Welcome to Dental Unscripted.

Where Mike Dinsio and Paula Quinn break down the practice ownership journey, one episode at a time.

Starting up, buying, and running a successful dental practice.

what is up guys welcome back to another episode of dental unscripted as matthew mcconaughey would say is all right all right all right let's get this party started we got another episode coming at you uh today it's just me and paula and we are gonna battle this is a battle of the brains battle brains um We thought it would be fun to talk about what KPIs are most important to dental practices.

And if you guys know anything about how Michael and Paula coach, I'm the more financial marketing guy.

Paula's all business, all operations and clinical.

She is all business, but she's all clinical, all operations.

And so we have our things that we look at when we're coaching our clients.

And we thought we would have a little fun today and just totally go unscripted, but before we get into it, little housekeeping, uh, if you're watching this on dental startup, unscripted or acquisition, uh, dental acquisition, unscripted, get over to the new channel.

It's called dental unscripted.

Uh, it's one channel and we're going to talk about all things, startup acquisition and practice, uh, success practice, uh, uh, practice consulting topics.

So, um, thanks again for, for following and being a part of the program.

and make sure that you actually write a review.

If you like our program, subscribe, pass it on to a friend.

But it's great talking to you all when you guys call me and you already know the program and we wanna make sure that we don't lose you.

So get over to the new channel.

So Paula, hi, how are you doing today?

I'm great.

Great, great, ready.

Are you ready to battle today?

I'm fired up right now.

I don't even know what to expect, but we'll go with it.

We'll do it.

We're just doing it.

This is totally unscripted.

Well, let's start it by just kicking it off with you.

When you are looking at a practice, one of our clients, and you're using all of your brain power to figure out how to move the needle and there's a hundred things that you could tweak and levers to pull and whatever what are some of the things on the clinical side that you think are super important for practices to pay attention to in your whole world and I bet you I have better ones so what's your first one go first one would be hygiene reappointment rates Of course, because you're a hygienist.

So why is that important?

Because it is the heartbeat of the practice.

It's why patients come.

So every dollar out of hygiene equals two to three in restorative.

And if we're not seeing patients out of hygiene, doctor doesn't get to do exam, there's no restorative, and we all go home.

So hygiene reappointment rate.

So what you're saying is the hygienists are are the most important people in the world to a dental office.

It depends on who's reappointing.

It could be the front office.

Then they're the most important.

Okay.

So that's interesting.

So it's not really the hygienist, but it's really just about the patients that come into the door for their cleaning and how many of them reappoint.

Yes?

Yes.

I mean, I would suggest the hygienist.

They are the ones that typically have a deeper relationship.

But yeah, it's just getting them reappointed.

People get off track really easy.

I mean, I've seen practices where, you know, again, we're talking to a bunch of dentists here so I can talk about money or maybe hopefully hygienists.

you know if insurance reimbursement is twice a year and somebody gets off track not only are we not taking the very best care of the patient but now that twice a year benefit because you know we're using it less and less and maybe over a five-year period we only use four of the cleanings instead of you know ten that we could have used or whatever you know I'm exaggerating there but I've seen that happen again and again.

And quite frankly, if you don't get them back on the books, you create more work for somebody having to fill the schedule, track them down.

And we've seen it a hundred times where that patient becomes no longer an actual active patient because they haven't been in the practice forever.

So they're probably going to go elsewhere if we're not keeping them in the practice.

So yeah.

You better not steal one of my KPIs.

I feel like you're- I feel like you're on the brink of taking one of my kpis I'm sticking to it I'm just saying hygiene reappointment rate is super important what about you what about what about you um I you know my brain goes to financials really quickly I mean maybe it's the ex ex-banker in me but I think profitability I think what are we doing if we're not making money and One of the things that I have our clients look at is wages in relation to collections.

And as you all know, this is actually a very complex KPI because there's production and gross, and then there's net, and then there's collections.

So after all the waterfall, the write-offs, blah, blah, blah, you get to the brass tacks of how much the practice collected.

And you compare what you collected to how much the team costs you.

