Ep. 15: 6 Metrics for Practice Success, Pt 1
Special guest Jeff Santone comes on this week to discuss six important metrics for assessing the health of your dental practice and discovering areas where you can improve. In part one, we focus on case acceptance and how much potential production you may be leaving on the table.
Topics:
0:11 – The 6 metrics you should focus on
2:55 – The best way to measure your case acceptance
6:10 – Value of treatment presented vs treatment produced
9:21 – Where the usual method of measuring case acceptance can be misleading
16:04 – How much potential production are you leaving on the table?
23:07 – What is the doctor’s responsibility and what it the staff’s responsibility when it comes to case acceptance?
Links:
Contact Jeff Santone at (800) 640-1140 or JeffS@mgeonline.com
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
Why is case acceptance percentage one of the most valuable metrics to actually track?
Because the patient is already in the chair, already engaged, already presented with a treatment plan, making it the fastest possible lever for real revenue growth with no added marketing cost. Most doctors self-rate their case acceptance skill highly, often an 8 out of 10, while simultaneously admitting they're uncomfortable discussing the financial side of a case, a clear sign their actual acceptance number is based on impression rather than any real tracked data.
What's the difference between the two case acceptance metrics recommended in this episode?
The first tracks dollar value presented versus dollar value actually produced, a straightforward revenue comparison. The second tracks case acceptance rate specifically, counting each individual case presented as one, and each case only as accepted if it's fully completed, regardless of dollar value. A single $91,000 case can make dollar-value acceptance look excellent while masking a genuinely poor rate of full case closure across everything else presented that month.
Why can dollar-value case acceptance alone create a misleading picture of a practice's sales performance?
Because one very large accepted case can dominate the percentage even if nearly every other case presented that month went nowhere. A practice that closes one $91,000 case out of $100,000 in total treatment presented looks like a 91 percent success story by dollar value, even if that same month included nine smaller cases and only one of ten total cases actually got fully accepted.
Does a scheduled appointment count as an accepted case?
No, only actual production counts. Scheduling reflects intent, not commitment, and appointments frequently get missed or rescheduled indefinitely. One newer client tracking this for the first time found that of four cases she believed were accepted and scheduled, two had already passed their scheduled date without the patient ever showing up.
Why is closing a treatment plan ultimately the doctor's responsibility, not the front desk's?
Because handing a patient off to a treatment coordinator or financial staff member doesn't transfer accountability for whether the case actually closes, that responsibility still belongs to the doctor. The comparison used is a retail employee pointing a customer toward someone else the moment money comes up, a doctor's training and relationship with the patient makes them the one best positioned to close the case, with support from staff, not the other way around.
Episode Transcript
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Jeff Blumberg: How is your practice doing? If you're like most doctors, you'd probably answer with one word, good, bad, or okay. But what metrics are you actually using to arrive at that answer? That's what I want to cover this week: the six key metrics that actually determine the health of your practice. My name is Jeff Blumberg, and I'm your host, joined this week by Jeff Santone, our New Client Services Executive.
Jeff Blumberg: Jeff, you're all hooked up?
Jeff Santone: I'm here.
Jeff Blumberg: Since you spend so much time talking directly to new and prospective clients, you have to size up a practice's condition quickly, which makes you the right person to walk through these. Heads up, this is likely going to be our first two-part episode.
Jeff Santone: Just two parts though, not three. We're not doing a whole trilogy here.
Jeff Blumberg: Right, let's start with the basics everyone already tracks: collections, production, and new patients. Beyond those three, what else are you looking at when you meet a new client?
Jeff Santone: Case acceptance as a percentage, call conversion, meaning new patient calls versus actual new patients who show up, and attrition rate, how many patients the practice is actually losing over time.
Jeff Blumberg: Let's take these one at a time so listeners can start calculating these themselves. Quick clarification before we dig in, since I know this comes up: if someone comes into the practice as an emergency, does that count as a new patient?
Jeff Santone: Yes, if they come into your practice, that's a new patient. Simple as that, if you're keeping records and X-rays on them, they count.
Jeff Blumberg: Good, keeps it simple. So of these additional metrics, which one do you look at first?
Jeff Santone: Case acceptance percentage, hands down. It's the biggest return for the smallest additional effort, that person is already sitting in your office, you've already talked to them, already presented a treatment plan. Getting more of those patients to say yes directly moves collections, production, and overall profitability, and it's genuinely not complicated, yet most practices don't actually track it.
Jeff Santone: In our surveys at the New Patient Workshop, we ask attendees to self-rate their case presentation skill, one to ten. Most rate themselves around an eight. Then we ask what percentage of patients accept the full case when a larger treatment plan is presented, and answers usually range from 60 to 90 percent, rarely below 50.
