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1248 The Keys to Successful Expansion with Michael Pontrelli : Dentistry Uncensored with Howard Farran

1248 The Keys to Successful Expansion with Michael Pontrelli : Dentistry Uncensored with Howard Farran

9/15/2019 6:00:00 AM   |   Comments: 0   |   Views: 72
Michael Pontrelli joined Memorial Park dental group as their chief operator in 2015 to help with the expansion of their dental group. In 2015, the group consisted of 1 practice, which was acquired in 2006, and today the group has 8 practice locations in the greater Houston, Dallas/Ft, Worth & Austin areas. 


AUDIO - DUwHF #1248 - Michael Pontrelli



Their group sets themselves apart by deploying a doctor-centric partnership model with an entirely bespoke purchase arrangement. They are willing to purchase up to 200% of the value of the practice. 



Howard:  It is a huge honor for me today to be podcast interviewing Michael Pontrelli: the COO and partner at Memorial Park Dental Group he joined Memorial Park Dental Group as their chief operator in 2015 to help with the expansion of their Dental Group in 2015 the group consisted of one practice which was acquired in 2006 and today the group has eight practice locations in the Greater Houston Dallas Fort Worth Austin areas their group sets themselves apart by deploying a dr. centric partnership model with an entirely bespoke purchase arrangement they are willing to purchase up to 200 percent of the value of the practice they are rapidly expanding group aiming to provide patients and their respective communities with unparalleled service this organization hopes to break down the barriers that exist between the patient and their dental health property practitioner by providing an experience that creates a sense of comfort trust an extensible and accessibility my gosh I'm such a it's the fastest-growing segment of Dentistry I'm so honored to have you come on the show all my homies listen to you there either just got out of school and they're an associate somewhere or they finally opened up their own one practice and they're having a hard time you know running one office so I'd like to get major operators like you you're running eight offices so I'm sure everybody having a hard time running their own office once they hear more so I want to start with this um are you hiring kids right out of school what is that is that part of your growth strategy that you come out of school and you'll give them a job now

Michael Pontrelli:  I mean typically not  at our size I mean are so  most of our engagements are arrangements with our doctor partners really are the doctors are staying on for a period of time and then we are finding and hand selecting and associate with  that particular dentist but we don't really hire new grads as a part of doing business 

Howard: now yeah you know what none of my friends wants to hire a new grad and so and then and then they badmouth these big DSOs that hire a thousand of these new graduates like back in my day the only person who would do that was the Army Navy Air Force Marine Indian Public Health Service yeah so kudos to all the people that will employ the recent grad who absolutely I mean does anybody want it who wants a new grad they've done like flying fillings when they get out of school I mean I thought 

Michael Pontrelli: we look at dentists that have sometimes a couple years of experience I mean they're not coming right out of dental school I think that because we're  so focused on and this doesn't this doesn't mean that the new grad can't do it but we're so focused on delivering an excellent patient experience and making sure the clinical work is really good that it's much easier for us to Bank on a true hard tested dentist who's whose work than some of those really arduous environments of corporate dentistry and we really set ourselves apart by not really being corporate in the way we run our business so I think we're really looking more for dentist that just have cut their teeth in the tougher environments know how to communicate with the patients well and and  it sort of honed their t clinical skills so that they fit with us 

Howard: so right now you're running eight practices and I don't even see anything off-the-shelf to run a single office I mean like  I take practice manager software I mean I I use open dental the most famous is dendrix and soft end and I mean they don't even cook up with an accounting package I mean they  don't interface with Quicken how's it so you must be using middleware accounting or how do you run the numbers of eight offices how do you do that 

Michael Pontrelli: well first I offer a plug in though I really love dental Intel right I think I think they're they're a great outfit and a great shop and they obviously plug in pretty easily with all of our practice matter systems and we have offices that are running on eagle soft open dental and dentists so we have them on all three platforms and  I really love what dental Intel can I love the people there as well in terms of the financial reporting we have an in-house CFO is actually a really brilliant guy his name is Vincent and Varghese he came on board roughly around the same time that I did when we first launched our expansion he really built all of our proprietary KPI reporting tools and and really built the valuation tool that we use and he has sort of a Pretoria way in which he looks at things but now on a quarterly basis he's the guy that we go to to give us that that information that is okay so you have a CFO then correct and what's his name is that Vincent white Vincent Vincent Varghese Vincent bargain VAR g is VAR g HT sv c you know does he is he the one who recommended dental Intel or actually we you know we really pride ourselves on trying to listen to everybody in the marketplace and we actually came across dental Intel when we were at Scott Lunas breakaway course we went out to go see what he was about and we ran into these guys at I dental Intel we just loved them loved their pitch and we started using them and it was a great tool great tool ever since better more robust 

Howard: my god I had him on when I podcasted him we talked for three hours we made three shows yeah Scott Lena um love Scott love his wives love you know I think he's a great guy but my God he's so controversial what do you think makes him controversial 

Michael Pontrelli: because he's in the DSO space and all the solo dentists want to keep it that way does he just represent the Diaz DSO Godzillas that way he's controversial or what do you make of it yeah yeah I mean well so I didn't know he was really quite that controversial I know Dino DSO that the term itself is is controversial right I also think that you know when you speak to some of these very big accountants in the community they'll tell you that most of their clients to have a thirst for wanting to understand what DSOs can do and what they're really about I think there's a lot of ignorance in the marketplace as to what they do and I think on them given themselves a bad name by just not operating properly and I think so anybody that really becomes a DSO sort of it's a sir reaps the  bad reputation that comes along with that but  Scott was a nice guy he was gray she's not a very smart guy he's  earned his I would say cockiness to a certain extent right I mean he's done some pretty amazing things yeah I know I mean and I thought his breakaway conference was his seminar was  quite in-depth and we do learn quite a lot coming away from that I think what really sets us apart makes us unique is we're willing to borrow and take from what many others in the community are doing I mean we don't know what we don't know and we're always willing to get better 

Howard: so you and you said I'm Vincent Varghese and you that you have offices and you have eight and they're running off Eagle soft open dental and enteric she's listening to me right now and she's thinking two things she's I want to set up my own office yeah dendrix is the largest white shiny Eagle soft Center or just by Patterson open dentals probably third and most people that come on the show won't talk about because let's say you came from dental Intel if I ask the guy from dental Intel which one's the best foreign software well he doesn't want to piss off his whole supply chain so yeah I don't see any horse that you're afraid of on this practice ranch software so which one of those three do you think you and Vincent like the most if she had to pick one of those which one and why

