Corporate Dental Branding- What Dental Consumers Need to Know
A brand is a
name, term or symbol which one company uses to differentiate its products and
services, from that of another company.1 Corporations employ numbers
of different strategies in branding. Healthcare professionals are generally
fairly ignorant on corporate branding practices, as this is not an element of
their formal education. By contrast, those parties which beneficially own
corporate dental practices retain individuals well-skilled and well educated in
all forms of retail sales, marketing, and finance. Their abilities include a
plethora of differing and complex branding methodology.
In its
simplest form, a chain of corporate dental clinics may seek direct brand
recognition by consumers. They may market “outstanding dental care at
reasonable prices”, all associated with their brand. Branding may be part of a
marketing program to generate public goodwill via broad mechanisms, ranging
from well-publicized charitable events to sponsoring a NASCAR driver.2 Branding
may also be associated with the business model of dental Medicaid care.
Unfortunately
for the corporate dental industry, many of their more established brands have
become associated with abuses to the public welfare.3-9
(Author’s
note: References only cite a mere handful of well reported abuses generated
from corporate dentistry, disclosed by government officials.)
Dental clinics
managed and directed by non-doctor corporate management often have a troubling
record, which the public is witnessing. Likewise, dentists who may be employed
in such workplaces are also witnessing abuses to the public interest generated
and facilitated by brand-name companies in corporate dentistry. As such, many
in the public are avoiding dental services offered by branded corporate dental
practices. Further, these branded corporate practices are finding
employee/doctor attraction and retention increasingly challenging. One
corporate chain recently reported over 10% loss in total dentist staff for a
one-year period.10
Crowd Sourced Branding-
Numbers of
branded corporate dental groups are increasingly discovering their branded
identity has negative consequences. In fact, the term “corporate dentistry” is
an example of “crowd sourced branding”, in which the public assigns a company a
brand (positive or negative), versus the traditional method of branding, in
which a company designs their branding scheme.
Some dental
corporations have fought back by explicitly marketing their distance from
“corporate dentistry”. One such ad from a corporate dental chain openly states,
“You Hate Corporate Dentistry and So Do We”. The veracity of their claim seems
highly suspect, especially when one views their multiple settlement agreements
with multiple states’ attorney generals. However, corporate dental management
is evidently far more concerned with negative fallout of crowd sourced branding,
versus presenting truth in the public marketplace.
To further
counter the negative public impression of corporate dentistry generated by
crowd sourced branding, numbers of corporate dental chains market the
misrepresentation of doctors, and not faceless Wall Street types, as owning
dental practices. The reality is very different and highly disturbing.
Other
corporate dental chains establish a group of dentists acting as sham-owners,
via the accounting mechanism of a professional corporation (PC). Again, these
doctors have no true and valid ownership privileges of dental practices, as
beneficial ownership passes to non-doctor corporations, often private equity
investment firms. Some of the world’s largest and most well-known private
equity firms currently are or formerly have been the beneficial holders of
corporate dental chains, which direct patient dental care. Examples
include Morgan Stanley11, Valour Investments Ltd.12,
Carlyle Group13, American Capital Strategies13, FFL
Partners14, Gryphon Investors15, MSD Capital (holdings of
Michael Dell family)16,17, etc.
Obviously,
private equity firms of such financial standing have great influence on
political leadership, inclusive of legislation and enforcement of existing
statutes. The big lie of dental service organizations (DSOs) “only controlling
the non-clinical aspects of a dental practice” are completely fallacious.
Corporations at this higher platitude easily alter and amend the public
discourse, in order to manipulate public perceptions (“astroturfing”).18-20
Multi-Branding Strategy-
A single DSO
may operate multiple dental clinics, each or several under different brand
names. The downside is that marketing costs may be higher, as each brand
requires unique and individualized marketing programs. An upside is that if one
clinic brand experiences regulatory sanctions or legal liabilities and
associated negative press, the entire chain of clinics operated by the DSO may
generate little to no bad attention.
One example
was the needless overdose and death of a pediatric dental patient in West
Phoenix, AZ, and multiple examples of physical and psychological child abuse,
inclusive of alleged Medicaid fraud, by dental clinics managed by the Small
Smiles Dental organization. Yet, various clinics assumed brand names such as
Medicaid Dental Center, Smile High Dentistry, Wild Smiles, Smile Starters, and
Carolina Dental Center avoiding a direct link to Small Smiles Dental (a/k/a
Forba). Efforts to mask a direct connection with Small Smiles Dental may have
been viewed as an attempted mechanism to deflect civil and criminal liabilities
away from senior corporate directors.21, 13
Often times,
doctors and other clinical staff employed by corporate dentistry, which utilize
a multi-branding strategy, have no idea of the overall corporate scheme. They
take their orders from middle manager supervisors, some of whom may be doctors
(some licensed and others not). Those pulling the strings at the top of the
corporate pyramid may be completely unknown to those providing direct patient
care, at the pyramid’s bottom. Regardless, those at the top have daily access
to every production metric of every clinical producer (dentist and hygienist),
in their employment, within each and every clinic they control.
