Ep. 250: Rating Your Treatment Acceptance
Better case acceptance leads to healthier patients, higher production, and a more profitable practice. In this episode, Jeff explains how to objectively evaluate your results and the practical steps to improve them.
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Questions From This Episode
What four numbers do I actually need to measure treatment acceptance objectively?
The dollar value of treatment diagnosed, the dollar value of treatment presented, the dollar value of treatment accepted, and the actual number of individual presentations you made. Tracking both dollars and case counts matters, since some providers close small cases easily but struggle with large ones, or vice versa, and either pattern gets hidden if you only look at one metric.
What actually counts as a real treatment presentation, versus just mentioning treatment to a patient?
A presentation is an encounter where you had genuine time to explain what you found, what you want to do about it, and why, answer questions and concerns, and discuss the fee, without feeling rushed. A five minute rundown before handing a patient off to a treatment coordinator does not meet that bar, even if it technically happened.
What should actually count as accepted treatment?
The patient has agreed to the treatment and made real financial arrangements for it, whether that's a payment plan, financing, or prepayment, not just insurance coverage kicking in automatically. A patient saying they will do it next year, or that it sounds like a good idea, is not accepted. If it isn't scheduled and paid for or arranged, it isn't closed.
What treatment acceptance percentage should I actually be aiming for?
At least 60 percent of both the dollar value presented and the number of cases presented, with 80 percent as a stronger target. If you present 100,000 dollars in treatment, you want to see at least 60,000 dollars actually accepted under that stricter definition, not just verbally agreed to.
Can I just let my treatment coordinator handle all the selling instead of me?
Not entirely, and not safely as your only plan. A doctor who can walk a patient through the full conversation, findings, fee, and even how they might pay, before handing off to the treatment coordinator for financing, is far less exposed if that coordinator ever leaves. Some busier practices do lean more heavily on an experienced coordinator, but usually only once the doctor can already sell and the two have built that working relationship over time.
Episode Transcript
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How good is your treatment acceptance, really? Have you ever given it an honest, objective assessment, taken away all the bias and looked at it from a neutral perspective, almost as if it were someone else's practice? If you're like most people, self-assessment can be difficult.
That said, the first step toward improving anything is establishing what the actual condition of that thing really is, and knowing what to improve and how to go about improving it. The next few statements may be something you're already intimately aware of, but it still bears saying: your treatment acceptance percentage, how well your treatment plans are actually accepted, is what actively drives overall practice income, overall practice profitability, and your patients' health.
Practice income and profitability are fairly obvious. The more patients who accept treatment, the more you can produce. A patient accepting all six crowns versus only the two insurance happens to cover this year is a 300 percent financial swing, and that doesn't even factor in the professional satisfaction of delivering comprehensive care.
But the third piece, your patients' health, matters just as much. You can't perform procedures patients don't accept, and a patient whose full treatment plan gets accepted and completed is, by definition, going to be healthier. So treatment acceptance is a big deal, and it's also one of the most misunderstood subjects in dentistry.
Here's an interesting way to look at why. If you think of your practice as a business and compare it to any other service business, what function would treatment presentation and acceptance actually fall under? Sales. And there it is, right, who wants to sell? That's not why you became a doctor. But it is what it is, it's sales. It's the part of the job where you explain to the patient what you found, what you want to do about it, how much it costs, and work out how they're going to pay. That can feel uncomfortable, since people can get emotional around money, and that discomfort is exactly why the subject stays so misunderstood.
It's less that people misunderstand it and more that they don't want to fully engage with what it actually is. They know what it is, they just don't want to admit it, so it either doesn't get labeled as sales, or strange workarounds get built around it because nobody wants to think of themselves as selling. We call it patient education instead, which you absolutely should be doing, home care instruction and so on, but to me that's a bit different from actually getting a patient to want the treatment they need.
The good news is that the best sales work isn't done by being pushy or sketchy. It comes from strong communication, persistence, the ability to handle objections, and a genuine desire to help. Improve those things and you can meaningfully move income, profit, and most importantly, patient health, all at once.
So this week, I want to walk you through a set of diagnostics you can use to grade your own treatment acceptance, and where the episode will also point toward the areas most likely to need work, so you can start addressing them right after this. My name is Jeff Blumberg, and I'm your host.
The best place to start is how we measure this and how we define our terms. We want hard numbers, not opinion, since opinion is a slippery slope. Ask somebody how new patients have been lately and you'll hear things like, they've been pretty good, or it seems like we're getting a lot of calls, or it feels like most people aren't getting approved for treatment. Feelings aren't numbers, and they can throw you off completely. I've seen people convinced things were going badly when the numbers said otherwise, and the reverse too.
