Best Practices from the Top Ten Percent

Is it still possible for a small or solo dental practice to grow and thrive in today’s DSO/Corporate dentistry-focused world?


Is it still possible for a small or solo dental practice to grow and thrive in today’s DSO/Corporate dentistry-focused world? According to our recent analysis of over 10,000 dental practices, the answer is “absolutely!” In spite of an incredibly challenging business environment brought on by a global pandemic, many of these small practices experienced record performance in the past twelve months. How is that possible? What did these practices do to succeed in a year where virtually every dental practice in the country was shut down for up to three months? How were they able to navigate such a difficult experience and still grow?


WHY THIS MATTERS: Before we share what they did, here’s why understanding what these practices are doing matters to any dental practice, regardless of size or location or specialty. Becoming a top-performing dental practice may not mean anything to you, and that’s great! This isn’t about bragging rights or “my practice is better/bigger than your practice” or anything like that. All of this is about one thing: Helping you and your practice improve and grow in the ways that do matter to you. Growth for you could mean more patients, new equipment, or offering new services. Perhaps it might include hiring new staff or bonusing your team or hiring a coach or practice consultant. It almost certainly includes providing even more and better dentistry to your patients.

But regardless of how you define “growth,” the things these top-performing practices are doing to experience success regardless of the business climate are things that any dental practice can replicate, and that is the objective behind sharing these principles with you. If only one or two of them is relevant, mission accomplished. If you take action on an idea shared here and it leads to growth and improvement, fantastic!

In no particular order, here are several of the reasons why these practices had a successful 2020, including suggested ways that your practice can experience similar growth.

They Measured & Tracked Performance Daily

What does this mean exactly? Doesn’t every dental practice keep track of their Key Performance Indicators? In an excellent three-part series in Dental Economics, Levin Group Founder & CEO Roger Levin shared some invaluable insights about the characteristics of these Top Ten practices, including this important takeaway: “Top 10% performing practices have an established set of key performance indicators that they are fanatical about tracking. When a key performance indicator is missed, they make the necessary changes or modifications to improve performance.”


Two things to note here: First, in Levin’s words, these practices are “fanatical about tracking.” Simply put, they are constantly measuring and tracking their key indicators in order to know where they are in comparison to the goals they’ve established for their practice. This isn’t an occasional, once-in-awhile behavior that is easily disregarded when practice leaders get too busy. This is a high-priority, can’t-miss habit that is repeated daily, weekly, and monthly.

Second, when these practices fall short on an important key indicator, “they make the necessary changes or modifications to improve performance.” The importance of this can’t be overstated. Paying attention to how you are doing is invaluable. But it’s only when tracking is coupled with this second habit of continually adjusting and modifying that a top practice truly rises to its potential.

What should we do now?

  • Don’t overdo it! There are dozens of KPIs you could start tracking, and they all matter. But this method will quickly overwhelm and discourage you and in all likelihood cause you to give up. Instead, pick one thing to start with. What’s one area you haven’t been paying attention to but know you should be? Start there.
  • Set a time to review your performance each day and then keep that appointment, day after day after day.

They Focused on Increasing Production Per Visit

At Dental Intelligence, we train thousands of dental practices to use data to improve patient care, team collaboration, and practice profitability. One of our tools for doing so is our Profitability Formula™, seen below. Notice that under the heading of “Production” there are only two categories: Visits and Production Per Visit. These are the only two ways for a dental practice to increase production. You can increase the number of patients coming into the practice and/or increase the amount of dentistry that patients receive per visit. Period. There’s no other way to increase production.

Top-performing dental practices have a mature understanding of this principle and build their schedules around making the most of each patient visit. Increasing PPV (Production Per Visit) isn’t just something that sometimes happens in these practices. They make sure it happens. They relentlessly focus on ensuring that each patient is properly diagnosed and then effectively presented with the treatment they need, leading to a higher rate of case acceptance in comparison to other practices.


For example, Smiles Services, a group practice based in the Northwest, had five of their offices finish 2020 with more production than they had done in 2019 – and they were closed for seven weeks in 2020! How did they experience such remarkable results? Here is what Dr. Raymond Frye, founder and CEO of Smiles Services, shared with us.

