Showing posts with label buying dental practice. Show all posts
Showing posts with label buying dental practice. Show all posts

Wednesday, July 8, 2015

What’s Most Important To You When Looking To Purchase A Practice ? Part IV


This is part four of my five part blog on “What’s most important to YOU when looking to purchase a practice ? In case you missed part I-III, there’s a great thread on www.dentaltown.com asking this question and it got a lot of great feedback from people with different perspectives. As a reminder, I won’t be telling what SHOULD be important to you, that’s for each doctor do decide and prioritize for themselves. I’m just giving you some food for thought as you contemplate purchasing a practice.

Part I and II revolved around the revenue and expense portion of the practices cash flow and assessing the asking price and practice performance while part III addressed the people issues related to a practice purchase.

In part IV we’ll address the location and facilities aspect of a practice you’re looking to purchase.
Likely the most important part of the “location and facilities” aspect of the purchase is the demographics of the area followed by the actual location of the space. So what does that mean ?
When we talk about the demographics of the area of the practice we’re wondering if the area is a good area to maintain a dental practice. What’s the competition like ? Is it saturated with other dentists ? Is it a growing area for the foreseeable future ? Or is it a declining area where people (potential patients) are leaving & moving away ? What about the patient demographics ? Is it mainly white or blue collar ? What about the average annual household income ? What about the age demographics ? Is it primarily a retirement type community ? Or an area with younger families ? Is it an area you’re going to live in ? Do you want to practice in the same area you live in ? These are some of the demographics questions you need to learn about when you’re looking at a practice purchase and there are companies that specialize in compiling demographic reports for prospective buyers.

Then we move to the specific location of the practice. Is it right on the street, maybe a main street with a ton of vehicle traffic ? Or maybe in or next to a popular strip mall or shopping center with a ton of foot traffic ? Or, is it “off” the road, maybe tucked back behind several buildings with no vehicle or foot traffic visibility ? Is it in a medical\dental complex with other medical\dental professionals ? These are issues that will likely determine how accessible you are or how easy you are to find. Signage also comes into play here. The actual space itself may not be as visible as you’d like, however, maybe you have great signage that fronts a heavily traveled road OR maybe you’re on a heavily travelled road among a lot of other businesses but due to signage restrictions the space isn’t easily identifiable as a dental office ? These are issues that a prospective buyer needs to consider when they are looking at a practice and during the office visit.

What about the specific space? Has it been kept in great condition or is it run down?  Is it an older building that may require a lot of repairs and maintenance or a newer building that may not be high maintenance? How’s the square footage ? Does it fit your needs ? If not, will the space allow for expansion if the practice grows ? Do you see yourself in this space for at least 15+ years ?
You also need to know if the space is leased or owned. If the space is leased you’ll want to get a copy of the lease agreement and have your attorney and\or lease negotiator review it to see if it’ll be a roadblock to buying the practice. If it’s owned by the seller you’ll want to know if the real estate is for sale & if not, when would it be available. If it is owned by the seller and they’re not ready to sell you’ll need to address the lease issues as well AND make sure you’re fully protected under the lease since the landlord is also the owner of the dental practice. The last thing you want are lease default provisions that make it easy for the landlord to throw you out and regain the dental practice. If the space is for sale you’ll have to decide IF you want to buy it at the same time as you buy the practice. If not, you’ll want provisions in the agreements that give you certain rights so you can own the property if & when you want.

Now we move inside the space. We talked about the “building” but what about what’s inside? How many operatories are there? Are there enough ? How’s the actual space, is it large enough? What about the layout ? Does it have\allow good patient flow throughout the space? How’s the technology? Is it current or outdated? What about the dental equipment? Is it brand new, almost new, mostly old, or so old it needs immediate replacement? What about the furniture and décor? Is it “fresh” or is it from the 1970s with old, dark wood paneling?

You may need more than one office visit to know all you need to know about the space as one of those office visits will likely be to do a chart review\audit which can take some time. One thing we recommend is when you do visit the office and if you do visit it more than once, you should take to opportunity to video tape\record your office tour and replay it several times to make sure you know all there is to know about the space, furniture, equipment and décor.

Lastly, you’ll want to understand the office hours that are currently in use and whether or not you can increase office hours based upon the community. For example, if you’re in the middle of a city where most of the “population” is there only from 9-5, Monday thru Fridays, then expanding into evening or weekend hours may not be beneficial. However, if you’re in a more rural area, maybe around schools, early morning, evening and weekend hours may be more valuable to you than the middle of the day hours. You’ll have to decide what you want now and in the future.

