Ep. 114: Optimizing Your Case Acceptance Process
In prior episodes, we’ve discussed several aspects of case acceptance. Now, Jeff brings it all together and walks through the entire process from a new patient initial to accepting and starting treatment. This will help you create an intelligent, organized system in your office to maximize case acceptance and ensure nothing slips through the cracks.
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Questions From This Episode
Where does improving treatment acceptance actually begin?
It begins with genuinely accepting that the doctor's job is to restore health, function, and aesthetics to every patient, regardless of what insurance will or won't cover. Whether a patient has coverage has no bearing on what they clinically need, and once a doctor internalizes that, they stop softening or withholding diagnoses out of fear of the patient's reaction.
Why does a practice need a fully grooved in process for treatment presentation, not just good communication skills?
A process that's consistently followed the same way every time becomes second nature for the whole team, the same way a well established scheduling or check-in routine does, so nobody has to think through it fresh each time and any deviation stands out immediately. Without a defined process for the exam, presentation, and financial discussion, results depend entirely on individual improvisation rather than a repeatable system.
How do you decide whether to present treatment the same day versus bringing the patient back for a consultation?
Check whether both the doctor and the patient genuinely have enough uninterrupted time, generally at least 20 to 30 minutes for anything beyond a small case, since a rushed presentation is far more likely to fail than a properly scheduled one. If either side is short on time, bring the patient back for a dedicated consultation within one to three days rather than starting a presentation that can't be finished properly.
What actually needs to happen during a treatment presentation itself?
Explain what's wrong, explain the consequences of leaving it untreated, explain how it will be fixed in plain, non-clinical language, confirm the patient actually wants it, and only then get into cost, followed by directly stating what the treatment costs. Skipping straight to price before confirming genuine interest, or avoiding stating the fee altogether, undermines the whole presentation.
How can you tell the difference between a real objection and ordinary sales resistance?
A real objection stays consistent under gentle pushback, the patient is specific and communicative about it, and it holds up even if you ask what would happen if they just moved forward anyway. Ordinary sales resistance tends to shift from excuse to excuse, vague and inconsistent, which usually signals the patient hasn't actually been sold on why they need the treatment in the first place rather than facing a genuine external obstacle.
Episode Transcript
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Over the past two years, some of our most popular episodes have covered how to improve treatment acceptance, from the financial discussion, to handling objections, to organizing your practice to maximize case acceptance. It's also the subject we get the most listener questions about, and I understand why it's such a hot topic. You're not going to produce what your patient doesn't accept, and improving treatment acceptance is the fastest and most sustainable way to increase collections in your practice. In the long run, better treatment acceptance also means better oral health for your patients, so it's genuinely a win-win.
For this week's episode, I want to revisit the subject of case acceptance, but rather than focusing on one piece of it like the financial discussion, I want to cover the whole process from start to finish, specifically the key actions you can begin implementing right now, meaning right after you finish listening to this episode, to see immediate improvement in your treatment acceptance rate. My name is Jeff Blumberg, and I'm your host.
There's a lot to cover here. The average MGE client, including office managers and treatment coordinators, spends 20 to 21 days on the Power Program specifically training on communication and case acceptance, what we call sales. I obviously don't have that kind of time in a podcast episode, though I could probably talk that long if pressed, just ask my wife. So I'm going to stick to the fundamentals we go over with every MGE client, the things that start creating real change the moment you actually implement them. As always, this information is meant to be applied using your own judgment, everyone is responsible for their own situation, so take what's genuinely useful here and decide how you want to use it in your own practice.
So where does treatment acceptance actually begin? Since we're talking to the doctor specifically here, not the treatment coordinator, it begins with the doctor's attitude. And I don't just mean a mindset you adopt looking in the mirror each morning, I mean your actual orientation toward what kind of practice you're building. I've talked before about how you carry three major jobs as a doctor owner: doctor, owner or executive, and salesperson, each with its own expected outcome, the same way you'd expect a scheduler to produce a specific result.
