Last updated on July 22nd, 2021 at 01:43 pm


MGE’s weekly webletter, Issue 29.


Keys to Improving Case Acceptance, Part II

By Jeffrey M. Blumberg, COO, MGE

This webletter is part 2 of 3 in a series on improving case acceptance in your practice. For part one in this particular series, click here.

Improving case acceptance is a win-win proposition for both you and your patients. In last week’s webletter we touched on five fundamental issues that should be addressed if you’re looking for improvement in this area.

They were:

1. Communication Skills (doctor and staff)
2. Organizational issues relating to case acceptance
3. The Schedule and Patient Flow (new and old) through the office
4. Staff Participation and Office Policy
5. Management of all of the above.

In our last webletter, we covered point 1 – “Communication Skills (doctor and staff).” In this issue, we’ll pick up with #s 2 & 3.

(Related: 4 Meetings You Should Be Holding in Your Dental Practice)

And with that, I’ll start with:

2. Organizational issues relating to case acceptance

Priority-wise, communication skills are the most urgent aspect of your case presentation skill-set.

Organizational issues and patient flow rank a close second and third (or third and second depending how you look at it).

Organizational issues that specifically relate to case acceptance are:

a. Scheduling.  Specifically the organizational aspects of the schedule – i.e. who you see when for what and how the schedule is constructed.

b. Who does what? Who is responsible or accountable for the various aspects of the process.

c. Statistics or indicators that tell you what is happening with case acceptance in your office.

We’ll pick these up individually.

a. Scheduling.

For simplicities sake, let’s look at where case acceptance fits in in your business model.

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You have marketing that attracts new patients and could also keep your existing base informed of new services and/or reactivate them to come back into the office.

You have case presentation and acceptance which is in effect the “sales” department or activity in your business. I know the word sales may turn people off – but if you look at it, this is what it is. You’re explaining needed treatment and patients accept and pay for it. In any other business – this would be called sales!

Then you have the delivery side of the business where you “deliver the goods” so to speak. This is where the dentistry is performed and delivered.

Many offices have a well thought out and organized delivery area. Meaning, you have systems to schedule, order inventory, track lab cases and treat patients. Of course this is as it should be – delivery of high quality dentistry is why you are there in the first place.  I mention this though as very rarely do you find this same degree of organization and system in place for marketing (new patients) or sales (case acceptance), or management for that matter. Sales becomes an afterthought. Organizationally sales or selling (case presentation) is not usually reflected in the office schedule.

In the end, if no one’s buying their treatment plans – whether they pay now or later – there is nothing to deliver!

Sure, you’ll see a consult scheduled once in a while for a larger case – but that’s about the only time sales is reflected in the schedule. Generally, cases are presented whenever and tracking whether the patient accepted or not is rarely done. At best you usually find an “incomplete treatment log,” which rarely produces patients to fill last minute openings.

(Related: Dr. Winteregg’s Scheduling Policies – Part 1)

The solution to all of this can be very simple:

1. When you present treatment, ensure you have the time to do it properly. If you’ve just finished a new patient exam and it’s a large case, look at how much time you have before you present it. If you have three minutes before you need to be in the next room, you might want to schedule the patient to come back for a consultation. If you do have the time, then go ahead and present. The case doesn’t even have to be that large. Three crowns run about $3,000 (or more these days).  Some patients may need more than three minutes of your time to explain why they need that much work. Either way, use your judgment and have this option available (i.e. bringing them back for a consult).

2. Have time built into the schedule for consultations. At the Art of Scheduling Productively Seminar, we go over how to ideally schedule consults. Barring this information, you might want to carve out some time first thing in the morning and right after lunch.  The advantages to this are many: if you set consults for these times, then you won’t be in the middle of something else while you’re trying to present a treatment plan. If it’s first thing in the morning, you have no one else to see yet and if it’s first after lunch, you can still do your consult distraction free even if you ran through lunch with your last patient. As an added benefit,  if you have a large procedure cancel last minute for the morning, you can ask the patient you are doing the consult on first thing if they would like to stay and get started now. In many cases they can and you can replace that open time from the patient that cancelled.

3. On the other side of the coin, you have to ensure that there is time to get the work done – quickly. There’s nothing more disappointing than presenting a treatment plan, having an excited patient accept it and then telling them your next opening is four weeks from now. Make sure you can deliver what you are “selling” quickly.

b. Who does what? Who is responsible or accountable for the various aspects of the process.

Organizationally, every staff member in your office should have a defined area of responsibility and a statistic that tracks whether they are (or are not) performing their functions. In smaller offices, someone might have more than one function (i.e. reception and scheduling, etc.) The case acceptance process is more than just the doctor presenting the case. It includes the receptionist who’s answering your phone, the person in charge of your schedule, your finance person and if you have one, a treatment coordinator. If you are presenting treatment that came up during a recall exam or if you see new patient initials in hygiene, this would also include your hygienist.