Many prospective buyers initially overlook the importance of the space, location and area and start out focusing on the financials of the practice. Instead, it may make sense to understand the area first, then when you’ve identified practices for sale in the area, do a drive by of the specific location and get some firsthand knowledge of where it is and what it looks like form the outside. If that all checks out then it may make sense to gather specific practice information to continue your pursuit of possible ownership.

Part V of this series, the last part will focus on some of the other issues that prospective buyers may find important about buying a dental practice.
 Written by Tim Lott, CPA, CVA

Send your questions to tlott@dentalcpas.com
For more information on our services, please feel free to contact one of the members of the Dental CPA team by calling or emailing info@dentalcpas.com.




Tuesday, March 11, 2014

Dental Practice Purchase Checklist

We've been getting inquires asking if there is a checklist a dentist can refer to when buying a dental practice.

And when asked, we deliver.

Dental Practice Purchase Checklist


Tuesday, June 19, 2012

Should Dentist Purchase this Practice?


The dentist is willing to take $335,000 down and lease equipment for $50,000. The practice broker is not very happy and he demands the seller to pay commission on total $385,000. The seller is backing out.

The office has 5 ops, paperless, digital, gross production of $515,000, equipment is 5-7 years old. The dentist had this practice for 12 years. It is an FFS/PPO office.

If the doctor has had the practice for 12 years, how is it the equipment is only 5-7 years old.

The dentist says he was out of the office for 21/2 months last year due to health issues.

What does that mean? Was office closed for 2 months? What has production been over the past three years?

The practice has approx 1,100 patients 

Not with $515k in revenue; maybe two-thirds of 1,100.

The practice generates 12-15 new patients every month. 

That's weak.

The dentist works 3 days only. The fourth day is booked when it is really busy. I currently work at a busier office and would like to work five days initially to pay all the debt.

Find out the breakdown between dentistry and hygiene.

What would be a good price range to place an offer? 

Not enough information to know.

The dentist is expecting $385,000. Does this sound reasonable?

Not enough information to know.

Does the allocation of the practice price play a role in any way ?

Yes, though it's way too early to even worry about that now.

You need to gather all the necessary information to do a proper assessment of the asking price and the performance of the practice. THEN you can get into structure of the deal, allocation, and all the other finer details of a practice transition.

This first appeared on Dentaltown.

For more information, please contact info@dentalcpas.com

Friday, June 19, 2009

Compare Two Dental Practices for Sale

I am about to finish a GPR and was hoping you could give me a little input on whether either of these options sound good.

Option 1 is a brand new, state of the art practice in a growing rural area. The practice grossed around 800k last year and has about 45 NP a month. The senior doctor wants me to work as an associate for 6 months to a year and then go into a buy in phase. He has been hesitant to establish the buy in price up front, but did give me a ball park price that seemed pretty fair. There is also a 15 mile non -compete radius.

How many days is the owner working now? How many days do they want you to work? How many days will they work once you are there? With a base of $800k that's about a 4-5 day per week practice (i.e. 32-40 doctor hours) so make sure you're not looking at a situation where you'll go in and sit around.

As others have said, nail a price down now. If he gave you a "range" asks that you agree to a number so you can move forward with the other issues.

You’ll need to see the financials (or returns) to make sure you're not getting sucked into something that SOUNDS great and winds up looking like crap.

The associate agreement is for 35% of collections and I would have to pay my whole lab bill.

35% of collections is good, again, agree with others, you should only pay at most 35% of lab, OR ask to keep it simple, 33% of collections period.

What about malpractice insurance, heath insurance, dues, licenses, CE? Who’s paying those?

There is a 5k minimum salary but I would have to pay the difference back to the doctor for months I under produced once I am making enough on my commission. For example, if I only made 3k the first month, I would get paid the 5k. But, if I made 8k on my commission the second month, I would have to pay the doctor 2k back for the first month and I'd take home 6k. Hope that makes sense.

You have no minimum then, you're working on straight percentage. If it's truly a minimum you wouldn't "owe" any shortfall back or have it offset future excess. Straight percentage isn't necessarily bad, just understand there is no minimum. Ask what happens if he pays you $5k for 3 months and you decide to split ways after producing only $30k. If it's a true minimum you'll owe nothing to him, just make sure you're talking apples and apples.

