Ⅲ Dental Clinics in the US
The dental industry is comprised of clinics of varying sizes and can be segmented as follows.
Exhibit: Size of the dental clinics and labor
The Dentists industry is highly fragmented with no single operator making up a significant portion of total industry revenue. In 2013, the four largest firms are expected to account for less than 2.0% of total industry revenue.
Visiting some dental clinics in the US, I sometimes realized that the operational IT system, such as electronic dental record system, is not introduced because the US does not have universal insurance system that covers dental treatments. In universal insurance system of Japan, dental offices need to send Medical prescription to insurer monthly, and they naturally have electronic system to make the operation smooth.
In the US, some small dental clinics even do not have appointment software system, and even manage the information in the hand with paper format scheduler. On the other hand, DPMCs that run number of dental clinics, has developed their own electronic systems for improving their operational efficiency as much as they can. Some of them even have their own engineering team. Last year, I visited a dental clinic of Smile Brands Group, and realized that dentist job in DPMCs is only treating patient in very efficient environment. Dentists even do not contact with managers of the company in their daily operation. This is totally different from that of Japan. Followings are representative dental companies in the US.
1. Comfort Dental Inc.
Estimated market share 0.1%, the company generated $154.7 million in revenue in 2013. Since its foundation in 1977, the Colorado-based company has become one of the largest dental franchises in the United States. Comfort Dental serves more than 3 million patients and has offices located across 10 states. The dentists own their offices independently. The company’s growth is attributed toward a low price strategy and other offerings targeted to a broad consumer base. Comfort Dental’s business model is oriented toward the lower-income population, with prices 20.0% to 30.0% lower than most local dental practices.
2. Coast Dental
Estimated market share 0.1%, the company generated $117.5 million in revenue in 2013. Established in 1992 as a single dental practice, Coast Dental has become the Southeast’s leading provider of dental services with more than 100 neighborhood dental practices in Florida and Georgia. Coast Dental was a public company until 2003. On March 24, 2004, the company issued a press release announcing intentions to unregister from the Exchange Act. The factors that led to the company’s decision to go private included the considerable legal, auditing, accounting and other costs associated with remaining a public company; the significant amount of time management spent meeting public company obligations; and the competitive disadvantages of public disclosure of sensitive information. In 2011, the company expanded significantly by acquiring Dental Technology, which gave Coast Dental about 60 SmileCare dental practices in California, Nevada and Texas. The acquisition also added about 1,200 staff workers and 130 dentists to Coast Dental’s workforce.
3. Dental Management Service Companies
As third-party payment, labor laws and technology grow more complex, group practice management companies are becoming much more relevant in the Dentists industry. Laws vary by state regarding the corporate practice of dentistry. In most states, direct employment of a dentist by a non-dentist is prohibited. Consequently, dentists use affiliation agreements that expressly dictate the non-clinical role a management company will serve. It also dictates that dentists should maintain complete discretion over clinical decision making and patient care activities within the practice.
Current market trends in healthcare, including provider demographics and resource requirements, are adding to the complexity of operating a dental group practice. In addition, the owners of many dental group practices are reaching retirement age and are beginning to investigate means for transitioning the non-clinical leadership and management of their dental group practices. The dental practice management business model enables dentists to focus on the clinical aspects of their dental group practices, while outsourcing the non- clinical aspects. This is totally aligned with what I saw at Smile Brands Group.
Dental management companies are also able to provide the necessary organizational structure, resources and capital for growth efforts. These companies often assist with organizational planning and development, administer employee benefits and payroll, manage inventory and supply procurement, maintain technology systems, assist with marketing and payer relations and provide financial planning. Management companies may also have authority to approve strategic and operational goals and review contractual relationships.
Based on the number of dental offices, Smile Brands Group is the largest provider of support services to general and multi-specialty dental groups in the US. Smile Brands’ services support more than 1,300 dentists and hygienists practicing in more than 400 offices nationally. The company canceled its roughly $125.0 million initial public offering in 2010 and withdrew its filing due to reportedly poor market conditions.
American Dental Partners Inc. is one of the largest dental management services companies in the US. Currently, the company is affiliated with 27 dental group practices, operating 300 dental facilities in 22 states. In 2013, its revenue is expected to reach about $307.1 million. In 2012, the private equity firm JLL Partners acquired ADPI.