Ep. 151: Simplifying the Case Acceptance Process
There are tons of tip and tricks and “pearls” out there about case acceptance, which can make the whole topic pretty complex and confusing. So this week, Jeff simplifies it down to the most important factors and the things you should focus on first to immediately improve case acceptance in your practice.
Links:
Morning Production Meeting - https://mgeonline.com/morning-production-meeting-download
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
MGE Power Program - https://www.mgeonline.com/power-program
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Questions From This Episode
Why does handing an overwhelmed staff member or client a long list of tasks usually backfire?
When someone already juggling a lot gets handed a long list of action items, they tend to get paralyzed by the sheer volume and end up completing none of it. Narrowing that list down to the two or three most critical items lets them actually make real progress, and once those are done, momentum builds naturally from there.
What's the single most important first step to improving case acceptance?
Make sure you actually have time built into the schedule to sell. Practices routinely build in time for diagnosis and time for the clinical procedure itself, but almost never build in real time to present treatment, and a patient isn't going to decide to spend a meaningful chunk of their income in five rushed minutes.
What should a doctor do if there isn't enough time to properly present a case right then?
Don't start the presentation at all, bring the patient back instead for a dedicated consult within one to three days, ideally the next day or two, with 20 to 30 minutes of genuinely uninterrupted time. A half finished presentation followed by the patient walking out undecided does far more damage to case acceptance than simply rescheduling to do it properly.
What actually needs to happen once you sit down to present treatment?
Explain the problem, the fix, and the consequence of doing nothing, all in plain language rather than dental terminology the patient won't understand, then state the fee directly instead of avoiding it. Patients respond strongly to hearing the fee from the doctor specifically, even when a treatment coordinator ultimately works out the payment details afterward.
What daily habit helps make sure all of this actually happens consistently?
A morning production meeting, distinct from a clinical huddle, where the team reviews every patient on that day's schedule, flags anyone with outstanding diagnosed treatment, and decides in advance who will talk to them and who needs to be available to help close the case, so nothing quietly falls through the cracks.
Episode Transcript
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Early in my career, I learned a lesson that turned out to be critical, both for helping clients and for working with team members generally. Here's the scenario: I was working with a newer client, a dentist new to the MGE Power Program. To give you an idea of how the program works, and this was a long time ago, but it still operates roughly this way, there's a lot of training built in, hiring, organization, staff management, and so on. When a client starts, they usually have all kinds of problems already happening, and they may not get to the specific training for a given problem for three or four months. So because there's a coaching component built into the program, we help with those immediate issues in the meantime, almost like triage, and work with the client on a coaching basis until they get to the appropriate training and learn to handle it themselves. We give them specific targets to work toward.
This particular client was newer to the program, and I sat down with her to look at what was happening in her practice. We came up with a list of about 18 action items covering the schedule, sales, staffing, and more, all things she was supposed to work on over the coming week to start bringing real order to her practice. She went off with the plan that we'd touch base the following week to check progress. When we met again, I went through that list to see how far she'd gotten. She had completed zero of the 18 targets.
Why? She was a genuinely productive doctor, also a mother, working long hours, chairside with patients constantly. She had an unstable office manager and a couple of unstable staff members at the time. There was nothing wrong with her personally, in fact, she went on later in the program to grow to nearly seven times what she was doing when she started, and became wildly successful. So what was actually going on?
Two things. First, she was overwhelmed, working hard with a great deal already on her plate, and something of an overachiever, which describes a lot of people, myself included, and honestly describes a lot of the clients we work with. She wanted to do everything, and she wanted it done immediately. Second, and this is the real lesson: when you hand someone who's already overwhelmed an enormous list of things to do, they usually end up doing nothing at all.
So what did I actually change? I dialed things back. I looked honestly at her actual situation and we narrowed that list down to the three most important things she genuinely needed to get done right then. Out of everything on that original list, I identified the three that would actually start moving things in the right direction, the things that had to happen no matter what else did or didn't. We met again the following week, and this time she'd completed all three, and her statistics had already started responding. I've applied that same principle with clients and team members for years since, and it consistently works: dial things down to the most important few items, especially with someone who already has a lot going on, let them focus and get those done, and then build from there. That's exactly what happened with this client eventually, her practice ended up thriving across the board.