And in every single business, wages is the most businesses, unless you're tech, I suppose.

But most expenses are people, me and you, our team, you name it.

And it's no different than any other business, typically.

And what I try to get my clients, and depending on where you're at, our clients, I shouldn't say my clients, our clients.

What I try to get our clients to think about is if collections is down, wages should be down.

And when collections are up, it would make sense that wages would be slightly up or maxed out.

And if you can manage that right there, if you could manage wages to fluctuate with collections, you'll make more money.

but if every single month your wages are fifty thousand let's just say that would be a big practice like twenty twenty thousand let's say your payroll is twenty thousand and you collect eighty thousand one month and fifty thousand the next month and then a hundred thousand and then thirty man like as a business owner that's super stressful because you're making money and then you're losing your ass and then you're making a little bit And then you lose your ass again.

So if we could just look ahead in the schedule and just see what we're scheduled to, and if you can see that you're not scheduled for some production, hey, maybe it's a conversation with your team that says, hey, guys, let's leave early.

Or hey, let's close down Friday and move those patients into Thursday or next week.

Because if you're willing to do that, then you can lower wages.

that match your collections and it's okay if collections go down it's okay that's normal business is up business is down same in our business right collections are up collections are down but if you can control that wage you make more money so that's mine is wages to you're probably going to ask and I'll just beat you to it where do I want your wages to be that's tough yeah you didn't ask me where you want my appointment rate to be oh but I was going to ask you because I was curious Michael, where would you want those wages to be?

So it's a tough answer because regionally it's all over the place.

So the way I answer that is if you're in a very desirable coastal states where I live, Washington, California, I suppose Oregon, all the way over in the East coast, you know, all up and down the border, people want to be with the coast and, and, and the coastal areas, the expenses, living expenses are higher.

So just, just by that wages are higher in those areas.

So the middle of the country, I would love for you to be at like.

Twenty five, twenty, twenty eight percent.

And then, you know, more like Seattle and, and, um, you know, nicer areas on the East coast, California, even, You're going to probably be closer to like thirty two to thirty five, sadly.

Those are kind of some ranges and that's a percentage.

But jumping real quick back just so that we can close the loop.

What was your hygiene percentage goal?

The reappointment rate?

Yeah, I say most offices, I would like to see them.

minimal ninety, but ninety four would be my get me excited.

Ninety four percent.

But I usually do.

I usually have them shoot for ninety percent because they're not there at all.

So the nineties, what would you consider average in that world?

In the eighties, probably eighty percent.

So out of ten patients, eight would be average.

Well, point it.

Yes, but we're talking a much bigger volume.

But yes.

Got you.

Okay.

I mean, hygiene is low-hanging fruit.

I mean, most people have benefits.

They get their teeth cleaned twice a year.

It really shouldn't be.

Maybe a fee-for-service patient might have some hesitation, but majority of practices are interns.

And if you've got benefits and it's a hundred percent covered benefit, why in the world would somebody not schedule?

So I think eighty percent is pretty pretty doable in nineties, you're becoming a rock star.

So.

I got a pop quiz challenge question for you on that topic.

Okay.

I'll throw you off a little bit.

Okay.

Is your answer the same for new patients?

No.

You passed.

Why?

They don't know you, you don't have a relationship with them.

Typically some of them might be coming in on some kind of special You know, just there's a lot of things.

Usually new patient average is probably about fifty percent and then top.

Well, actually, probably even a little lower than that.

Forty, fifty percent.

And then top is sixty four percent.

So, oh, I didn't realize new patient hygiene reappointment rate was lower than fifty percent on average.

That's nasty.

Yuck, yuck, yuck, yuck.

I'm going to get into some marketing kpis wait I didn't get to do my second one no you are I just I you are I'll touch back though on this this topic of reappointing new patients in the hygiene chair so what I heard you say just to jump back and and put an end cap is paula wants you at eighty plus percent no ninety ninety okay okay follow once ninety percent but the average was eighty is what I heard and of existing patient hygiene reappointment but for new patients you wouldn't she wouldn't be surprised if fifty percent of your new patients reappointed and she would love at least sixty percent is that what I heard yeah dang yours was way more complex than mine what's your second kpi because I got a really good one that's going to smoke yours case acceptance Oh, shoot.