All it takes is nonperformance by one person on this “chain” to slow (or stop) the entire process. If your receptionist is rude or short, patients never show up in the first place. If your scheduler controls the schedule poorly, this can also lead to problems and so on.

Make sure everyone involved with the case presentation and acceptance really knows their “stuff” and how it interrelates with the rest of the office. You can even role play it a bit during training time in the office and show what happens with a new patient from start to finish (i.e. the phone call all the way through treatment acceptance and completion). Doing this can help you to pick up and iron out any confusions as well as sort out things that should or shouldn’t be being done.

c. Statistics or indicators that tell you what is happening with case acceptance in your office.

Statistics are more than a number. They should show what’s going on. Driving a car, you look at the speedometer to determine how fast you’re going and if you should slow down or speed up. Running a business without statistics is like driving a car without instrumentation (i.e. speedometers, gas gauges, etc.). Statistics tell you what areas need attention or what might happen in the future.

For management purposes, you might want to track treatment diagnosed and accepted, along with case presentations (number of). Why?  Well, if you want to produce $100,000 per month, you would need a commensurate amount of treatment accepted. If you’ve presented $200,000 and only $10,000 has been accepted, then something is wrong. You would also know from this $10,000 figure that rough times are ahead on the production line!

Number of case presentation is also good to track. It’s tough for people to accept treatment if it’s not being presented! I’ll give you an example of this. I spoke to an office manager about eight or nine years ago who was panicked by the low production on the books.

(Related: Fixing a Broken Area of Your Business)

I had her go back and look at how much treatment they had presented the prior couple of weeks and how many consults were done. They had done one and $500 was accepted. The answer to the low production was right there. Someone had messed with the schedule and pushed eight or nine consults off a week (to next week).  They fixed the schedule, brought those patients who were scheduled next week into this week and turned things around.

Now, I know the tone of this is very “businessy.” Well, that’s what we are looking at right now – the business. I want you to know that I write this though with a number of assumptions:

1. That the treatment being proscribed is needed treatment.

2. That the most important thing in your office is technical (clinical) quality and

3. That the purpose of all of this is to perform better, faster and more comprehensive service to your patients.

OK, that about covers the organization aspects.  Let’s move on to the next point:

3. The Schedule and Patient Flow (new and old) through the office

If patient flow is slow (both new and existing), this of course affects the amount of treatment to be done.

Generally speaking, the work that ends up on the doctor’s schedule comes from three places:

1. Hygiene

2. New Patients

3. Emergency treatment

Now, you’re not going to necessarily “control” how many emergency patients you get. Advertising may get you more – if that’s what you want. But these situations are what the name implies – emergencies – which by definition are not normally planned.

With that in mind, let’s focus on 1 & 2.


Surprisingly, I often see offices that, despite decent new patient numbers, still have the same four or three days of hygiene that they have had for the past five plus years.

The problem – the hygiene area should be growing but it isn’t.

Why?  Most often the office’s primary focus is to keep the hygienist busy, whether it’s with some type of perio (scaling) type treatment, new patient or a recall patient. As long as the hygienist isn’t sitting and doing nothing for $40-$50 an hour, everyone’s happy.  This misses the “big picture,” which is comparing overall practice patient load (i.e. potential hygiene visits) to what is actually happening (actual hygiene visits). We have a formula to calculate this in a previous webletter.  Try it for your practice and see how you measure up.

New Patients.

I don’t think I have to explain how few new patients can affect treatment presentation opportunities. If you want more new patients, I would of course recommend the MGE New Patient Workshop. There are a few interesting nuances to this subject though and if you’re interested, you can learn more about this from the New Patient Acquisition webletters series.

Ideally, you would have a nice balance between these two, along with a well-run schedule which would allow for the office to continually (stably) expand.

And that brings us to the end of this week’s issue.  Next week, we’ll jump into points 4 & 5: Staff Participation and Office Policy and Management. Hope all of this helps!

(For Part III in this series, click here.)

Jeffrey Blumberg provides this general dental practice management advice to furnish you with suggestions of actions that have been shown to have potential to help you improve your practice. Neither MGE nor Mr. Blumberg may be held liable for adverse actions resulting from your implementation of these suggestions, which are provided only as examples of topics covered by the MGE program.


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  1. Keys to Improving Case Acceptance, Part I - MGE: Management Experts Inc

    […] (For Part II in this series, click here.) […]

  2. Three Case Acceptance Killers

    […] The simplest way to handle this is to reschedule if you don’t have time – which means you need somewhere to reschedule a patient to. So, make some time in the schedule for consultations.  For more information on this, see my webletter on Case Acceptance (Part II). […]