Jan/Feb 2011
Volume 32, Issue 1

Practice Growth Drivers in a Slow Economy

By Roger P. Levin, DDS

It comes as no surprise that the economy has affected the decision-making process of many dental patients. National surveys conducted by Levin Group in the last 3 years indicate that practices have experienced higher levels of no-shows, last-minute cancellations, and rejected case presentations. What can practices do to change such patient behavior? The answer is simple: Get back to basics.

When the economy is going well, practices can often get by with inefficient systems, processes, and protocols. It is much easier to overlook, tolerate, or work around poorly functioning systems as long as the demand for dental care is high and the schedule is full. When the economy hits a rough patch, however, inefficient systems are exposed for what they really are—barriers to increased production, revenue, and profitability. The longer outdated systems are allowed to stay in place, the harder it is to adjust to a changing economic landscape. To get back to basics and jumpstart practice production, practices can begin by implementing a few key management drivers.

98% of Patients Should Be Scheduled at All Times

Dentists need to do more with patients already being served by the practice. Unfortunately, many practices believe that they have more active patients than they really do. Reactivating overdue patients and maintaining patients in an active status can add significant revenue, and serve to jumpstart practice growth. Every practice should perform a chart analysis to identify unscheduled and inactive patients.

In the current economy, many patients are debating whether to put off hygiene appointments. A phone call from the practice can make the difference between patients keeping or breaking their appointments. In addition, patients should not leave after one appointment without scheduling their next visit. People are more likely to remain patients if their appointments are scheduled before they leave the office. It is no longer acceptable for patients to become inactive, leave practices, or not return regularly—for their own oral health as well as the performance of the practice.

Make Patient Financing Available to Every Patient

Patient financing is not a new concept for dental practices. Many offices, however, do not understand the best way to implement patient financing. Prior to the recent recession, many practices could be very successful offering little or no patient financing. That is a rarity now, as more and more consumers tighten their belts in a challenging economy. Dental practices that do not offer some type of financing will experience lower production, because fewer patients will be able to afford treatment out-of-pocket.

Every patient must know financing is available, and putting a sign at the front desk is not enough to generate widespread patient awareness. Patients need to be introduced to financing during new patient orientation, and reminded of it during every case presentation, however large or small. Companies such as CareCredit have improved their processes to the point that patient approvals—which are now higher than they have been in 3 years—can be achieved within minutes.

During case presentation, dentists and the dental team should educate patients about all available financial options. Patients should be informed there are four options that will be reviewed, with at least one being convenient for them.

From a psychological standpoint, this statement is critical. Case acceptance rates will decline if patients are unaware of the financial options available to them. The four options that work best are:

  • 5% discount for payment in full prior to treatment.
  • Half up front and half before treatment is completed.
  • Credit cards.
  • Patient financing.

Patient financing is always the fourth option. If patients have not responded favorably to the first three options, patient financing provides them the best opportunity to accept treatment with terms they can manage.

Many doctors may not prefer to use financing, because they have to give up part of their fee. But, these doctors should ask themselves a simple question: Would they rather have 95% or 0% of their fee? The answer is obvious, and asking this question helps many doctors understand they are losing not 5%, but 100% in instances where patients simply cannot afford treatment without outside financing.

Practices that offer patient financing should be sure that patients understand all fees clearly, so they know exactly what they are committing to pay. The practice needs to be certain to work with a finance company that offers different options so that patients receive the best service and convenience. Most patients appreciate being given options and the opportunity to choose the one that works best for them.

Measure the Call, Appoint, Show, and Acceptance Rates

Today, techniques have been developed using scripting to schedule 98% of all patients who call the office. This is why it is important to measure the call rate and appoint rate of patients. The next step is to measure the show rate. The goal is for 96% of original callers to keep their first appointment.

To achieve this goal, the team must be made aware that every patient interaction is important. During the phone call, the front desk team should promote the doctor and the team’s expertise and caring approach. This type of communication creates a "transfer of trust," which builds the practice’s value in the eyes of patients. Once this has been accomplished, new patients develop very positive feelings about the practice.

The next step is to measure how many new patients accept treatment. The goal should be to achieve 90% case acceptance across the board, whether it is need-based or elective dentistry. As new patient work-ups are usually a loss for the business, many practices spend a great deal of time and money on consultations, only to have treatment rejected. By training the team on the appropriate systems—scheduling, customer service, and case presentation—prospective patients will be more likely to keep appointments and ultimately accept recommended treatment.



The economy is slow right now, but will gradually improve. Practices that get back to basics will be the ones that reap the rewards of increased productivity and production, and these three management drivers are keys to jumpstarting practice growth in 2011.

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