Michael Pontrelli:  yeah so I think Vincent would tell you I'll answer for him I think he would say open dental is his favorite that's why I tell you I would I tend to agree with him I know dendrix is far more robust but I think if you want to do a little bit more I think open dental is a little friendlier well what I like about it is everybody now has it 

Howard:I met this kid over the weekend and he's been watching all these what is a Python artificial intelligence programming okay I've just been watching YouTube videos and he's already a fairly good Python programmer an open dental you could hire that and he can make a bridge to anything and you're out there and you want to make a bridge will somebody please make a bridge from open dental to any accounting software that can run a real business and that and if you say quicken or QuickBooks Pro you're so green behind the ears you don't even know you're an amateur what so that's my next question for you so to run eight offices what accounting system are you on 

Michael Pontrelli: yeah so I actually do think we use QuickBooks and we have it in it we have an accountant that we partner with we're still in the we're still in the startup phase right we have eight locations I think we don't even become an emerging DSO until we hit about ten and really what we've been focused on as of late is really honing that infrastructure and getting the right people in place right now it's just been a three-man team and we're doing everything we can to make sure we deliver great service and experience for our patients and  we trust the people that we've surrounded ourselves with so really we rely on our accountant to provide us with that information and and we do use QuickBooks as the primary accounting software and our CFO is the guy we really lean on to to give us the insight that we're looking for from a financial perspective 

Howard:um yeah and that is the only reason that that is the main reason I cannot stand Bill Clinton they they never talk about religion politics sex or about politics all day with you but Bill Gates I mean yeah Bill Gates you know he set a standard you know when they start building railroads the United States everybody was building their on their own with and dimension so they a banker I don't use the asset so they finally the economists explain to the malfunctioning government that you need to create standards and we you know it and look at electricity I mean by having everybody use a 120 anybody can make a toaster buy a toaster and Bill Gates what he did was he created a standard it was mainframe computers and you had to learn colbalt and Fortran and then they came out with the mini the micro computer so he came out Microsoft software which became a standard with Word and PowerPoint and Excel and he tried to buy Quicken so there'd be a standardized accounting Patchett and Bill Clinton blocked it and went to war with them and when when Bill Gates finally threw in the towel that was when the y2k bubble he'd started selling all of his positions about a year before the y2k bug popped and what he should have been doing with Bill Clinton is saying hey Bill let's get your government paper us here it is 20 years after that 20 years after that I couldn't get my driver's license online they're not paperless they're not all digital because Bill Clinton had to go the Battle of the bills and we're sitting there two decades later not paperless and we're sitting here today and these dentists don't know you know like if a patient if I go to a dental office and the doc walks out of the room and I said Hank sure you just did an MOT composite on number three did you make eight dollars after taxes net income or did you lose four bucks they have no idea they have no I have no idea and so as long as we're sitting in the in these bizarre time so you like dental Intel why did you go with dental Intel as opposed to practice by numbers let's say 

Michael Pontrelli: it was just we when we we were into them we just tried them on we got used to what we had and I think just like with anything else relationships are important and we learned how to use the software they took a lot to learn how to use it and implement it and once you're in the group of things and in the swing of things why change if it ain't broke right so I'm sure maybe there are some other competitors out there they can provide the same information but we've really fall in love with dental into and really like their team and their support frankly

Howard: okay yeah I agree um so what makes what makes the dentist founder of that group I'm doctor Nishino Thomas what's going on in her journey when she decided I want to go from a solo practicing I'm all good Monday through Thursday so now I want to tackle Godzilla and own eight offices well where does that come from

Michael Pontrelli:  yeah so you know there's a story behind that which I think will sort of pull your heartstrings back in 2004 if I could be about a year off on this one so 2004 to by dr. Thomas at the time the Shawano had kidney failure and because of that she was put on to dialysis and if you know anything about dialysis I mean it's one of the most draining things you can to be alive right it's one of the most draining things that you can put yourself through she was working for a dentist in town she's actually a oral surgeon from South Africa originally very well trained she went to UPenn under the international program and then moved to Texas with her husband and while she was working the dentist took her off of her Dilli guarantee and put her on production because she was going on dialysis and she hadn't about producing her  day rate three times much to the chagrin of the Dennis she was working for at the time it's quite unfortunate then the dentist started playing some games back and forth and kept changing her cob structure really to just affect his own pocketbook and she would come home rather unhappy she wasn't being treated properly it treated well and she supposed she was being abused and used improperly and her husband really took the initiative to say look you love practicing dentistry we all know that what can we do to get you out of this situation so she found a he got a letter in the mail believe it or not which doesn't happen frankly that often and the letter was for a practice in sale right in downtown Houston right across from immortal Park believe it or not and that office was a very small office it was like a $600,000 office and really without much thinking just bought the office for her for his wife because I mean look it was even about making the money it was about the quality of life and the lifestyle and her being able to do something well found out that it was a dhmo office and we all know what happens in that situation so $600,000 DM office is a barrier to running I'm making any money so today that flagship is doing about three and a half million and it took a lot of work to get it to that to that level but since that time since 2004 2005 to present day she's had three kidney transplants and so really the main driver for this has been how does she create a long lasting legacy for her family and part of that is obviously making money and she get out of the chair and not you know be working such a back-breaking taxing job which it is to be a dentist so she practices when she wants to practice and she's around the patients he wants to be around and her family largely is around her family and friends to help run the rest of the practice for her so really this has been an evolution since 2004 2005 the present day to get her out of the chair and to create a legacy for her family we're not a non-for-profit business we do want to make money and we think we're good at it but really what we've been very good at doing Howard is growing practices we've seen as the best growth I think was reported in about three hundred and sixty-six percent from Memorial Park but our lowest in about six months it's about twenty five percent so we're all over the map but we do a very good job for our dentists and obviously Machado is very happy about that 

