Many dentists believe that all their revenue problems lie with case acceptance. But there is an interesting financial reality that parallels the patient journey from first contact through case presentation, case acceptance, treatment and follow-up. Essentially, there is a significant reduction in potential revenue from each new patient “opportunity” as the patient moves along the path through your practice. We call this the “Revenue Black Hole.”

The basic assumption to the Revenue Black Hole model is that not every patient will book an appointment, not every patient will show up for their appointment, and not all patients will accept recommended treatment. So the Black Hole is a mechanism that demonstrates revenue attrition at each step in the patient journey.

Watch Alex Nottingham JD MBA, Larry Guzzardo, All-Star’s Head Instructor, and Eric Vickery, All-Star Coach, discuss Case Acceptance and the Black Hole…

"Opportunites" = potential revenue

For our exercise, we will assume $5 Million in new patient opportunities. Let’s look at what happens to this number as a patient progresses.

a friendly voice taking calls

Step 1 – The Phone Call

The first interaction with your practice in the patient journey is the phone call into the office. Call tracking research that shows that, on average, only 35% of prospective new patient calls actually convert to appointments. This means that significant potential revenue from new patient opportunities is lost with only the phone call itself.

So, that $5 Million in opportunities is immediately reduced by 65% to $1.75 Million – a “loss” of $3.25 Million.

Why is this important to case acceptance?

Ultimately, you need to see that you will never get case acceptance from a patient who doesn’t book an appointment. Another way to look at it is that the process of case acceptance begins with whomever speaks with the prospective new patient.

Therefore, training for case presentation begins with training on the phones. 65% of Black Hole revenue losses come with being unable to convert phone calls.

Start with the Phones

It’s important to start with phone calls because this is where people form opinions about what working with you will be like. And the ability to give a great impression of the practice to the prospective patient is not intuitive for most of us. It is also where you begin to establish rapport with the new patient. In our other case acceptance videos, we have shown just how critical rapport is to your ultimate success at case presentation.

One of the great things about the Revenue Black Hole model is that it is simple and stark. Use any number for opportunities and it will be immediately cut to less than half – just on that first phone call. This loss is so significant that it should be obvious that you must start training your team on the phones to have any hope of improving case acceptance.

Your patients need to show up for their apointments

Step 2 – Showing Up

Research shows that, typically, only 85% of patients show up for their appointment. The 15% who fail to show up represent another huge loss in revenue. Our original $5 million in opportunities was slashed by 65% loss due to failed conversion, and cut again by 15%. We went from $1.75 million and are now at $1.5 million in opportunities – another loss of $250,000.

Why is it that 15% of patients who have made an appointment fail to show up? We have an entire course on productive scheduling and how to ensure patients show up, but it boils down to a failure on the part of the staff to establish the importance and value of the appointment to the patient. Outside of a true emergency, most broken appointments are due to other things that the patient values more than their health. It is critical that whoever is working with patients on the phone work diligently to establish the value of the appointment.

Case Presentation

Step 3 – Case Acceptance

Research shows that only 60% of patients accept treatment recommendations. This represents another significant loss in opportunities and revenue. The original $5 million in opportunities is now only $900,000. The Revenue Black Hole gobbled up another $600,000.

But, in reality, when you analyze what types and dollar value of the cases that are accepted, our measurement of “real case acceptance” is even lower – more like 30% – which takes our ultimate revenue opportunity down to $450,000.

Revenue Black Hole

Final results

We went from $5 million in opportunities to $450,000. That’s a loss of $4.5 million, or 91%!!! That’s a just bit shocking.

Study Club Replay: Case Acceptance Verbiage

What next?

Case Acceptance: What’s Next?

Some doctors may see this exercise as a challenge to spend more on marketing. But in the end, one perspective on the Revenue Black Hole shows that small changes in the way you and your team operate at each stage of the patient journey will have massive impact on revenue. For example, plug a “better” number into the Revenue Black Hole equation, such as improving phone skills 5% to a 70% conversion rate, and you can net an extra hundred thousand in revenue.

Understanding your strengths and weaknesses is the first step in identifying areas to train. Being complacent only puts you at a disadvantage. You need to know what parts of your business don’t work and why. A commitment to training, effective patient communication, and a focus on service are vital for your long-term success.

A lot of opportunities exist for your dental practice and the best way to harness these opportunities is to train. Success with case acceptance begins with an emphasis on establishing a relationship with a prospective patient, so start your case acceptance training with fundamental skills such as how to work effectively with callers on the phone.

Join us for our online training event “Case Acceptance: Getting Patients Saying YES without Hype, Pressure, or Sales.” We will explore issues such as the ones in this blog post that keep your patients from accepting dental treatment.

Listen to Alex Nottingham JD MBA, Larry Guzzardo, All-Star’s Head Instructor, and Eric Vickery, All-Star Coach, discuss Case Acceptance and the Revenue Black Hole…

Alex Nottingham, JD, MBA

Alex is the CEO and Founder of All-Star Dental Academy. He has authored the dental practice game-changer book “Dental Practice Excellence” and co-wrote a bestselling book with Brian Tracy. Alex has shared the stage with Michael Gerber (the author of “The E–Myth Revisited”), and lectures nationally and internationally to prestigious dental organizations.

He is a former Tony Robbins top coach and consultant, having worked with companies from $1 million to $100 million. His passion is to help others create personal wealth and make a positive impact on the people around them. Alex received his Juris Doctor (JD) and Masters of Business Administration (MBA) from Florida International University.
Alex Nottingham, JD, MBA