“We are literally a phoenix rising out of the Covid ashes!  We are hyper focused on using the PPV (production per visit) tool on Dental Intelligence as a strategy to conserve our PPE.  We want to make sure we go above and beyond to do as many procedures on each patient as possible, so we are not wasting PPE.  We are going to be monitoring the PPV numbers on Dental Intel for each office as an indicator on how well they are doing with mitigating the waste of PPE as well as minimizing the traffic flow and maintaining social distancing.  I believe the PPV tool is now more powerful than ever with our new normal in dentistry!”

 There’s that principle of monitoring again. What methods are you following for increasing your Production Per Visit? Here are some additional suggestions:

  • Prior to when a patient arrives for an appointment, review their current treatment plan and identify presented care that still needs to be done. Call the patient and discuss with them to see if any of it can be completed while they are in the chair.
  • Do the same for any family members that might be overdue for hygiene or who may also have unscheduled treatment and identify whether or not that can be scheduled.

They Focused on Same-day Treatment & Same-Day Treatment Acceptance %

 Another practice that thrived in 2020 was Dee For Dentist in Las Vegas. Dee is a fun, high-energy practice with a patient-first culture and data-savvy leadership team. As Dee waited for their practice to reopen, they knew the patient experience would be different and wanted to make the most of that change. Here’s how Mike Cruz, Office Manager at Dee For Dental, described what they did.

 “At the beginning of 2020, we had a goal to increase our Production Per Visit (PPV) but had been stuck at the same figure for a while. The pandemic shutdown gave us a chance to fix this problem. With the combination of fewer available appointments and the heightened requirements to protect patients and team members, we made sure patients understood it would be far better to complete more treatment in a single visit. This has led to much more same-day dentistry and has increased our PPV significantly.”

Simply put, Dee For Dentist incorporated same-day dentistry into their philosophy of care. They educated their patients on the value of completing more treatment during a single visit and also communicated this to them when confirming appointments. They established a culture of care that made it easier for patients to prioritize needed treatment and to complete some or all of it during the same visit.

Screen Shot 2021-09-13 at 11.52.24 AMHere’s an eye-opening statistic that validates how impactful this approach can be on a practice: In 2020, the top-performing practices completed almost 50% of the same-day dentistry they presented to their patients. In contrast, the lowest-performing practices completed around 15% of presented same-day treatment. What made the difference?

  • The first and obvious is that these practices are presenting same-day treatment. Make this a standard operating procedure in your practice. If every team member is committed to this approach and consistently follows it, your same-day treatment acceptance % can only move in one direction – up!
  • These practices also focus on how to present same-day treatment, especially in the current environment. And then they practice and help each other to improve. As the example from Dee For Dentist shows, emphasizing the convenience and need to complete more treatment per visit has led to an increase in their Same-Day Treatment Acceptance %. What could you do here?

They Held an Effective Morning Huddle – Every Morning

 Morning huddles are something everyone knows about, right? The idea certainly isn’t a new one. Meeting as a team for a few minutes each day to coordinate schedules and patient visits is a standard practice for many dental practices. Are these successful practices doing something different in their huddle than what you are doing? Here are three things that are included in their morning huddle that could impact your huddle as well.

  1. They use data to determine what they discuss. This is different than just reviewing numbers. For these practices, holding a data-driven huddle means they are using their KPIs to understand what happened the day before, what is happening today, and what is scheduled to happen tomorrow and as needed, adapting to improve performance.
  2. They involve every team member in the huddle. Instead of an office manager or doctor running the huddle, these practices ask team members to come prepared to contribute, which leads to a sense of ownership and accountability.
  3. They celebrate success and set goals to improve. This is a big one! Successful practices thrive because they have a positive culture of growth and validation for team members. This culture is built on celebrating success and holding each other accountable, which builds trust and confidence. Here’s how one of these practices, Greenville Family Dentistry in Greenville, Illinois, is making the most of their morning huddle.
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“We try to make every huddle a celebration, even if we might have missed some of our goals from the day before,” office manager Whitney Thornton shared. “Highlighting even small wins does so much to unify and energize our team. Being able to see everything in one place using Dental Intelligence makes this so easy. Using this platform helps us to operate at a higher level. No more running reports or trying to find out what’s happening in our practice. Now we know what’s happening. Instead of searching through our files for patients to fill holes in the hygiene schedule, we can find that information in seconds. It just feels like we can operate so much quicker and more efficiently, and I can’t say enough about the huddle and what it’s done for us.”