A percentage might be an issue if the practice doesn't grow fast enough to support both of you OR the owner doesn't reduce their days.

There is also a 15 mile non- compete radius.

NOT for the first 6 months to a year....

Option 2 would be a very small practice that is only open 2-2.5 days a week, 3 ops and is a little dated on equipment. The gross last year was about 250k and overhead just over 50%. I am still waiting on some more details, but will post more once I get them. This practice is also in a growing rural community and I suppose I could open it up 5 days a week and take Medicaid or more insurance plans to bring the production up.

Do either of these situations sound like good deals? How do the numbers in option 1 stack up to what the rest of you have been offered, and what aspects need to be negotiated before proceeding?


Depends on the price, many more specifics and what you're looking to do....

and what aspects need to be negotiated before proceeding?

On option #1, all aspects of your employment and buy-in.

On option #2, the purchase details....


Thanks for the reply. Here's the deal, doctor is not that old and is not planning on cutting his hours at all (4 days). I would probably be working 5 days a wk.

Can the practice support 2 full time doctors? Does it have 2 full time doctors now? If not, how is it that a one doctor practice can jump to two full time doctors immediately?

You suggest looking at the financials but what specifically should I ask him for? The transition company has done a full run down on this practice but I haven't seen any of it.

Ask for that, it may already have the practice financial information in it.

As far as benefits, I'll be responsible for everything in the 3 month probationary period and if we continue beyond that, I'll be reimbursed for malpractice and my license fees. No health insurance benefits though and I don't like that.

Then ask for it! Just because it's not offered doesn't mean you can't ask for it and maybe even get it.

You mentioned that the non-compete won't hold until after a 6 months to a year period.

What I meant is make sure that ANY non-compete they want you to agree to doesn't kick in until 6 months or a year. It can kick in immediately if you agree to it, however, the last thing you'd want to do is agree to NOT compete and leave an area you'd like to stay after 3 months because you agreed to do so.

Is this true everywhere because the contract doesn't make any distinctions on time period? I wish I could give more specifics about where I am and who the company is but I don't want to violate my confidentiality agreement.

Most if not all confidentiality agreements allow you to share the info with your advisors...so that means you'd have to hire me to tell me...

On option 2- I met the doctor yesterday and got some more specifics. Practice has grossed an average of 220k for the last 3 years and doctor has worked 3 days a week and taken an average of 2 months of vacation a year. Extremely low overhead and the doctor has netted a little over 50% of that. He is entirely fee-for-service and has pretty high fees for the area (8-900 per crown). He refers out all endo, extractions, implants, dentures, partials, perio other than scaling, and ortho. Basically, he only does fillings and crown/bridge. He is willing to stay on for 6 months to a year but no longer. The building is shared between him and another dentist and they have a common waiting room and lab/sterilization. It's 3 ops, 2 hygiene and 1 doctor. I would have the option of buying half ownership in the building or renting from him. Should also mention that the town has 12 dentists and only 2 are under 50 years old.

The buy out price is still in the process of being set but from what the rep said, they generally place practices at about 70% of gross which would be about 154k. I am sure I can’t do a startup for that and at least this would give me a little bit of a patient base. It would seem that if most of them stuck around, and I did all the procedures that he's referring out, that this could be a good deal.

Any advice on this one?

I don't like the office sharing arrangement and even if you wanted to own it's 50% at best. What was their relationship with the other doctor in the space? Did they cover for each other? Do the patients know the other doctor? I know it's a small amount to pay, still at $150k I just don't like the setting....

I'll continue to update as I get more info.

This first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

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Friday, May 29, 2009

Dental Practice Buy-Out Question

Looking for advice on future practice transition....let me give you some background...

1. I worked as an associate for 3.5 years. Through the help of the owner (a great guy), he helped me grow my patient base to about 1,400 active patients by giving me most of the new patients. He brought me into the practice in order to take over when he retired so he wasn't so concerned about seeing new patients as long as his schedule was booked. He had a very busy practice and did not plan to retire any time soon, he was just too busy to handle anymore patients.

2. After this time (about 6 years ago), I bought half of the practice - which was basically the patient base, equipment, and everything I had built in those 3.5 years. After this half of the debt was paid, I was obligated to buy the other half, which is his patient base, equipment, and such. At this time, we started splitting the new patients. We have a joint operating agreement, meaning he takes what he collects, and I take what I collect. We pay for our own staff members and overhead, except that which is considered joint operating expenses (rent, phones, etc.).