Let's look at the doctor job specifically. You could reduce it down to pure clinical excellence, how well you prepped that crown, whether the procedure went smoothly. That's certainly part of it. But there's a broader dimension too, one that isn't about any single procedure, but about the patient as a whole. What is your actual job in relation to your patients? At the most basic level, it's restoring health, function, and aesthetics, making your patients as well as they can possibly be. If you look at every patient through that lens, how do I restore health, function, and aesthetics for this specific person, certain things simply stop making sense. Restoring health based on what insurance happens to cover isn't actually part of that job description. Whether someone has coverage has no bearing on whether they need to be made well.
Here's an analogy, not a perfect one, but sometimes stepping outside your own field helps clarify things. Say you're an MGE client going through the Power Program, executive and sales training for the doctor and office manager. Say I'm meeting with a client, and it's clear from what they're describing that they're missing a substantial amount of case acceptance because their office manager is buried in acting as treatment coordinator, with nobody actually running the business side. As the technician in that moment, my job is to identify what this practice actually needs, in this case, a dedicated treatment coordinator, regardless of whether the doctor happens to dislike spending money right now, or is mid-renovation on something else, or has other financial pressures going on. That's simply not relevant to the technical diagnosis. Once we're figuring out how to actually pay for it, that's a completely different hat, the salesperson hat, and the two shouldn't get mixed together.
The same logic applies clinically. The fact that a patient has financial pressure, or only wants what insurance covers, doesn't change what they actually need. It's easy to get worn down by this over time, this side of practicing dentistry was probably never on your radar in dental school, sitting down with patients to talk money, insurance coverage, financing. But none of that changes what the patient actually needs. I've seen doctors get so worn down that they start only doing what insurance covers, purely to avoid friction, convinced that's what every patient wants, based on maybe four negative experiences out of the last twenty patients. Eventually they stop telling patients what they actually need at all. I've discussed this in prior episodes too, a new patient needing $15,000 of treatment, and the doctor, entirely confident clinically that this is exactly what's needed, starts second-guessing themselves purely out of fear the patient will feel like they're just after their money. None of that fear has any bearing on what the patient actually needs.
So from the doctor's perspective, ask yourself honestly what you're actually trying to accomplish. If your goal is genuinely to get patients healthy, that should be the lens you bring to every single patient, regardless of their financial situation. Not everyone is going to respond well to that, some people may get upset hearing they need significant treatment, but if you're expecting to make everyone happy all the time, that's simply not realistic in any profession. So why hold back? Patients came to you because you're the expert, there's no reason to be afraid of telling them what you actually found.
That, to me, is the single biggest factor. I've met with countless clients over the years, and when you've been doing this long enough, you've genuinely seen it all. I've seen doctors avoid disclosing everything a patient needs at once, deliberately presenting periodontal treatment first so that on a later visit they can bring up the restorative work separately, worried the patient will otherwise think they're just chasing money. None of that should matter. You're the doctor, that's exactly why the patient is there, your job is to get them well.
So it starts with the correct attitude: what insurance covers or doesn't cover has zero bearing on the clinical recommendation. Will everyone follow through on everything you recommend? No, probably not, but at least they know, and you've been completely upfront with them. Plenty of people will do it, and plenty will genuinely appreciate that you were forthright rather than worried about hurting their feelings, because that honesty is exactly why they sought out an expert in the first place. You have to be comfortable in your own skin and clear on what kind of practice you're actually building. Otherwise you end up in one of two bad places, either only offering what insurance covers and leaving active disease untreated, or refusing to treat a patient at all because they insist on staying in an unhealthy state, whichever direction, you have to be able to stand behind your own clinical integrity. That's genuinely what lets you sleep at night, and it's also what makes the profession fun again, since you're finally doing exactly what you went to school for.
