Ep. 73: Streamlining Case Acceptance in Your Office, Part 1
There is a lot more that goes into case acceptance beyond just your treatment presentation. There is an organizational side to case acceptance and everyone on your team has a part to play. So in this series, Jeff breaks down the entire process from the initial contact through to starting treatment and all the moving parts involved.
Topics:
1:11 – The organization and scheduling side of case acceptance
18:06 – The exam process
18:44 – When to do treatment presentations and how much time you need
Links:
New Patient Intake Form - https://www.mgeonline.com/np-intake-form
The MGE Communication & Sales Seminars - https://www.mgeonline.com/abc
Learn more about MGE - https://www.mgeonline.com
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Questions From This Episode
What's more important for case acceptance: sales skill or having a proper process?
Both matter, but process wins more often than people expect. A mediocre closer with a solid process, adequate time, enough prospects, will consistently outproduce an excellent closer stuck with five rushed minutes and too few opportunities. Process determines how many chances you get to use whatever skill you have, which is why it's worth fixing first.
Why shouldn't you mention specific procedure names like root canal or crown during the exam itself?
Because the moment you name a specific procedure, you've started the sales process, and you don't want to start it unless you're actually in a position to finish it right then. Using abbreviations while charting, then explaining everything clearly once you're ready to actually present the treatment plan, keeps the exam from turning into a rushed, incomplete sales conversation.
How quickly should a new patient actually be seen after they call?
Within one to three days, ideally within 24 to 72 hours, unless the patient themselves requests a later date. A new patient has essentially no loyalty to your practice yet, and a five or six week wait for a first appointment is enough to lose them to whichever office can see them sooner.
Should the doctor or the treatment coordinator present the treatment plan?
The doctor should always be capable of presenting and closing a case personally, even if a treatment coordinator eventually handles more of it as the practice matures. Patients consistently give more weight to what the doctor tells them than to anyone else in the practice, and a doctor who can't sell is fully dependent on staff who can, with no ability to correct or improve that process when it isn't working.
What should I do if I only have five minutes left to present a treatment plan?
Don't present it. Five minutes is rarely enough time to properly explain the problem, the solution, the consequences of inaction, and answer questions, especially for a treatment plan worth a meaningful share of the patient's income. It's better to schedule a dedicated consultation within one to three days than to rush an incomplete presentation and leave the patient sitting in unresolved objections.
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We all know improving case acceptance is a good thing, but I think its importance tends to be undervalued. It becomes just one more item on a long list of things someone wants to fix about their practice, improve case acceptance, fix the schedule, develop job descriptions, and so on. In reality, raising your case acceptance percentage is overwhelmingly the most immediate and effective catalyst for sustained practice growth. It raises collections and profitability, it increases new patient referrals, it improves career satisfaction since you're doing the kind of treatment you actually enjoy, and most importantly, it improves the health of your patient base. More patients get the treatment they actually need. It's genuinely a win for you, your practice, and your patients.
So if you want to improve in this area, where do you start, and what should this sales process actually look like in your practice? That's what I want to cover this week and next week, a two part episode of Dental Business Rx on strengthening and streamlining the treatment presentation and acceptance process. My name is Jeff Blumberg, and I'm your host.
What I'm covering is essentially what we teach MGE clients directly, though normally over hours in a seminar format. Given the time constraints here, I'm going to focus more on the how than the why, how to actually execute this rather than just explaining why it matters. I've touched on pieces of this in prior episodes, but here I want to bring it all together along with material you haven't heard yet.
I'm structuring this in two parts: first the big picture, what actually creates case acceptance in a practice, and then a step by step walkthrough of the full process, starting with a new patient initial exam, covering how it should work and where it tends to break down. You could listen to this with your team and check your own practice's process against what I'm covering. And as always, you're the owner, you decide how to apply any of this to your specific practice and your own better judgment.
The first thing to understand is that case acceptance really comes down to two components: the process itself, the organizational side, and actual skill, what we might reluctantly call sales skill. Both matter, and you can't fully substitute one for the other, but here's something that might surprise you: a solid process with mediocre skill will outperform excellent skill with no process.
Skill is simply how good you are at closing, how well you communicate, how effectively you handle objections so someone moves forward. Process is everything around that: how many people you actually have to sell to, how much time you have with each one, how much dead time exists between opportunities.
