Ep. 259: Is There a Million Dollars Sitting in Your Software?
Your incomplete treatment list may represent one of the biggest untapped opportunities in your practice. In this episode, Jeff explains how to reactivate these patients, bring them back into the office, and get more diagnosed treatment accepted.
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
DDS Success (coupon code RX269) - https://ddssuccess.com/
Morning Production Meeting - https://www.mgeonline.com/morning-production-meeting-download/
Dental Business RX Episode 34 - https://www.dentalbusinessrx.com/episodes/ep34
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Questions From This Episode
Why is a practice's incomplete treatment list often called gold, and why doesn't that match how useful it is for filling last-minute openings?
It's called gold because a practice that's been open for a while accumulates a genuinely large amount of previously diagnosed, unfinished treatment sitting in it, real dollars and real patient health represented in one place. But calling a patient and asking them to fill an opening next Tuesday rarely works, since these patients usually need a real sales conversation, not a same-week appointment slot.
What's the software problem that can quietly sabotage an incomplete treatment list?
In a lot of practice management systems, marking a presented treatment plan as refused removes it from the incomplete treatment list entirely, or at least strips it out of that report. That's a real problem if the patient simply said they wanted to think about it, since the practice then loses the ability to identify and keep marketing to that patient at all, when refused should really be reserved for a patient who's told you directly they're getting the treatment done elsewhere or genuinely aren't coming back.
Why is presenting a treatment plan more than once not just acceptable, but expected?
There's a common misconception that once a patient says no to a treatment plan, it should never be brought up again, but sales in general, and dental sales specifically, often takes multiple conversations before someone actually says yes. The recommended approach is acknowledging the patient's earlier hesitation, then presenting the case again with a different angle or detail, sometimes across three separate conversations, rather than treating a single no as final.
What are the four basic categories a practice should sort incomplete treatment patients into?
Patients already on the recall schedule just need to actually show up, so the focus is confirming the appointment. Patients due or overdue for recall need to be called back in for their regular visit. Patients not due for recall but with real outstanding treatment can be brought in for a quick 20 to 30 minute stability check. And patients who never returned at all after a larger diagnosed case, especially involving something like periodontal treatment, should be brought back in for a full re-exam.
Why shouldn't a practice rely on text messages alone to bring incomplete treatment patients back in?
Text tends to only reach the low hanging fruit, patients who didn't need much to push them over the edge in the first place, and realistically only recovers about 20 percent of the list at best. A genuinely effective campaign layers text, email, mail, and phone calls together, prioritizing phone outreach toward more recently overdue patients first and working backward toward those who've been off the schedule the longest.
Episode Transcript
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Somewhere in your software, you'll find a report. Depending on which software you have, it could be called the unscheduled treatment list, the money finder, or the treatment finder. We just call it the incomplete treatment list. For years, various industry consultants have called this list gold, and I can understand that logic to some degree. If your practice has been around for a while, there's a tremendous amount of undone treatment sitting in there. What you used to hear was advice like, use this list to fill a last-minute opening, or fill that three hours you have available next Thursday.
But let's return to the real world for a minute. Ask any scheduler how useful this list actually is for filling an opening, and the general answer you'll get is not so much. Sure, once in a while you'll get lucky and land someone from that list onto the schedule, but for the most part, it isn't especially useful that way. Here's how it normally goes: say you have an opening next week, you call and say, this is Jeff from Dr. Smith's office, Dr. Smith has some time available next Tuesday to get those crowns done. What do you hear back? Yeah, like I told Dr. Smith, I'm going to have to wait on those, I'll talk to you next time I'm in.
I know this can be frustrating. You have a large list of patients with treatment you've diagnosed, and it just sits there like a historical record. The real question is, how can you use this list effectively to get patients back on the schedule and actually make that incomplete treatment complete? That's what I want to talk about in this week's episode. My name is Jeff Blumberg, and I'm your host.
This week we're going to look at a few things. First, how this list is actually compiled in your software, and a feature that exists in most systems that can quietly damage this list. Then I want to walk through a number of ideas many of our clients have used to get patients back in and through treatment off this list. I'm going to cover a lot here, and you may not use everything I mention, but I'm confident you'll find several things you can put to immediate use.
Let's start with a bit of a thought experiment, followed by a reality check. First question: roughly how much is outstanding on your unscheduled or incomplete treatment list right now? $200,000? $500,000? A million? Two million? If you genuinely have no idea, you need to find out, once you're actually at the practice, not while you're driving.
And let's not focus purely on the dollars. Look at the patients themselves. A lot of what you've diagnosed is active disease, treatment these patients genuinely need to restore their health. So imagine for a minute, what if only 20 percent of the patients on your incomplete treatment list actually came in and completed their treatment? What if it were 30 percent? We're not even close to half yet. What impact would that have on your practice, and on those patients? Worth remembering too, a patient who completes their full treatment is considerably more likely to refer other people, which means this doesn't just increase your production and your patients' health, it increases your new patient numbers too. And the truth is, you're already halfway there, you've already done the diagnosis. So what's actually standing in the way?