So what we actually want to measure comes down to two things: how much diagnosed treatment is being accepted in dollars, since that eventually shows up in production, and how many individual presentations are actually being accepted, the count of encounters, not just dollars.
This matters because someone might close smaller cases easily, seeing ten patients where two are large cases worth 10, 20, 30 thousand dollars and the rest are two or three thousand each, closing eight of the ten smaller ones but neither of the larger two. Or the reverse: someone who only focuses on closing the big cases and doesn't even present the smaller ones. That's why you want to track both case counts and dollar values.
So what numbers do you actually need? First, the dollar value of treatment diagnosed, your software already tracks this, anything diagnosed goes into the system. Second, the dollar value of treatment presented. Third, the dollar value of treatment accepted. Fourth, the actual number of individual presentations made.
I want to define a few of these carefully, since this is an area where definitions tend to get fuzzy and people end up measuring the wrong thing. Diagnosis is straightforward, you diagnose treatment, it lands in the software, assuming you're doing comprehensive exams, which I'll assume everyone is.
Presentation is trickier. What actually counts as a presentation? Say I'm a new patient scheduled for an hour, spending the first 40 minutes with your hygienist for X-rays, probing, and diagnostics, then you come in, do the charting, meet me, and spend five minutes presenting a 10,000 dollar treatment plan. Technically, a presentation occurred. But was there enough time to actually explain the treatment, answer my questions, handle any concerns, and discuss finances? No, five minutes isn't enough.
So I define a presentation as an encounter where you sat or stood with a patient and genuinely had time to explain what was wrong, what you found, what you wanted to do about it, answer questions and concerns, and not feel rushed. You may find you're not doing this at all in some cases. I've seen doctors so slammed they don't have time to explain treatment, spending two minutes and handing the patient straight to a treatment coordinator, sometimes without even telling the patient what they need. And if the treatment coordinator also doesn't have time to properly explain it, you can technically say a presentation happened, but did it really?
Next is accepted, which is also something of a moving target. Take the six crown example again. If a patient needs six crowns and you explain that, and they ask what insurance will cover, and you say two this year, two next year, two the year after, and they say, let's do the two this year, I've heard people describe that as the patient accepting all six crowns. They didn't. They accepted two. That's what they're doing and paying for right now. How many times has a patient pushed treatment to next year for insurance reasons, and then next year rolls around and they say, oh, I thought we already did that?
So accepted means the patient has actually agreed to the treatment and made financial arrangements for it, whether insurance covers part of it or the patient has worked out their portion through a payment plan, financing, or prepayment. Saying I'll do it next year, or that sounds great, isn't accepted. That's not closed from a sales perspective, the paperwork isn't signed.
Then there's the number of presentations, meaning encounters that actually meet the presentation definition above. A rushed five minute conversation where you didn't have time to explain everything doesn't count.
Those are the four core definitions, and once you have them, you can see where you stand. The next question is what percentage you should be aiming for. If I'm presenting to ten people, how many should I expect to close? Same question in dollars, if I'm presenting 100,000 dollars worth of treatment, what percentage should close? I'd want to see at least 60 percent, 80 would be better, but 60 is the minimum. So on 100,000 dollars presented, I want to see at least 60,000 dollars accepted, under the strict definition, not someday, but actually scheduled and financially arranged. Same logic with case count: presenting ten cases, I want at least six closed, ideally eight.
If you run these numbers and your acceptance rate lands in the 30s or 40s, what are the common reasons? There are plenty of possibilities, but here are the ones I see most often.
First: not enough time to present, meaning you're not really doing presentations by the definition above at all. Some practices solve this by having the doctor step back from selling entirely and relying on a treatment coordinator. Here's my take on that. As the doctor, you should be able to close treatment plans yourself, meaning sit down with a patient, walk through exactly what's going on, explain the fee, and even discuss how they might pay, not running the credit card or the financing application itself, but getting that far.
If I'm your patient with a 10,000 dollar treatment plan, here's what I'd expect: you'd walk me through it start to finish, what's wrong, what you want to do about it, why now, what happens if we don't, whether I have questions, and then the fee. If I said, that's a lot of money, I don't know how I'd pay for that, I'd expect you to ask how I'd normally handle something like that. If I mentioned a credit card or asked about a payment plan, and said I could pay it off over two years, you'd have enough information to hand me to your treatment coordinator already knowing I'm a reasonable candidate for two year financing.