Here's the math. Say you have an excellent salesperson who closes 80 percent of the people they talk to, and a mediocre one who closes 30 percent. Give each of them ten prospects and a full thirty minutes per prospect, since that's genuinely what this kind of sales conversation requires to do well. The excellent salesperson closes eight, the mediocre one closes three.
Now take away the process. Give the excellent salesperson only five minutes per prospect and just five prospects instead of ten. They might close one. Meanwhile, if the mediocre salesperson keeps their full process intact, ten prospects, thirty minutes each, they still close three. The process itself is doing real work here, independent of raw skill. Both areas are worth improving, and today I'm focused on the process specifically, but that doesn't mean skill doesn't matter too, improving your actual closing ability maximizes whatever opportunities the process gives you.
So what's the actual recipe for sales in a dental practice? Four basic things. First, you need patients who need treatment. That opportunity comes from two sources: new patients, whether initials, emergencies, or second opinions, and patients of record coming through recall. And this bears repeating, roughly 50 percent of a doctor's production, not hygiene production specifically, but the doctor's own production, should come from patients of record.
A common trap here: a doctor runs four full days of hygiene for years and assumes their patient base simply doesn't need much treatment, since everyone coming in looks fine. But that upper tier of consistently compliant patients, the ones who never miss a recall and always follow through on recommended treatment, is exactly who fills those four days. Meanwhile, the patients who actually need treatment and aren't being proactively called back in are sitting quietly on an incomplete treatment list, not showing up at all. If you actually pull that list, you'll usually find it's substantial, it's just invisible because nobody's calling those patients back.
Second, that treatment needs to be diagnosed, or in the case of existing patients, the diagnosis needs updating if it's been a while. Third, the treatment has to actually be presented, which requires dedicated time built into the schedule specifically for that conversation, not just time for the exam and time for the actual treatment, which is where most practices already allocate time, but genuine, protected time to sell. Fourth, assuming all of that happens correctly, the treatment gets accepted, paid for or financially arranged, scheduled, completed, and the patient goes back on recall. That's the full sales process.
Let's walk through this with a new patient initial, covering each team member's role along the way, since this really does function like an assembly line. If one person on a stuffed-animal assembly line skips their step, sewing on the eyes, stuffing it, attaching the ears, quality control, you don't get a finished product at the end, no matter how well everyone else did their part.
The process begins with whoever answers the phone. The biggest problem here is usually invisible: the patients you never actually see. The average new patient phone conversion rate across North American dental practices is 23 percent, meaning out of 100 calls, only 23 end up actually showing up on the schedule. The real problem isn't the 23 who convert, it's the 77 who don't, and that directly limits your case acceptance simply by limiting your opportunities. We've covered this at length in episodes 3, 48, and 70, episode 3 on dental reception generally, episode 48 with Sabri going deeper on reception, and episode 70 with Jeff Santone, which includes a full 10-point checklist for grading your receptionist. I'll include that checklist, along with a new patient intake form and call log, as downloads on the episode page.
A well performing receptionist should be converting 50 to 60 percent or higher of all incoming calls, and that means all calls, shoppers, second opinions, everything, not just someone explicitly asking to schedule a cleaning. Every call is a legitimate prospective new patient if handled well.
The other major factor here is availability. If someone new to the area calls wanting to get established with a dentist, and your next available new patient slot is five or six weeks out, that's a real problem, since an unreferred caller has essentially zero loyalty to your practice. You're one of potentially over a thousand dental offices within a reasonable radius. If your marketing got them to call, it did its job, but a long wait means they might schedule and then cancel once another office offers something sooner, or simply not book with you at all.
It's worth occasionally walking into your own practice as if you'd never been there, seeing it the way a new patient would, noticing the things you've become numb to, stacks of folders behind the front desk, coffee cups accumulating, whatever's become invisible through familiarity. The same applies to how quickly you can actually get a new patient in the door. If you're actively marketing for new patients, pay per click, Facebook ads, mailers, you need to be able to see them within one to three days, ideally within 24 to 72 hours.
One caveat: if you offer a patient tomorrow at 11 and they can't make it, then the next day at 4 and that doesn't work either, and it turns out they genuinely can't come in for two weeks, that's on them, not your scheduling. But if your first available opening is five or six weeks out regardless, that's on you, and it will quietly undermine your marketing investment.