The first thing to understand about an incomplete treatment list is simple: if a patient is on that list, the case is not closed, or sold, whichever word you prefer. I like using closed. Whatever the reason, if they're on the list, it isn't closed. That makes it primarily a sales problem. It might not be purely sales, it could be timing, it could occasionally be genuinely about money, though that's a far less common reason than people assume, it could have been an emergency patient you simply never saw again. But whatever the specific reason, what you diagnosed was never actually closed.
This is actually part of why the MGE program is structured the way it is, a little differently than most programs out there. The very first areas we focus on are new patients and sales, because those are the two levers that actually increase income in a practice. If you're getting a solid flow of new patients and you can genuinely close them, get patients to want the treatment they actually need, you'll see real income growth, which in turn lets you properly organize the rest of the practice. Go after organization first, before income, and you can genuinely go broke in the process, it just doesn't work in that order. If you'd like to learn more, I'll put a link to the MGE Communication and Sales Seminars, what we call the ABC seminars, on the episode webpage.
So, these patients aren't closed. The question becomes, how do we actually close them? First, you have to get them back in to see you again. A couple of things worth noting here. Dental sales, for the most part, happen face to face. You're not going to call someone off the incomplete treatment list and close them purely over the phone. It happens occasionally, you call someone you presented treatment to three or four months ago and they say they're ready now, but for the most part, this genuinely has to happen in person. Unless the patient is physically back in the practice, it's very difficult to actually present treatment effectively.
The second thing worth addressing is a strange idea that seems to have taken hold, that once you've presented a treatment plan, you're never supposed to present it again. I've seen this happen with newer clients, they assume whatever they're learning about sales or treatment presentation only applies to new patients. It doesn't, I expect it to be used on patients of record just as much. In fact, the wins clients typically see in their first month usually aren't with new patients at all, they're with existing patients of record, people they'd spoken to before, hadn't closed, and are now able to close.
To that end, at least 60 to 70 percent of a practice's income should be coming from patients of record. So sales techniques apply to everybody in the practice, not just new patients. The idea that you present a treatment plan once, the patient says they don't want to do it right now, and you simply never mention it again, I have no idea where that idea originated, but a lot of people genuinely operate that way. They'll look at a given day and focus entirely on how they're going to hit their production or collections goal purely through new patients, while ten hygiene patients that same day are sitting on $50,000 of already diagnosed treatment. Ask why nobody's talking to those people, and you'll often hear, we talked to them last time and they said no.
But think about it honestly, how many times have you personally been talked to about buying something and didn't actually buy it until the third, fourth, or fifth conversation? Maybe it was timing, maybe you were in the middle of refinancing your house, who knows. That's simply how sales tends to work, and there's a way to revisit it without making it feel awkward. You don't ignore the fact that they said no previously, but there's a genuine way to bring it back up that lands well.
Without getting too deep into specifics here, we actually cover a related concept in our Communication and Sales Seminar B, that same link is on the episode webpage, called the scale of selling, a process everyone goes through before making a purchase. Some people move through it quickly, others very slowly. Have you ever presented a treatment plan, had a patient say they'd think about it, and then at their next visit, perio maintenance or otherwise, they respond as if you'd just said it to them thirty seconds ago? Doc, I've been thinking about what you said, and I think I'm going to go ahead and do it, without ever mentioning it had actually been three months. That's simply how long it took them to move through their own version of that scale. This is also exactly why second opinions tend to close so easily, that patient is already halfway through the process.
So here's something worth keeping in mind. Say you see a patient at recall who needs a couple of crowns, you present it, and they want to wait. When they come back for their next visit, there's no reason you can't bring it up again. Hey Joe, last time you were in we talked about getting these crowns done, and you mentioned wanting to think about it, let me explain again why I think it's important we get moving on this. And explain it again. In a lot of cases, Joe will simply go ahead and do it. He generally won't respond with I already told you, it's a new conversation, and there's no reason not to bring it back up.
This is actually something we tell clients before they've received any formal sales training at all: present a treatment plan up to three times. That doesn't mean presenting it robotically the same way three times in a row as though nothing happened. You present it, the patient responds however they respond, you acknowledge their objection, then point out something else about the case. They might raise another objection, you acknowledge it, and go again. In a lot of cases, the patient will move forward, for reasons rooted in that same scale of selling I mentioned, which we cover in depth in Seminar B and on our online platform, DDS Success, also linked on the episode webpage. The core point is simply this: there's nothing wrong with presenting a treatment plan more than once. Maybe not within that same single appointment, but absolutely the next time they're in, until the patient actually accepts it.