Howard: wow that is a that is a tear-jerking story how is she doing now

Michael Pontrelli:  she's much better much better I mean her creatinine is down to I think point seven and it was I mean before Trent the last trend transplant she had I think it was probably hovering around three or four something like that I mean she was she really was she's a walking miracle when you think about it and it is her husband part of the team - yeah her husband's a part of the team he's really the brains behind it is that is that mark that is mark they're different last names though that's what's confusing me is that because she's got it yeah so well it's interesting actually so Michonne oh and Mark both come from a very interesting Christian sect that originates in Syria called kunai and as a part of their culture they'll take the first name the wife or woman will take the first name of the father as their last name so her father's first name is Thomas hence the reason why her name is Michonne Oh Thomas 

Howard:Wow and that's a Syrian Christian group huh a Syrian Christian who's very very old goes back about 1,500 years or something like that in fact every marriage is recorded in one book in Syria 

Michael Pontrelli: today you can still go to Syria and you can see your marriage recorded there you can't marry out and you can't marry in so it's a very  unique religion ha that is very interesting very their  Orthodox Christianity and I've been to their baptisms and I mean they're very long their masses during Christmas or sometimes four to six hours it's a very old-school religion 

Howard: very interesting Steve Jobs his father was Syrian yeah Steven Paul Jobs his uh his biological father Abu Fatah John Adel Arabic grew up in Homs Syria and was born a very interesting I I that the funniest thing I always can't understand about America is that if you ask anybody with a PhD in economics or history what made this the greatest country in the world they said because people emigrated here on they voted with their feet for 500 years the greatest most ambitious bright-eyed bushy-tailed people came here from all around the world and then you're like okay so so you you're ready to open back up Ellis Island and keep it going no no sorry oh ok so what made us great you just want to stop no absolutely it's like okay we're done so I'm the crazy so um whenever you talk to anybody in DSO world yeah the number one problem is finding associates yeah and and  a lot of people say you know the average dinners and these deals only last year or two well it's the same in private practice there's nothing different than private practice for those how do you find a dental associate you and I both don't want out of school you want to with experience how long how long do they have to stay with you do you before you say this is a good deal they lasted this long so they made relationships we made money it was all a win-win situation and then where do you see the turnover where it's starting to scare the patients every time you know that's why I'm not afraid to yes I was out here every time someone comes in from DSO they just say well I went in there and they said I needed eight fillings I went back to have it done that dentist wasn't even there and then there's another one and then another one and finally after I've seen four different dentists my friend told me to come see you so so yeah dental associates where do you find him how long do they stay what percent of the graduates do you think just want to be a dental associates what percent of them just want to work for you until they learn how to do basic dentistry than open up so talk all things associates  

Michael Pontrelli: yeah I mean so I've interviewed a lot of associates and it's sort of all over the map I think you know just to sort of touch on something you and said before about some of these practices especially the corporate practices where the associates are funneled in and out and the patients aren't getting good experience I think that's really largely reflective of a poor comp structure and retention strategy for the dentist and it's a very you know basic human capital approach that just gets missed and overlooked III think it's also very poor middle management really managing those  dentists and largely advocates also once these corporates get so big and get so bloated I think that they can't really provide the right kind of experience it's just too big of an operation to manage and  most of the executives and the DSO world would agree with me when it comes to that and I think the other big issue is that a lot of a lot of non clinical professionals executives however you want to put it start getting involved in the clinical even though they say they don't and they start talking about pushing performance and metrics in areas that really you can't push and drive right it's you have a doctors capability and they can only improve so much so I think that's the reason why you see a lot of that turnover but now finding the right dentist is  what about making the right kind of connection it's a still a very big human element you know do you get the right vibe when you get in front of that dentist do they get along with you  know do you get along with them do you think you can work with that person we use many different sourcing methods everything from dental post to indeed to using recruiters I mean there's a whole gamut of strategies and ways in which you can you can find and attract associates all pretty standard like any other profession um but as long as you get the right associate with about three to five years of experience minimum and you give them a couple of good working interviews really you don't find out how well they really work for with six months right you just you just don't but you really aren't at any Liberty to just kick that doctor out after six months really what I think you do is help improve that doctor when you have them so I mean it's Harper to answer a part of your question which is what are the long-run effects of that because I mean we've only been doing this the acquisitions for you know about 30 months so what I can tell you is that the doctors who have stayed on seem to like working for us which is great for us and for the associates that we've brought on board they seem like more they like to work for us as well but I think the  associates that do want to leave they mostly want to leave because they want to open up their own practice and I think that you know you're always gonna run into that problem with associates cuz any associates worth their own salt eventually right once they've they've proven themselves to be legitimate producers they they get that itch and they want to they want to see what it's gonna be like on the other side my job is really to prove to them or show them an alternate option to stay with us 

Howard: so um what when you you've acquired how many practices have you bought so 

Michael Pontrelli: we purchased six offices we've done one de novo and then watching we've actually purchased all together seven offices but the first office our flag that was bought in 2006 and we've done about six acquisitions since 2016-2017 ish and one de novo we did back in 2015-2016 and so de novo is I yeah start from scratch and no acquisition

Howard:  so you've bought seven dental office acquisitions she's listening right now she's never bought one my first question on acquisitions is when you go to Wall Street they're always I mean when I was born I'll be this Thursday I'll be 57 I was born in 62 the average S&P; 500 company was about that age it was over 60 now that I'm gonna be 57 almost 60 the average S&P; 500 companies not even is a teenager it's not even 18 years so they're always merger acquisition merger acquisition and most of the dentist they'll be in a small town of like or dentist and the old fat senile guy finally gets ready to retire and it's like okay so you're gonna buy that right you're gonna buy that role in your own no and then and then it'll sell this um 25 year-old highly energetic person that's willing to and it's like and whenever I see a dentist that's doing 2 3 4 million dollars a year they're like I didn't want that old guy to sell us some young puppy I bought it when he put the practice old I bought it rolled it up to mine in fact I was able to talk him into coming back and working for me a day or two week so my question is why do you think dentists don't do mergers and acquisitions and when you do one what are you actually looking for why did you buy the 7 you're looking for yeah yeah so well that's a very deep question asked right and say there are multiple answers there why don't Dennis do a lot of mergers and acquisitions work 