That's a good one.

Okay.

I don't know if I can compete with case acceptance.

All right.

So what's case acceptance?

If you were a dentist, you're a business owner, you're tracking your KPIs.

When you say case acceptance, what do you mean?

I'm usually doing dollar.

So I'm looking at if you present ten thousand, how much of that gets on the schedule?

Okay.

Okay.

and unfortunately you know I suppose there's a lot of ways to track it but it's kind of like did they schedule that day I mean it would be a constant moving target if you went back to say like okay then how many scheduled the next time and the next time so unfortunately there kind of has to be a a way to calculate that and so it's you present they schedule so yes of course If it's a phased out treatment, you know, maybe, of course, they're not going to schedule.

There's no way for them to schedule all of it if teeth have to be extracted.

But because top is sixty four percent, it takes that into consideration of.

Wait, you said the top is sixty four percent?

Yeah.

Case acceptance.

Okay.

So can you just say that again?

Say how you define it, because I know for a fact there's listeners driving to work right now and they're like, dude, I have eighty, ninety percent case acceptance.

I'm awesome.

And you're saying that the the top is sixty, sixty, sixty, sixty three, sixty four.

I know what you mean.

You need to tell the drivers heading to work.

I say it again.

How do you.

How are you doing that?

It's dollars.

What do you mean?

It's dollars.

I mean, because if you have ten patients and you're diagnosing two hundred dollar fillings, all all all ten of them are probably going to accept that treatment where if you have.

Crowns and you're presenting all kinds of mixed bags of stuff, it's going to look different.

So if you're presenting one hundred thousand dollars worth of treatment, And sixty three thousand of that gets accepted.

That's good.

It's not the hundred.

It's not going to ever be one hundred percent.

And it takes into consideration that, you know, some of that treatment needs phased out.

That's why top is sixty three.

Not.

So that makes me think that like.

I'm not going to say conservative.

I'm stupid for using that adjective, but like.

If you're a dentist that does really, really conservative dentistry and you're truly bread and butter and you kind of stay away from anything too robust, in theory, you could have a much higher case acceptance.

Whereas we have some clients that sell sixty thousand, forty thousand dollar cases and their case acceptance much, much lower because these are big cases.

You don't have any statistics on that, probably.

You just have kind of everybody thrown in one pot.

Exceptional would be would be sixty percent, right?

Yeah, but but you kind of think about it.

The only time I feel like maybe it shouldn't equal because if I'm selling forty thousand dollar cases.

And I win some my dollar is going to be way bigger, so I have to win a lot of crowns to equal one all on four.

So really, but it's a percentage.

It's a percentage.

It's all percentage.

If you just, if I do ten fillings and I get everyone saying, so why, why shouldn't their case acceptance be equivalent to proportional?

It probably is.

The only reason it's not is because it's harder to sell.

It's harder to it's harder.

That's what I was thinking.

Yeah.

However, if that's my specialty and I'm really good at enrolling and people are picking up my marketing and coming to me because I'm marketing that.

We should have exceptional treatment plan coordinator with with exceptional follow up and ways to finance.

I'm not saying it's not going to be way more difficult and I'm not going to say their percentage is probably on average or a little lower.

But if you really think about it, it should be similar.

Now, when someone the one caveat to that is if I'm doing You know, I offer a partial denture versus a denture or versus a extract everything and do an all on four.

I'm going to have maybe a couple different options routes for the patient to go.

That's the exception because I could have a hybrid, like I could have two different big cases in there and saying we could go this way or this way.

And until that gets cleared up, it could, the acceptance rate could look lower.

So on those higher things, but.

you know, if we're doing a bunch of ortho cases, you know, presenting a lot, I mean, we should win them, right?

I mean.

Yeah, yeah, yeah, yeah.

No, I think you're right.

I think that makes sense.