Beyond attitude, and beyond specific communication and closing skills, the next thing you need to improve treatment acceptance is an actual process. Think of it like a wagon wheel that's carved a groove into a dirt road over time, the wagon doesn't have to figure out where to go, it simply drops into the groove. You already have grooved-in processes for plenty of things in your practice. If an existing patient calls needing crowns done, there's already a clear process, how they get scheduled, what the financial arrangements look like, how long the appointment runs, how the room gets set up, which lab you use. Nobody has to think it through fresh each time, the whole team already knows it.
Sales needs that same kind of process. The process from the exam, to the presentation, to the financial arrangements, to actually getting the patient scheduled needs to be clearly defined, fully understood, and agreed upon by everyone in the practice, your hygienist, your dental assistant, your treatment coordinator, all working from the same playbook. It should work exactly the way you want it to work, I'll offer suggestions, but ultimately you decide what fits your practice and make it clearly known to your team, whether through a staff meeting or a recorded explanation someone transcribes. The more consistently that process runs without variance, the more deeply it becomes grooved in and second nature. I've noticed this pattern in organizations generally, if you hold a meeting at the same time consistently for long enough, people show up out of habit even if you cancel it at the last minute, they're that conditioned to it. You want that same consistency around your sales process, so that when something's done incorrectly, say a new treatment coordinator or scheduler, the rest of the team notices immediately, because they're that used to it being done right.
So: exam, presentation, financial arrangements. Let's start with the exam, specifically a new patient initial, which every path should eventually lead to, even an emergency patient should be brought back for a full initial exam. The clinical steps of that exam are entirely up to you as the doctor. One thing I'd recommend to every MGE client: whatever your new patient exam sequence looks like, put it in writing. First, so your entire team, dental assistant, hygienist, knows exactly how you like it done. Second, because as you grow and eventually bring on an associate, having that written down makes onboarding dramatically easier and adds real consistency, it becomes an actual practice policy.
But let's talk about the nonclinical side of that exam, since this is your first real opportunity to meet this person. One of the first things worth establishing, beyond the chief complaint, is simply asking what they'd like you to do for them, how you can help them today. Let them actually talk, whether it's I don't love how crooked my teeth are, this tooth over here hurts, or I'm honestly very happy with my teeth. There are two good reasons to ask this. First, you're finding out why they're actually there before you start looking in their mouth. Second, it gives you a real read on their mindset. If someone tells you they're perfectly happy and just here for a cleaning, and your exam then reveals significant issues, that tells you you're likely in for a bumpier conversation later when you present what they actually need, worth keeping in mind as you plan that presentation.
Once you've gotten a sense of their mindset, go ahead and conduct your exam however you normally would. If you're charting using tooth numbers while examining, I'd recommend sticking to abbreviations rather than full procedure names. It's faster, and more importantly, the moment you start saying things like root canal on number three out loud, you've unintentionally started the sales process before you're ready to. Use a simple shorthand, CR for crown, RCT for root canal, and just let the patient know up front that you'll be using shorthand as you go and will explain everything fully once you're finished. That keeps you from inadvertently kicking off the sales conversation mid-exam.
Once your exam and charting are complete, and you're formulating the treatment plan in your head or already entering it into the computer, stop and take a moment to genuinely assess the situation. Check the time. Are you about to step into another room for a longer procedure you can't easily step away from? Is this patient only scheduled for another five minutes before they need to get back to work? If it's a substantial treatment plan, you need real time to explain it properly, and I wouldn't recommend presenting it right then if that time genuinely isn't there, because you likely won't close it.
Here's a thought experiment worth repeating: say the treatment plan comes to $8,000 and this patient earns $80,000 a year, you're effectively asking them to commit a tenth of their annual income. Whether financing is available doesn't change that relative weight, $8,000 might be nothing to someone earning $80 million a year, but it's a serious decision for someone earning $80,000, and an even bigger one at $40,000. You need genuine time to explain it properly and answer questions, because the goal here is making sure this patient actually gets the treatment they need, and rushing it is one of the surest ways to prevent that.
