Dental Practice Case Study: How a Multi-Specialty Dental Practice Increased Net Production by $800,000

Case study documented by Russ Ledbetter — lead dental practice consultant at The Ledbetter Group.

The Client Story

This case study is about a past consulting engagement with a two-doctor practice in an urban area. One doctor was a pediatric dentist and the other was a general dentist. Although they practiced within one business, the two sides of the practice had different scheduling and operational demands.

The practice had grown to a high level of production. By the time the doctors hired us, it was increasingly difficult to manage, and the stress was high.

The Challenge: Management Systems That Had Not Kept Pace With Growth

Communication between the front and back offices was severely lacking. The business office did not have the systems needed to operate effectively and efficiently at the practice’s current size. Important responsibilities were falling through the cracks or simply not getting done.

The doctors were also frustrated by the very high contractual write-offs required by their PPO plans. They were working hard, dealing with recurring operational problems, and feeling exhausted.

This was not simply a question of how to produce more. The practice needed an internal management structure capable of supporting continued growth, improving profitability, reducing stress, and giving the doctors more control.

The Goals for the Consulting Engagement

The doctors hired us with the following goals for the 15-month consulting engagement:

Increase production, collections, and profitability while positioning the practice for steady future growth.
Train the team in effective, efficient, and productive scheduling.
Improve communication between the business office and clinical team.
Evaluate each insurance plan and determine whether the practice should continue participating.
Build a well-run, efficient, and productive business office.
Implement a fair and motivating employee bonus system.
Reduce the pediatric dentist’s schedule to four days per week during the school year and three days per week when her children were out of school for the summer.

The Starting Point

At the beginning of the engagement, the practice was recording $5.7 million in annual gross production, before PPO contractual discounts. After those adjustments, annual net production was $2.69 million.

What We Changed

Scheduling Pediatric and General Dentistry Differently

Pediatric and general dentistry are similar in many ways, but their scheduling needs are different. Pediatric dentistry is naturally more of a volume business because children typically do not require the higher-value restorative treatment common in adult dentistry. One exception is hospital dentistry, which the pediatric dentist performed twice per month.

Using our scheduling model, we increased volume capacity on the pediatric side, while slowing the pace on the general dentistry side. The pediatric dentist moved to a four-day week during the school year and a three-day week during the summer. We trained the team to focus on quality over quantity and use staggered scheduling so production goals could be met without expecting either doctor to be in two places at once.

Improving Communication Between the Front and Back

Our company stresses effective, professional, and results-oriented communication. We trained the front and back teams to give one another the information needed to complete their responsibilities without repeated follow-up. As the handoffs improved, many of the practice’s everyday inefficiencies disappeared.

One example involved treatment plans. When an assistant spent an additional 30 seconds completing the necessary treatment-plan information in the back, the front-office team member did not have to leave the desk, find an available assistant, and wait for an answer while the patient stood at the front. Over a day, those 30 seconds combined could save the business office as much as 15 minutes. The same principle worked in both directions.

Building Dependable Business-Office Systems

We put clear procedures, timing, and accountability in place for work that had been inconsistent or falling through the cracks. These systems included:

Checklists for front-office responsibilities
Schedules for completing recurring responsibilities throughout the month
Methods for turning new behaviors into lasting habits
Effective scheduling and schedule repair
Consistent hygiene recall
Collecting patient portions at the time of service
Making financial arrangements that helped patients afford treatment
Preventing patients from falling through the cracks
Professional telephone procedures
Following up on past-due insurance claims
Handling new-patient calls effectively and converting more callers into scheduled patients

Evaluating PPO Participation Carefully

We evaluated the practice’s insurance plans by looking first at the lowest-reimbursing plans with the fewest participating patients. After evaluation, the doctors withdrew from plans slowly and conservatively rather than making a sudden, across-the-board change. During the engagement, the practice eliminated roughly half of its plans.

Each decision considered reimbursement, patient count, available capacity, and the effect the plan had on the practice. The goal was to improve the value of the work already being performed while protecting patient flow and practice stability.

Building Team Ownership and Accountability

We implemented a simple, fair, and motivating employee bonus system—a win for both the team and the doctors. Giving employees a direct stake in the practice’s success helped raise the team’s performance to a level that impressed the doctors.

What Did Not Change

The practice’s fee schedule remained unchanged.
The general dentist’s schedule remained unchanged.

The Results at the End of the 15-Month Engagement

By the end of the consulting agreement, the practice had achieved the following result:

Overall increase: 29.7%

Increase: +$800,000

Result: $3,490,000

Starting: $2,690,000

Annual Net Production

Collections kept pace with net production, and profits increased dramatically. Most of the practice’s expenses stayed about the same. The main increases were for dental supplies and laboratory fees needed to provide the additional treatment. That meant much of the increase in production went directly to profit.

Less Stress and More Control

The operational improvements also gave the doctors more control over the practice by:

Creating schedules suited to the different needs of pediatric and general dentistry
Reducing delays and duplicated work between the front and back offices
Giving the doctors confidence that essential business-office responsibilities were being completed
Improving team ownership, accountability, and performance
Allowing the pediatric dentist to work four days per week during the school year and three days per week during the summer so she could spend more time with her two young children

Continued Growth After the Consulting Engagement

When I followed up a few years later, the doctors had reduced their PPO participation to one remaining plan. Their contractual write-offs had dropped dramatically, and they were working less hard while collecting substantially more.

In the years since the consulting engagement, the practice has moved into a much larger space, added two associate dentists, and continued to grow. It is now nearly fee-for-service. The doctors report lower stress, and the practice has a high-energy team whose members are motivated and work together effectively.

The Bottom Line

This productive multi-specialty, two-doctor practice did not need a generic push to work harder. It needed management systems capable of supporting the practice it had become: scheduling designed for two different clinical models, dependable communication between the front and back offices, consistent business-office procedures, careful evaluation of PPO participation, and a team aligned around shared goals.

By strengthening those systems, the practice increased annual net production by $800,000, improved profitability, reduced stress, and gave the pediatric dentist more time with her children—without changing the practice’s fee schedule or expanding the general dentist’s workweek.

How Much Untapped Potential Is in Your Practice?

Your practice may be capable of producing substantially more with the team, patients, and resources it already has. Schedule a free consultation with The Ledbetter Group to explore opportunities for stronger production, better systems, and less stress.

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