Of course, typical Mike D'Incio overcomplicating a very simple.

Yeah, you said mine is complicated because you ask a lot of complicated questions.

You know, so if you're about in the forty percent range, you're about average.

Okay.

okay average if you're below that you know I always say let's let's take a look it's it's a combo of patient experience follow-up and case presentation so it's not all on the doc although it could be you know it could be the front failing something you know it could be so you really have to know whenever we come in we usually work on the front office system first because if we've got the input and the treatment plan and all of that looks good we got the financing we've got the follow-ups down now we can say did it improve nope okay now let's look at what is the rest of the patient experience look like or that that case presentation delivery so okay so let's make this super dummy style you you present ten thousand dollars you're at and and by the way most of you that listening probably don't track case presentation dollars so start that's that's probably kpi one start paying attention to how much you gotta have the hygiene reappointment rate to get to look at the mouth to do restorative all right all right all right are we I heard unless they're an emergency or a new patient I heard your first KPI.

We're on case acceptance.

So start tracking how many dollars you diagnosed today, this week, this month.

Then start tracking how many of those dollars get accepted.

And if ten thousand dollars is diagnosed, your average, if you get four thousand dollars accepted, You're exceptional if you get six thousand accepted.

If you're less than four thousand out of the ten thousand, start looking at some stuff.

That's what I say.

Wait, is anyone voting on which KPIs are most important?

We can we can look.

I'm I'm going to go to my next one and I'm going to give you round one, but I just can't give you round two.

So you can't give me case acceptance over wage percentage.

No, I can't.

Maybe if we're getting all of our cases accepted, we wouldn't have to worry about wages.

Which is why I'm giving you I'm going to give you a win for round two.

I thought you'd be humble and give me round one.

But hey, that's it is what it is.

Can I give you my second KPI?

I'm already I'm already yielding.

You're the one asking like a thousand questions when I bring up one KPI.

Well, look, I just want to make sure our listeners understand what you're going after.

My second KPI is patient retention.

I think dental, this camera's driving me crazy.

I move a lot, so it just tries to keep track of me.

But for those watching on YouTube, it just jumps around because I'm a fidgeter.

So my next one is patient retention and it's similar.

It's similar to your hygiene reappointment rate.

It's very similar.

It's, it's, it's mashed together.

So I thought that's where you were going to go.

I'm glad you did it.

So we, we talk about marketing a lot and everybody's like, I need new patients.

I need new patients.

I need more volume.

I need more at bats.

I need more new patients, new patients, new patients.

And I don't think enough of you are looking at how many of your existing patients are staying with you or leaving out the back door.

So new patients, so it's a patient growth or retention, patient retention factor.

So we look at how many new patients you got in, how many did you reactivate that were inactive, we look at how many patients went into inactivity, which is leaving.

And then how many did you inactivate?

So it's like a plus minus, right?

So like we got five new patients, we reactivated three.

So that's eight total, but we lost ten to inactivity.

And Nancy Jo moved away to a different state and we inactivated her.

So it's like a plus minus.

And I just, I just feel like, and I got an email today by a doctor, you're on it.

And he's like, new patients or life or new patients will like, it's all about the new patients.

We need more growth.

And the reality is, is it's not all about new patients.

I'll quote Heartland.

I read an article about Heartland.

You've probably heard me say this statistic that it takes twenty two new patients to to break even or level out a practice.

Twenty two.

So if you're not getting twenty two on average, twenty two new patients, you're you're dying.

So it takes twenty two to level up.

That's because twenty two are leaving out the back door or we're inactivating them.

So if you can really tighten up the back end.

and then focus on new patients, your active patient count will grow.

And I just feel like we need to have more conversations about not just new patients, but the patients that we're not paying attention to that you already have in the practice.

So that's my second KPI.

Nineteen percent growth.

month over month is exceptional.

Uh, ten percent is average.

But I know that's the industry telling us that, uh, I actually have observed that the average is ero percent growth, just flat.

Our our dental intelligence, who we use as as some of our data authority, say that ten percent growth in active patients month over month is average.