Michael Pontrelli: I don't think it's really in their blood and that's not a bad thing I think that Dennis become healthcare providers because they like working on patients they like helping people and helping patients and I think that there sometimes there's that there's a point where you stop being able to do that as a provider unless you have associates in your office and you're a great manager you stop being able to do that if you're if you're owning multiple locations right which is why when  a dentist does do it they have to step away right then step away and they have to give the reins to the associates and pick the right associates to do that buddy but they can't step away completely so I just don't think it's in there at the you were to ask Mary who works for us what gives you the  greatest satisfaction every day it's helping out that patient in the chair that's what they like doing that's what she likes doing I could speak for her and I think the same thing could be said for Jody and any of the dentists that are working for us today you know what do we look for well so we have pretty specific criteria so I a little plug in here for us you know we're typically looking for practices that are doing you know north of a million dollars we like practices doing about 1.2 1.3 we like passes in suburban areas high growth areas we don't really do any  D HMO or Medicaid business the practices are usually going to be Network preferred although we will work with a fee-for-service practice and ideally a doctor looking to stay on and most of the doctors who are looking to partner with us which is how we really think about this even though we're acquiring that practice most of most of the doctors are looking to get equity out of that practice you know cash in some chips pay down some debt some are looking to flat out just retire because they're tired of practicing or they're tired of managing and they need more time with their family and we're able to facilitate that for them in fact this is one little plug in and I hope I answered your question if not please just challenge me on it now I'll continue you know answering for you but we have gotten so confident in our ability to grow up practices now we have started communicating with some of our partners in the dental community everything down to it to a supply rep to an executive at a big holding company or even accountants in the community we've pretty much told them look we're willing to go into a dental practice that fits our basic high level criteria and invest up to a hundred thousand dollars of our own money into that practice zero recourse to the dentist they don't owe us anything and the only thing we ask is that if we grow their practice which we can do and we've done it in fact our last pipes acquisition was nine hundred thousand it's now doing 1.8 million or 1.7 million it comes out to roughly 96 percent growth all we ask is that we take 50% of the results so both parties win and I don't think there's anybody in the dental community willing to do that to put their money where their mouth is or anybody willing to work on a contingency they're more likely to come in there and tell them tell the doctor that they've got the secret sauce and they're gonna have to pay them monthly and hopefully something happens that's how confident we are about our business model of what we do and how we can grow practices into these results for doctors 

Howard: ok so let me say you prefer acquiring dental offices to collect what did you say 1 million year or what did you say collect so they've got to be doing least a million dollars a year there's reasons for that yeah multi-million dollar year a network preferred low weight talked about she needs to know how you think why do you want a dental office that's collecting at least one million year 

Michael Pontrelli: we also it's a little bit different when a known occupier runs in office they can risk to take a lower salary right fort for us after all the overhead is taken off the table there's not much margin left I mean even put it in perspective you know we might make 50 to $100,000 on a practice that's doing about a million dollars okay at one point to 1.3 million the profitability is a little bit better but we can we can compensate our doctors more handsome Lee or richly we should say and be able to provide them with greater earnings potential as an associate as opposed to them going somewhere else and you said dental offices that are in network for dental insurance and not for a fee-for-service we would prefer that we can't work with people serving offices but we prefer to network office 

Howard: okay she doesn't even know what in-network dental office means she's a quarter of my homies are still in dental school and the rest are all under 30 so who Condon did my dental kindergarten class what does that even mean in network explain explained what that is and why you're looking 

Michael Pontrelli:  so in network means are contracted with the insurance company is based on particular price guidelines right so the insurance company recognizes you as a preferred provider through their network and as a result the network will at some level deliver you patients it also communicates to the public that you from a pricing perspective are within an affordability range as opposed to give you the best example right for those listening who don't know I give me an out-of-network office and be charging $1,500 for a crown as opposed to an in-network office charging $800 for a crown right so there's a there's a big difference with that there are some considerations though which means you've got to do much more work in a network office than a network office to earn the same amount of money but you've got what I would say to be a more recession-proof and a safer business that you're running one that isn't as dependent upon the doctor so um so another way to say mister is just dental offices that are signed up for the PPO s exactly and you take all the PP o--'s you said you didn't take Medicare or Medicaid well so that wouldn't be that wouldn't be considered a PPO so Medicare and Medicaid would be government insurance typically we don't favor that because there's just too much I would say regulatory risk around Medicare and there's also a ton of compliance risk I'm sure you're familiar with make shot Murfreesboro out of Tennessee are usually yeah

Howard: just a real simple you get in bed with the government you're going to get screwed and that's way a very heavy hand and I know a dentist right now who's practicing in Mexico because his beloved and beautiful and I loved Karen his wife receptionist was screwing up all the Medicaid billing okay so international by accident quite accident yeah yeah so international people it's so confusing the United States has a federal government and that's Medicare which which takes care of people over 65 Medicaid is with each one of the 50 states Obama did the craziest thing when he rolled out Abama care since he rolled it out through Medicaid it was 50 most people like in Arizona that were an access didn't even know Obamacare was access so it was a branding nightmare if he would have done Obamacare for Medicare at least everyone would have known what the hell he's doing but Medicaid is different all 50 states but here's a deal you  he'll half the dental offices right now are getting embezzled again so obviously if you can be embezzled against you're gonna have a receptionist screwing up all your billing codes and then if Medicaid at the state level finds out you're doing something wrong you'll probably go to freakin jail so happen you know

Michael Pontrelli: I mean the most recent case we were actually floored by this I mean what would really happen sorta synopsis of his office was that he had employed a bonus system in his office and you know that dental employees sometimes they're not cut from the right cloth sometimes they come from the wrong you know area and I'm not speaking for all broadly but it can happen in any business right so he's been talking about my five sisters no but sure  what they were doing was they were just submitting fraudulent leaders to the insurance company because it would cook the production number so they get a bonus but the effect of that was that the doctor who's in charge of that unknowingly was  then being investigated and they wanted to make an example of him because they don't have a huge budget to do that and he's now in prison for 30 months all because his employees wanted to hit a bonus so anything that can  cause a loophole like that for our business we want to stay away from completely yeah  

