Modern practice management software captures so much information that most of it is overlooked and unused. Peering through the clutter and gaining a clear understanding of the key numbers that determine the success of a practice is more critical now than ever. Practices face new challenges such as competition, lower insurance reimbursements, and rising overhead. Even in the face of those challenges, most practices have the potential to grow 30%–50% within three to five years. Understanding these key numbers is the ticket to knowing what aspects of the practice to improve, modernize, and streamline. It is important to have a sense of areas with the most potential to improve production by significant amounts.
A primary driver of key numbers
Case acceptance can be rapidly improved when the correct system is implemented in a practice. All too often we create mystery around the concept of case acceptance. It is similar to all other systems in the practice, such as scheduling, hygiene productivity, customer service, etc., which can be designed in a step-by-step format for ease of implementation.
In most practices, case acceptance is actually high, but for the wrong reasons. According to Levin Group data, about 80% of general dental appointments are single-tooth treatment, so the majority of patients are accepting treatment, but in small- to medium-sized cases. This means that practices are using volume to achieve their target level of production. Basic math indicates that one way to increase production would be to increase case size. Doing so even by 10% or 20% can quickly increase practice production and profitability without increasing fixed overhead or adding more hours to the dentist’s schedule.
The metrics
The starting point for identifying the metrics for case acceptance is broader than case acceptance itself. We need to start with the three numbers every practice needs to know:
- Total production
- Production per day
- Production per hour
These numbers do not specifically reflect case acceptance, but without them it will be hard to put case acceptance metrics into perspective. And it is not enough to simply have the numbers. Each practice must also define targets or goals for each of these categories. For example, did production grow by at least 12% in the last 12 months? Do all members of the practice team know the daily production goal and does the practice achieve it over 85% of the time? Is the schedule mathematically constructed using the targeted production per hour for each provider?
Only by answering these questions do the metrics begin to tell a story and identify opportunities or weaknesses. Take the example of a practice with six doctors (all equal partners) producing millions of dollars in revenue. That sounds very impressive. But what if two of the doctors were producing half the revenue and the other four were producing the other half? That wouldn’t seem fair, would it? Only by analyzing each provider’s production (total/daily/hourly) would it become known that all partners weren’t contributing equally to practice profitability, which opens the door for honest conversations about compensation as well as identifying opportunities for the four low-producing partners to improve their performance. A better case acceptance system would be one of those opportunities.
Measuring case acceptance
The following statistics will help you measure case acceptance and understand what those measurements mean.
Production per patient. This gives you a sense of where you stand today. Going back to the earlier data point that about 80% of general dental appointments are single-tooth treatment, the overall average production per patient is relatively low in most practices. Rather than seeing more patients to increase production, establishing scripting and systems to increase the average production per patient will improve total production. It would also mean that you do not need as many active patients or new patients to build a world-class practice with excellent production.
Case acceptance rate. To state the obvious, case acceptance rate is a measurement of how many patients accept presented treatment. Keep in mind that many practices currently have a false impression of the strength of their case acceptance rate. While it may feel gratifying to feel that your case acceptance is extremely high, it may be better for the practice financially if your true case acceptance rate was a little lower but the average production per accepted case was much higher. That is the goal.
Certainly, there will always be patients who only need single-tooth treatment, which should be proposed and is usually accepted. It is when cases become larger or have multiple aspects to them that patients begin to reject treatment, put it off, or not respond. The reality is that as the size of a case increases, the harder it is to maintain high case acceptance. If your current case acceptance on restorations is 99% and crowns is 96%, then it is more than acceptable with cases two or three times the size for the case acceptance rate to be 89% or 90%. You can have a lower percentage of case acceptance with a much higher practice production overall. Higher total practice production is often best achieved when you focus on presenting the larger cases well.
Production accepted versus cases accepted. To fine-tune this a bit further, consider the difference between measuring your case acceptance rate by the percentage of presented production that is accepted, versus the number of patients that accept treatment regardless of case size. Many dentists have a mindset that “all of my patients accept the treatment I recommend” and therefore believe they have almost 100% case acceptance. It is more effective from a business perspective to measure case acceptance as a percentage of the total dollar amount of treatment you present.
It’s fine if you want to know how many patients accept treatment, but it is equally important, or even more important, to know the level of production being generated by case acceptance. Very few practices measure this, and they operate in the dark without realizing that they could improve practice production and performance significantly.
Summary
Case acceptance is not complex, but it does require a dedicated system to improve it. It is one of the three most powerful ways to quickly increase practice production. However, case acceptance is not taught in any influential manner in dental school, and most dentists never truly master the art of case presentation.
Case presentation is like any other system in the practice. It can be defined step-by-step and script-by-script. Practices should have a straightforward approach to presenting cases in a positive, energized, enthusiastic matter. Dentists need to study and learn the case presentation system. When the entire team is properly focused on case presentation, starting with the morning meeting all the way through to the presentation of financial options, then case acceptance increases, not only based on the number of patients, but overall practice production. It is truly one of the most powerful systems in terms of enhancing practice performance and success.
Editor's note: This article appeared in the October 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