So I think it's somewhere between ero percent and ten percent.

Exceptional is eighteen percent.

Start paying attention to that guys.

Okay let's vote.

I think mine's pretty important but I'll give you treatment treatment acceptance as the win on the second round.

Does that mean I have to give you the first one?

Is that what you're saying?

I wouldn't be bringing it up.

Okay, how many more do I get?

That's the question.

You get you get one more.

So we're gonna go the third round.

This is the tiebreaker.

So I can't.

Yeah, this is a battle's best of three.

I mean, I combo two because they kind of go.

Are you really trying to win the third round is what you're trying to do?

Sure, Paula break the rules.

What's your third KPI?

Uh, would be production production backslash collection.

So I'm saying it kind of goes, they are two different KPIs.

Okay.

So what do you mean?

So doctors, everybody always, and I get it.

People are saying, well, you know, production doesn't meet anything net production.

So we'll say, let's schedule the goal.

What, what are your production?

And they'll say, well, what about collections?

But I can't schedule to collection collection.

is done on the back end and it's also sometimes insurance driven and you hope at the end of the month or it'll go up and down and some months will be even and some will be up and some will be down when it comes to collections because it really depends on when did that check hit the account.

You're waiting on insurance, but if we're really, really tight in collections, It shouldn't take any more if it's an EFT electronic deposit to if it's check no more than six.

So we're talking about we average out about a thirty days.

We should be doing that.

And then you're always chasing last month.

So you would hope that those collections would come in.

So I always focus on net production because it's really the only stable thing that we can control.

And then the collections, if we're all doing our job, should ultimately equal that over time.

So I'm focusing on net production, scheduling to goal.

We would want, you know, and it depends on the size of the practice and the patient flow and a lot of things.

But I'm usually, I would say my doctor's, average somewhere between thirty five hundred and five thousand is their goal um you know it just depends if they do clear liners I mean I have doctors that go up to thirteen thousand a day you know it's all over the place but I think that the important thing is you've got to look at quite a bit of metrics to get there and then once you know what you want for the year you waterfall that backward by the day but that's an important KPI that you're coming in every day and you're looking at that production and saying did we hit it because usually if we hit it and we're doing our job on collections again we're going to be hitting that but you can't If you're looking at collections, it'd be maybe from two thousand.

So anyways, I feel like production is a huge driver.

Production per day is a huge KPI that you should be looking at.

The whole team should be looking at every single day.

Yeah, I don't think anybody can compete against production per day.

So no matter what I say, you win round three.

And I think you, in my defense, in my defense, my first KPI was about collections compared to wages.

So it's kind of related, but- Mine's production.

I feel like that's a dirty, it's such a dirty move choosing production per day, but okay.

Fair enough.

There were no rules.

Nor a prep, so I had to go with it.

We needed a referee.

That should have been on the exclusion list, but since you did that.

All right, then I guess I'll go to the last one, and that is it's new patient acquisition cost per new patient.

And that's a pretty loaded KPI because most of the time, when I look at doctors spend for what they're spending in the marketing, like we've got an email right now, just, I just saw it pop in and she's spending, four thousand dollars a month in, in marketing spend.

And then I can see how many new patients she's getting.

So I can easily do four thousand divided by how many new patients and get a cost per new patient.

And, and, My number is somewhere south of three hundred dollars per new patient.

The best ones are less than a hundred.

So I guess what I'm saying is, yeah, I mean, a hundred bucks per new patient is incredible.

But a review is free.

A review is free.

That's right.

That's right.

So that amazing buying power in today's world.

Yeah.

I mean, that's why reviews are so, so important because that's free marketing.

But, but to that point, if you're doing external marketing, you guys, you have to track where your new patients are coming from.

That's probably the number one thing that we really stress in any office is like, if you're not tracking how these patients hit your books, like, what are you doing?

Because what happens is you end up spending a lot of money, maybe like this doc who's spending four grand.

And a lot of it's just going to stupid activity.

And, and the strategy needs to be figure out what works, figure out what doesn't cut, what does it and double down on what does and track it.