Howard:and you know what so it's called the downside it's like when you say you want to go parachuting and you know your best idea was to jump out of a perfectly good airplane and I say well what's the upside oh I can say I did it what's the downside you're flipping dead I mean and you don't deal with the government mean like right now everybody's outraged because you're hearing that China has like a million Muslims in prison and I'm like yeah that's  really bad right so how many how many does your government have in prison right now yeah well your government has 2.3 million people in prison so if you're our age you're china so you're gonna let everybody out of jail who smoke pot and did not do a violent you're gonna part them all today oh no so um yeah you just you just can't do business with the government because their hand is so heavy it's not worth the downside it's like why I don't do in office sedation because if it goes right it's just awesome you put her to sleep she woke up or was it aa person saying if it goes wrong one time you're toast you're depressed and that's why the only three publicly-traded DSOs in the world - and - in australia 1 300 dentist 1 300 smile the other ones a smile Pacific and then the one H & R out of Singapore all three in order to go public their lawyers said no in office sedation for anyone under any form and over 65 because that's when everybody dies from IV station under 18 over 65 and you and they don't want to do business with the government either because they don't want to have Karen in accounting do in this case my friend is wife just she was just incompetent and now they get to retire in Mexico and live out their life because they come back to here they're gonna go to jail for just being ignorant yet the government is the most ignorant entity in in the country today so enough enough of that stuff so I'm so you don't take minutes oh you're so you wanted a dental office that collects 1.3 million a year you wanted one that's in network and sign up for PPOs I know you don't take Medicare or Medicaid or getting better the government but do you take every PPO in Texas I should pretty much

Michael Pontrelli:  I mean there are some restrictions in that some of these PPO insurances will only like see a specific in network provider which if we're out of network we won't be able to do that 

Howard: are you gonna change their name I mean are you Kroger where you buy girls stories I'm keep your name are do you you let them keep their own name 

Michael Pontrelli: no so one of the things that really sets us apart not only is a flexible engagement model which you opened up with is that we don't mess with the community brand there's very similar where Heartland does is an example we don't mess of the community brand but more specifically we do not mess with the staff culture I think too often doctors are not given enough credit for the culture they built and what a lot of acquirers make a mistake in doing is when they walk in a dental office they think that they know how to do things properly and they know how to do it right well you can have a million of one great ideas but if you don't have the people that execute them that they no longer are good ideas so you know one of the things we typically try to do is understand how that office operates before hand and work with the doctor very closely to have that doctor remain a leader in their practice so that that transition is smooth and so that we don't ruffle any feathers in that process right so the employees feel like they're appreciated and and then that their practice is gonna remain the same practice it was before they sold it in fact as far as we're concerned nobody has to know they sold it to us we can be introduced as partners for all we care we have no ego in the game whatsoever

Howard:  um so you're you're just like Kroger then when Kroger buys the grocery store like I said Kroger and ona's fries in Kansas Dillons what's the Kroger grocery store called out there Kroger is it 

Michael Pontrelli: Kroger that's why I didn't know I don't know much about the kroger brand to know that they own a lot of other subsidiaries but no it's just Kroger here but we don't believe in franchise value ie you know castle dental or any of those things we don't do that at all yeah so 

Howard: Kroger owns my gosh Ralph's Dylan Smith's Kings super-city market pharmacy Harry and but but you said it elegantly you said you don't want to interfere with the the community brand so they've been they've been first brand dental sup but I worry I'm going to keep honing down this you talk about when you go into an office you're able to grow their practice and yeah I look at the behavior on dental town they'll spend the most amount of time if they're gonna have to spend a lot of money so this she's wondering she just walked out of school 208 dude when you say you spend a hundred thousand dollars in newly acquired dog is that because you spent $100,000 on a new cad/cam machine or a CB CT machine or some hundred thousand dollar laser industry does she need those big purchases to be all in the fast lane like you you know this this could go multiple directions right but it depends what you want to do as a dentist right

Michael Pontrelli:  I mean is the technology necessary absolutely is it is it is it necessary right out of the bat maybe not so it depends on what your proficiency and capabilities as a dentist are if you know if you're very confident your capability you just want a bread-and-butter General Dentistry Office yeah I mean you probably want a comb beam because it's it's a great piece of technology but it might not be something you need for the first six months as you're scaling up your business maybe you want to focus on getting cleanings in the door and and do you know bread and butter dentistry like crown filling and bridge do you think a hundred thousand dollar cad cam is a wise investment or not really you know it's hard answer that question is again it all comes down to the dentist I mean for us we really just want to focus on practices that are that have a very strong annuity based hygiene program meeting patients coming in the door they trust you they believe in you as a dentist they're not afraid to come to you and when they have to do their work they'll do the work crown filling and bridge I mean if you want to do implants as an example and  you have a goal set to do a certain number of implants you could probably back out the ROI on spending $100,000 on a comb beam I mean you know we  have one office that we're looking at actually getting one but it's going to be a hub where we send a lot of our patients and I think we can get that cad/cam for around 75

Howard:  so I mean we don't know where you buy the cheapest cad/cam where where dental town house the classified yet we have five thousand six or twelve classified ads and it's the big and I when I go out there and lecture the dentist's I came up and they want to buy me dinner or that they feel like they really owe me it's because they bought some forty thousand dollar laser on dental town classified ads that the guy bought for a hundred and twenty thousand so yeah the classified ads but I don't know hold your feet to the fire yeah do you prefer urban or rural okay 

Michael Pontrelli: very good question I would say we prefer neither so I would prefer that was one of the choices it was here because can't make city to it I would tell you both have their complexities in terms of the best doctor relationship power go rural every day of the week I mean I have met some of the friendliest and nicest dentists in rural Texas in rural America for that matter they're there they're just a different breed and their practices are I think I can make this claim most of the time majority of the time they're more profitable and that's because I think these rule dentists are able hold on to a greater market share than you can in urban areas that are having more heavily saturated conversely you  have a much harder time staffing those offices over the long run and I think that's what a lot of rural dentists are actually finding urban urban offices you have no problem staffing them and you don't have to worry about some of those trickier issues and running the business that you would in a rural area but if you really were to hold my feet to the fire I would tell you I love rural practices because I think what really is the best thing is the relationship with the doctor that's the most important thing have you've got a good relationship with a doctor and you both agree on things together you can make anything happen but 

Howard: but some people say they don't want to be a DSO in a rural area because it's uh it's it's hard to find doctors to work out there yeah but I asked you did you for urban or rural you said neither is that because the answer was suburbian correct 

