Ep 153: Recapturing Lost Treatment Opportunities
The majority of your revenue should be coming from your existing patient base. But most dentists have thousands of dollars in outstanding treatment that wasn’t accepted by patients in their practice. So how do you bring these “unclosed” patients back in and get them to accept this needed treatment? Well that’s what Jeff covers in this week’s podcast.
Links:
Morning Production Meeting Handout – https://mgeonline.com/morning-production-meeting-download
MGE Communication & Sales Seminars – https://mgeonline.com/mge-communication-and-sales-seminars/
DDS Success - https://www.ddssuccess.com/
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Questions From This Episode
Why does Jeff say more than 60 percent of a healthy practice's revenue should come from patients of record, not new patients?
He points to clients who see a real revenue jump after Communication and Sales Seminar training well before any new marketing could have kicked in, evidence that the increase came entirely from better converting the existing patient base. He also recommends pulling up your own incomplete treatment list, since he's seen practices with $1 million to $3 million sitting in diagnosed but never-accepted treatment.
Why does Jeff say assuming a patient will say no again is a mistake, even if they declined treatment months ago?
He compares it to basic marketing repetition, sometimes a message needs to be repeated several times before someone acts on it, and circumstances change in ways a practice can't predict. He shares an example of a patient an office manager assumed couldn't afford $4,000 in treatment, who accepted it the moment it was actually presented.
What's the purpose of the "morning production meeting" Jeff recommends?
It's a daily review of every patient coming in with outstanding, previously diagnosed treatment, building what he calls a "lineup" with a real dollar figure attached, unlike new patients, whose needs are a complete unknown until they're actually diagnosed. That gives the practice a predictable, trackable basis for hitting daily and monthly revenue targets.
Why does Jeff say a doctor should never start presenting a case unless there's enough time to actually close it?
A half-finished presentation is worse than one that never happened, since a patient left mid-conversation about their own health rarely gets appropriately re-engaged. He recommends scheduling a dedicated consultation appointment instead when time is short, rather than rushing through diagnosis and treatment options during an already-tight hygiene visit.
What does Jeff say it usually means when a practice's hygiene schedule looks entirely "clean," with no outstanding treatment on the books?
Rather than a sign of success, he says it usually means the practice is only seeing its most motivated top 20 percent of patients, the ones who show up reliably on their own, while a much larger group, patients who need active follow-up to stay engaged, has quietly gone inactive. He recommends checking the incomplete treatment list and focusing on reactivation to bring those patients back.
Episode Transcript
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When training a new client on case acceptance techniques, or how to organize their practice to increase case acceptance, for whatever reason the majority of new clients assume these techniques are meant only for new patients, not for the patients already in the practice, patients of record, your charts, whatever you want to call them. I understand the logic behind that assumption, it might go something like, my current patients are used to the old me, I don't want to shake things up too much, so I'll show the new patients the new way we do things going forward. In other words, the idea is that the practice gets remade gradually as new patients accumulate over time. I get the thought process, it just doesn't actually work that way.
So how should this actually work? Let me frame this week's topic with a number: more than 60 percent of your monthly revenue, month in and month out, should be coming from patients of record, people already in your practice. That runs against the common instinct that if you want to increase collections, you need to go get more new patients. I'm not saying you shouldn't pursue new patients, and I'm not downplaying their importance, of course they matter. But the majority of your revenue should be coming from people already there, and I don't just mean through hygiene, I mean on the doctor's schedule too.
If you want a more concrete look at this in your own practice, pull up your incomplete treatment list. I've had people run this exercise and find it totals in the millions of dollars. Some people call it the list of missed opportunities, I call it the not-closed list, treatment plans diagnosed for patients who are already in your practice, who already know you, that simply never got accepted.
We see this play out constantly with clients who go through the MGE Communication and Sales Seminars, I'll put a link on the episode webpage. A client might be doing $60,000 or $70,000 a month, and the following month they're at $95,000, then $100,000, then $105,000. In that first month or two, it's too early for any new marketing to have kicked in yet, so where's that increase actually coming from? Their existing patient base, people who were already there.
Before we get too caught up in dollar figures, or accuse ourselves of being overly focused on money, let me ask three questions. First: what's the purpose of your dental practice? For most doctors, it's making patients healthier, improving oral health and, by extension, systemic health, restoring function and aesthetics. Second: should patients pay for services that genuinely benefit them? Of course they should. Third: is it better for a patient's overall health to complete their full treatment plan, rather than only the portion insurance happens to cover? If I need six crowns and do all six, that's clearly better for my oral and overall health. It also happens to be better for you as the dentist, both in the satisfaction of actually restoring someone's health through a complete treatment plan, and in your practice's revenue. This is a genuine win-win, you benefit, and so does the patient, and it directly serves your practice's actual mission. It's not fundamentally about the money, it's about getting patients healthy, and getting more patients genuinely healthy happens to generate more revenue as a natural consequence.