If you're running short on new patient slots, start by blocking dedicated new patient time on the schedule. Whether new patient initials go on the hygiene schedule or the doctor's schedule is genuinely a 50/50 split among practices we survey, there's no universally right answer, it's whatever works for your practice, since the doctor is doing the exam regardless of which schedule the appointment lives on. Some practices route overflow new patients directly onto the doctor's schedule when hygiene is fully booked, simply to avoid making the patient wait, which can also be a signal that it's time to add more hygiene capacity.
Whoever answers the phone and schedules, whether that's one combined receptionist role or split into a receptionist and separate scheduling coordinator depending on your call volume, needs to be able to handle this without excessive interruption. If you listen to your incoming calls, and you should, and you notice the person scheduling sounds frequently interrupted, rushed, or flustered, not because they don't know what to say, but because they're juggling too much at once, that's worth addressing. Not necessarily by replacing that person, they may be doing a great job under bad conditions, but by adding support. This is part of why corporate call centers convert so well, the person on the phone has nothing else competing for their attention. Ideally, a new patient call should be uninterrupted, with hold time under about 10 seconds if any, and 5 to 8 minutes of focused, distraction-free attention to gather information and schedule the appointment.
Now let's move to the exam itself. I won't get into the clinical specifics of how you conduct an exam, that's entirely your call as the doctor, but I'd recommend documenting your own process and sequence as a simple internal policy, especially useful if you ever bring on an associate or a covering doctor, so there's real consistency. The same goes for whatever your hygienist or assistant does before you enter the room, write down what's expected so a new hygienist isn't left to improvise their own approach. People fill gaps with their own assumptions when clear guidelines aren't provided, and you may not love what they come up with.
Based on new client surveys, the average new patient initial runs 60 to 70 minutes, the 70-minute figure being more common post-pandemic to allow extra time for room turnover and related logistics. Typically, if the patient is in hygiene first for probing, charting, and other intake work, that leaves the doctor roughly 15 to 20 minutes for the actual exam. Most doctors spend about 15 minutes building rapport, reviewing X-rays, and examining the mouth, leaving only about 5 minutes to present treatment, which is a real problem I'll come back to.
A few practical tips for the exam process itself, none of which affect your clinical judgment. First, never leave a new patient sitting alone in the room with nothing happening. Second, use language the patient will actually understand, save periapical radiolucency or abscess for later if at all, say infection instead. People generally won't ask what unfamiliar terms mean, since nobody wants to feel uninformed, they'll just stay quiet and possibly confused, which isn't the impression you want to create.
Third, and this one surprises people: avoid naming specific procedures out loud during the exam itself, even when charting with your assistant. The moment you say root canal, crown, or implant, you've begun the sales process, whether you intended to or not, and ideally you don't want to start that process unless you're in a position to finish it right then, which you usually aren't mid-exam. Use abbreviations instead, you can even tell the patient directly: I'm going to use some numbers and abbreviations as I go, don't worry about what they mean, I'll explain everything once I've gathered my findings. Then chart normally with your assistant and develop the treatment plan, saving the actual procedure names for the treatment presentation itself.
Make sure you're genuinely addressing the patient's chief complaint during the exam, ignoring it tends to genuinely upset patients even when everything else is handled well clinically. But the most important thing happening during this exam is that you're getting to know the patient: their general attitude toward dentistry, their past dental experiences, what they're hoping to get resolved by coming in today, anything specific they want addressed.
You're gathering a real read on this person's mindset, and a less-than-ideal mindset isn't inherently a problem, it's just useful information. Some patients arrive ready and eager, having saved up and expecting significant work. Others will tell you directly they only want what insurance covers, or that they're not particularly invested in keeping their natural teeth long term. People vary enormously, and understanding where a given patient actually stands tells you how much groundwork you'll need to do to get them genuinely invested in addressing what you find. That's simply part of the work, not a bad thing.
One more important reason to do this well: in an informal review of dental practice Google reviews I did a while back, counting negative reviews specifically, at least 30 percent traced directly back to the treatment planning and presentation process. The classic pattern: I went in for a routine cleaning and was told I needed 10,000 dollars of work, my last dentist never mentioned any of this.
