> ## Documentation Index
> Fetch the complete documentation index at: https://dso.getlemma.com/llms.txt
> Use this file to discover all available pages before exploring further.

# Integrate the practice

> Bluebird's first 90 days after close: converting the PMS, loading fee schedules, keeping the team, telling patients, re-running the diligence reports, and re-anchoring hygiene recall.

The first ninety days show whether the assumptions in Bluebird's deal model hold after closing. Patient retention, hygiene reappointment, staff continuity, and data conversion all affect the result. This page organizes Bluebird's integration plan by workstream.

## The plan on one page

| Workstream                  | Days  | Done when                                                     |
| --------------------------- | ----- | ------------------------------------------------------------- |
| PMS conversion              | 0–30  | New location live on Bluebird's PMS; legacy system read-only  |
| Fee schedules               | 0–30  | Every effective contract's schedule loaded under the PC's TIN |
| Team retention              | 0–90  | Key roles retained; compensation transition completed         |
| Patient communication       | 0–45  | Announcement out; Dr. Ellis introducing, not disappearing     |
| Diligence re-run            | 30–60 | Post-conversion reports match diligence baselines             |
| Hygiene recall re-anchoring | 30–90 | Reappointment climbing toward location one's 84%              |

## PMS conversion: move the data before you need it

Dr. Ellis ran a server-based practice management system (PMS) installed in 2009. Bluebird uses the vendor's conversion service to move the practice to its cloud PMS during the first month. Its conversion plan follows three rules:

* **Convert before go-live, then verify.** Demographics, insurance plans, and ledger balances usually convert cleanly. Periodontal charting, imaging, clinical notes, and especially **recall intervals and due dates** may convert only partially. Confirm the result for each data type before the first patient checks in.
* **Keep the legacy system read-only for the retention period.** The records-custody obligation from the [close](/start/first-acquisition/close-and-transition) doesn't care that the software is old. Bluebird keeps the old server accessible, read-only, for as long as state retention rules require.
* **Use one system of record.** At go-live, the new PMS becomes the ledger and the old system becomes an archive. Running active billing in both systems creates avoidable gaps.

Choosing the platform itself is a separate decision. See [Choose a PMS](/guides/billing/choose-a-pms).

## Load the correct fee schedules

For every payer contract that is effective, Bluebird loads the **contracted fee schedule under the PC's TIN** into the PMS before submitting that payer's first claim. Accuracy matters here:

* A wrong schedule produces wrong expected amounts and can cause contractual write-offs to conceal underpayments. Expected-versus-paid variance is useful only when the expected amount is accurate.
* The schedules are **not** Dr. Ellis's old ones. Bluebird's contracts are new paper at new rates, including the Delta network question from [diligence](/start/first-acquisition/run-diligence) (Premier vs PPO schedule), now answered in ink.
* Pending payers are configured as out-of-network with the interim cost-sharing policy from the close, and re-configured the day each contract goes effective.

## Retain the team and the patient relationships

The hygiene program depends in part on two hygienists whose patients rebook *with them*. Bluebird takes these steps during the first week to support staff and patient continuity:

* Meet every staff member individually; offer employment on day one with tenure honored, compensation at or above current, and benefits harmonized to Bluebird's plan by day 90.
* Give the office manager a defined role in the integration. She knows the practice's systems, exceptions, and informal workflows.
* **No production quotas or per-sale bonuses for clinical staff.** Review production-linked incentives under applicable employment and professional-control law. The 2026 California Aspen settlement specifically banned per-sale incentive payments to hygienists for the settling parties.<sup>1</sup> Bluebird pays for time and quality and measures recall health at the practice level. See [DSO enforcement and risk](/concepts/model/dso-enforcement-and-risk).

Dr. Ellis's own year is scripted: four days a week in the first quarter, tapering as an associate absorbs his book, with his real job being the sentence "I picked these people, and I'm staying to make sure they take care of you."

## Patient communication

Patients receive the notice required by state law at closing. In week two, Bluebird sends a separate letter and email signed by Dr. Ellis and Dr. Okafor. It leads with continuity of care, then explains practical improvements such as online scheduling and extended hours. The new brand is secondary.

The front desk gets one short, consistent explanation to use on the phone. During the first quarter, staff continue asking hygiene patients to book their next visit before leaving.

## Re-run the diligence reports

Between days 30 and 60, Bluebird re-runs the diligence reports **in its own PMS** and compares them to the diligence baselines:

| Report                                | Diligence baseline               | Post-conversion check                               |
| ------------------------------------- | -------------------------------- | --------------------------------------------------- |
| Active patients (18-month definition) | 1,480                            | Did conversion drop anyone?                         |
| AR aging                              | Clean                            | Post-close AR building normally under the PC's TIN? |
| Credit balances                       | \$\$18,400 (allocated to seller) | New credits being worked weekly?                    |
| Hygiene reappointment                 | 71%                              | Trending up?                                        |
| Production by provider                | 68% Dr. Ellis                    | Shifting toward the associate on plan?              |

A gap between the baseline and rerun often points to a conversion problem, such as missing recall flags or plans mapped to the wrong payer. Finding those errors in month two reduces the risk of losing patients later in the year.

## Re-anchor the hygiene recall

Prioritize recall due dates during the conversion. These fields can be lost or mapped incorrectly, which means affected patients may miss reminders and fall out of the active-patient count. Bluebird uses this sequence:

1. Rebuild recall intervals for every active patient in the new PMS, audited against the legacy system.
2. Give the **unscheduled recall list** extra attention for the first ninety days. Patients who were already past due at closing may be easier to lose during a transition.
3. Make pre-booking the standing habit: reappointment percentage on the weekly scorecard, with the location-one playbook and an 84% target.
4. Fold the location into Bluebird's normal [billing rhythm](/guides/billing/run-the-dental-billing-cycle), including daily eligibility, daily posting, and weekly credit-balance review.

Bluebird's cited benchmark puts hygiene at 25–35% of production.<sup>2</sup> Sam also modeled an improvement from the acquired practice's 71% reappointment rate toward the 84% rate at Bluebird's first location. The integration team now measures whether scheduling changes actually improve that rate.

## What Bluebird built

Ninety days after closing, Bluebird has two locations, one PC, one dental support organization (DSO), an MSA covering both sites, and a shared billing routine. The team can use the same checklist for the next deal while adapting it to the new facts. See [Acquire a dental practice](/guides/growth/acquire-a-dental-practice). Expansion into another state requires a new state-law analysis, covered in the [next tutorial](/start/second-state/overview).

## Next

<Card title="Tutorial: expanding to a second state" icon="arrow-right" href="/start/second-state/overview">
  A new PC, a new CPOD analysis, and payer enrollment all over again.
</Card>

## Sources

1. California AG, [2026 Aspen Dental settlement](https://oag.ca.gov/news/press-releases/attorney-general-bonta-announces-settlement-aspen-dental-over-corporate-practice) (bans per-sale incentive payments to hygienists, among other terms).
2. Dental Economics / Levin Group, [2024 annual practice survey](https://www.dentaleconomics.com/practice/article/55016675/higher-production-and-much-needed-stability-the-2024-de-levin-group-annual-practice-survey); Dental Economics, [research report on hygiene](https://www.dentaleconomics.com/practice/article/16388055/research-report-the-state-of-hygiene-in-todays-practices).