And I'll, I'll leave you with, with this.

But I have a comment to make before you leave, leave.

Well, well, There's a lot of comments to make on this topic, but thank you for trying to steal my KPI.

You made lots of comments on my KPI.

The thing about it is, if your referral sources are vague, So like, for example, a new patient goes online, signs up, how did you hear about us?

And they click Google.

That's very vague, Google.

And you could have driven by the office and Googled.

I don't know.

Was it the sign that made the call?

Your friend could have told you, oh, Lakeview Dental Office.

And then you Google that.

Well, it was really your friend who referred, but I Googled it.

It could have been an actual advertisement that you paid for.

That's probably what you mean when you say Google.

It could have been the postcard we mailed you.

And then that patient Googled you.

And all the patient said was Google.

So you have no idea what Google means.

That's a perfect example of being too vague.

So drill down on where you're getting these patients and then truly figure out the ROI return on investment of what marketing your marketing is doing.

So yeah, what did you want to add to that, Paula?

Well, I just wanted to add, you know, circling back around to case acceptance is when you're doing this marketing and you're putting in the referral source, it's also measuring, you know, marketing is a lead that's brought in.

How your team and you handle it is up to you.

So once you get the rear and the chair, you may only get five patients out of that marketing strategy.

But if those five patients equal fifty thousand dollars.

Yeah.

You've got that measurement.

And then you got did you close those case?

Are you good at enrolling?

So there are so many things that go into marketing.

We'll have doctors all the time say, well, that didn't work.

It's like, well, how many patients you get?

Well, five.

What's the dollar amount you got out of that?

And I think that's...

I'll call you out because even when you owned, we tried a mail campaign and you know where I'm going with this story.

You did not want to do the mail.

It was very expensive.

And I'm like, you got to try it.

We drop a ton of mail.

Paula just owned practice.

She just like any buyer was being very conservative with her spend, trying to try to try to maximize profit.

You did all the things everybody does.

It's not, not, not wrong.

but marketing is your money now.

Yeah.

It's your money.

So we do the mailer and it by the numbers.

And by the way, that was my KPI, three hundred dollars or less per patient.

But you'll notice the cost per patient is different than production per patient on those.

And so that's what you said, Paula.

And so like, let's say we do a lesson.

So I learned a lesson and now you did now.

That's right.

Let me, let me close the loop though.

You, you only got like maybe five patients on that mail campaign.

And you're like, that totally sucked.

That was like, I, it costs me whatever, uh, call it eight hundred dollars per patient.

That was the cost of each patient.

You paid thousand.

You got whatever.

Right.

It was you paid five thousand.

You got five patients.

I'd be a thousand dollars per patient.

Not very good.

But one of those patients was like a ten thousand dollar case.

So absolutely it works.

That's what you're saying, Paula, is you got to look at it two ways.

And I agree.

You stole my KPI.

So it's cost per patient.

You said I'm wrapping up.

I had I actually did.

enhanced your kpi you could have won you might have won that round now because I also because I are you saying that I win the third round no I I'm out of the audience yes I wasn't I didn't say that I said I enhanced you might have you did enhance you did enhance so so it's cost per patient and production per patient new patient and acceptance acceptance okay paula all about Okay, all about your KPI in the second round.

All right, I hear you.

Well, I concede.

I'm not going to give you the third round.

Let's put this out on social and have everybody vote.

I think mine are great.

We'll leave it to the third round for people to vote on.

I think mine are great.

Vote for me below.

I love it.

All right.

Well, that's the episode for today.

We busted it out in thirty six minutes.

I'm shocked that it took that long, but we probably could have debated another hour again.

I had to suppress it.

All right.

Thanks so much for your time, guys.

Again, reminder, please like, subscribe, vote.

vote write google reviews no they do need to vote they do need to vote that's right um and uh yeah stay tuned we'll be putting out some more stuff later this uh this month thanks guys all right bye see you I win definitely win bye thanks for listening let us know how you like the show rate us on apple and spotify subscribe and follow for more