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At the start of the year, when Dr. A.J. Acierno became the CEO of both the DecisionOne and Midwest Dental divisions of Smile Brands, he jumped from managing 33 dental locations to managing over 230. At Dykema’s 2021 DSO conference, Patient Prism’s CEO, Amol Nirgudkar, interviewed Acierno about the strategies he used to integrate the culture of both groups.


“Smiles for everyone” is a win-win mission

Smiles for Everyone

“With Smile Brands’ purchase of Midwest Dental, it became my job to bring those locations on board with a different type of culture,” says Acierno. “Smiles for everyone is our mission, and it brings with it a culture of altruism, a servant mentality. And for me, this meant I needed to teach the Midwest providers and their teams about the win-win of our mission.”

When he was managing only 33 DecisionOne locations, Acierno had his “fingers on the pulse on everything.” At over 230 locations, that wasn’t possible. “So, I learned right away I was an influencer, and the influencer has to move forward,” says Acierno. “I started teaching the leaders in our organization what smiles for everyone means. What's a win-win? How are we going to change dentistry? What does it mean to have a customer? Who is that customer? How do you treat that customer? How do you learn their why? How do you speak to that why?”

Acierno knows the answers to those questions because, as a dentist for 21 years, he had the hardest job of any salesperson ever. He had to sell a product that was expensive and people did not want.


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A growth map for every doctor

“As a dentist, I learned right away what it is to drive culture, and what it is to drive people, and what it means to have a customer,” says Acierno.

Starting with “smiles for everyone,” regional managers meet monthly with providers and ask, “How are we going to change the way dentistry is done in order to improve lives?” That places focus on improving the health of patients, not just seeing patients. It sets the stage for understanding why patients do and do not accept the treatment that will improve their lives. 

To engage providers, A.J. Acierno asks the big question: “How are we going to change the way dentistry is done in order to improve lives?”

Providers are repeatedly reminded that the path to greater treatment acceptance is to “Engage, Retain, Grow” (ERG). Each provider needs to commit to engaging and retaining patients and growing in clinical and behavioral competency. This commitment then creates the win-win productivity and profitability of their membership in the DSO. 

“Our job is to put together training tracks based on what each provider wants to do most next,” says Acierno. "If the doctor wants to do implants, it's going to be the implant track. If a doctor wants to make more money, it’s going to be the treatment acceptance track.” 

There are multiple tracks of development the providers can go down. Every month they sit down with their regional manager to go over their individualized success plan. They are reminded of the “win-win” that is in it for not just the DSO but also for themselves, their teams, and their patients. The business is to improve patients’ health and lives. The name of the game is “ERG,” to constantly Engage, Retain, Grow to better improve patients’ health and lives.

“No relationship works without a win-win relationship, even in private practice,” says Acierno. “So, it's the same way with a DSO. The provider has to be committed to a path that is a win-win for everyone involved.”  

Acierno says the secret sauce is asking each provider what they want and think they can accomplish. Once they state that, they own it. Now, put a bonus system around meeting that goal. “When they say, ‘I can’t hit this goal,’ you can say, ‘It is your goal. It is what you wanted. We can help you accomplish it.’”

Pragmatically, new providers coming on board need to see what is in it for them. It’s more than the bonus. As each new provider agrees to their individualized growth map, big motivators are the DSO’s implementation of optimally efficient technology and systems that will enable the provider and team to work smarter, not harder, to meet their goals.  


Every single segment of the patient experience needs to be over the top

The biggest fallacy in the DSO industry is the notion that DSOs are overtreating. “In fact, underdiagnosing is the bigger problem,” says Acierno. “The reality is that 44% of our nation goes to the dentist and only 22% moves forward with treatment to get better. Why do we accept this behavior in dentistry? We’re in business to get more patients into treatment. The hard part is that the dental experience is touched by so many things that can ruin it. You can have an A+ treatment presentation—all the photos, everything. You can knock it out of the park. They love you. Then they walk up to the front for that financial presentation, and if it is a dud, it’s over.”

In the DecisionOne and Midwest dental divisions, every segment of the entire patient experience is monitored and improved. Bringing in people from the salon and restaurant industries to critique and coach them has opened their eyes to the many touchpoints and possible ways to optimize that experience. Acierno is pleased with the results.


The internal driver is “making a difference”

Acierno’s passion as a DSO leader is to leave the dental industry better, and by better, he means making “a difference in dentistry for the improvement of patients’ lives.” 

“You realize how powerful our industry is in impacting people's lives,” says Nirgudkar. “It's quite fulfilling to see that you can change somebody's smile. You can change somebody’s health. You can change their attitude. And if the things you do enable providers to move from 22% to 30% treatment acceptance, the amount of health and happiness delivered will have an exponential impact on the whole of society.”

“We would need ten more dental schools,” says Acierno. “Dentistry would grow like crazy.”


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