Jeff Santone: But then we ask a follow-up: are you comfortable discussing the financial side of a case with a patient? About 80 percent say no. Those two answers directly contradict each other, you can't genuinely be closing cases at a high rate while being uncomfortable with the money conversation. Which tells you they're using an entirely different, much looser definition of case acceptance.
Jeff Blumberg: So what are they actually counting?
Jeff Santone: Honestly, I think in a lot of cases it's not much more than a head nod, sometimes just the patient scheduling an appointment. I wanted a way to track this with real certainty, so that when I sit down with a client and ask how their case acceptance is doing, they can tell me an actual number, say 68.6 percent last month, not a general impression.
Jeff Santone: The number most doctors give isn't based on reviewing real patient data, it's just, I'm an eight out of ten, and most people accept comprehensive care. It's entirely opinion-based, there's no actual data behind it.
Jeff Blumberg: Which is a bit concerning, especially since if a doctor eventually brings on an associate, they become an investor in the practice and genuinely need to know their real efficiency numbers.
Jeff Santone: Exactly, case acceptance is essentially an efficiency metric, how well the practice converts a patient walking in the door into someone actually treated. So I started having clients track it directly using what I call a case acceptance log, a simple spreadsheet anyone can build. Mine included the date, patient name, ID number for easy follow-up, a brief note on what was presented, and two key figures: total dollar value presented, and dollar value actually produced, not accepted, not scheduled, produced.
Jeff Blumberg: So walk me through an example.
Jeff Santone: Say a patient comes in today, gets presented two crowns totaling 2,000 dollars, agrees to it, but schedules for next week rather than doing it same day. In the log, that's 2,000 dollars presented, zero dollars produced, with a note on the scheduled date. If I come back to that log months later and it's still showing zero produced with a note that the appointment was never kept, that's an immediate, visible pattern worth following up on.
Jeff Blumberg: And if they do come back and complete it, even if it falls into the following week?
Jeff Santone: As long as it's actually produced, even if the visit itself happens a few days later, it counts as both presented and produced for that same original period, since the commitment and the follow-through both happened.
Jeff Blumberg: So that's the dollar-value side of it. But you mentioned running into a problem with tracking dollar value alone at your own oral surgery practice.
Jeff Santone: Right, we were doing a lot of large arch cases and had genuinely strong dollar-value acceptance, but smaller case acceptance had quietly dropped without us noticing, because tracking dollar value alone can produce false positives. Say a practice handles everything in-house, extractions, bone grafts, implants, restorations. One patient comes in for a double arch case worth, hypothetically, 91,000 dollars, and it gets fully accepted and produced. Meanwhile nine other patients each present around 1,000 dollars in smaller treatment, and none of them accept anything.
Jeff Santone: By dollar value, that's 91,000 out of 100,000 dollars total presented, a 91 percent acceptance rate. Looks fantastic. But you actually only closed one case out of ten total presented that month.
Jeff Blumberg: So the dollar figure alone can genuinely mask a real problem.
Jeff Santone: Completely. Which is why I added a second metric, a simple binary count: was a given case fully accepted or not, regardless of its dollar value. The 91,000 dollar case counts as one, the single crown case also counts as one. Ten total cases presented, only one fully accepted, that's a 10 percent case acceptance rate by this measure, even though the dollar-value number looked outstanding.
Jeff Blumberg: And the reverse can happen too, where dollar value looks weak but the actual close rate is strong.
Jeff Santone: Exactly, you could close nine out of ten cases presented but still only capture 9,000 of 100,000 dollars in total value if that one large case falls through. One measures dollar value produced, the other measures the rate of cases actually closed. Most practices don't track this second number at all, they assume it takes too much time, but realistically they're not presenting so many cases a day that logging this becomes a real burden. And these numbers exist in your practice whether you track them or not, you're simply better off knowing them.
Jeff Blumberg: One thing worth clarifying, since this trips people up: if I present six crowns and a periodontal program totaling 10,000 dollars, and the patient only agrees to start with the periodontal portion, 2,500 dollars, how does that get logged?
Jeff Santone: The full 10,000 dollars gets logged as presented, since that's genuinely what was proposed. But in the binary acceptance column, that's still a zero, since the full case wasn't accepted, only a portion was. It doesn't matter that something was produced, partial acceptance doesn't count as a closed case in that column.
Jeff Blumberg: So over time, if that same patient eventually completes the rest of the plan, does it balance out?
Jeff Santone: Generally, yes, it evens out over time. The point is you can't game this metric, either a patient is getting comprehensive care or they're not, and this makes that distinction impossible to fudge.
Jeff Blumberg: You mentioned this comes up with implant cases specifically, a patient who declines an implant, seeks a second opinion, and ends up doing a bridge instead somewhere else, or even coming back to the original practice for the bridge.
