You have a ton of metrics at your disposal, but have you given a thought to what are you missing 

By Roger P. Levin, DDS

Almost every orthodontist that I speak to has an interest in increasing practice production. It’s essential to every practice that seeks ongoing and sustainable success. Practice management expertise has created excellent platforms to understand key performance indicators or key practice statistics that can help a practice determine how it’s performing, where it’s strong, where it’s weak, and how it can improve. This is all positive and certainly should be part of the monthly analysis of every orthodontic practice.

However, within the effort to increase practice production and enhance overall practice performance, there is another area that is rarely addressed by most orthodontic practices and can have a dynamic effect on increasing practice production and profitability. At Levin Group we refer to this as “Invisible Opportunities.”

You Can’t See Them

The reason that most practices don’t analyze, strategize, and take advantage of invisible opportunities is simply that, as the name implies, they can’t see them. We become accustomed to information that is easily accessible, but we never consider information that is difficult to access. Some of the greatest businesses in the world, like Apple and Microsoft, have had many of the biggest breakthroughs because Steve Jobs or Bill Gates saw things that no one else could see. They saw the invisible opportunity. There were no key performance indicators, statistics, or metrics that told Bill Gates to build Microsoft software or Steve Jobs to build the iPhone. While these are very large world-class stories of success, every orthodontic practice can access and interpret the invisible opportunity and then create specific plans to improve practice production and profitability.

Invisible opportunities are often missed because they aren’t readily available. Orthodontic software today is excellent, but it is only as good as what it measures and what is entered. Here are some examples of the invisible opportunities that most practices miss.

1. New patients that never schedule.

Every year, orthodontic practices have many patients contact the office but many never may actually make an appointment. Why not? The caller may simply be shopping or seeking information, find it difficult to find the right appointment time, not get an answer to their question, and/or became dissatisfied in the conversation. These patients add up to often tens of thousands or hundreds of thousands of lost revenue dollars per year and they are invisible. The reason they are invisible is that almost no orthodontic practice has a clear statistic on how many potential new patients contact the office but never make an appointment.

The reasons that they are not making appointments are not the main point of this article. It is the fact that significant revenue dollars are lost every year to an orthodontic practice and yet no one thinks about it or knows about it or measures it. Over the course of a career this becomes literally millions of lost revenue dollars. Or, to put it another way, the orthodontist could reach financial independence 5 to 10 years earlier.

This is a perfect example of an invisible statistic that could have a critical benefit to an orthodontic practice, especially if that practice has production that is flat or declining in this more competitive era. The real question is why this statistic is not tracked and the real answer is that many practices never think about it. Some technology systems may have mechanisms to figure this out, but it isn’t top-of-mind for most orthodontic teams.

The way to handle this is simple. A good old-fashioned pad and a pen. Every front desk staff member should simply record every time a patient contacts the practice and does not schedule. If you want to go further you can make notes about that patient such as whether they were a child or adult patient, what questions they asked etc. This is certainly an easy task but what can make it difficult is that sometimes front desk people are averse to keeping complete records because they feel it is a negative factor for them if patients are calling and not scheduling. Be sure to help them understand that this is about tracking and taking advantage of an invisible opportunity to enhance performance and not a reflection of them. 

2. Treatment coordinator follow-up.

Many patients sit through a treatment coordinator (TC) orthodontic consult only to tell the TC that they need time to think about it. Unfortunately, most orthodontic practices have a very weak follow-up system, and rarely track how many patients are in the follow-up phase of the treatment coordinator process schedule or who do not schedule. We have had tremendous success with clients by very quickly implementing a powerful follow-up system with appropriate scripting that adds significant revenue to orthodontic practices. This is another area, however, that is invisible to most practices. How often, if ever, do practices track the number of patients that enter the follow-up phase and end up as a start? Only by evaluating this statistical performance can a practice then understand how to improve their TC process.

At first, one might simply say that follow-up should be created as a powerful system within the orthodontic practice, but that isn’t targeted enough to get the best results. First it’s important to know what percentage of patients in the follow-up phase end up as a start in the orthodontic practice. It’s also important to categorize the reasons why patients don’t start. How many patients never contact the office again or respond to follow-up communication? How many contact the practice or TC with a question? How many have financial challenges and mention it to the TC in the follow-up phase? How many simply picked another office? Without a follow-up process by the TC and asking key questions, the practice will not know how many patients it is losing each year in the follow-up phase and in each of the categories. Once again we are talking about tens of thousands or hundreds of thousands of dollars of revenue per year.

3. Financial options.

Another invisible area that is growing in scope is that many patients can’t afford the down payment or the monthly payments. I’ve spoken to many orthodontists who have told me that they don’t need or want patient financing because of the discount, that it’s unnecessary, and that their payment plans cover this situation. Unfortunately, this is often untrue. Many patients don’t tell the practice that the down payment or monthly payments are a challenge and they simply shop around for another practice.

Once again this is an invisible opportunity. By not knowing that a patient cannot afford the down payment or monthly payment but that they would be open to some type of financing, practices have another measurement that cannot be measured. The good news is that this can be solved by making patient financing options available to every patient. 

There are many more examples of the invisible. However, we now believe that when practices access, measure, and address the invisible challenges and opportunities they can increase production significantly. This can literally revive the practice or move it to the next level of production and profitability. The opportunities are right in front of everyone in the practice, but normally go unseen. Use the strategies above to be able to see and understand them. OP

Roger Levin

Roger P. Levin, DDS, is the CEO and founder of Levin Group, a leading practice management consulting firm that has worked with over 30,000 practices to increase production. A recognized expert on orthodontic practice management and marketing, he has written 67 books and over 4,000 articles and regularly presents seminars in the U.S. and around the world. To contact Levin or to join the 40,000 dental professionals who receive his Ortho Practice Production Tip of the Day, visit or email [email protected]