This is exactly why understanding the patient's starting mindset matters so much. If someone believes they're in great oral health, insists their last dentist called them a model patient, and your exam reveals 8,000 to 10,000 dollars of real treatment need, saying nothing until the formal presentation creates a real shock. At that point, some patients assume you're either exaggerating the problem or being dishonest, and you risk losing them entirely, along with a negative review describing exactly that experience.
The fix is foreshadowing, gently signaling before the full presentation that something may need attention. If you're charting and notice something significant on a patient who insists their oral health is excellent, you might point it out directly during the exam: have you ever noticed this cusp is missing here? You can run your tongue over it, look in the mirror. Or, do you see this dark spot here, it looks like it's gotten a bit soft. Pull it up on an intraoral camera if you have one. You're not diagnosing out loud or naming procedures, you're simply planting the idea that something may be off, so the eventual treatment presentation doesn't land as a complete surprise.
I think about this the same way I think about employee discipline, the worst thing you can do, barring something truly serious, is fire someone with zero prior warning over one mistake. Give people a fair chance, a clear heads up that a pattern needs to change, and if it doesn't improve, the eventual consequence isn't a shock, it's an outcome they saw coming. The same principle applies here: a little forewarning during the exam means the treatment presentation doesn't land as some devastating surprise.
Once the exam is finished, you're ready to work up the treatment plan and figure out the next step: present now, or bring the patient back. Take the average scenario: 20 minutes allotted for the doctor's portion, 15 spent on the actual exam, leaving 5 minutes, and the patient needs 10,000 to 12,000 dollars of treatment. In this situation, and this is where a lot of practices get it wrong, you should not attempt to present right then. Five minutes simply isn't enough time to properly close a case of that size.
Some consultants recommend solving this by having a treatment coordinator handle essentially all treatment presentations. I respectfully disagree with that as a default approach, for a specific reason. If you own the business, anything you personally can't do makes you that much more dependent on someone else to do it well, and harder to correct when it isn't going well. If I own a furniture store but genuinely can't sell furniture myself, I'm entirely at the mercy of my sales staff, with no real ability to course-correct them if they're underperforming. As the practice owner, you need to be able to present and close a case yourself, even if, over time, you delegate more of that work once your practice matures.
There's also a simpler reason: patients consistently give more weight to what the doctor tells them directly than to anyone else in the practice, ask your own staff if you doubt this. A doctor who personally explains the findings, walks through the plan, and takes time to answer questions makes a real impression. Some of our more established clients have gradually handed off more of this to trained treatment coordinators over time, which is fine, but they can still do it themselves if needed, and that capability matters.
Back to our five-minutes-left scenario: that's genuinely not enough time, so the patient needs to come back. Let's talk about what an adequate amount of time to sell actually looks like. Consider the scale of what you're asking: if a patient earns roughly 60,000 dollars a year and you're presenting a 5,000 to 6,000 dollar treatment plan, you're asking them to commit close to a tenth of their annual income. Think about how long it would genuinely take someone to convince you to spend a tenth of your own annual income on something, it's rarely a five-minute conversation.
A proper treatment presentation needs enough time to explain what's needed, why, the consequences of not addressing it, and to fully answer questions. Many practices set a default consult length, 20 or 30 minutes, built into the schedule as standard. For something larger, a full mouth reconstruction case, you might block a full hour. But even a default 30-minute slot matters more than people assume, if you're asking for a tenth of someone's income, that's worth real time rather than a rushed five minutes that accomplishes nothing. And the impact on patients is real, you'd be surprised how much patients appreciate a doctor who sits with them for a full, distraction-free half hour and genuinely answers every question. These aren't occasional events either, they're a daily part of a well-run schedule, often two or three consults a day.
A consult doesn't always require a separate future visit. If your schedule happens to open up, say your next patient cancels, or you simply have the time available, you can ask the patient directly whether they're free to sit down right then. If yes, take a few minutes to organize the treatment plan and present it properly using the time you now have. If you genuinely don't have the time, don't start presenting at all. This is one of the earliest principles we instill in clients: if you don't have time to close the case, don't start presenting it, since a rushed, incomplete presentation is usually where the sales process actually breaks down in most practices.
This applies directly to recall appointments too. A five-minute recall exam isn't enough time to properly present 8,000 to 10,000 dollars of newly identified treatment, and cramming it in usually means no time for questions and a patient caught off guard. They get sent off to a treatment coordinator, and later that day you hear they said they'd think about it, which lands them on the incomplete treatment list. That list isn't the goldmine people sometimes assume, it's largely a record of unclosed conversations, and calling someone back three months later to ask if they're ready yet rarely converts well.
