Every practice wants to be the $2 million practice. We set production goals, track collections, watch the schedule, and celebrate when the numbers tell us we are moving in the right direction. But in our focus on reaching that $2 million number, I think we often spend too much time worrying about the big losses and not enough time paying attention to the $100 and $200 opportunities happening around us every day. Those small numbers may not seem significant on their own, but they are part of what eventually determines whether we reach the big number at all.

I have spent many years in dentistry, working through almost every level of operations. I started at the front desk, answering phones, checking patients in, and making appointments, and eventually grew into a multisite executive leadership role. That experience has given me the opportunity to see dental practices from very different perspectives, but one thing has remained remarkably consistent: We spend a lot of time looking at the big numbers.

You can see it every morning in the huddle where we review the previous day’s production and collections and look at whether we are on track to meet the monthly goal. If we hit the target, we celebrate the win and recognize the team. If we missed it, the conversation quickly turns to what happened and why. Usually, the explanations are familiar. The schedule fell apart or a high-production patient canceled at the last minute. Maybe we did not receive a case from the lab in time or did not have enough new patients. These are the things everyone can see, and they are often discussed at length. But these are the big losses and maybe should not be the focus of these meetings since they are so obvious.

The small misses

I am the person who likes to know the “why” behind everything, so many years ago I started paying closer attention to what was happening inside the practices I managed. I became less curious about the obvious losses and more curious about the smaller ones. I am talking about the $100 and $200 ones—nothing that anyone would call a crisis and nothing that would cause someone to stop the day and call a midday huddle, but ones that still could leave us short of our goal. And as often happens, once I started noticing those small misses, I began seeing them everywhere. Just like on the cartoons, the little adding machine in my head started chiming away at how much we were losing out on.

What surprised me was how many of these opportunities were not difficult to find. Some were truly going unnoticed, while others were happening right in front of us but had become such a normal part of the day that no one stopped to think about what they were costing the practice. These opportunities are the low-hanging fruit, and I found that many of them fell into three areas of the practice: administrative, clinical, and insurance. Here are a few examples.

Administrative opportunities

• A patient leaves without scheduling the next appointment, with “I’ll call you” treated as the end of the conversation.
• Outstanding patient balances are allowed to accumulate instead of being addressed consistently at the time of service.
• Fees, adjustments, or write-offs are entered without anyone regularly looking for patterns that are quietly reducing revenue.

Clinical opportunities

• A hygienist identifies something during the hygiene appointment, but the opportunity gets lost during the handoff.
• A doctor diagnoses treatment, but when the patient hesitates, no one takes the time to understand the objection.
• An emergency patient receives care for the immediate problem but leaves without a plan for comprehensive follow-up.

Insurance opportunities

• Benefits are not completely or accurately verified before the patient’s visit.
• A prospective patient calls and is simply told, “We don’t take your insurance,” without a deeper conversation about their options.
• The practice continues participating with an insurance plan without evaluating whether the reimbursement actually supports the cost of providing care.

When the small numbers stop being small

None of these examples look particularly significant on their own. That is exactly why they are so easy to overlook. There is no line on the end-of-day report that says, “Here are all the $200 opportunities you missed today.” But when the same types of opportunities are missed repeatedly across different areas of the practice, they stop being small numbers.

That made me look differently at the $2 million practice. Creating $2 million in patient-care revenue is absolutely an accomplishment worth celebrating, but the practices reaching those numbers are not getting there because of one big thing they are doing differently. They are better at recognizing the smaller opportunities in front of them and capitalizing on them consistently.

This is not about asking teams to work harder, blaming anyone, or looking for fault. It is about looking more closely at what is already happening inside the practice. These examples are some of the easiest opportunities to recognize, but they are only the beginning.

In future articles, I will dig deeper into these and other opportunities that practices overlook every day. Because once you learn how to see them, you will begin to understand how much they contribute to the big number.