How to use your ledger to improve case acceptance, Issue 5

As part of DPR’s From The Office Manager’s Desk Series, Jill Nesbitt tells you how to use your ledger to manage and increase case acceptance in your office.

As part of DPR’s From The Office Manager’s Desk Series, Jill Nesbitt tells you how to use your ledger to manage and increase case acceptance in your office.

Think about the most recent large case you presented. Did the patient nod and smile at you while you described the steps involved in bringing her mouth back to health? Did she say that she wanted treatment right away? Now, are you wondering why you haven't seen her in your schedule?

Being successful at gaining case acceptance on large cases is critical for running a successful dental practice. Most general dentists enjoy the challenge of tackling a complex case so they can use their skills to the fullest.

It's also personally rewarding to bring a patient up to an acceptable level of health and watching that patient develop more self-confidence and pride in her appearance. It's also financially rewarding. As Stephen Covey might say, the large cases are the 'big rocks' that help fill schedules and fill bank accounts.

Check out one of Jill's favorite videos from Stephen Covey:


You can use the ledger to manage your case acceptance. Our group uses Dentrix dental practice management software, which makes this tracking easy. First, you need to charge out your case presentation-create a no-fee code with the description "Consultation" or "Conference" because this will print on a walkout statement. Then, treatment plan this code in the appointment when you plan to present your large case.

At the end of the month (or week) run a report to find everyone who has been charged out for this code. Look to see if there is a large credit on the account, indicating the patient paid some amount down for future treatment. Check to see that this patient has either completed the first steps of treatment or is scheduled to return.

What’s your average?

At the end of each month, compare the number of patients that had a case presentation with the number moving forward with the treatment plan. If you present 10 cases and 8 accept, set up financial arrangements and schedule their first visit, then you can count these 8 as accepted and in progress. So, 80% would be your average. Calculating the average for each dentist in your group provides valuable feedback and is an indicator of successful dental practice management.

The dentists can discuss their successful and failed cases and exchange ideas to improve. They also can use the failed cases as a call list to try to fill schedules later.

It makes a difference when the dentist calls. By simply taking the time to call the patient to say "I'm following up on a conversation you and I had last month where we talked about dental treatment for you-I wanted to offer to answer any questions you might have if you're still thinking about getting that dentistry done-can I answer anything for you?" Usually, this starts a very nice conversation and hopefully the dentist wraps up by offering to have his treatment coordinator set up financial arrangements and schedule the visit.

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Tracking orthodontic success

Orthodontists can use this same approach to track their success at gaining different types of cases. By charging out code D8000 Ortho initial exam or D8001,2 Ortho re-eval, again at no fee (most orthodontists aren't charging for new patient visits anyway) and tracking the kind of case presented and accepted, the orthodontist can see his success rate with Phase 1, full braces, Invisalign, etc.

Some of this work is manual-looking to see if treatment has been started or scheduled takes time, but the feedback for the orthodontist is worthwhile. If a trend starts to develop-for example, if you’re successful at starting 70% of full braces cases, but only 30% of phase 1 cases then it makes sense to look at the phase 1 approach to look for ways to improve. The same is true for Invisalign or even limited treatment on adults.

Tracking pediatric sedation cases

Another way to use the ledger is to track pediatric oral and IV sedation cases. Again, I'm targeting these cases because they are generally more complex and expensive than regular treatment plans. When you charge out D0150 comprehensive exam for children and compare that with the oral sedation and IV sedation codes, you can see your success rate for doing these types of cases.

Tracking wisdom teeth cases

This same approach makes sense for oral surgeons as well. Charge out the D0150 comprehensive exam for wisdom teeth extraction and then look in the ledger at the end of month to see if the case is completed or scheduled. Again, for cases that do not schedule, your oral surgeon can take these patient names and make a follow up call to answer questions and try to get these patients into your schedule.

Tracking trends and comparisons

Using the ledger to track case acceptance and provide feedback to dentists is one of the most valuable coaching mechanisms available in dental practice management software. It can be easy for one dentist to blame a patient's finances for his lack of success with these large cases, but when another dentist in the same group has a markedly better track record the conversation usually changes to asking "How do you do it?"

Because the reality of our economy is that patient finances really do affect large case acceptance, spending time looking at the black and white results also can open up some conversations about financial arrangements policy and options. Dentists may want to start to offer phased treatment and then again, track their success.

I've been tracking large case acceptance for every general dentist and specialist in our group for more than 6 years using Dentrix, so if you have any questions about how to set up this approach in your own office, feel free to contact me.

I want to help you to run a dental practice successfully. A dental office manager has an opportunity to go above and beyond by establishing this type of tracking and then providing an end of month report to her dentist or specialist. I would be happy to share my sample spreadsheet for the codes we track depending on the type of dentist you're working with.

Jill Nesbitt is a dental consultant and practicing office manager for a multi-specialty private dental group. Nesbitt has managed the practice for 14 years, has state-level quality training, and coaches dental teams to improve the business-side of their practices.