It's with that concept in mind that I want to approach this week's episode on the subject of sales. I've done a number of episodes on sales already, getting into plenty of complexity around improving case acceptance, and there's still a great deal more we could cover. But for this episode, I want to dial it all the way down to simplicity: three specific, vital things you could focus on right now to simplify your sales process and start moving toward real improvement. My name is Jeff Blumberg, and I'm your host.
Let's start with why sales matters so much, since it's usually one of the very first areas I focus on with newer clients. Sales connects directly to your income. I know in healthcare people tend to dislike the word sales, since it conjures up car sales or cell phone sales, but at its core, sales is simply getting someone to move forward with something they need or want, that's closing, and in dentistry we call it case acceptance.
Why does this matter so much? Say a patient comes in needing six crowns, and you don't have enough time to present the case properly, or you're not entirely sure what to say, and you don't close any of it. If your fee is $1,400 a crown, you've just potentially lost $8,400 in production. Or say you don't present it quite effectively, and the patient only agrees to two of the six, now you've done $2,800 instead, and lost roughly $5,600 in the difference. And here's the thing worth remembering: if that patient does all six crowns, it's genuinely a win for both sides, not just financially for you, but because the patient is actually getting the full treatment they need to resolve their situation.
So let's look at a few immediate things you can do here, no formal training required, though we do have extensive training on this subject, including the MGE Communication and Sales Seminar, nine days of dedicated sales training, I'll put a link on the episode webpage, along with additional sales courses built into the MGE Power Program. I won't link the Power Program directly here, but I'll include a link if you want to learn more about it. For now though, here are three things you can start doing the moment you walk into your office today.
The first thing: make sure you actually have time to sell. We build time into the dental schedule for diagnosis, exams and the like, and we build in time for the actual clinical treatment, but we very rarely build in real time for treatment presentation. That part tends to get squeezed in on the side, or the doctor handles a small piece of it and hands the rest to a treatment coordinator. This has been the norm for a long time, and there are more advanced setups eventually where the doctor has minimal direct involvement in presenting treatment, but that's for a genuinely evolved practice. For the average solo practitioner, or even a practice with one associate, it usually starts with the doctor presenting the treatment plan directly, which means the doctor needs enough time to actually do that effectively.
Here's a way to frame it: say you're presenting a $6,000 case to a patient earning $60,000 a year, and you're trying to do it in three and a half minutes because it's a recall appointment and you only have five minutes total to do the exam and explain what they need, even if you'd diagnosed it before. Most people simply aren't going to decide to spend a tenth of their annual income in five minutes. You need real time. If you're trying to improve sales in a practice, there are three areas to focus on: first, making sure there are enough people to actually sell to, meaning enough new patients and hygiene patients who genuinely need treatment; second, improving sales skill itself, which is what those seminars cover; and third, handling the organizational side of sales, which includes literally organizing the time to sell in the first place.
So how would this actually look walking into the office? Say your schedule is packed, you've got new patients coming in through hygiene for an hour-long visit, and recall patients where you only have five minutes to pop in for a quick exam. Let's look at each. With a new patient in a 20 minute slot for a smaller case, your hygienist is doing the full mouth series and perio probing, and you'll likely spend about 15 minutes getting to know the patient and doing your exam and charting, leaving five or six minutes to actually explain your findings. For a smaller case, you can likely just present and close it on the spot. But say it's a $10,000 case, and you've just spent 15 minutes meeting this patient for the first time, you only have five minutes left, and you simply don't have enough time to properly present a case that size. Even a $5,000 case might not fit comfortably into that window.
Here's what I'd change, and to be clear, if you're already closing 60 to 80 percent of your cases with your current approach, don't change a thing, it's working. But for roughly 90 percent of the people I talk to, here's the adjustment: figure out realistically how much time it would take to properly present this specific case, answer every question the patient has, and explain everything clearly, probably at least 20 minutes, sometimes longer for a larger case. If you don't have that time available, you're better off not presenting the case at all in that moment and bringing the patient back, rather than half presenting it and leaving the room. Half presented cases are exactly the ones where you rush through it in five minutes, walk out, and later ask your treatment coordinator or front desk what happened with that patient, only to hear they're thinking about it. Don't start a case you don't have time to close.