What happens instead in a lot of practices is the doctor doesn't want to discuss money, worries about seeming like it's all about the money, or is simply uncomfortable with the conversation, so they do a partial diagnosis at most and send the patient straight to the treatment coordinator. I have a real problem with this pattern, because it makes your collections entirely dependent on that one person. If your treatment coordinator leaves for another job or moves out of town, your collections crash. I think that's a mistake, and it's something we actively coach clients out of.
There are practices where the doctor covers the basic treatment and fee, then hands off financing details to the treatment coordinator, and it works fine, but usually because both the doctor and the coordinator can independently sell, and they've built a strong working relationship over time. The reason I push for the doctor to be able to sell independently regardless is that you should be able to stand on your own two feet. If you run a private practice and depend on patients accepting and paying for treatment to keep the doors open, you have to be able to sell, that's simply part of running the business.
This is exactly why we run the MGE Communication and Sales Seminars, nine days of training focused on communicating with patients so they actually want the treatment they need, I'll link it on the episode page. If you can't sell, running a private practice is going to be a genuinely rocky road. Picture the finest technician in any service field, auto repair, whatever, who simply cannot sell their services. The world is worse off for it, because that skill never gets used. I've seen this repeatedly with excellent clinicians who just can't get patients to understand why they need something and want to move forward with it. It's not about tricking anyone into paying, it's about helping them genuinely want what you're recommending, and that is the sales skill.
So if I were debugging a low acceptance rate, the first thing I'd check is simply whether there's enough allocated time to actually present treatment. If you're slammed and just not carving out time for this, that's step one, allocate it.
Part of the underlying issue in dentistry is that we allocate time for diagnosis and time for treatment itself, but rarely allocate dedicated time for patient interface or selling. A few ways to fix this: set aside consult time in the mornings and right after lunch specifically for treatment presentations. Or use your new patient intake process a bit more deliberately, you can't always predict perfectly, but a caller mentioning missing teeth and cold sensitivity across the upper arch is a reasonable signal they may need comprehensive care, worth booking an hour and a half instead of the standard slot, so there's time for diagnostics plus a real half hour to actually present treatment afterward.
Scheduling itself is something of a lost art over the last couple of decades, right alongside accounts receivable management, which has also slipped compared to the 1990s. Patients often get slotted into generic time blocks rather than booked for the actual time a procedure requires. I'd always build a bit of cushion into scheduling policy. If a single crown prep genuinely takes 50 minutes start to finish, numbing, prep, temp, post op instructions, I'd book the full hour. That extra 10 minutes here and there adds up, and sometimes gives you 20 to 30 minutes you can actually use to sell.
Next pattern: closing smaller cases fine, but struggling with larger ones. This could be a time issue or a skill issue. You might be allocating 20 minutes to explain treatment, which works for most plans but isn't enough for something like a full mouth reconstruction case that genuinely needs an hour, in which case allocate more time. Or there may be genuine discomfort discussing larger cases, in which case that's a sales training gap, which is again what the communication and sales seminar addresses directly.
The opposite pattern, closing big cases but not small ones, is rarer. When it happens, it's usually because the person is genuinely excited about the bigger case and gives it real attention, while smaller cases get a rushed five minute conversation instead of the same care. I'd treat every case as worth real time and attention, obviously a larger case takes longer to close, but that doesn't mean smaller cases deserve less focus, unless the real issue is simply not having enough time, which we'll get to next.
Here's another common blind spot. Of the four metrics, diagnosed, presented, accepted, and number of presentations, what about treatment diagnosed previously that a patient didn't accept? I've seen practices where the entire focus is on new patients, which matters, don't get me wrong, but where patients of record sitting in the hygiene chair get almost no attention. Staff build assumptions about these patients: Mr. Jones needed four inlays at his last checkup and said no, so this time nobody even brings it up again.
Meanwhile, all the energy goes toward, say, a new patient implant consult, which deserves attention too, but it shouldn't be the only focus. Make it a policy that any patient coming in that day with outstanding treatment gets a conversation about it. They might say no again, that's fine, but they should be asked. You'll surprise yourself sometimes, maybe last time you only had five rushed minutes with Mr. Jones during a recall exam, and this time you actually have fifteen and can close him. You don't want a practice that only lives off new patients, patients of record should generate enough revenue on their own to cover your overhead.
Sometimes the real constraint is simply resources. Picture a fairly busy practice pulling in 40 to 50 new patients a month with two to three hygiene chairs running, and patients in those chairs with diagnosed, unaccepted treatment, but it's just you, the owner doctor, and maybe one treatment coordinator, not enough hands to cover the sales side of the practice. Naturally you triage toward what feels urgent, the new patient in front of you, while Mr. Jones gets told there's no time today.