So how do we recapture these lost treatment opportunities already sitting in your patient base, while improving revenue and patient health at the same time? That's what I want to cover this week. My name is Jeff Blumberg, and I'm your host.
There are four major reasons practices consistently miss out on these opportunities, and before we get into them, here's a quick exercise worth doing, whether you're at the office right now or you'll check it when you get in: look at the total amount of treatment diagnosed over the last five years that was never completed. Add it up. Most practice management software will show you the dollar figure tied to that incomplete treatment. This isn't even accounting for patient health yet, just the raw business impact. I've had people run this and find $1 million, $2 million, even $3 million sitting there. That's a lot of missed opportunity, and it starts to paint a real picture of what's actually happening in your practice. So how do we start getting these patients back onto the schedule? Let's get into the four reasons.
The first reason: let me give you an example. I was actually at a client's practice during their morning meeting once, looking over the day's patients. One of the first hygiene patients that morning was a woman who needed $3,000 to $4,000 worth of treatment. I asked who was going to present that treatment plan to her, since she was just there for a routine recall visit. The office manager said, oh, she's a janitor at the local hospital, she already paid off a more comprehensive treatment plan last year, she's probably still paying that off, she won't be able to afford it. That was the instant response. I asked whether they'd actually talked to her about the remaining balance of treatment. Yes, six months ago, briefly. I asked if they were planning to bring it up again today. No, they weren't.
I don't remember my exact wording, but it was something along the lines of, you never know if you can get something unless you ask, or the classic, you miss a hundred percent of the shots you don't take. So I suggested they just present the treatment anyway, have the doctor explain it and the associated finances, and see what she says. The office manager was fairly sure it would be a waste of time. They did it anyway, she accepted the treatment, financing wasn't an issue, and later I walked by the front desk and got a knowing grin from the office manager, a silent acknowledgment that I'd been right.
In a lot of cases, the reason you're missing these opportunities is a preconceived notion about what the patient's going to say. We talked to Bill about those four inlays during his last perio maintenance visit three months ago, and Bill said no, so why bother bringing it up again? There's a well-established marketing principle behind why repetition matters, when you're marketing something, you repeat the message over and over until it genuinely sinks in, and it can take a while for someone to actually act on it. Think of any brand slogan you can recite from memory without even trying, Geico, for example, that recall exists because of sheer repetition, whether or not you ever bought the product. I've heard from clients who send postcards that a new patient showed up specifically because it was the third or fourth postcard they'd received, they hadn't responded to the first few, but eventually it landed.
The same thing happens with treatment presentations. You might explain a treatment plan to a patient, move on with your day, see twenty more patients, and genuinely forget about it entirely. Then six months later they come back and say, doctor, remember that thing you told me about last time? I think I'm ready to go ahead with it. You might have to glance at the chart to even remember what "it" was, but for them, it took time to actually process and decide. Some people move faster than others. Sometimes it takes talking to a patient three, four, five, or six times before they're finally ready to say yes. This applies specifically to genuine health-related treatment, active disease, functional issues, not purely aesthetic requests like veneers, which are more of a want than a health necessity. But for things like crowns or implants addressing a real health issue, the message sometimes just needs time to land, and that varies person to person.
Assuming a patient will say the exact same thing they said months ago is a flawed way to think about it, and honestly, it's a poor sales instinct too. Anyone genuinely experienced in sales knows better than to write someone off permanently just because they said no once, people's circumstances change, their priorities shift. Maybe they saw a news segment last week about someone who ended up hospitalized over a dental infection and thought, I really should get that taken care of next time I'm in. You never know. But your job is to help patients get healthy, and if they're not healthy, you have to tell them, repeatedly if necessary. So I'd make sure every patient coming in with outstanding treatment gets spoken to about it that visit, even if it was already discussed three or six months prior. They might say no again, but in plenty of cases, even when you're sure they won't, they'll say yes. And beyond the revenue recapture, it genuinely matters for their health.