In these situations, bring the patient back on the schedule within one to three days for what we call a consult appointment, maybe 20 minutes, two blocks on a 10 minute book, or 30 minutes depending on how much time you realistically need to explain things properly to this particular patient. Here's roughly how that conversation goes: after finishing your exam and any scans, you tell the patient something like, it was great meeting you today, here's what I'd like to do, I'd like to bring you back for a consultation appointment where we can go over what I found and the course of action I'd recommend to resolve it. You're not trying to fully explain the treatment plan without having time to finish explaining it, you're leaving a bit of intentional mystery. The patient will naturally ask what's going on or how much it will cost, and you can simply say you want time to properly study everything and make sure you land on exactly the right course of treatment for them, which is why you're bringing them back for a dedicated, undisturbed conversation where you can answer every question fully.
You might also ask at that point whether anyone else is typically involved in their healthcare decisions, a spouse for example, in which case they should bring that person along, and then figure out timing together. You might have dedicated consult time already blocked on the schedule, or simply ask your assistant when the next available consult slot is. Consult time has to be genuinely uninterrupted, you can't be popping up to numb another patient or run a recall exam during it, ideally it's first thing in the morning or right after lunch. Tell the patient, I have an opening the day after tomorrow at nine, can you make that? Most will say yes.
Will some of these patients not show up for the consult? Sure, that happens sometimes. Will most show up? Absolutely. And if a patient asks something like, am I okay, do I have cancer, and you genuinely see no indication of anything like that, don't leave them needlessly frightened, that's the exact feeling we all hate about waiting weeks for medical test results. If there's no sign of pathology and you're comfortable saying so, reassure them directly, there's nothing like that going on, there are just some things I'd like to go over with you properly. Then bring them back for that consultation.
That's the approach for new patients: if you don't have time to close it today, don't start the sale, bring them back for a day when you genuinely do, and that day needs to fall within one to three days, never next week or further out. I generally prefer the next day or two days out, but three days works if that's what's needed. The key is getting them back in while they're still genuinely engaged in actually resolving their dental issue.
There are more advanced scheduling techniques eventually, where you can bake this presentation time directly into the schedule for new patients, and ways to gauge from the initial phone intake whether a case is likely to be more or less involved, asking whether the caller is missing any teeth or in pain, for instance, which can help you pre-block appropriate presentation time even before the doctor sees them. But for now, we're keeping this simple: if you don't have time to present and close, don't start.
Now, if you do have the time, say you've finished your 15 minute new patient exam and you don't have another patient for the next 20 or 30 minutes, ask the patient directly how much time they have. If they say they're free for the rest of the day, sit down right then and go over what you found and present the treatment plan. Same-day presentation is always better than bringing someone back, that's a given, but it's worse to half-present a case than to not present it at all and reschedule properly. To restate that clearly: if you only have five minutes, which isn't enough time to close the case, bring the patient back. If you have the 20 minutes or however long you actually need, present it now. And remember, it's not just your time that matters, the patient needs adequate time too. If they're rushing out the door in six minutes, don't try to cram the conversation into six minutes, you'll simply blow the sale, which is bad from a business standpoint, but also means this person may not get treatment they genuinely need. Give yourself, and them, the time to properly explain it.
That's the first thing: time to sell. How does this apply to existing patients of record? Interestingly, when clients go through the MGE Communication and Sales Seminars specifically to raise treatment acceptance, most of their initial income increase actually comes from patients of record, not new patients, since any new marketing efforts haven't had time to produce results yet. These are patients who were already diagnosed with treatment previously, six months ago, three months ago, whenever, and didn't accept it at the time. Clients typically see an immediate lift in case acceptance with exactly these patients, since the diagnosis work is already done.
