefits and protections of California’s employment laws – such as overtime wages and proper meal and rest breaks – they must be paid in the form of a “salary.” If they are not, they must be provided these benefits and protections.

California law does not provide a definition for the term “salary.” Instead, California courts look to federal regulations for the definition of “salary.” The pertinent federal regulation, 29 C.F.R. § 541.602(a), states that an employee is paid on a “salary basis” if he or she “regularly receives each pay period on a weekly, or less frequent basis, a predetermined amount constituting all or part of the employee's compensation, which amount is not subject to reduction because of variations in the quality or quantity of the work performed.” This same federal regulation also explains that if an employee is ready, willing, and able to work, but he or she does not work due some reason occasioned by the employer, he or she is not being paid on a “salary basis.”

At the conclusion of trial, the judge held that the dentist I represented was not paid in the form of a “salary.” The dentist never received on a weekly, or less frequent basis, a predetermined amount of compensation which was not subject to reduction based upon variation in the quality of quantity of work performed. He was only paid for the days that he worked and on occasion received a percentage of the production he generated. On numerous occasions, even though he wanted to work, if he was not called into work, he was not paid. Given these circumstances, he was entitled to overtime wages and proper meal and rest breaks like other non-exempt staff employed by Western Dental.

As a result of the judgment issued in my case, all dentists – and for that matter any licensed dental healthcare professional (such as orthodontists, periodontists, etc.) – in California paid on any basis other than a salary basis are “non-exempt” employees who are entitled to overtime wages, and proper meal and rest breaks.   

Dr. Davis:  The defendant in this case, Western Dental, is the largest employer of dentists in the state of California. They also operate dental clinics in Nevada and Arizona. They are the largest provider of dental Medicaid services for California. As large of a dental industry operation as is represented by Western Dental, is it reasonable to speculate on the pervasiveness of dentist/employee workplace labor violations (both in Western Dental and the dental service organization (DSO) industry, as a whole)?   

Mr. Sohn: During the course of my case against Western Dental, I discovered that Western Dental’s approach to how it compensates its dentists is not unique. I spoke to a number of dentists and specialists who worked for other practices large and small, including other DSOs and small private practices, and the impression I received was that the overwhelming majority of dentists and specialists in California – and in the country – are paid on a similar non-salary basis. That’s when I realized my case could have significant industry-wide consequences.

Warning To Dental Grads Being Wooed By Corporate Dental Companies

Be careful about how you interpret the word "guaranteed” income when being wooed by a corporate dental management company such as FORBA, Heartland or Western Dental. Read this next paragraph very carefully.

A lot of these corporate associateship contracts are set up so that you are guaranteed a certain salary based upon a specific (and sometimes unattainable) level of production. If you don't hit that level of production, you are still "paid" that salary, but you then owe the corporation the difference between the salary and what you actually produced.

So, in many cases it may seem that you will be guaranteed big dollars right out of graduation, but often that is based upon unrealistic levels of production. They spin it as "guaranteed" because you will in fact be making that money, but you will ultimately have to pay part of it back.

Go ask a few optometrists or pharmacists how much they like the corporatization of their respective professions, and you'll hear all the reasons why every effort should be made to preserve dentistry's professional autonomy.

Then you get hooked up with a Corporate Dental Company that gets nailed for mistreatment, over treatment and over billing insurances or using a blanket DEA number for prescriptions and your once stellar reputation is tarnished forever.

All those long months, days and years spent preparing yourself for a wonderful noble career is gone down the drain in less than 6 months. Not even mentioning the enormous education debt you’ve accumulated and now you won’t be able to get a job that would earn enough wages to make your loan payments let alone live, have a family or anything else. All those dreams of a fruitful life that got you through all those years of study are gone in a flash.

Lets say you don't like the procedures they teach you at their "training camps". What are you to do, you have signed a "non compete" clause in your contract. Then what are you going to do. Talk about stuck between a rock and a hard place!

There's no altruism involved in these corporations' business decisions. Corporate mills are notorious for encouraging over treatment in order to meet production goals. If you're seriously trying to come up with a minimally acceptable treatment plan for a Medicaid patient, you're looking at sealants vs. restoring every pit & fissure in the mouth, complex direct restorations instead of pressed ceramic crowns, periodontal debridement, flippers instead of implant-supported bridges, etc.

Heartland and Western shareholders are just like the ADHP proponents in that respect--they're out for their own best interests, not the public's, but they also know saying "it's for the greater good!" is a nearly impenetrable moral shield for them to hide behind.

The moral in both cases is that dentistry needs to start being proactive about figuring out solutions to the access to care problem, instead of letting other groups seize the initiative and then trying to fend them off while backpedaling.

Some companies like Kool Smiles ask employees to sign a 'restrictive covenant for 1 or more years in a radius of 5-10 miles. This mean you might be SOL if you want to work in that area.

A portion of Small Smiles /  FORBA contract says:

...for a period of 2 years following termination, you can't provide dental services for Medicaid patients within 10 mile aerial radius of the Practice Location, or Employer's practice location on the date of termination if Employer has moved its location, or the location of any of the Employer's related practices.

Add this to the $500 a day penalty for not giving them a 90 day notice and you are just screwed!  What if you had relocated!  What now?