Michael Pontrelli: yeah suburban suburban is really our target market and that's because you have a lot of rooftops you have a lot of families that are gonna be staying in the area okay I'll give you a good example our marketing spend in urban practice locations is much higher than it is in suburban and that's because the urban areas in the UT Houston is an example it's a heavily oil and gas rich business market it has a lot of foreign transplants a lot of yuppies and what ends up happening is when the foreigners come in and out and leave you have a cycle of your patient base the marketing spend must be higher in order to attract new patients because of that but when people get married and have families then moving and settling in the suburbs so overall your patient experience has to be much better and your marketing spend is much higher to keep fulfilling the new patient bucket every three to four years

Howard:  okay so you bought seven dental office via acquisitions and you did one de novo so does that mathematically mean you just prefer acquisitions over de novo why  was only one a de novo which  means starting from the beginning anew why don't why just one start from beginning scratch practice and why seven acquisitions 

Michael Pontrelli: yeah so that's the interesting question that's more of our personal experiment you could talk to people in the community doctors in the community or even non doctor operators that love to know bosz because they believe they have the secret sauce for it for us when specifically when our CFO crunched the numbers this we found out that you're running a higher risk with a de novo in opening it a financial perspective but you also can exceed the entire cost for that practice when doing a de novo the capex and the operational expenses associated with a de novo sometimes can exceed that of an actual acquisition between 7080 percent of revenues so it's also very  location dependent I really do believe my our conviction is that the success of your de novo practice is gonna be probably seventy five percent at least dependent upon the location you put that practice in alone I think you know visibility is extremely important when it comes to getting new patients 

Howard: so you think the location is seventy percent of your success you know I'm throwing a number out there

Michael Pontrelli:  I'd hate for someone who could prove me wrong to prove me wrong but our conviction is it's a big majority a vast majority of the success it's gonna be location driven its location driven and so it's not urban which is downtown which

Howard:  but by the way lecturing in 50 countries the reason downtown's are so messed up in America is because of the way you subsidized gas so and what I mean by that is when you go to buy gas it's just you're buying the gas from the gas company in all the other countries the gas is taxed to pay for all the roads and bridges so that's why your gas is two dollars a gallon and it's $8 a gallon everywhere else because when you're paying $8 a gallon you don't want to commute in from the suburbs so you realize man I'm finding $10,000 a year in gas I'm just gonna move downtown so when you go to London and Paris and Tokyo and at all everybody has an awesome downtown because they heard the government doesn't subsidize the gas and what they do here is they pay for all the roads and bridges out of general taxation so no one has an incentive to conserve in fact you even call it a freeway and  you can't have anything free in the world because then you violate all the rules of economics so you don't want to go urban because of the there's no we don't tax gasoline for the total cost of the car the roads the bridges whatever so we have freeways so they all escape the urban blight and go to this suburbs and you're saying that's where the sweet spot is in dentistry you like that absolutely those are the best locations okay and then when and by the way when I was talking to other DSO people they said they don't like to acquire practices they prefer to do a de novo because when they go to acquire dental practice that the staff is so dysfunctional that by the time the fire Karen the assistant and hire Ellen it's a new idea by the time they go over all that stuff they've got a migraine and they wish they never even went into dentistry and so you're saying what you're really looking for the most is a trusted brand loyal staff culture and that's why you don't change the community brand absolutely

Michael Pontrelli:  absolutely you know we have had our issues of course when when transitioning a practice everybody will but we just feel like the risk profile is much higher on the on the de novo and I can point to people I know in the community very very well that would disagree with me on that but for us we just believe that the risk profile is lower on the acquisition front and  we believe that we're able to with our capabilities to manage the staffing a little bit a little bit better I think that the main issue with acquisitions and the reason why they don't work and the reason why that culture is an issue is because they go about it the wrong way what they do is a lot of these DSOs will go in and communicate quite overtly that things are going to change and change drastically as opposed to were coming here to work with you I think that is the key the key component to failure for a lot of these major dsos but then again I want to be careful in even classifying them as failures because I'm only 30 months old so what I have to I have to take a step back and and be careful what I'm saying as well right because you know we may have an issue down the road as well 

Howard: so I loved your pun when you said would you buy a dental office you $100,000 into newly acquired dental office you put your money where your mouth is put your money where your mouth is if that isn't the hallmark pun of dentistry you know when you invest $100,000 into a newly acquired dental office where these uh Benjamins going

Michael Pontrelli:  well so it's a six to six step process but let me clarify something right the six step proprietary process a good majority of is marketing both internal and external we believe we do have a secret sauce when it comes to that and understanding its attribution which a lot of dentists especially those that you were talking about when they come out of dental school are probably gonna spend money on when trying to grow their de novo or start out but it's not a hundred thousand into the practice we just bought what I was actually referencing was a whole other strategy for practices we haven't bought in order to justify our capabilities in the marketplace I'm willing to go to an office I don't even own and I'm willing to tell that office that's doing a million a million-two Hey look I know that I'm good enough at being able to grow your business my team is good enough to grow your business then I'm willing at no recourse to you to invest a hundred thousand dollars of my own money into growing your business for you and all I ask is that we split the results 5050 I think that is the pun of that makes a lot of sense right it's we are putting our money where our mouth is and we're proving to the dental community that we're worthy to do business with as opposed to what I think really exists in this community is a lot of sharks both marketing supplies everything when they come in and they sell a dentist on a lot of great things and it just never comes to fruition so for us that message I think resonates with high-performing doctors where we can say look we'll  come in and we'll grow your business on a hundred percent contingency all we're asking is that we get paid if we have results for you and you win and we win together and then yeah 

Howard: so um so to keep this straight okay so my office does $1 a year and it Nets a dime if you come in invest your dollar into my practice and it goes from doing it dollar and netting a dime then now and that's two dimes I'll split that other dime with you will you write it well above the exactly it has to be above the norm right above the average Yeah right it's any increase above that so we went on so would you rather going forward is that your business model you'd rather do that then actually get married and buy the practice and on the practice would you rather just have that nobody bull I know but which one excites you more well

