A pre-close operational review of a dental or orthodontic target is run by an operations specialist working alongside the deal team, separate from the quality of earnings review. GME Dental Professional Services does this work for buyers of practices, groups, and emerging platforms: an operational review of the target, a gap and risk inventory scored by impact, and operational risks that bear on the investment thesis.
The operational read before you close. Operations that can carry the deal.
Both belong in the same deal and they answer different questions. A quality of earnings review will show you a weak collection rate. It will not tell you whether that rate is held up by a system or by one financial coordinator's memory, and that is what decides whether the rate survives the sale.
The same applies across the operation. Production is a number. Whether the schedule that produced it can run without the selling doctor in the building is a different finding, and it is the one that moves value after close.
| Quality of earnings | Pre-close operational review | |
|---|---|---|
| Question | Are the earnings real and repeatable on paper? | Can the operation that produced them keep producing them after close? |
| Evidence | Financial statements, add-back support, working capital | Practice management system data, process observation, role and accountability structure |
| Typical finding | An add-back with no documentation behind it | A collection rate that depends on one person's follow-up habit |
| What it changes | The earnings the multiple is applied to | Price, terms, and what the buyer fixes first |
| Who runs it | An accounting firm | An operator who has run and sold practices |
Scoped to the target and the deal timeline, pre-LOI through close. Findings are ranked by impact, so the largest issues are named first with what each one is worth.
These are the thresholds used on a review. A target that falls short of them gets priced accordingly, and each gap becomes a line on the fix list with a dollar figure attached.
An orthodontic case is a fixed fee paid over 18 to 30 months, split across a parent, sometimes a second household, an insurer, and occasionally a second insurer. The case is booked once and collected two dozen times. A generalist reading an ortho book from the financials alone will price the top line and miss the contract book underneath it.
Orthodontics is where GME goes deepest. The work runs across general and multi-specialty dental as well, and that ortho depth is what makes a multi-specialty read hold up.
The method behind the review: Lean Six Sigma in dental operations →
Most recently, she ran operational due diligence and closing support for buy-side clients of an investment banking firm. Before that she built practices on the operations side, spent four years taking them to market as a sell-side broker, and designed the operating model behind a franchise-like orthodontic concept. Every side of a dental transaction, from four different seats.
Gretchen leads every engagement. Specialists join based on what the work needs.
A pre-close operational review looks at how the target actually runs, done before close. It maps the current process, inventories the operational gaps and risks by impact, and gives the buyer the operational risks that bear on the investment thesis. It covers scheduling, patient flow, revenue cycle, recall and reactivation, role and accountability structure, and how much of the result depends on one person.
They run alongside each other and answer different questions. A QoE is run by an accounting firm and tests whether the reported earnings are real. A pre-close operational review is run by an operator and tests whether the operation that produced them survives the handover. On a platform deal you want both. On a single practice the QoE is often light, and the operational read is where the risk actually sits.
Pre-LOI through close. Early enough that findings can still move price or terms while both are still open. Scoping runs to the deal timeline rather than a fixed calendar.
Both. The work is scoped for anyone evaluating an acquisition: an individual dentist buying a practice, a group adding locations, an emerging DSO, an investor, or a private equity deal team. Target size and complexity drive the scope, not the buyer type.
GME prices a pre-close operational review by target size and complexity rather than a flat fee. Scope depends on the target's location count, its specialty mix, and how much runway the deal timeline leaves. Ask for a quote and you get a real number rather than a range.
A written report, walked through with the deal team in a live readout. It carries the operational review, the gap and risk inventory ranked by impact with a figure on each, and the operational risks that bear on the investment thesis. Findings that could move price reach you as they surface rather than waiting for the final document, because a finding that arrives after the price is set is worth a fraction of the same finding a week earlier.
Tell us the size, the specialty mix, and where you are in the timeline. We will tell you what we would look at first, and whether a review fits the deal you are running.
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