So you have a decision to make. If you have the time and the patient has the time, and by that I mean they're not just being polite while secretly wanting an excuse to leave, present the treatment plan right then, that's ideal, since they don't have to come back. But if either of you is short on time, don't say something like I don't have time to explain your treatment plan today, that sounds terrible. Instead, bring them back for a consultation: something like, Joe, here's what I'd like to do, I want to go over what I found today in real detail, I'll need about 20 to 30 minutes, and I want it to just be the two of us so I can walk through everything and answer every question you have.
If they press you, asking why you can't just explain it now, you can say you want to fully review everything, their x-rays, models, scans, whatever applies, to make sure you land on exactly the right treatment plan for them specifically. You're genuinely buying time to think it through properly, not simply because you're too busy. If they press again, reassure them you want to do this right, and that you can see them back within one to three days for your undivided attention. There's always some risk in sending a patient away, but a bigger risk comes from naming specific procedures and then asking them to wait, since that often sends people straight to researching prices online. I'd avoid getting into specific procedures until the actual consultation. Present same day whenever you genuinely can, but when you can't, bring them back quickly.
When you do bring someone back for a consultation, don't wait longer than three days, the longer the gap, the more likely they are to no-show or simply lose momentum. As for where to place consult time on your schedule, I've suggested before putting it first thing in the morning or right after lunch. Morning consults, say two 20-minute slots, work well because you're not yet mid-procedure with another patient, and if a larger morning procedure cancels last minute, there's a real chance one of those consult patients could fill that opening the same day. Right after lunch works well too, since even if you're working through lunch a bit, you're starting that slot completely distraction free.
What size case actually justifies a consultation is ultimately your judgment call. Two or three surface composites clearly don't need one, that's simply a trip to the front desk. But three or four crowns, say $1,200 each, a $5,000 case, might genuinely justify spending 20 minutes to make sure that patient gets exactly what they need, which also makes your schedule more productive overall. If you are bringing someone back rather than presenting same day, it's worth staying a bit involved in the actual scheduling of that follow-up, since patients are generally most likely to listen to the doctor specifically. Right there in the room, you might turn to your assistant and ask when your next consultation opening is, confirm it works for the patient, and lock it in together before they leave. That gives you real influence over exactly when that opportunity actually happens.
Now let's talk about the treatment presentation itself, whether same day or at that follow-up consultation. This requires a bit of a different skill set beyond diagnosis, genuine willingness to communicate clearly and comfortably. If you find communicating with patients genuinely uncomfortable, that's worth addressing directly through real training, since it matters enormously. I remember taking my wife to an ENT once who stared at the floor the entire appointment, technically a fine doctor clinically, but that kind of disconnect makes it very hard to actually sell anything, which, again, is one of your core jobs as the doctor.
So what actually needs to happen during a consultation? Once you've sat down and made a bit of small talk, walk through this: first, explain what you found, what's actually wrong. Second, explain the consequences of leaving it untreated, even if they're already aware of the missing tooth itself, explain what could happen if it isn't addressed. Third, explain how you'd actually fix it, and make sure they genuinely understand the treatment involved, without burying them in clinical terminology they won't follow. Don't say things like see this periapical radiolucency here, most people don't even know what an abscess is. Use everyday language, and if you do need to use a clinical term, explain it plainly, here's what a crown actually is, sometimes an old lab case or a model implant is genuinely useful to physically show them what you're describing.
Once you're confident they understand what's wrong, why it matters, and how you'd fix it, and they should feel free to ask as many questions as they want throughout, the next question is simply whether they want it. How does this sound, any questions, does this make sense? Cost is likely coming up soon if it hasn't already, but I wouldn't get into cost until you're reasonably confident the patient actually wants the treatment you're recommending. If they're still unsure whether they even want it, go back through the first three steps rather than moving into a financial discussion.
