Who is actually allowed to fix an underperforming practice?

A few days ago I posted how dental groups should improve their existing locations before they expand. My friend David Eslinger, who has spent 35+ years in the industry, dropped a great comment that I wanted to address here.

His point was essentially that groups are sitting on years of unaddressed operational issues because of how the early consolidations were sold in the first place. Owners were told nothing would change, to keep running things their way. Which was good for closing deals but bad for operations. The selling dentist got paid, coasted toward the exit, and had little reason to fix problems they'd tolerated for years. So the portfolio fills up with baked-in neglect that nobody inside has the will or the authority to touch.

David then asked me something important. Can the sponsor actually require the fixes? And with more states tightening the rules around corporate influence over dental practices, at what point does a sponsor pushing operational change start to look like the kind of interference those laws are meant to stop?

He's touching on a real bind, and I don't think you resolve it by having the capital partner lean harder on the practice. The more a sponsor reaches directly into how a practice is run, the more it looks like exactly what the new laws are circling.

The thing is, the difficult part was never seeing that a practice is underperforming. Everyone can feel that. The hard part is that the people who can legally act on it, the dentist and the clinical leadership inside the practice, often don't have a clear, quantified reason to, and the capital side that wants it fixed can't be the one directing the fix.

This is why DRAI addresses that gap. Our Operational QoE doesn't tell anyone what to do, it puts a defensible number on what revenue is actually recoverable, where, and why, and hands that independent analysis to whoever is allowed to act on their part of it. The dentist decides what happens clinically. Operations handles what's operational. The capital side gets an honest number to decide from, and the people who are allowed to fix things finally have the clarity to do it. No one has to overstep for any of it to happen.

That's the part I find genuinely interesting about where this is heading. As the rules tighten on who can direct what, a neutral, independent read becomes even more useful. It's one of the few things that surfaces the problem without anyone overstepping.