The biggest reason most of these cases stay undone is simply that nobody ever brings it back up, which leads directly into the second reason: not having the time to actually discuss it. You might recognize, okay, Jim had outstanding treatment from six months ago, but I genuinely don't have time to get into it with him today. So nobody does, not the doctor, not the treatment coordinator, not the front desk, and the conversation just never happens. I covered part of this a couple of episodes back, in an episode about simplifying the case acceptance process, specifically the idea of baking real time into your schedule for treatment presentations, and not just for large full-mouth or All-on-X cases, even a $3,000 to $5,000 case deserves dedicated time. It's natural to think of that time as being for new patients, but it should also be used for patients of record.
Say I'm in for a recall appointment, and you've only got five minutes since you're running behind and just numbed a patient for a root canal, and I've got outstanding treatment I declined six months ago. Rather than rushing through it, you might do my exam and say, Jeff, I'd like to get you back in for a consultation, there are a few things I found today I want to go over with you properly. If I ask what those things are, you can simply say, let's get into the details when we're actually sitting down together, I want to give you my full attention and make sure I explain everything clearly, then set the appointment, maybe day after tomorrow at 8:20, and confirm it right there with your assistant or hygienist checking the schedule in real time. If the patient starts pressing for details right then, gently redirect: I want to review everything properly first so I can explain it right when we sit down. The goal is securing that dedicated, uninterrupted time, not diagnosing on the fly in a rushed hygiene appointment.
One more thing worth remembering here: don't start presenting a case unless you genuinely have time to close it. It's actually worse to start a presentation and leave it half-finished than to simply schedule a proper consultation for later. That rule applies just as much to patients of record as it does to new patients. So use that consultation time you're setting aside for exactly this purpose, both for new patients and existing ones with outstanding treatment you don't have time to properly present in the moment.
So: reason one, it just doesn't get done because we assume the answer will be no. Reason two, there's no time carved out to do it properly. Reason three has to do with how differently we treat a new patient versus a patient of record. Think of it from a business-manufacturing lens for a second, raw materials come into a business to be turned into something. A new patient is essentially a different kind of raw material than a patient of record. With a new patient, most practices have a whole defined process, an hour, an hour and a half, a treatment presentation built in. With a patient of record coming in for hygiene, there's often no equivalent process at all, they get their recall exam, maybe something gets mentioned, and life moves on.
This is exactly why one of the first things we teach a new client is something we call the morning production meeting. I'll put a free download of that handout on the episode webpage. The whole point of a morning production meeting is this: if you want predictable revenue, you need a clear sense of what's actually walking into your practice each day, and what you could realistically sell that day. Nothing lands on your schedule to be produced unless it's sold first. You might not love the word "sales," fine, call it case presentation if you prefer, but it's still sales, explaining something to someone so they understand it, want it, and agree to pay for it. The upside in your case is you're selling things people genuinely need, not some useless product with no real benefit to them. But it still has to be sold. If it didn't, you could just hand patients a treatment plan and they'd hand over their credit card. That's not how it works.
Selling is what actually creates production and income in your practice, so if you want real control and predictability over your collections, you need visibility into what's coming through the door each day. Without getting into every detail of who does what in the meeting, that's covered in the handout, essentially you're reviewing who's coming into the practice that day with outstanding treatment. Maybe they're on the hygiene schedule, maybe on the doctor's schedule. Say you've got two hygienists running, and the 10 a.m. patient was diagnosed with three crowns and some fillings three or six months ago that were never accepted. Someone needs to talk to that person today.
You do this across the whole day, building what we call a lineup, all the treatment opportunities walking into the practice that day. There's the 11 o'clock, another with the second hygienist at 10, one at noon, one in the afternoon. What makes this different from a new patient? With a patient of record, treatment's already been diagnosed, so there's an actual dollar figure attached. Maybe today you've got $26,000 in outstanding treatment walking through the door. That gives you something real to plan around, if your monthly quota is $12,000 a day, and you can close roughly half of what's walking in today, you're on pace. You simply can't do this math with new patients, since you genuinely don't know what they need yet, maybe nothing, maybe a lot, and even with intake form data, you don't know if they can actually afford whatever gets diagnosed. Even an implant consultation is a complete unknown until you've actually met the person and made a diagnosis, you can't attach a number to it in advance. New patients, implant consults, second opinions, these are all genuinely valuable, I'm not knocking them, but you can't build predictable revenue projections around them the way you can with patients of record who already have diagnosed treatment on the books.
If you're not actively lining up who's coming in the next day and what they need, and instead just hoping new patients or the occasional implant consultation will carry your revenue for the day, you've effectively turned your general practice into a specialty practice from a business-model perspective. An endodontist genuinely lives off new patients, that's simply how that model is structured, and that's fine for them. But as a general dentist, the majority of your revenue shouldn't be coming from that source.
