Keys to a Smooth Practice Transition, with Danielle McBride, Oberman Law Firm

Intro: [00:00:02] Broadcasting from the Business RadioX Studios in Atlanta, it’s time for Dental Law Radio. Dental Law Radio is brought to you by Oberman Law Firm, a leading dental-centric law firm serving dental clients on a local, regional, and national basis. Now, here’s your host, Stuart Oberman.

Stuart Oberman: [00:00:26] Welcome everyone to Dental Law Radio. We have a very, very special guest today, Danielle McBride, Partner in Oberman Law Firm. And a little background on Danielle – she’s very busy right now – Danielle has been practicing for 21 years and her primary focus is health care transactions, mergers, acquisitions on a local, regional, and national basis. Big, big in M&A transactions, employment law compliance, tax strategies – as you heard on a previous podcast. And we’re going to have some subsequent podcasts that Danielle is going to join us on – practice valuations, DSO formation. Lord, everything is DSO. Everything is scaling nowadays.

Stuart Oberman: [00:01:13] A little education background on Danielle, she graduated from Ohio Northern University with her law degree. And she has a Masters in Taxation from Case Western University. And we are absolutely delighted to have you in the studio, as we say, Danielle. And I know today you’re going to talk about keys to ensure a smooth practice transition, and you could maybe elaborate on this. It is an amazing market. It is a hot market like I’ve never seen in my years of practicing. Valuations are out the roof. Private equity is throwing money at transactions.

Stuart Oberman: [00:01:58] But there’s a lot of misconceptions about what it takes to have a smooth transition, and I really want to drill down on your expertise. You’ve been doing this for over 21 years, and I want to hear what you have to say and your thoughts all the way from due diligence to leveraging advisors. So, give me your thoughts on some matters regarding what it takes to have a smooth transition, as we say.

Danielle McBride: [00:02:29] Well, thanks, Stuart, for having me on the podcast. And, yeah, this is Keys to a Smooth Practice Transition. I kind of call this my ABCs. A is for advisors. One of the best things that you can do for yourself is to surround yourself with the best advisors you can. And they should be specialized, you know, professionals in this area, in the dental industry.

Danielle McBride: [00:02:57] Leverage your advisors that have the experience in these transactions. I mean, there are dental specific lawyers like us. There are dental accountants. There are dental finance lenders. There are dental brokers. All of these people, all of these advisors have a ton of experience. This may be your one and only transaction, buying a practice or selling a practice or merging going in with a DSO. We’ve done hundreds, if not thousands, of these transactions, these advisors have.

Danielle McBride: [00:03:29] So, you know, it’s important to get those specialized professionals to work with you. And they’re out there. And if you have at least one of those advisors, they can help you find others. If you’re in need of a dental specific lender, if you’re a buyer of a practice, if you’re in need of a dental specific accountant, there are lots of other financial business and consultants that have specialized knowledge in the dental field. And that’s my A, you know, my ABCs.

Danielle McBride: [00:04:04] The second is your business. You’ve got to know your business. And it’s important whether you’re looking to sell to a third party or to a DSO in these transactions. Knowing your business, knowing the numbers, having the data that’s going to be requested through all of the due diligence is going to be one of the most important things that you do in these transactions.

Stuart Oberman: [00:04:25] I got a question for you. I got a question for you. You do valuations. We hear –

Danielle McBride: [00:04:30] Yes. I do practice valuations. And so, one of the keys in those valuations is profitability in the practice transition.

Stuart Oberman: [00:04:37] We hear this all the time, “Know your numbers,” what does that mean? When someone says, “Well, I got to know my numbers.”

Danielle McBride: [00:04:47] Know your numbers.

Stuart Oberman: [00:04:48] What does that mean? I mean, our guys, it doesn’t seem like they understand that a lot of times.

Danielle McBride: [00:04:55] Yeah. So, knowing your numbers means a couple of different things. One is being able to get the data on new patients, and insurance plans, and how much of your practice is PPO plans versus fee for service. Those kind of numbers are important. But the key numbers are profitability.