With a patient of record, presenting a treatment plan generally takes less time than with a brand new patient, mainly because there's already a degree of familiarity built up. But you still need real time to present it properly. Say it's a patient named Bill, and four months ago at his last recall visit you diagnosed two onlays and two crowns, explained it to him, and he said he'd think about it, and nothing happened since. Now he's back for another recall exam, and you've got about five minutes. If you have the roughly 20 minutes you'd need to properly present and close this case, present it to Bill. If you don't, bring Bill back for a consultation, the same way you would a new patient, because you need that time to properly explain what Bill actually needs, answer his questions, and make sure he genuinely understands the situation. Something like, Bill, based on what I found in your exam today, I'd like to bring you back for a consultation to go over a few things properly, just the two of us, and answer any questions you have, since there are some things I want to make sure we address soon. If Bill asks what exactly, you can say you want to review his new x-rays and everything else first, and go over it fully when he comes back. Patients of record tend to keep these consult appointments reliably. Same rules apply: within one to three days, 20 to 30 minutes of genuinely uninterrupted time. And again, if you can present same day to Bill, do that instead, but start giving yourself the time to close these cases properly either way.
That's the first change you could make immediately and see a real lift in case acceptance from. Number two is the actual presentation process itself. To be clear, I'm not getting into the clinical side of your presentation at all, that's entirely your call as the doctor, I'm only talking about how you explain the treatment plan to maximize the patient's understanding.
Say Bill is back for his consultation, or you're presenting same day because you have the time, either for that new patient or for Bill as a patient of record. A few core principles apply. First, remember that most of the people you talk to day to day are your own team, your hygienist, your assistants, possibly associate doctors, so you're constantly using dental terminology, abbreviations, and shorthand without thinking about it. Patients don't speak that language. They don't necessarily know what an abscess is, or a radiolucency, or the buccal surface of a tooth. They know they have teeth, and that's largely where their dental vocabulary ends. So explain everything in plain, everyday language, as though you're talking to someone with zero dental background, because you generally are. Don't use surface names or tooth numbers unless you're explaining what those mean, just say the tooth in front, or the outside surface next to the cheek.
Second, when you explain the treatment plan itself, keep the structure simple: here's what I found, make sure they genuinely understand that, here's what I want to do to fix it, and here's why it matters, along with what happens if we don't address it. Make sure they actually grasp what an implant is, or what a crown is, if they've never had one. It can genuinely help to have a model implant or an old lab case on hand, an extracted tooth or an unused crown from a case that never got delivered, so the patient can actually see and touch what you're describing rather than just imagining it. If they don't fully understand the problem itself, use your intraoral camera to show them directly, or a mirror, or have them run their tongue over the area, whatever helps make it concrete. Make sure they understand the problem, the proposed fix, and the real consequence of doing nothing. If a tooth is trending worse across recent checkups, and waiting means it eventually needs a root canal instead of a simple restoration, or eventually an implant instead of a root canal, waiting often ends up costing considerably more than acting now, and that's worth explaining plainly.
The last piece: mention the fee. At minimum, tell the patient directly what the treatment will cost, for these four crowns, or these two onlays and two crowns, it's going to be this amount, whatever your actual fee comes to. Have a simple treatment plan sheet on hand if that helps. For larger treatment plans specifically, it's often worth having your treatment coordinator or financial coordinator, or your office manager if you don't have a dedicated role for this, present in the room while you go over it, and at minimum, state the fee clearly. If the patient reacts with sticker shock, that's fine, acknowledge it, and let them know you'll have them sit down afterward with your coordinator to look at the different ways they might be able to handle it. That's the bare minimum. I'd actually recommend taking the conversation a step further, which I've covered in other episodes, asking directly how they'd normally handle an expense like this if they're not ready to commit on the spot. But at minimum, state the fee, walk through what's wrong, how you'll fix it, what happens if you don't, and what it costs, and if there's a reasonable insurance estimate, share that too, then hand things over to your treatment coordinator to actually get them paid up and scheduled.
