• SmileMD

Small Business, Big Mission: SmileMD

SmileMD CEO Saket Agrawal started tracing the advance of the novel coronavirus when the first reports emerged from Asia in December 2019. His mobile operating room startup was just starting its expansion to Cleveland and Northeast Ohio from Central Ohio with even greater plans in place for 2020. Still, Agrawal started talking to his board about taking steps to conserve cash.

"I start to think through: This is now hitting Italy and Europe – not sure how this is going to just stop," he said. "You’re going through all the what ifs in January and February." SmileMD, the DBA of OFFOR Health Inc., had grown revenue quickly enough that it still had cash left from a 2018 seed round. Instead of speeding growth to other states as planned, the company held on to its nest egg.

“Luckily, we did the work and had a game plan," Agrawal said. "When March rolled around, we were able to respond pretty quickly.” That's when Ohio abruptly canceled all non-emergency medical procedures. That meant SmileMD and its dental clients stopped 98% of their business for nearly two months.

The 7-year-old company brings mobile anesthesiologists, support staff and equipment to dental practices so they can do outpatient surgery without waiting weeks or months for a slot to open up in a hospital or surgery center. Patients saw procedures canceled, but still had need. "It's not like the pain goes away," Agrawal said.

A federal Paycheck Protection Program loan and savings kept SmileMD operating while employees developed new safety protocols, surveyed and trained dental clients and secured scarce protective equipment.

As operating rooms began to reopen, dentists found their slots had been pushed back even more as hospitals had to first catch up on more lucrative backlogs. Suddenly, small practices were in trouble.

"We went from having at least three days a week (in a hospital OR) ... to having maybe two a month," said Dr. Jonathan Draney, whose pediatric dental practice in Lancaster had been a SmileMD customer five years. "The number of kids we had that needed surgery didn’t go down, but we had no way to do them."

After losing two months, the practice greatly expanded its in-office procedures with SmileMD and finished 2020 even with 2019. “I don’t know how that was possible,” Draney said. "I don’t want to think what would have happened if we did not have SmileMD. I would have had to let people go. "They absolutely saved our bacon."

SmileMD's delayed expansion was now essential. Hiring to meet growing demand started in April. Headcount was 16 at the start of 2020, 38 in January 2021 and 43 as of this month. There's also a contract network of more than 100 anesthesiologists and clinical support staff.

The company started practicing in Illinois and Kentucky. While concentrating for now on those markets, explorations are starting in other states, too. This year, SmileMD raised $5 million in venture capital and moved from Dublin to a larger office in Columbus.

The enduring lesson of the pandemic is that healthcare needs to extend care beyond hospital walls, Agrawal said. Telehealth took hold during the pandemic, but hands-on care still needs space. "Once you have offices that get used to your services and see the benefits we’re driving – that was the larger impact, introducing our services to more people," he said. "It’s been a win-win-win across the board."

Agrawal learned how his company could adapt and keep up morale through a crisis. "It was great to see how into our mission our employees are," he said. "They stuck by us they saw where we are going. There is a light at the end of the tunnel."


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