3. Currently, my half of the practice has about 2,100 active patients, and his half has about 2,400.

4. My half of the practice collects about $650,000/year and his half about $480,000/year - he works 3 days/week.Now....after all that...here is where I need advice. He is about to retire, but still wants to work maybe 2 days/week. I am about to start paying for the other half of the business, which means I, technically, own the practice (patients, equipment, etc). He will work as an associate. I will pay all overhead and he will make a percentage of his collections. In the transition, what patients will he see? I also want to bring in another associate to help out with patient load. His half of the practice could easily collect $650,000 with 4 days/week and some "want-to".

Should he do hygiene exams on his former/regular patients on his two days, and book diagnosed treatment on his schedule?

Should I give the new associate all new patients in an effort to build his patient base, as I don't need them with the current volume of patients? Eventually, it will be a buy in opportunity.

I guess I really need advice on how to make this a smooth transition, without making the retiring dentist feel like he doesn't need to be there. I really look up to this man, as he was a true mentor and friend. I know he is having a tough time with retirement and "giving up" his practice that he has grown for 35 years. Any advice is welcome.

Thanks!



I also think that when you have a sit down with the retiring doctor, you need to make sure he understands that the priority is that there be enough work for you and your new associate as you'll need that associate for your future. The retiring doctor needs to understand that and accept that he is third in line to see patients, in my opinion.

If you can work it out that he can work two days per week I agree that you'll want the new patients to see you or the new associate. After they've become practice patients though does it really matter which existing patients he sees? Won’t it depend upon the patients wishes to a certain degree?

I need some clarity on some of your numbers though.

1. You say your half of the practice collects $650k, is that JUST you or you and your hygiene?
2. 2,100 "active" patients? The typical GD practice with 1,000 patients does about $750k. You say you have 2,400 yet only collect $650k? I must be missing something.
3. He has more patients and less production? Again, maybe the $650k and $480k are just doctor revenue and even still, that seems really low for nearly 5,000 "active" patients. Maybe the 2,400 and 2,100 is simply chart count?
4. How many chairs do you have?
5. How many hygiene hours do you have each week, average?

We are primarily a PPO practice, so yes, those numbers are lower than avg. Those are not production numbers, but collection numbers, after write-offs. They include hygiene.

Yes, he has more patients and lower numbers. He only works 3 days a week and isn't really motivated to be busy. That's an issue for me. There is a gold mine a treatment to be diagnosed from his patients, he is just really conservative in his treatment planning.

It is not just a chart count. Every January, we purge charts and inactivate anyone who hasn't been in within the last two years. We may have lost quite a few patients due to the recession and just haven't realized it yet, as their charts haven't reached the two year mark.

We have 7 chairs, 2 for each of the doctors, 3 for hygiene.

32 hygiene hours per week.

32 hygiene hours equates to approximately 1,000 patients, $200k in hygiene so your gross moneys make a little more sense. The "active" patient count still doesn't make sense though. I’m still wondering if you'll have enough work to keep the retiring doctor there for 2 days.

Sorry....I should have clarified that we have 32 hours hygiene per week with each hygienist. I'm not sure if the retiring doctor keeps accurate count of his "active" patients. I know they purge charts every year, but I'm not certain they inactivate every patient that they should. Like I said, this is a joint operating agreement...I don't have much say in how he runs his side of the practice. He is not a great businessman, but an incredible dentist. I just want to move this practice in the right direction when he retires.

Ok. Now the numbers are beginning to make a little more sense. Sounds like you have a practice that can support one and a half plus doctors, hygiene is doing approximately $300k-$400k?? Therefore dentistry should be approximately $900k-$1.2million for a gross production of between $1.2million and $1.6million. Depending on your PPO mix you should be collecting approximately 85-90% of that on average and I think you said you're doing approximately $1.130million.

So with a retiring doctor that really doesn't have the desire to be as productive as they can, keeping them around too long won't be helping the situation if your real goal is to add another productive doctor who would become your partner some day unless you also implement a marketing plan to grow the practice with new patients, which would likely mean adding another hygienist.

It appears you do have a great patient base to work with, now it's a matter of choosing the direction you want to take the practice in, choosing the right mix of team mates and if necessary, making the difficult decisions that business owners must make.

Good luck.

This post first appeared on Dentaltown.

Send your questions to Tim Lott, CPA, CVA at tlott@dentalcpas.com

For more information or to sign up for our newsletter, please contact arose@dentalcpas.com
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