In the morning production meeting, it's not just about identifying the outstanding treatment, the handout gets into this in more detail, it's also about coordinating who's actually going to present it and when. The treatment coordinator should know, for instance, that at 11:45 you'll be in with Jim in the hygiene operatory to discuss the three crowns and fillings diagnosed last visit, and that they should be ready to step in right then to help close and schedule it. You'd already know what openings exist in primary time over the coming week, two hours available the day after tomorrow, an hour open Monday, and you're actively working to fill those specific slots with these specific opportunities. That's the whole purpose of the meeting, it puts real attention and visibility on your patients of record so you're actually converting diagnosed treatment instead of letting it quietly pile up.
Will everyone lined up that morning accept treatment? No, that ultimately comes down to sales skill, which again is exactly what we cover in the Communication and Sales Seminars, link on the episode webpage. But I can tell you with confidence, if you present it and give yourself adequate time to do it properly, you will close some of it, and you'll start converting opportunities you weren't converting before, while genuinely improving patient health along the way.
So that's reason three, no lineup, no morning production meeting. The fourth and final reason is a bit more specialized. Say you're already doing everything right, running your morning production meeting, carving out real time to sell, committed to representing previously declined treatment. But then you look at your hygiene schedule for the day and there's simply nothing to present, every patient coming in has no outstanding treatment at all. First off, genuinely well done if that's the case. But here's what's most likely actually happening: say this is you, you've been in practice ten years, running one hygienist, with three or four thousand charts, and you look at your schedule and it's, as I've heard some newer clients put it, "clean."
What's likely going on is that your issue isn't the patients keeping their hygiene appointments, it's the large number of patients who aren't being kept active in the practice at all. In the Communication and Sales Seminars, we cover something called the scale of sales resistance, I won't get into the full details here, but it's also covered on our online platform, DDS Success, I'll put a link on the episode webpage, Dr. Winteregg discusses it in more depth there. Broadly, the top 20 percent of patients coming through your practice are your best, most reliable patients, the ones who do everything you tell them to, who chase your own office down if they happen to miss a hygiene visit. If you've been in practice a while and built up three, four, five thousand charts, roughly a thousand of those people will show up like clockwork on their own, and it's easy to look at a fully booked single hygienist and conclude you're maxed out, while ignoring the other three or four thousand charts sitting untouched.
Beyond that top 20 percent, the next 60 percent are genuinely good patients who just need a bit more active follow-up to stay engaged in the practice, someone needs to call them, follow up, get them back on the schedule. It has nothing to do with their dental IQ or how much they care about their teeth, that's simply how most people operate, they're busy. If nobody's following up with this group, you're artificially suppressing your own hygiene schedule. With that many charts, your hygiene department should genuinely support multiple full-time hygienists, not just one. The real problem isn't the patients already coming in, those are the ones who were always going to show up regardless, it's the patients nobody's actively working to bring back.
I've covered this in a number of past episodes, including a bit of it last week specifically on patient retention. If actively working your existing patient base, following up, staying on top of scheduling, isn't part of your regular business process, you're going to steadily lose a meaningful share of your patients. Maybe they don't switch to another practice outright, but they simply stop staying active, and these tend to be exactly the patients sitting on outstanding treatment, while the ones who reliably show up are usually the ones who already completed everything you recommended. So if you find yourself with a large chart count, limited hygiene capacity, and a schedule that looks entirely "clean," take a hard look at your incomplete treatment list, you'll likely find a large number of these people simply aren't scheduled for hygiene at all, and reactivation efforts are exactly where you should be focusing to bring them back into the practice.
These are just a few ideas to work with, there's certainly more that could be said on this topic, but the core point stands: at least 60 percent of your revenue should be coming from your existing patient base, and these are a few concrete ways to start recapturing what's currently being missed. I'd genuinely encourage you to try this. It makes running the practice considerably easier, since you're no longer relying entirely on new patients, which you shouldn't be doing anyway. New patients absolutely matter for a general dentist, I'm not suggesting otherwise, but they shouldn't be the only thing your revenue depends on.
I hope this helps, give it a try and see how it goes. I've got the downloads mentioned, the morning production meeting handout, along with links to the MGE Communication and Sales Seminars and DDS Success, all on the episode webpage. If you want more information about MGE, you can find us online at mgeonline.com or call us at (800) 640-1140. Folks, have a great week, and I'll see you at the next episode.