Hundreds of accepted treatment plans, sitting unscheduled, on the day you list

Most dental groups going to market have hundreds of accepted treatment plans sitting unscheduled across their locations, and the EBITDA the deal gets priced on reflects none of it.

The seller goes to market with a clean financial QoE, the deal gets priced, diligence runs its course, and the transaction closes. Every professional at the table executed their scope well, but sitting inside the PMS across those locations the entire time was a patient cohort that already said yes to treatment, already had it diagnosed and presented, and never got a follow-up call to schedule it. Across a six to ten location group that backlog typically runs 400 to 700 cases annually, and at average case values it represents $180K to $350K in revenue the group should have captured yet didn't.

The problem is that nobody evaluated it. The CPA's scope is financial normalization, not pulling unscheduled treatment reports from every location and mapping why the conversion rate at Location 5 is half what it is at Location 2. The broker's role is positioning the group and managing the deal, not diagnosing why the treatment coordinator process broke down at three offices after turnover. The buyer's diligence is mainly just built around the financial and legal picture. And the lender just underwrites against the EBITDA they receive without evaluating how consistently it gets produced across sites.

Every professional is doing their job correctly, but the operational layer sits between all of them without an owner, quietly suppressing the number the entire deal gets built around.

The cost of this is specific. That unscheduled treatment backlog flows straight into the EBITDA gap, and at 5x to 6x multiples on a mid-market group it's $900K to $2M that transfers from seller to buyer because no document ever surfaced it. The broker's commission gets calculated against a deal that was smaller than the group warranted, and the lender underwrites against earnings that don't reflect what the group is actually capable of producing.

None of them even find out because the analysis that would have surfaced it doesn't get produced at any stage of the deal by anyone.