Danielle McBride: [00:05:17] Or sometimes in these DSO transactions you hear being thrown around EBITDA, E-B-I-T-D-A, Earnings Before Income Taxes, Depreciation, and Amortization. It’s essentially, not just the net income, it’s profitability, it’s the cash flow in the practice. You got to look beyond W-2 compensation or net profit. It’s that plus add back. Discretionary expenses, I like to call them. The perks that the doctor runs through the practice.

Danielle McBride: [00:05:49] It can also be things like family on the payroll, if they’re being paid more or less than what would be fair salary for someone doing the work that they’re doing in the practice. It can also be rent. You know, looking at fair rent and whether you’re paying yourself above or below what fair market rent is on a piece of property or your office building that you also own along with the practice.

Stuart Oberman: [00:06:13] Is your specific profit margin? You hear like, “Well, you should be netting out 20 percent profit or 40 percent profit.” Is there a magic number that’s sort of advisable for those things?

Danielle McBride: [00:06:26] Well, it varies based on the specific type of practice. So, your general dental practice might be running an overhead of 60, 61 percent, 40 percent profitability. And that 40 percent of profitability is your W-2 income, your profit, your discretionary add backs, adjustments for paying yourself high rent on your building, non-recurring expenses, if you hired a consultant to come in one year, those sort of things. It’s going to vary if you’re an oral surgeon or if you’re an orthodontist or a pediatric dentist. There are different percentages for those different specialties.

Stuart Oberman: [00:07:11] Huh? Now, I know we do a lot of DSO transactions as a firm, so if they’re getting ready to sell their practice, how should they prepare due diligence? Should they say, “Hey, Danielle. I’m ready to sell my practice. I know there’s a lot of due diligence on the DSO side. Can you send me a due diligence checklist so I can start preparing for this?” How do they prepare for due diligence, which will wear them out a lot of times?

Danielle McBride: [00:07:42] Yeah. It’s going to wear them out and you’re going to get asked for stuff over and over again.

Stuart Oberman: [00:07:46] The same stuff.

Danielle McBride: [00:07:46] You’re going to send them all of your quarter one, quarter two, quarter three, quarter four financial statements and tax returns. And every insurance provider you take in the practice. Some of the banks even ask for monthly profit and loss statements for the year, especially after COVID.

Danielle McBride: [00:08:13] COVID kind of changed things from a financial perspective. From the lender’s perspective, it used to be that you could get away with sending them the years worth of financial statements and tax returns. And then, we had COVID and then they wanted to see month by month. So, we wanted to see every month of 2019, and every month of 2020, and every month of 2021 so far.

Danielle McBride: [00:08:36] So, having the ability to get at least quarterly financial statements is an important part of the due diligence. And then, they’re just going to ask you for every business insurance, every business license, every license for every staff member and doctor in the office. They’re going to ask for balance sheets.

Danielle McBride: [00:08:56] And if there are liens on the practice, which is often one thing that people forget. So, if you had an SBA loan, for instance – a lot of people had this. I just had this with a transaction – SBA EIDL Loans, you can pay those off. My client actually got an email from the SBA saying, “This is your authorization to file a UCC termination on the lien that we have on your practice.” And we needed to get that termination statement filed to clear it for the lender so that the buyer’s lender would actually fund the transaction. So, there are things like that.

Stuart Oberman: [00:09:36] Do you see a lot of PPP problems right now? Loans are not being authorized to pay back and items are being withheld on the transaction?

Danielle McBride: [00:09:48] I did earlier in the year. So many of the PPP loans have finally gotten forgiven. That that problem has started to get a little bit easier to deal with. Usually, it’s some document references on the PPP loans and that it’s been forgiven and some sort of proof to the lenders or the buyer that it’s actually been forgiven.

Danielle McBride: [00:10:12] But I did have to do a lot of escrows. And back in 2021, I first started doing transactions again after COVID opened back up and the lenders started lending again. I was having to escrow funds for PPP because the guidance came out from the IRS saying that you had to escrow the amount of the PPP loan with the bank. And the banks were like, “We don’t know how to do this.” So, you know, I was actually escrowing funds into attorney escrow accounts and holding it because the bank wasn’t prepared to do it.

Stuart Oberman: [00:10:44] Wow. So, do you recommend from an expedient standpoint smooth transaction that we have sort of a due diligence checklist, whether it’s us or whomever, provide that due diligence checklist information to whoever the adviser is and then put that information – we’ll call it a data room? And then, this way the seller or the buyer can get in there and start plucking that information. Is that something that you thought?

