In 2009, Merritt Dake was approached by a group of orthodontists to help create a business model to build a national orthodontic group practice. While that group never got off the ground, one of the ring-leaders based out of Jonesboro convinced him to leave his practice as a CPA in Dallas and move to northeast Arkansas to help build a group practice in Arkansas.
While working in Jonesboro, Dake formed a relationship with Dr. Bryan Hiller. Aligned in their vision and ethics, Dake and Hiller set out to build a group practice of their own, starting with a clinic in Hot Springs.
Together, Hiller and Dake opened several new orthodontic clinics around central Arkansas. During that time, they also started leveraging their expertise in creating scalable systems to support the back office functions of other orthodontic and dental practices as the third-party management company, AXPM. Among the group of practices supported by AXPM were the orthodontic clinics owned by Merritt’s father, Dr. Mark Dake of West Plains, Mo., who partnered with Hiller and the younger Dake in founding the management company.
As the number of clinics being supported by AXPM grew, so did the trend of consolidation in the dental industry. In 2014, many of the doctors being supported by AXPM made the decision to form a group practice of their own.
“With the trend of consolidation ramping up, a lot of the doctors didn’t like their options for partnership. Jokingly, I tell people that instead of ‘selling out to the man,’ the doctors that were supported by AXPM decided to bind together themselves and ‘fight the man,’” Dake said. “And it made a lot of sense, as so much scale was already built in with each of these clinics already sharing the same tools and systems for all of their back office support.”
In 2015, the group of providers officially joined together under the name Rock Dental Brands.
“The most important thing to us from the beginning was that we had to be led by providers,” Dake said. “As CEO, I am not involved in any patient, clinical or provider aspects of the business, nor is anyone on the Rock Dental Brands team.”
One of AXPM’s key functions was a practice management software, which has since spun off as a stand-alone business also based in Little Rock, called Greyfinch.
Today, Rock Dental Brands has grown to include 82 providers working in nearly 100 clinics across Arkansas, Tennessee and Missouri, and is composed of four distinct divisions: Rock Family Dental, Westrock Orthodontics, Impact Oral Surgery and Leap Kids Pediatric Dental. While most are physically stand-alone clinics, some locations have pediatric dentists and orthodontics practices located next door to each other for the sake of patient convenience.
While those four brands have the biggest presence in Arkansas, there are up to 15 subsidiary brands across the network since some providers choose to maintain their own independent identities. Since the parent company’s goal is to “treat the community,” members are allowed to choose the type of branding that makes the most sense for them, either individually or regionally.
Dental support organizations (DSOs) like Rock Dental have become more commonplace, comprising about 20 percent of the national market as dental students graduate with astronomical debt and find working with a larger support structure essential since they face difficulties getting loans to start their own independent clinics. Regardless, Dake points out that Rock Dental doesn’t operate as a franchise model along the lines of Aspen Dental, 1800 Dentures or Affordable Dentures chains.
“The real way to look at it is that groups like Aspen Dental are set up in the de novo type of model, in which they go out and build practices that are always under the same brand,” he said. “By and large, we at Rock Dental act as support arms for efficiencies of back-office services for the practices. Our providers are all part of one group on a state-by-state basis.
“The unique thing about us is that our providers also own part of the support company,” he added. “They operate on the same team, but we make sure that our providers have their own independence and ability to have a brand that works for them specifically and for their community. We’ll support you how you want, but there are some common things that make logical sense to get the most out of your practice.”
All of Rock Dental’s outlets share the web-based portal, AXPM One, across all practices, which allows team members access to documents, emergency action plans and policies and procedures at any given time. The team approach is also special because of the fact that the dentists, orthodontists and oral surgeons across the network of clinics help consult with each other on the entire range of dental needs through their Peer Review Program.
The clinics also share a Doctor Executive Committee, which provides oversight of quality and standard of care, maintains defined clinical guidelines for all practices, evaluates the peer review findings and defines continuing education needs.
“As far as I’m aware, we were the first ones in the area to do it,” Dake said. “It really was born out of our original providers saying, ‘If we’re going to do this as a group, I want to make sure we can prove we have quality care, and we don’t just say that’s what we’re doing.’ We also have a quality assurance metric in which there is an ongoing review of randomly pulled cases for providers that are evaluated to ensure that everybody is providing quality care.”
The peer review program reviews cases from all levels of doctors in the group, ranging from the newest through the most experienced. The goal is to provide leadership amongst the providers in a way that is akin to the medical boards found in hospitals, and its participants are involved on a rotating basis in order to ensure that all have input on key decisions.
“To be honest, for some providers it’s a little bit scary at first, but the goal is for learning,” Dake said. “There are a lot of side study groups, which share their knowledge and create a support group for cases that may be difficult. It is a collaborative approach to try and ensure that quality is happening, and we tend to attract providers that are comfortable operating in that more transparent environment.”
As a provider as well as Rock Dental’s president of orthodontics, Hiller has been able to see the positive effects of the DSO from both sides of the business.
“Managing the team and worrying about accounts payable and receivable are things that you never really focus on in school,” Hiller said. “Being able to have them take that away and be able to focus on the patients is far and away the best part of it.
“Rock Dental coordinates all of the behind-the-scenes stuff like paperwork and calendar. With COVID, dealing with quarantine and all the new regulations and procuring supplies was difficult to do, but handling those functions made life much more manageable.”