So to recap where we are: real time built into the schedule, plain language instead of dental terminology, a clear explanation of the problem, the fix, and the consequence of inaction, and a direct statement of the cost. Two final notes here. First, if a patient is pushing back specifically on the fee, hesitating, saying they'll need to think about it, it's worth asking directly whether they actually want the treatment in the first place. I've seen people argue back and forth over cost for a solid half hour, only to eventually ask the patient if they even want the treatment, and hear an uncertain answer. There's no point negotiating over the price of something someone doesn't actually want yet, that's a sign they need more explanation of the problem itself, not a different price.
Second, stay reasonably persistent. Your job as the doctor is to help restore your patients' health, that's the whole reason they're in the chair. Don't fold the moment someone says they need to think about it. If you've explained a treatment plan and the patient hesitates, don't just repeat the exact same explanation word for word, that comes across as robotic. Instead, bring up one specific point again, let me show you this particular thing about this tooth again, or here's something worth pointing out here, and bring them back into the conversation naturally. Staying a bit persistent, without being pushy, genuinely matters.
All of this does require real time. And here's the almost silly part of it: if you set aside even 60 to 90 minutes a week specifically to make sure you have time to properly sell, your income could genuinely double, purely from that time investment alone, since it captures sales you'd otherwise lose trying to squeeze everything into five rushed minutes. And explaining the fee specifically makes a real difference, hearing it directly from the doctor carries real weight with patients. If you don't believe that, ask your own staff who a patient is most likely to actually listen to, and they'll tell you it's the doctor.
So that covers the first two things: building in real time to sell, and running a clear, structured presentation. The third thing is planning your day around this. We have a downloadable handout for this called the Morning Production Meeting, I'll link it on the episode webpage. A lot of practices already run some kind of morning huddle, but the morning production meeting is different from a clinical meeting, it's not about deciding which cement to use on an 11 o'clock patient. It's specifically about reviewing every patient coming into the practice that day, identifying anyone with outstanding diagnosed treatment, especially on the hygiene schedule, and deciding in advance who's going to talk to them and how the case will actually get closed.
Say you're a solo practitioner with one hygienist, an office manager, one more front desk person, and a couple of assistants. During the morning production meeting, you'd look at everyone coming in through hygiene specifically, not just new patients, since you genuinely don't know yet what a new patient's situation looks like, a broken tooth or a toothache could mean almost anything. But you can see clearly that the 10 o'clock hygiene patient was diagnosed with four crowns at their last visit, so you plan to step in and talk with them, even if they're not due for a full exam yet, and you make sure your office manager is available at that same time to join you in the room for the financial conversation. That's the whole point of the morning production meeting, making sure the time and the right people are actually lined up in advance.
I won't go through every detail here, we've covered the morning production meeting in a dedicated episode before, and the downloadable handout is fairly self-explanatory. I'd recommend implementing it regardless of whether you've done anything like it before, just try it. I've observed plenty of morning production meetings over the years, some genuinely rough, but even an imperfect one beats not having one at all. Every one of our consistently successful clients runs some version of this, and it keeps patients actively moving through their treatment plans, since someone is deliberately engaging with them and encouraging that progress rather than letting it drift.
So those are the three basic things. If I were sitting across from you right now, overwhelmed with a lot going on, wanting to improve case acceptance, these are the three things I'd have you address immediately, before any formal training: build in real time to sell, tighten up how you actually present treatment, and plan your day in advance so you know exactly how that time gets used.
If you want to see whether this would genuinely help your practice, here's something you can do right now: pull up your practice management software and look at how much treatment you've diagnosed and presented over the last month or two, then compare that to how much of it has actually landed on your schedule. If you find you've diagnosed $300,000, $400,000, or $500,000 worth of treatment and only a fraction of that is actually scheduled, that gap tells you exactly where the problem is, and it represents both lost income and, more importantly, lost potential for patient health. That's something you can start addressing immediately. Long term, of course, real training in this area, through the sales and communication training I mentioned, is where you truly master it and keep improving.
That's everything I have for you this week. I've included the downloads along with links to the MGE Communication and Sales Seminars and the Power Program on the episode webpage. I hope this helps, and if you'd like more information about MGE, you can find us at mgeonline.com or call us at (800) 640-1140. Have a great week, and we'll see you at the next episode.