Michael Pontrelli:  I mean the acquisition is definitely excite us but I do think that there will be some good will that starts rolling here when we're able to do this for these practices and if they do want to sell in 1 to 20 years they'll be able to come to us and they'll be able to say hey you did a good thing for us we'd like to talk to you about what we want to do with our practice from a transition perspective I mean there is that angle but ultimately what we've got to do lots of different things to raise awareness in the community that we are talented skilled operators and we know what we're doing and we think we want to change the face of Dentistry by providing a different type of relationship with the doctor 

Howard: and so but what you said when you acquire practice that you have a six step four type proprietary system

Michael Pontrelli:  correct well there's a six step proprietary system that we go through to grow those businesses that's correct can you can you summarize what that is yeah again it starts it starts with elementary marketing it goes into deeper marketing which you know  includes internal strategies as well focusing on patient experience focusing on reach care making sure your hygiene program is full we even have one of our last steps of that is actually a network analysis strategy where we actually will assess whether we should take an office and it's important I mention this in or out-of-network depending on its demographics and what we look at which is proprietary to to grow that business as well 

Howard: okay let me go Gillian so the six apps were first elementary basic marketing number two is more advanced internal marketing internal marketing correct three was patient lock I'm not I'm not listing it out exactly but yeah three would be you know we're focusing on what we're focusing on re care read care is a big strategy patient experience would be another part of that as well that's for yeah two more so they're weary care to be 

Michael Pontrelli: patient experience there's a patient experience element as well it would be standardizing patient experience and then the sixth part is the the network analysis essentially where we we are going to assess broadly whether we should take an office in or out of network and it can go either direction right I think when some doctors don't know is how should I run my practice from a network status perspective some practices actually would fare much better out of network and some private would be fare much better in network and so we look at both of those as a part of our analysis so on 

Howard: so it's basic elementary marketing then advanced internal marketing the reek air which you call the hygiene annuity the patient standardized patient experience network analysis does anything I missed I think I think that would probably summarize it up there's probably another step in there somewhere that I'm just not coming up with right now but there would be six yeah and what is your exit strategy for this I mean are you doing this so that some day that you can sell 100 locations to Heartland are you thinking that IPO what is your exit strategy we would be honest 

Michael Pontrelli: we don't know yet I mean it's very attractive obviously if we want to sell these practices but we sell a lot of runway to go but I mean the cash flow on on a group of dental practices is also quite rich and if you are still you still want to remain in the game and operate them it might not be who you'd actually sell and you guys are based out of Houston we're based out of Houston that's correct yeah

Howard:  um yeah sorry about that that a hurricane you guys are you guys back on your feet from that completely or yeah I would say I would say 

Michael Pontrelli: I mean there are some areas that have sort of been transformed you go to the Maryland area as an example and most of the homes are still on stilts or they put them on stilts because they'll never get out of that floodplain lovely where I live I wasn't affected by it but I did have a lot of people that I knew that were it was it was quite a disaster what I thought was really interesting though being someone that's not from Houston originally I grew up outside Philadelphia was quite interesting how the community not just in Texas but from other neighboring states like even Louisiana had come to pitch in and really to help out that was that was quite amazing to see I got

Howard:  four of my five grandchildren live in Beeville do you know where that is no where's that it's between it's about 30 minutes from Corpus Christi okay  I think I thought a far as you said from Corpus couple hours well yeah and they no longer see me as a dentist because of my good buddy Tim Rainey in refugio Texas has taken over them but oh my god those storms are crazy down there I mean my gosh  I mean it was it was crazy I mean to see how that thing through it was throwing trees around well when I was down there it looked like it looked like Godzilla took a tree and threw it like it chuckling a spear crazy stuff but um so I'm um I'm thinking um oh well first of all I know someone's listening right now and they like well I got a unique story if someone wants to know if you acquire them are you only looking in the Texas area I mean what you know how far away from home would you go we're looking to go in any of the states of the union there are some exceptions like for instance I'm speaking very broadly right now I mean New Mexico might be a tough market to break into staffing the type of dental practices that exist their staffing might be an issue Florida's very hard for licensure standpoint but I mean the list goes on was from a license your standpoint yeah I think Florida  is kind of difficult to for a dentist that doesn't have a license to go through the application process we have partners that we want to work with in that situation friends actually so where's their number 1 next state that you want to go to um well I mean I'm looking all over the place I love Florida I will tell you to us in oh my god I'm looking at one in Scottsdale right now it's being the only state that just passed a law that will accept a state license from any professional of any of the 50 states I don't know Arizona is in 