So, to get people back in off this incomplete or unscheduled treatment list, there are four things we need to do. First, identify who these people actually are. Second, find a way to get them back on the schedule, there needs to be a real reason for them to come back. Third, have someone actually working the list. Fourth, close them once they're actually back in front of you.
Let's walk through these. Step one sounds simple: identify who these people are, and here's exactly where a software issue can quietly work against you. There are a lot of different dental practice management systems out there, Dentrix, Open Dental, Curve, Eaglesoft, and each has its own way of generating this incomplete or unscheduled treatment list, and a feature in a lot of them that indicates whether treatment was presented and whether the patient refused it.
Here's the problem. Say Joe comes in and you present four crowns, and Joe doesn't accept them. If you mark Joe as refused in some of these systems, that treatment disappears entirely from the incomplete treatment list, or at minimum no longer shows up on that report. That's a real problem in my view. If you've diagnosed treatment and the patient is still active in your practice, you need to be able to identify that outstanding treatment, not just for your own reference as the doctor, but for the entire cycle of production in the practice, everyone working to identify patients with incomplete treatment and get them back in front of the doctor.
How you actually solve this in your specific software, I'll leave to you, but I do think this is worth examining closely. I wouldn't mark something as refused unless the patient genuinely isn't coming back. Say a patient comes in for a second opinion, you present treatment, and they tell you directly they're having it done elsewhere, or you follow up a week later and they confirm they already had it done somewhere else, fine, mark that as refused. But if a patient says they want to think about it, or simply doesn't want to move forward right now, and you mark that as refused, it vanishes from your unscheduled list, which is a real issue. I'd want that treatment to stay visible, since I still want to keep marketing to that patient and eventually get them back in. Part of your job as a practice is getting patients genuinely healthy, and sometimes that takes real persistence, since not every patient moves quickly.
So that's the first major issue worth examining in your own software. If that treatment isn't staying visible, you're already losing ground before you even get to the next step, since step one was identifying who's actually on the list in the first place.
Which brings us to the next point. Assuming we have an accurate list, everything diagnosed but never completed, the next step is actually getting these people back in. There are a few different options here. If you're a general practitioner, you have an incredible tool built directly into your practice, hygiene. It's essentially baked into people's minds across North America that you're supposed to see a dentist twice a year for a cleaning or checkup, you can thank Crest and Colgate for that. So we use recall, along with a few other tools, to get these people back in front of us, since again, we're not going to sell these treatment plans purely over the phone.
Here's how this list actually breaks down. Some patients are already on the recall schedule and confirmed, in which case, great, don't worry about closing them yet, just make sure your front desk confirms they actually show up. Say Joe, who needs four crowns, is already scheduled for perio maintenance next week or in three weeks, good, just make sure Joe shows up. That's where the cycle of production comes in specifically. On the day Joe's actually scheduled, you'd run a morning production meeting, I covered this in episode 34, called making your morning huddle more effective, we call it the morning production meeting.
During that meeting, you're reviewing everyone coming in that day and identifying who has outstanding treatment. Joe's on the schedule, Joe has four crowns you diagnosed last visit, so the doctor gets carved out ten minutes to sit down with Joe and the treatment coordinator to close that case and actually get it scheduled. This is essentially the only patient population you can plan around with real certainty, since you already know exactly what a patient of record needs, you genuinely don't know yet what a new patient needs until you've actually seen them.
So, Joe's already scheduled and confirmed, no need to worry further. But say instead you have patients on this incomplete treatment list who aren't scheduled for anything at all. If they're simply due or overdue for recall, that's the easy case, get them back in for their regular appointment.
Now say it's someone who isn't yet due for recall, but has real outstanding treatment sitting on the incomplete list. A few options here, depending on how busy you are, how large this list is, and how many people you actually have working it, since those factors will shape how quickly you can realistically get to everyone. Say you saw Joe two months ago and he isn't due again for another four months, you could still have the front desk call Joe in for a quick appointment, hey Joe, the doctor wanted me to call and get you in for a quick twenty to thirty minute visit, he just wants to check and make sure everything's staying stable, so he can talk with you again about the treatment he recommended.
You may also have patients on this list where you recommended a substantial amount of treatment, say including periodontal work, and they simply never came back at all, maybe it's been a full year. I'd bring those patients back specifically for a re-exam. Doc wants to see you again, I never actually did what he recommended, that's fine, he just wants to do a fresh exam, he's genuinely concerned about your health, let's get you back in. Put them directly on the doctor's schedule so the doctor can talk with them personally. The goal throughout all of this is making it as easy as possible for the patient to say yes to coming back in.
So we've got four basic categories: patients already scheduled and confirmed, where you simply make sure they show up, patients due or overdue for recall, who get brought back in through that channel, patients not yet due but with real outstanding treatment, who get a quick stability check appointment, and patients with a larger diagnosed case who never came back at all, who get brought in for a full re-exam.