At that point, it's worth evaluating whether you need an associate, an additional treatment coordinator, or a reorganized schedule. Two to three hygienists running steadily is usually a sign you're approaching the point where an associate makes sense, and it's not unusual for one doctor to eventually work alongside two treatment coordinators. As a practice grows at a healthy clip and retains new patients into hygiene, hygiene volume keeps climbing until a solo doctor simply can't keep up with selling on top of everything else, particularly once you're doing multiple hygiene checks an hour with a strong new patient flow. At that point, production itself starts to suffer, because treatment simply gets pushed further and further into the future.
That's the point to consider a part time associate or a second treatment coordinator, it's genuinely situational and depends on what's actually going on in your practice, but it's worth a real conversation if you're there.
A pattern I see often in practices shaped like this, two to three hygienists, one doctor, one treatment coordinator, all stretched thin, is that despite being busy, their inactive patient list is enormous, and their incomplete treatment list is substantial. I ask this at seminars regularly: how many people here have an incomplete treatment list, and how much treatment is sitting on it? I hear numbers like 800,000, a million, five million dollars. Nobody's calling these patients, and what you'll typically find is that most patients on that incomplete treatment list also have no next scheduled visit, they're inactive too. So you did the work to acquire the patient, get them comfortable in your practice, diagnose their treatment, and then nobody follows up. You might feel busy while simultaneously sitting on a large group of existing patients you're not tracking down at all, which means if you thought you needed one associate, getting those patients reactivated might mean you actually need two.
This is exactly where a treatment coordinator's job should extend beyond keeping pace with walk-in traffic. If the coordinator is only managing what comes through the door that day, and even that's a stretch, a meaningful chunk of their time should go toward calling the incomplete treatment list and getting patients back in. Some of those patients aren't due for hygiene yet and just need a check-in visit to confirm things are stable, others are overdue and can simply be scheduled for hygiene, at which point they're back in front of you and the sales conversation can restart.
If you find yourself in that stretched-thin situation, there are a few paths: add an associate, add a treatment coordinator, reorganize scheduling. One option I haven't mentioned yet: if you're 70 to 80 percent in network and overwhelmed, dropping plans can actually lighten the load somewhat, since done correctly, you won't lose much patient volume, so it doesn't fully solve a capacity problem on its own, but it does let you start collecting your full fee, which gives you the financial room to bring on more help.
Finally, if your close rate is genuinely low after accounting for all of this, it may simply come down to closing skill. There are three basic ingredients to selling anything: someone who actually needs what you're offering, the ability to sell, and time to sell, the organizational piece. Give a strong closer only five minutes on something that genuinely needs thirty, and they won't close much. Give a mediocre closer the full thirty minutes, and they might close 30 to 40 percent of what they see. Fix the time problem first, since that's immediately actionable, and you'll likely see your close rate rise even without being the best closer in the world.
But if you fix the time issue and your close rate is still sitting in the 20 to 40 percent range, that's the signal to work on selling skill directly, which again is what the MGE Communication and Sales Seminar addresses. In practice, a low close rate is often some combination of everything covered here, time, definitions, patients of record being neglected, and raw selling skill, but those are the main things I'd check first.
A little bit of work here goes a long way, and while some of it shows up quickly, real improvement compounds with time and practice. I'll share a small example. At one seminar, an attendee asked what exactly they should say to a patient about a large fee, expecting some polished script. I told them, just tell them how much it is. They joked, and then brace for them to get upset, right? No, I said, just tell them the number, then ask how they'd normally take care of something like that.
It's ten thousand dollars, let the patient sit with that for a second, wow, that's a lot, wasn't expecting that, I understand, how would you normally handle something like this? They were skeptical that something so simple would actually work. It did, they went back, used it, and closed a fifteen thousand dollar case, and it genuinely boosted their confidence. That confidence from one win tends to build toward the next one, along with the objection-handling techniques covered elsewhere in the seminar, but the basic principle holds: wins breed wins.
So start simply. If you're not finding time to present treatment, start there. If you're avoiding fee conversations, start there. Get one win, and you'll walk into the next similar situation with more confidence. And if you're serious about mastering this properly, it's worth genuinely learning how to sell, especially in private practice, since it drives your practice's long-term success and directly supports your patients' health. The sooner you start, the sooner you see the benefit, both a healthier practice and a healthier patient base, and more enjoyment in the work itself.
Simple episode this week, I hope it helps. I've linked the MGE Communication and Sales Seminars on the episode page. If you want to learn more about MGE, find us online at mgeonline.com, or call 800-640-1140. Have a great week, and we'll see you at the next episode.