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Running the Place, lesson 1 of 4
The Numbers That Mean Something at These Rates
Half the standard practice metrics assume you set your fees. You do not. Production per hour is close to meaningless when the rate is fixed and the mix is driven by a benefit, and chasing it pushes you toward decisions that are bad for the practice and worse for the patient.
- Drop. Production per hour as a headline number
- Watch. Completion, chair use, denial rate, oldest aging bucket
- Split. Adult and child, always
- Compare. To your own last quarter, never to a private benchmark
Why the Usual Headline Number Breaks
Production per hour is useful when you control price and mix. Here the price is set by the program and the mix is largely set by what the benefit covers and who walks in.
Managed as a target, it pushes toward selecting patients and procedures by what pays best, which in this setting means quietly moving away from the people the practice exists to serve. That is a slow drift and it usually happens without anybody deciding it.
Keep it as an observation if you like. Do not put it on the wall as the number the team is judged by.
The Four That Actually Tell You Something
Completion rate. Of treatment plans started, how many finished. This is the single best measure of whether the practice is working, because it combines scheduling, trust, and whether the plan was realistic.
Chair utilisation against your own broken appointment rate. Not how full the schedule looked, but how full the day actually was.
Denial rate by reason. A process measure that converts directly into money and points at its own fix.
The oldest aging bucket, as a trend. Whether it is growing is the earliest warning you get that something upstream has broken.
Split Everything Adult and Child
These are two different businesses under one roof, with different benefit stability and different patterns of attendance. A single blended number hides both of them.
When an adult benefit changes, a practice that has been tracking the split already knows what share of its capacity is affected. A practice that has not spends a month finding out.
Compare to Yourself
Published benchmarks come from practices with a different payer mix, a different fee schedule and patients who pay a share. Against those, a healthy practice here will look like a failing one, and the demoralising effect of that on a team is real.
Your own last quarter is the fair comparison, and the direction of travel is the thing worth discussing.
Show the team the measures they can actually move. Completion and broken appointments are within their control. The fee schedule is not, and putting a number in front of people that they cannot influence produces resentment rather than improvement.
Before You Spend a Dime
Should we track production at all?
Track it, do not manage to it. It tells you about volume. It does not tell you whether the practice is healthy.
What about overhead percentage?
It is useful, with the caution that a fixed low fee schedule makes the percentage look alarming next to private practice figures. Watch its direction rather than its level.
How often should we look?
Weekly for the operational ones, monthly for the trends. Any less and problems that are cheap to fix become expensive.
Next Problem to Solve
- What a Dental Compliance Package Actually NeedsNext in the course. What is really in a dental compliance package, which parts a small practice can do itself, and where the paid bundles earn their money.
- Reading Your Own Aging ReportRelated. The one report that tells you whether the practice is actually being paid, what the shape of it means, and the trap of judging a program practice by private practice benchmarks.
- Building a Schedule That Survives a Broken AppointmentRelated. Broken appointments are structurally higher in this population and mostly are not about motivation. How to build a day that absorbs them instead of one that breaks.
- Adults and Children Are Two Different BusinessesRelated. Why children's dental coverage is steady across the country and adult coverage is not, and what that means for how you plan a practice around it.