Jeff Santone: Right, Dr. Philomin actually brought up a similar scenario at one of our recent seminars, an associate presented an implant, the patient sought a second opinion, came back, and the associate ended up doing a bridge instead, not the ideal outcome, but it happened. Whatever the original plan was, if the patient doesn't move forward with what was actually presented, that's still a zero in the binary column, even if some form of treatment eventually gets done.
Jeff Blumberg: This connects to something practical: does scheduling an appointment count as accepting a case?
Jeff Santone: No, only actual production counts. I had a newer client, someone who'd just purchased her practice, ask exactly that, can I count it if it's scheduled? I asked how many cases she currently had scheduled into the future. She said four, only a month into tracking this. I then asked if any of those scheduled dates had already passed without the patient showing up. Two had.
Jeff Blumberg: So half of what she assumed was accepted had actually fallen through.
Jeff Santone: Right, no-showed or rescheduled indefinitely. That was a real moment of realization for her, these patients hadn't actually committed to the treatment, whatever their reasons, scheduling alone simply isn't a reliable signal of genuine commitment. Which is exactly why we train clients to get real commitment from the patient toward their treatment specifically, that's the next best real indicator available.
Jeff Blumberg: This connects to something true of any sales role, including here at MGE, the job isn't done when someone agrees to something, it's done when they actually start the service. Same logic applies in a dental practice, until the patient is genuinely in the chair receiving treatment, there's still a real chance it doesn't happen.
Jeff Santone: Exactly, which is why I built this log in the first place, originally just for myself as an owner, but I realized most doctors are essentially treating a head nod, or even just a scheduled appointment, as a completed sale. It's a bit like a car salesman asking if you like the car, hearing an enthusiastic yes, and walking away considering the deal already closed, before any actual commitment has been made.
Jeff Santone: It's genuinely ironic, doctors go through years of rigorous clinical training and then don't finish that very last, comparatively simple step, actually helping the patient want and commit to what they need. But the real value of this metric isn't just balancing dollar value against case count, it's using it to directly diagnose exactly where a sales process is breaking down.
Jeff Blumberg: How so specifically?
Jeff Santone: Say a patient's plan includes crowns, fillings, a denture, an extraction, a bone graft, and an implant, and everything gets accepted except the implant. Look at that pattern across your log over time, and it becomes immediately obvious: implants specifically aren't closing. That's a targeted, specific answer, not a vague, generalized sense that something in the practice isn't working.
Jeff Blumberg: Which is a lot more useful and a lot less demoralizing than a generic team meeting where the doctor says we're not doing well and everyone privately feels like they personally are doing fine.
Jeff Santone: Exactly that scenario, the hygienist feels great about hitting their own numbers, the front desk feels good about answering calls well, and meanwhile the person with the least influence over the practice's actual revenue outcome ends up carrying the responsibility for it in everyone's mind, when the real gap is usually elsewhere entirely, often specifically in how the doctor personally handles closing a case.
Jeff Blumberg: Which gets at something important: when a doctor hands a patient off to a treatment coordinator or front desk staff member who doesn't close the case, the missing accountability there is still ultimately the doctor's, not the staff member's. That team member can support the process, but closing the case is fundamentally the doctor's job.
Jeff Santone: Exactly right, and that's a genuinely hard thing for a lot of doctors to confront directly. It's a bit like the Best Buy example, you wouldn't expect an employee to point you toward another department the moment pricing comes up, saying money isn't really their department. The doctor is the one best positioned to close the case, with support from staff, not the reverse.
Jeff Blumberg: And just paying attention to a number like this tends to improve it almost automatically.
Jeff Santone: Consistently, yes. And it's all relative to where a specific practice is starting from, not some absolute target. Take that doctor who presented 220,000 dollars and produced only 50,000. He doesn't need to hit 100 percent, moving from roughly 25 percent up to even 40 percent case acceptance could genuinely double his practice's output. Getting him to 75 percent would feel like an enormous win, even though there'd still be real room to improve beyond that. What matters is whether the trend is actually moving in the right direction.
Jeff Santone: This metric also matters enormously from an ownership and succession standpoint. If a doctor has consistently presented around 200,000 dollars a month in treatment for years, and hands the practice to an associate whose presented volume drops to 100,000 or 150,000 with the same patient base, that's a clear, measurable signal something changed on the clinical or sales side, not with the patients themselves.
Jeff Blumberg: So to sum up for everyone listening: track two related statistics. First, dollar value of case acceptance, dollar value presented versus dollar value actually produced. Second, case acceptance rate, a binary count of full cases presented versus full cases actually closed, regardless of dollar amount.
Jeff Santone: That's exactly right.
Jeff Blumberg: If anyone wants to take Jeff up on his challenge here, track this for a month and follow up directly, he's genuinely happy to walk through it with you. You can reach Jeff Santone directly at jeffs@mgeonline.com, we'll include that on the episode page, or call 800-640-1140. We'll be back next week with part two of the six key metrics for practice health.