Howard: Arizona that's great then that works to our advantage yeah and that's what the whole country should do I mean if you imagine why is that because it's all restrictions of Barrett anytime a business goes to the government they're gonna form a cartel because what does the government have it has two things it has the legal system which they call justice yeah and who writes the laws the congressmen where money's the answer what's the question so everybody goes and gives the Congress money and then Justice Lady Liberty is like oh well this is justice no it's not you're enforcing a cartel and if we don't go along with it we'll be put in a cage and it's all you know even Adam Smith said when two or more men are meeting they're conspiring against the masses and it's all restrictive governance so our business minded governor said no if you're if you're an accountant or a pharmacist or a dentist in New Jersey and you want to move to Arizona well we'll accept your license and so if I was a DSO there's only one plate and that's why I'll give you the other measurement the highest dias Oprah print penetration according to the ad a who has the best economist in all of healthcare with Mario just just nomas Marco he's either peachy used to work in the World Health Organization United Nations anyway Arizona is the highest and penetration of dentists working for a DSO it's 18% its own wanted one in five and yeah and they and you know people just don't like the weather in New Jersey and Minnesota in Canada I mean why I mean if you're living in Canada you're probably happy because your brain is frozen and you can't think straight and and so that's the next question they're all asking they're like what about foreign licenses because the next logical step is for my Canadian homies a that come on here are practicing dentists in Toronto by the way when you said some you were over an hour when you opened up with that very sad story about um her Michonne Oh Thomas's kidney transplants when I got out of school I came to Arizona and I was looking for a job but I was building my office I only want to work somewhere for months well no one wanted to hire an associate for four months but there was this one lady and she was like an 80 year old lady who owned like four dental office I said well what's her story and they said well she fled Adolph Hillier and and when she got to America they wouldn't accept her dental license which I agree with because she came from the country that makes Mercedes Benz and you know we this land of Chrysler so obviously a German dentists making Porsche and Audi is not good enough to be an American dentist and she went to an attorney and they said well you know it's all restriction against fair trade but you know what there is a loophole you can own a dental office so she was handcuffed she said she cried she cried she cried but since she couldn't drill with her hands she just had to do the business and because of that what did she have four officers doing two and a half million yeah a ten million and when I met her she had a limo and a driver  in her offices great having the time of her life and she was like in her 80s netting 1 and 1/2 million in cash because she couldn't drill fill and bill and if you look at Heartland dental that guy owns the most dental offices he hasn't seen a patient in 30 years the other Rick you know Rick working on the other Rick Kirchner he hadn't seen a patient 30 years so what that remind you is when you get out of school and you're trying to take every hands-on course and you're trying to get your fa g BM AGD diplomat like I did all that time you're drilling filling and billing you ain't learning nothing about the business of dentistry and then and then what are you Dennis do they say you know what I'll do I'll work hard Monday through Thursday then Friday morning I'm going into the business yeah they wake up Friday morning they're fried so they go golfing and they and  I say you know if you want to do business half day a week make it Monday flippin morning go and they're strong and so and they don't want to do any of that because any day were chefs we want to make lasagna I'm a dentist I'd rather pull wisdom teeth and go play golf at any golf course in the world and my homies they they work with her hands they their art is fixing teeth I'm addicted to it they love it and that's why guys like you are gonna make a big impact on this career because you see the Achilles tendon and that is yeah one of them knows their numbers well I said I think I mean within the broader context of the education crisis here like especially with student loans and everything I think it's important to mention I I don't know how a dental school can justify charging the amount of the charges and there could be some ignorance on my end here because if you're outraged that the dental schools are charging that much for they graduate with $280,000 student loans and are you outraged by the lawyers where the average dentist divorce is a million dollars I mean alright if you think their student loan goes high wait till you get your divorce bill but when you but when you say two hundred eighty thousand dollars man I haven't met a dentist that's that's under 400 and so you know what I find to be a problem is that they're going to school and they're not being taught anything about business I mean even basic prerequisites for someone like yourself as an MBA basic prerequisites and even even hands-on practical like having a conversation having courses focused on working with office managers and understanding human capital and understanding human behavior and understanding you know how to manage people and how to lead those are things that that are vitally important to the success of your business while you're carrying all that debt and paying that debt off and I think it's a travesty that I'm not the only one echoing this I'm sure but it's a travesty you can come out of school with that much debt and there isn't a cry from almost a unionization of those going to dental school to say you need you must provide this to me as a part of the curriculum that's I think I think that's vitally important that you know another thing too is I might get in trouble saying this but I think in a way if you are anti corporate again I think we're a different breed of group dental group dentistry but in a way if corporate dentistry is going to take off it's going to take off as a byproduct of the student loan situation and the inability of dentists to understand how to manage and scale a business if they did they wouldn't be forced into the situation where they'd have to actually work for for corporates for ten years right I mean this is my personal take on it but again I'm not going I'm not going to dog the the dentist working for corporates eventually they come work for me but but I do think that that will be a byproduct that needs to be recognized so do you think but you don't want new graduates anyway no it's a they don't want it this sounds so mean right like I don't I don't know why I don't want right yeah I mean I just I need the experience right it's it's hard for me to take a new grad who you know it's gonna take them you know three hours to prep right I can't do that yeah well I mean if I mean we're all selfish that's you today I mean if I had to have a a surgery say say I'd have a bypass or a prostate or whatever I don't I don't I want that guy in the sweet spot between like 40 and 50 I don't want someone as old as me and I don't know someone as young as them I was some guy right in the sweet spot so uh yeah that's why I think Army Navy Air Force I love Aspen Aspen they go to the port that their focus is on the Medicaid where there's no dentist with an in-house lab man and and my um they I've lost a lot of patience to them because they have they'll go in and get a their denture realign for $89 it's like oh yeah I don't want to do that in fact I'd pay em $89 and drive them to Aspen just I don't want to do that it's not my markup niche and and and God bless them that they they want to do that I don't want to get in better Medicaid and I sure as hell don't want to realign dentures and if I do it I certainly am NOT doing it for 89 bucks but uh my god I could talk to you forever I'm last thing I want to ask just last les ass and when you're growing these high-value practices or any expensive equipment that you think is is mandatory or an obvious basic Gibbon 

Michael Pontrelli: no I mean III do think any good imaging I think sensors myth on a real high ticket item but I do think going digital is really important I do they can enroll digital scanner is really really important we use I Tarot I think that's something I think would be mandatory I think if it provides a better clinical experience and it allows you to I think even the progression dental progression is important as well being able to take those multiple images over time and show the progression of someone's oral health I think that's that's extremely important I would say that's I don't want to say necessary but but darn you're necessary is there and 

Howard: someone wants to talk to you about a specific deal if they're like you know I I want you to come by my office or do that ring I'm how would they contact you really simple me don't want me to get my number I 

Michael Pontrelli: give you a number email so my phone number is six one zero seven five zero zero eight three six that's direct to me it's my cell or you can reach me via email it's gonna be Michael dot pond Raleigh that's P o n TR e Li at Memorial Park Dental com that's Memorial Park Dental com all one word but I'm happy to talk to anybody about even if they have an office doing you know a million million won and and they don't want to sell it right now but they could use some growth advice and I can go in there and analyze their practice for them and I'm willing to invest one hundred thousand of up to a hundred thousand dollars of my own money of our own money into it to show them what we can do all we ask is for that that consideration down the line and

Howard if you want to email me my email is Howard at Chippendales calm that CH IP PE and DA le s where I'm not just the owner I'm actually the dancer Howard knows that hey Mike it was awesome to have you on the show I learned so much um and I wish you'd go into dental town because dental town like to say it's where everybody thinks DSOs our public enemy number one and yesterday some little girl said well you know what I yeah I they gave me a job and I I really like working here in fact we published that list of the the Inc the Inc 5000 fastest-growing private companies in America and 29 of them were Dental companies and so I posted that on dental town and people said yes this little girl says well man I'm proud that my company's on the list and I'm proud they gave me a job and all you old farts didn't give me a job and I don't want to give him a job so uh thanks for coming on the show and talking about this area and it's been a real informative time for me to pop you thanks Mike oh thank you have a great day bye-bye you too

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