Here's the thing about cost specifically: if you find yourself arguing back and forth about price, that's usually a signal the patient doesn't actually want the treatment yet. In that case, it's worth asking directly again whether they genuinely want to move forward, and if the answer is uncertain, drop the money conversation and go back to explaining why they need the treatment in the first place. Arguing about the price of something someone isn't even sure they want doesn't accomplish anything.
Assuming they've confirmed they want it, let's get into cost. I'll give you a bare minimum standard first, then a better version once you're comfortable with it. Most doctors coming into MGE simply aren't comfortable discussing fees directly with patients, often because they've been told for years that it's off-putting or makes them look bad. That's largely untrue. Someone will occasionally give you a hard time about nearly anything, that's just human nature, but if you actually compare how many patients have ever given you real pushback on cost against your total patient volume over that same period, it's usually a tiny fraction, often under one percent. There will always be a handful of people like that, and they may simply not be the right fit for your practice, which is fine too.
Here's the bare minimum: once the patient wants the treatment, ideally with your treatment coordinator present throughout the presentation, especially for a larger case, you simply say something like, this treatment plan comes to about $8,000, and we expect your insurance to cover roughly $1,500 of that. The patient might respond with something like that's a lot of money, or ask about payment plans. At minimum, you'd say, completely understand, I'm going to have you work out the details with John here, he has several ways to help you figure this out. That's the floor, never do less than that.
What I'd actually recommend instead: state the cost the same way, then ask directly, how would you normally take care of something like this? Let them start solving it themselves, maybe they mention a credit card, in which case you might mention a prepayment discount if you offer one, save 5 percent or $400 by paying today, for instance. Or they might say they'd need a payment plan, in which case your treatment coordinator can walk through whatever financing options you offer, and asking how much they could reasonably pay monthly can help determine which option genuinely fits, since not everyone qualifies for every plan. I covered patient financing in a separate episode, but the short version is, don't over-rely on financing companies when a patient could simply pay directly, if someone can put it on their own credit card, there's no reason to route them into financing at 15 percent interest instead. Either way, your role as the doctor is simply making sure the patient knows the actual cost, since patients are most likely to actually listen to that number coming directly from you.
Before leaving the room, even though the financial details aren't finalized yet, it's worth locking in a placeholder on your schedule to protect your productive time. Say your primary procedures run in the mornings, you might say, I only do this type of procedure in the morning, turn to your treatment coordinator and ask for the next available opening, then confirm directly with the patient whether that time works. That keeps you with some real control over how your most productive hours actually get filled.
Now, objections. There are really only two things worth knowing here. First, check whether the person genuinely understands what you're recommending and why, since cost is something everyone intuitively understands, but the actual clinical need may not be equally clear. If they do understand and they're still raising objections, you need to recognize which of two categories that objection falls into: real, or faulty, meaning ordinary sales resistance rather than the patient's stated reason.
A faulty objection tends to shift constantly and stays vague. Sounds great, but I'm really busy right now. A bit later: there's no way I could afford that, with no actual explanation of their financial situation. A bit later still: I'd need to check with work about taking time off. It's essentially changing the channel every time, a way of ending the conversation without directly saying no. With these, acknowledge what they've said, make sure they genuinely understand what they need, and steer straight back into the treatment plan itself rather than continuing down whatever tangent came up, and I'd drop the cost conversation entirely if it seems like the patient doesn't actually want the treatment yet.
A real objection looks different in three ways: it sounds genuinely plausible, the person stays communicative and specific about it, and it doesn't shift even under gentle pushback. Say a patient tells you they need to talk to their spouse first, because they've made an agreement to always discuss major purchases together. If you ask what would happen if they just went ahead anyway, and they say something like I'd be sleeping in the yard, that's real, and pressing further just gets you the same consistent answer. Or say someone tells you they're mid-refinance on their home and their lender specifically told them not to apply for any new credit until it closes in a few weeks, they can put down a deposit to hold their spot on the schedule, but can't move forward fully yet. That's specific, consistent, and entirely plausible, a genuine real objection worth actually planning around, possibly pushing the case out a few weeks rather than continuing to press.