So if you're genuinely out of time, whether the next patient is already seated or the patient themselves has to leave, bring them back for a proper consultation instead. Here's language one of our clients shared at a seminar that worked well for him: something along the lines of, we've gathered a lot of information today, and there's a fair amount to go over, I want to make sure we have the time to sit down properly with everything we've found, your X-rays included, and come up with the right plan together. I'd like to have you back within the next few days, tomorrow, the day after, whenever works, for about 30 minutes so we can really go through it and answer all your questions.
Patients generally appreciate this coming directly from the doctor. A nice reinforcing touch: ask right there, in front of the patient, when your next consult opening is, then confirm directly with them, can you make it Wednesday at 8am, rather than leaving the scheduling entirely to the front desk afterward. That direct doctor involvement adds real weight and improves show-up rates.
Occasionally a patient will ask directly how much the treatment will cost, or what exactly is wrong, right when you're setting the consult. One client handled this well by simply saying he wanted to take a bit of time to review everything properly before discussing it, rather than rushing an answer on the spot, and framing it as wanting to get it right for them specifically. Most patients respond well to that. On the other end, if a patient asks something like, do I have cancer, and clinically you have no indication of that, tell them the truth directly, don't leave them anxious unnecessarily, that's simply unkind. Just don't get into the actual treatment plan itself yet, since naming specific findings before you're ready to fully present still starts the sales process prematurely.
As for when to schedule these consults, they need to be genuinely distraction-free, no being pulled away mid-conversation for an unrelated recall exam or phone call. I generally recommend scheduling them first thing in the morning or right after lunch. First thing in the morning works well because you haven't seen any other patients yet, and because many practices schedule larger, higher-value procedures earlier in the day, if a scheduled morning procedure cancels unexpectedly, one of your morning consult patients might be able to start treatment immediately, turning a lost morning into a productive one. After lunch works for similar reasons, you're not walking straight out of another task into the conversation.
A couple of final points on setting up these consults properly, since this needs to become a genuine daily habit, not an occasional special event. First, when you're not going to do a consult, small cases like a couple of straightforward fillings don't need one, just get those patients scheduled directly through the front desk. Use judgment on where the line is, generally a few thousand dollars or more in treatment value, or anything requiring real explanation beyond a couple of minutes.
Second, while setting the consult appointment, find out if any other decision-maker needs to be present. You might ask directly whether the patient typically makes healthcare decisions independently or usually wants a spouse involved. If they mention wanting their spouse there, schedule both of them together, this preempts a common objection down the line, I need to talk to my husband or wife, and if that spouse isn't already a patient, it's a natural opportunity to bring them into the practice too. We apply the same logic here at MGE when someone's considering a training program and worries about a spouse's reaction, we'd rather get everyone aligned upfront than create friction at home.
Third, some practices try to eliminate the return-visit risk entirely by building consult time directly into the original new patient initial appointment, scheduling some new patients for 60 minutes and others for 90 minutes based on how the intake call goes. This requires real skill at the front desk and a strong new patient intake form, a sample of which is available as a download on the episode page. If a caller mentions missing teeth, ongoing pain, or other signals suggesting more involved treatment is likely, that patient gets the 90-minute slot, leaving a genuine 30 minutes for the doctor to present after the standard hour of hygiene and exam work. If the intake sounds routine, no missing teeth, no pain, nothing flagged, the standard hour applies. This isn't diagnosis by the front desk, just informed scheduling based on the information gathered, and it does require real training to avoid over- or under-booking that time incorrectly.
So at this point, we're either presenting the treatment plan right now, or bringing the patient back within one to three days to do it properly. Next week, we'll get into the actual consultation process itself, working with a treatment coordinator, the financial conversation, and the remaining components that maximize your close rate.
I'd hoped to fit all of this into a single episode, but that clearly wasn't realistic. While you wait for part two, it's worth reviewing what we've covered so far with your own team and checking it against how your practice currently operates. That's everything for this week, downloads and links mentioned are on the episode webpage, and I'll see you next week when we cover the closing process and patient retention. If you want to learn more about MGE in the meantime, visit us online at mgeonline.com or call 800-640-1140. Have a great week, and we'll see you at the next episode.