 They Focused on Increasing Annual Patient Value (APV)

 Annual Patient Value? Is that even a thing? Very much so. Annual Patient Value (APV) or collections per patient for all active patients, isn’t something a lot of practices think about, but it should be? If your average APV is increasing, that’s a good indicator you are on the right track. Determining APV gets rid of a lot of the “fluff” around gross production. Knowing the annual value of each patient helps you accurately answer questions like “Is my practice healthy?” “What am I collecting per active patient?” “Are we seeing our patients enough?” and others. For these successful practices, APV is something they are tracking constantly.

For example, here is what Sullivan Dental Partners in Brentwood, Tennessee is doing to increase the annual value of each of their patients. “Annual Patient Value helps us to answer the question ‘What are we getting out of our patient base at large?’” Dr “Sully” Sullivan, the practice co-owner, recently shared with us. “Having time to focus on the important but not urgent areas helped us to see remarkable improvement in a short span of time. Somebody needs to do fillings. Someone needs to do hygiene checks, crowns, etc. We need someone to do more of our low-value dentistry,” Dr. Sullivan added.

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When he started working in 2015, Sullivan Dental’s APV was around $400 per patient, and because he was able to take on a lot of that “low value” dentistry, their APV started to go up. Their focus for the past five years since he started has been on increasing their annual patient value, and that effort shows – it is now at $972. They’ve basically doubled the average value of every patient in just five years! Sullivan has been able to grow from a $1.5 to a $3.5 million practice in spite of only growing their patient base by 10%. This has enabled them to add new capabilities to their practice (implants, Cone Beam, etc.) They are still asking how they can get APV even higher – their goal is $1,500 to $2,000 – which means they now need an associate to begin handling the basic care so Dr. Sullivan can focus on providing the higher value care.

  • Calculate the APV for each of your patients. Dental Intelligence can automate this for you so you have instant insights, or you can attempt to do this for each patient. Regardless of the method, you need a baseline for what each patient is “worth” to your practice.
  • Start with those at the bottom of the list. Do they have unscheduled treatment? Are they current on hygiene appointments? You’re going to be stunned to see how many ways there are to increase APV just by focusing on these patients.

They Focused on Patient Growth

What was the first thing you thought when you read “patient growth”? Probably adding new patients, right? Most practices make adding new patients a priority, and understandably so. New patients are an important contributor to the growth of any dental practice. But are they the best source of that growth? You might be surprised. In 2020, top-performing practices increased patient growth by 18%, which represented a 4% increase over 2019. In contrast, the lowest-performing practices were down almost 12% from 2019, which represents a 30% gap between Top 10% and Bottom 10%. What’s going on here?

 Two words: Patient Retention. The difference between the Top 10 and Bottom 10 in 2020 was how well these practices retained their existing patients. To repeat, new patients are important. But more importantly, successful practices focused on their existing patients in 2020. They made sure each one had scheduled appointments, that they were current on hygiene care, that they were being effectively presented with needed treatment (which was then scheduled and completed,) and that family members were also receiving care.

Here’s the formula we use at Dental Intelligence to calculate Patient Growth %:

New patients + Reactivated patients – Patient attrition = Patient Growth %

 For example, if you added 50 new patients, lost 40, and retained 10, you’ll have positive patient growth. You can see the levers here and make decisions about which ones deserve your attention. Perhaps you would try to increase that new patient number to 60 or reduce that lost patient number to 30. Maybe your focus is on reactivating more patients. Regardless of what you decide here, it’s important to know what your current Patient Growth % is and then develop and implement a plan to improve your %. This is how these practices saw growth in 2020, and it’s how they (and you) will grow in 2021.

  • Run the formula above on your practice to determine your current Patient Growth %. Not to be too repetitive here, but the first step is always going to be determining where you are.
  • With this number in hand, identify which lever needs your immediate attention. New patients? Reactivated patients? Patient attrition? Don’t try to do too much. Begin with one and expand from there.