The spousal objection deserves special mention. When scheduling a consultation, it's worth asking upfront whether anyone else is typically involved in the patient's healthcare decisions, and if so, having them present for the consultation itself so this doesn't come up unresolved at the very end. Some doctors are comfortable simply asking the patient to call their spouse on the spot, that's a personal preference, not something I'd necessarily push. But if the spousal objection comes up after a full consultation where the spouse wasn't present, I generally prefer getting the spouse genuinely on board rather than letting the patient go home and explain everything secondhand, since there's a real chance the spouse fixates purely on the price without understanding any of the clinical reasoning behind it. There's also a real side benefit here, that spouse may not already be a patient of record, and this becomes a natural opportunity to bring them in too.
In that situation, I might say something like, we've spent the last 20 or 30 minutes going through everything about this treatment plan together, and my only real concern is that you'll go home and your spouse, who wasn't part of this conversation, ends up fixating purely on the cost. So either we set up a time for both of you to come back in and I'll walk through it all again together, or we set up a call so I can explain everything to both of you at once, so you're both genuinely on the same page before deciding. To me, that's worth the extra effort, since the most important outcome here is that the patient actually receives the treatment they need, and making sure their spouse fully understands the reasoning matters toward that. You won't close everyone, and that's simply the reality, even the very best communicators don't close every single case. But if you're currently closing 30 to 40 percent of full treatment plans and you can get that up to 50, that's a meaningful shift in both practice revenue and patient health, and if you eventually reach 80 percent, that's an entirely different level of both job satisfaction and practice performance.
Once financial arrangements are worked out and the patient heads off with your treatment coordinator, a couple of final points. If the patient balks once they're with the treatment coordinator, say they only want two of the six crowns you presented, that decision has to come back to the doctor, since a treatment coordinator isn't qualified to make that clinical call. If you genuinely can't step away, say you're mid-root-canal, don't leave the patient waiting 30 or 45 minutes, set a specific follow-up time instead, the doctor will call you at five, for instance, rather than something vague like we'll follow up later. If it's only a short wait, a few minutes, having them wait briefly is fine too, just don't create unnecessary inconvenience.
Finally, and this is genuinely important, once financial arrangements are settled, get that patient onto the schedule as quickly as possible, not two or three weeks out. The longer the gap between commitment and the actual appointment, the more time and opportunity there is for the patient to second-guess the decision. Move with the same urgency getting them scheduled that you used getting them to actually accept the treatment in the first place, since scheduling and completing the treatment is the entire point of everything covered here.
So that's the process from start to finish. I didn't get into the deeper communication skills or specific closing techniques, that's genuinely days of training, but these are fundamental, immediately actionable steps you can start applying today. A couple of recommendations: if you want a sense of how productive your office currently is versus its real potential, fill out our production calculator, link on the episode webpage, and talk with one of our practice management specialists, they'll give you a real read on where you stand. And since you're a doctor, an executive, and a salesperson, I'd recommend investing in actually learning how to sell, whether through our nine-day Communication and Sales Seminars, also linked on the episode webpage, or our online platform, DDS Success, which includes sales training for the doctor alongside staff and positional training, something you can start working through right now.
If you take away just one thing from this episode and change just one thing starting today, start telling patients directly how much their treatment plan costs. Just that alone tends to produce a real improvement nine times out of ten.
That's everything I have for you this week, a bit longer than usual, but I wanted to give a genuinely complete picture rather than having you piece it together across five or six older episodes. I hope this helps. If you have any questions, you can email me directly at jeffb@mgeonline.com, or if you'd like to learn more about MGE, call us at (800) 640-1140 or find us online at mgeonline.com. Folks, have a great week, and we'll see you at the next episode.