There are also a few campaign-style ideas I've seen clients use successfully. You could section your incomplete treatment list by treatment type, and some clients run this toward the end of the year, a text or email campaign, for the month of December, full mouth makeovers or implants are 10 percent off, or something similar during a specific window, entirely up to you. One note on texting specifically: I'd run a combined campaign rather than relying purely on it, especially if you're sectioning the list by treatment type, implants, full mouth cases, Invisalign, however you want to break it down. Text tends to pick up the low-hanging fruit, patients who didn't need much to be pushed over the edge in the first place, and will realistically get you maybe 20 percent of that group back at best. Real results are going to require phone calls too.
So I'd run a genuinely multifaceted campaign, text, email, physical mail, and phone calls together. Think of it as marketing, the whole job of marketing is creating want and actually making the sale, so don't limit yourself to a single channel. I know mail has gotten considerably more expensive, we used to send a great deal of it before 2020, when a first class letter cost around forty cents, now it's closer to seventy. We used to mail out our own company magazine to every dentist in the country, we don't anymore since it simply isn't as cost-effective with prices roughly doubling. But there's still nothing wrong with using mail to reach your own patients of record specifically, that's a genuinely worthwhile use of it.
So now, actually having people work this list. This depends heavily on your available resources and the size of your list. If patients already have a recall appointment, leave them be until they show up. If they're not scheduled and are due or close to due, depending on your resources, you could split this work between the front desk and the treatment coordinator. I'd start with patients who are more recently overdue rather than someone who's been overdue for three years, you'll want to eventually reach that person too, and at minimum keep texting and emailing them, but phone calls specifically should probably start with the more recent, more current group and work backward from there.
If a patient isn't due for any recall visit and you simply want to get them back in front of the doctor, that's a natural call for your treatment coordinator to make. Doctor just wants to check in and make sure everything's staying stable. This is exactly the kind of work a treatment coordinator should be doing whenever they're not handling financial arrangements or sitting in on a treatment presentation, working this list.
In some cases, it genuinely helps for the doctor to personally review the incomplete treatment list. You'll likely recognize names, oh, I thought this person was going to move forward, or, whatever happened with them. There's nothing wrong with the doctor personally calling a few of these patients. Hey Joe, I was just thinking about you, saw your name and wanted to give you a call, I know we talked about getting some treatment done nine or ten months ago, how have you been? Why don't you come back in so I can take another look and see how things are going? There's genuinely nothing wrong with the doctor doing this personally, and if you can fit in even a few of these calls a day, it can make a real difference for the practice. Just make sure whoever's making these calls knows how to actually get the patient onto the schedule, otherwise your scheduler ends up caught off guard. How you allocate this work really depends on your list size and available staff, if you've got five or six thousand people on an unscheduled treatment list, you may genuinely need someone working it full time.
So now patients are actually starting to show back up on the doctor's or hygienist's schedule. Now we have to close them. This is exactly where that morning production meeting becomes essential again, episode 34 if you want the full breakdown, since that's where you line up the day, who's actually talking to whom, and when. This connects directly to the organizational side of sales we cover in the Communication and Sales Seminars too, specifically how to build real presentation time into the schedule. You're looking at who's coming in, what treatment presentation opportunities exist that day, and who's actually going to handle each one, since the doctor may be mid-procedure and unavailable, in which case someone else needs to explain it, or an associate doing the exam may need to be the one presenting it instead.
However you handle the specifics, make sure the treatment is actually being presented again. There's no rule against doing this, and you absolutely should. I've genuinely seen practices simply not do this, which I think is a real mistake, especially when active disease is involved rather than something purely cosmetic. These patients should be reminded that this is still an active issue and that something needs to be done about it.
So to sum it all up: this list is genuinely valuable to your practice when it's properly used, and knowing how to actually sell makes an enormous difference too. Assuming the list stays accurate, meaning it's set up so treatment doesn't quietly disappear before you have a chance to present it again, and you work it correctly to get people back in, you'll end up with healthier patients and a considerably more productive practice.
If you have any questions about this, feel free to email me directly at jeffb@mgeonline.com. And if you've found this episode or previous ones helpful, whether you're a longtime listener or new to the show, I'd genuinely appreciate it if you took a minute to rate or review the podcast wherever you're listening, Apple Podcasts, Spotify, YouTube Music, or otherwise. It genuinely helps get the show in front of more of your colleagues, and I always appreciate the feedback.
I've got links to the Communication and Sales Seminars, the morning production meeting episode, and DDS Success on the episode webpage. If you'd like to learn more about MGE, you can find us online at mgeonline.com, or call us at (800) 640-1140. Folks, have a great week, and we'll see you at the next episode.