Tag
#Private Equity
19 articles
Private Equity Isn't Wrecking Dentistry. It's Pricing It.
Is private equity wrecking dentistry? No. It is pricing it, with an instrument that cannot see where a dental practice's value lives. A former DSO operator on what the machine measures, what it misses, and what owners should actually be angry about.
The Second Bite: How Rollover Equity Works and Who Gets Paid First
Rollover equity is a security — minority, illiquid, leveraged, with an exit you don't control. The five questions that decide whether it's a second bite or a second haircut.
The Moving Target: How Dental Practice Earnouts Are Measured and Controlled
An earnout is not a number — it is a measurement system administered by the buyer for 3-5 years. The five clauses that decide whether yours pays $2.1M or $0.
The Blind Claim: The Three Hidden Failure Points Where Your Enterprise Value Is Actually Decided
Buy-side diligence rebuilds your EBITDA from your PMS data. The three failure points where enterprise value is decided — and how sellers defend each one.
The Graded Exam: Why Your Earnout Is Scored by the Person Who Owes the Money
An earnout is 10-30% of a dental practice sale, paid only if targets are hit — targets the buyer models, under operations the buyer controls, measured on the buyer's books. The mechanics, the tax trap, and the five clauses that un-tilt the table.
The Paper Millionaire: What Your Rollover Equity Is Actually Worth
Rollover equity is 20-40% of a dental practice sale taken as stock in the buyer's platform. The buyer audits you for 90 days; most sellers audit the buyer over a dinner. The five-question diligence every seller owes their second bite.
The LOI Is Not the Deal: The Chronological Anatomy of a 90-Day Enterprise Value Extraction
85% of dental practice sellers lose enterprise value after the buyer's Quality of Earnings audit. Here is the exact chronological anatomy of what happens inside the 90-day exclusivity window — and how $4.2M becomes $3.15M.
The Defense Gap: How Private Equity Monetizes Asymmetric Diligence in Dental M&A
Institutional buyers spend $1.2M to $3M on diligence per lower-middle-market deal; sellers spend almost nothing. 85% of deals are re-priced after the LOI (SRS Acquiom), and in dental the extraction runs through five years of PMS data. The Defense Gap, the mechanism, and what closes it.
The KPIs That Kill Your Multiple: Which Dental Practice Metrics Institutional Buyers Actually Score
Not all dental KPIs matter at exit. Here are the metrics PE-backed buyers weight most, the thresholds that move multiples, and the vanity metrics they ignore entirely.
How DSOs Actually Evaluate Your Dental Practice: The 11 Underwriting Criteria They Score But Never Publish
Former NADG regional director reveals the 11 criteria DSO underwriting teams actually score — and the specific thresholds that separate premium multiples from discount ones.
The Same Playbook: What a Harvard Hospital Study Tells Us About the Future of Dental Practice Valuations
A Harvard study on PE-owned hospitals revealed a 13% rise in ER deaths after acquisition. The same debt-loading, cost-cutting playbook runs in dental M&A — and understanding it is the difference between a defended exit and a seven-figure re-trade.
The Dental Practice Data Room: What to Build, How to Structure It, and Why Starting 5 Years Early Changes Your Multiple
Most sellers assemble data rooms in 60 days. Here's the forensic-grade folder structure PE buyers actually expect — and why building it early changes your multiple.
The Algorithmic Denial Machine: How Payer AI Is Weaponizing Your Radiographs
Insurance payers are deploying pixel-level AI to deny claims at scale. The same weaponization PE firms use during QoE is coming to every claim you submit.
The Data Room Nobody Builds: What Buyers See That Sellers Never Prepare
A QoE team spends 30 days dismantling the story you spent 30 years building. Sellers who pre-audit their data room dictate the terms of their exit.
The Silent Margin Collapse: Clinical Judgment as Enterprise Value Destruction
A single D4910-to-D1110 downgrade costs $70. Repeated daily across 3 locations, it erases $504,000 in enterprise value at a 6x multiple.
The Due Diligence Ambush: How PE Weaponizes Your Data to Hijack Your Exit
Private Equity QoE teams extract raw PMS data to systematically dismantle your EBITDA. A $3M group lost $13.8M in enterprise value to unsanitized data.
Eyes Wide Open: What I Wish Every Dentist Knew Before Signing a DSO Contract
DSO contracts are built to maximize platform EBITDA, not doctor compensation. Realization rate traps, capitation true-ups, and non-competes explained.
EBITDA Laundering: The Clinical Blind Spot in Dental M&A
The EBITDA Laundering blind spot in dental M&A: how compliant-looking revenue masks clinical fraud that survives standard due diligence.
The EBITDA Illusion: Why DSOs Buy You at 5x and Trade at 14x (And How to Keep the Difference)
Why dental DSOs trade at 14x while acquirers pay 5x — understand the Multiple Arbitrage mechanism that transfers wealth from practices to PE.