Stealth Branding-
Since the
public’s perception of corporate dentistry is too often negative, numbers of corporate
directed dental clinics engage the practice of stealth branding.22
Nowhere on-site in their dental facilities is a corporate name, logo, or
graphics. There is nothing visible to connect their dental clinic to the
corporate brand.
Employees of
these clinics may have no idea their ultimate supervisors are distanced
corporate financiers and administrators. Perhaps initially, a doctor sold a
practice or few practices to a DSO. That doctor would realize those clinics
were now beneficially owned and controlled by a corporate entity. Subsequent
employed dentists may be fully unaware and ignorant of true ownership, and only
directly answer to a mid-level manager.
Similarly, a
DSO may establish de novo clinics (startup clinics) under a nominee owner dentist’s
name. Naturally, clinic control rests in the hands of corporate beneficial
ownership, not a facade shell company dentist owner. On-site employees may have
complete ignorance of their company’s structure, which is by corporate design. Truth
and full disclosure of ownership is not an issue some in corporate dentistry
wish to reveal.
Stealth
branding allows for corporate dental managers to escape “sins of the past”. The
consumer dental public falsely views the dental facility as a totally unique
entity. Past abuses by a corporate chain will not be connected to this
individual company or a corrupt industry. One might ask, “Is stealth branding
an opportunity for a corporate do-over to get it right? Or, is stealth branding
another cover-up with design to cheat the public out of their money?”
Conclusion-
The public
should be entitled to full disclosure of beneficial ownership of their
healthcare facilities. This currently is not the case, and great efforts may be
made to hide facts. State and federal regulators, government auditors, and the
general public making healthcare decisions for their families merit full
disclosures. Unfortunately, corporate dental violators face few consequences
for hiding or misrepresenting truth.
Healthcare
is not a marketplace act, like the buying and selling of ordinary goods and
services. Patients are at a distinct disadvantage in the doctor/patient
relationship (contract), by lacking a doctor’s expert skill and training.
Patients must rely that their doctors will place their interests to the fore.
By contrast,
the free market business world, inclusive of the private equity investment
industry, has a distinct obligation to place the interests of their investors
and generation of profits to the fore.
This conflict of interest to the doctor/patient relationship (contract)
couldn’t be clearer. Corporate control and beneficial ownership of healthcare
clinics, including influencing decisions of their employee doctors, is not in
the public interest.
Techniques
used in corporate branding are employed by highly educated elite business
people. These are business professionals who operate at the top of their game.
They can often buy and sell politicians and government officials with money
they consider “chump change”. Dentists attempting to service student debt loads
over $1/4 to 1/2 million are ripe for ethical corporate compromise. When this corporate third party enters into
the doctor/patient relationship (contract), without the knowledge or consent of
the disadvantaged party (the patient), the patient loses.
New
paradigms need to be established, in which patients win. Full disclosures in
healthcare services, ownership, and clinical direction must be created, and
most importantly lawfully enforced. Patients require complete
assurance that their doctors only work in their interests. This
must be backed by enforcement of existing statutes, which today is rarely the
situation.
References
1.
Brand. Wikipedia (last modified 12, 02, 2016). https://en.wikipedia.org/wiki/Brand
2.
Staff report. NASCAR.com. Danica extends deal with aspen dental. http://www.nascar.com/en_us/news-media/articles/2015/9/18/danica-patrick-aspen-dental-sponsor-renew.html
3.
NY AG Eric T Schneiderman. AG Schneiderman announces settlement with Aspen
Dental that bars company from making decisions about patient care in New York
clinics. June 18, 2015. http://www.ag.ny.gov/press-release/ag-schneiderman-announces-settlement-aspen-dental-management-bars-company-making
4.
MA AG Maura Healy. Aspen Dental to pay close to $1
million to settle allegations of deceptive advertising, charging for services
not provided- thousands of consumers in Massachusetts to receive restitution.
Dec 22, 2014. http://www.mass.gov/ago/news-and-updates/press-releases/2014/2014-12-22-aspen-dental-aod.html
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the matter of determining whether there has been a violation of the Franchise
Investment Protection Act of Washington by: Comfort Dental Group, Inc., Rick
Kushner, Neil Norton and Graig Bears. Order No. S-11-0766-12-CO01. May 1, 2012.
http://www.dfi.wa.gov/documents/securities-orders/S-11-0766-12-CO01.pdf
9. Joint Staff Report on the Corporate Practice of Dentistry in
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