Danielle McBride: [00:11:16] A lot of times, if you’re working with these bigger DSOs, they will do exactly that. They’ll have some sort of service where you’re uploading your documents and they will have a checklist that they have to go through. Because a lot of the private equity lenders, they’ve got checklists and they want to see each and every one of those items checked off before they will give the green light to fund the transaction.

Stuart Oberman: [00:11:36] Now, some of these bigger deals, we hear the term quality of earnings. Quality of earnings, what does that mean? Because a lot of the buyers on the corporate side will spend a lot of money on quality of earnings. Our doctors, I don’t think, really understand what that means and how that affects their practice.

Danielle McBride: [00:11:58] Well, I think the quality of earnings is really going back to the profitability in the EBITDA of the practice and the better the cash flow is. It’s sort of like when you hear the old adage, “Okay. Well, what is my practice worth as a percentage of collections?” And everybody says, “Oh, it should be 75 percent of collections or 65 percent of collections.” Well, that’s great.

Danielle McBride: [00:12:19] But if you have two $1 million practices and one has a 65 percent overhead and the other one has a 50 percent overhead, they’re both not worth 65 percent of gross revenues. One has a better quality of earnings. One has a better cash flow. One has higher profitability. And the practice is going to support that buyer and provide a higher profit ratio for that buyer, that DSO, that corporate purchaser.

Danielle McBride: [00:12:53] And especially for a private party, too, I mean, that’s what you want to look for, a practice that has a better cash flow, higher profitability. And you can clearly see that in the tax returns. That’s another thing, too, that a lot of sellers have to think about this. A lot of them have been aggressive with their deductions, but they’ve also maybe been a little lax about putting the documentation together and being clear on that. And so, sometimes when you get a practice like that where they’re just running a ton of things through the practice, you got to sometimes do a little bit clean up because the buyer is going to ask those questions and they’re going to want to see, “Well, where is the cash flow?”

Stuart Oberman: [00:13:30] That never happens. You mean doctors are running their personal stuff through the practices? Are you kidding me?

Danielle McBride: [00:13:34] That never happens, right?

Stuart Oberman: [00:13:39] Are you saying the house payment, and the kids, and the trip – wow. Well, they call this add backs. Is that what they call those?

Danielle McBride: [00:13:51] Add backs. I like to refer to them as discretionary expenses.

Stuart Oberman: [00:13:55] Or having their six year old child, son or daughter, make $10,000 a year –

Danielle McBride: [00:14:02] Yeah. They model for the website. They got to pay them something.

Stuart Oberman: [00:14:05] Or the flyer for the office. Wow. That’s a lot of stuff. And this could be a conversation for hours and hours and hours. Well, I think that if our doctors take this information, figure out when they’re going to sell, how they’re going to sell, who their advisors are, what do they need to do to get prepared, I think this is great advice. How do they reach you if they have any questions on the sale, the due diligence?

Danielle McBride: [00:14:38] They can reach out to Oberman Law Firm at 770-886-2400. My email is danielle@obermanlaw.com. And you can go on our website, too, obermanlaw.com for information. There’s some blog posts and lots of information about the practice on there. And, yeah, reach out. Give us a call. We’ll help you. The other key to a smooth transition is not waiting until the last minute to plan for it.

Stuart Oberman: [00:15:11] Well, that never happens either, huh? Well, I know you’re a regular contributor to the firm’s newsletter, Advisor Insights. Great information coming in there. And I know in a previous podcasts, you had a great, great information on tax. I know you got some other podcasts that you’ll be on the air for. Amazing. Danielle, thank you. Thank you so much.

Stuart Oberman: [00:15:36] Ladies and gentlemen, thanks for joining us on Dental Law Radio. If you have any questions, please feel free to give us a call, 770-886-2400. And email me directly, stuart@obermanlaw.com.

Stuart Oberman: [00:15:49] Guys, ladies and gentlemen, thank you very, very much. Danielle, thank you again. Amazing job as always. We rely on you a lot on the acquisition, and tax side, and general guidance on compliance. So, thanks everyone and have a great day.