 They Focused on Hygiene Re-Appointment %

What is Hygiene Re-Appointment %? It’s the percentage of hygiene visits that, on the same day as their hygiene visit, have scheduled a subsequent hygiene appointment before leaving the dental office. In 2020, the most successful practices scheduled over 90% of patients for their next hygiene appointment before those patients left the practice. In contrast, those practices at the low end scheduled 56%, or just over half of their hygiene patients for their next appointment. This is obviously a significant gap and should motivate every practice to determine what their current Hygiene Re-Appointment % is and if attention is needed here.


Unless you’ve already been focusing on this, your current re-appointment % might be discouraging. We advise against despairing too much, and instead, encourage you to view this as a huge growth opportunity. Improving your Hygiene Re-Appointment % is a relatively easy process. Mostly this is about forming new habits around a consistent and practice-wide process that everyone follows. Simply put, make scheduling patients for their next appointment before leaving your practice a Standard Operating Procedure. Doing so will have a significant impact on your schedule and on the health of your patients.

What should we do now?

  • Start by figuring out where you are. You can do that instantly using Dental Intelligence’s Growth Platform, or you can calculate this manually. For the next week, at the end of each day, divide the number of patients that scheduled their next appointment before leaving your practice by the total number of hygiene patients treated that day. For example, if you had 30 hygiene patients come in today and 20 of them left with a scheduled appointment: 20 ÷ 30 = 66% hygiene re-appointment.
  • Discuss as a team what you could do to make sure that more of your hygiene patients are being scheduled before they walk out the door. Develop a plan and spend the next week tracking how you are doing. Be prepared to celebrate, because your efforts to improve your hygiene re-appointment % are going to work!

Customer Convenience > Patient Loyalty

 This final takeaway is a trend that has been developing for several years and which accelerated in 2020: Patient loyalty is decreasing as their desire for convenience continues to increase. It’s likely you are already aware of this trend and are adapting to it. If so, well done. If not, it’s not too late to deliver a robust response to this “new normal.” Here are some of the conveniences that patients say they want their dental practice to offer:

  • Online scheduling. Over 70% indicate this is important to them and even indicate they’re willing to switch dentists to find one that offers this service. To be clear, this isn’t simply providing an online appointment request widget. Patients want to use a platform like Dental Intelligence’s Online Scheduling platform to find and schedule their own appointments without ever needing to call or email their doctor’s office.
  • Text-to-Pay. Patients have also expressed a strong preference to use a Text-to-Pay solution like Payments to pay some or all of their balance versus the outdated billing statement approach that has been used (and is still being used) by so many dental practices. This is an easy-to-implement, low or no-cost service that patients are asking for.
  • Patient Safety. Patients have always wanted to feel safe when visiting their dentist. In 2020, safety took on new meaning as COVID-19 elevated many patients’ anxiety about the risks of exposure. Our data analysis indicates that the total number of appointments per day is down, which makes sense given that a visit takes longer with new safety protocols, cleaning requirements, and the need to isolate patients from each other. Rather than begrudge these new realities, patient-friendly practices are embracing them and making sure patients are aware of how their visit will be different.


There are certainly other things these practices are doing to succeed. It’s likely you are doing some or many of these things as well. Growth in a dental practice isn’t one-size-fits-all. As mentioned at the beginning, practices that are built on a culture of data are going to make decisions and take actions that lead to success. In his Dental Economics series about top performing practices, Dr. Roger Levin shared this important insight:

“What we did consistently find was that the leaders of top 10% practices built a strong and recognizable culture by following basic leadership principles. First, these leaders established a practice mission and mission statement early on, which they truly believed in and lived out each day. These doctors didn’t view their mission statement as just a public relations blurb that looked nice on the practice website. Instead, it became the DNA of the practice, woven into all procedures and communicated to the team regularly.”

If your practice is built around a strong and recognizable culture, you are well on your way to sustainable growth. If you are still working on developing that culture, we wish you all the best and hope these “best practices” from some of the best practices will inspire and motivate you to build the dental practice of your dreams.