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It sounds pretty ominous doesn’t it? You have probably heard me say many times that great leaders ask the “right” questions. Your ability to ask questions can catapult you to new levels of productivity if you act quickly on the answers that you get. There is another layer of asking the “right” questions and the amount of time you dedicate to the answers. Always start with questions about problems. Identify the most pressing problems with the highest return on your time for a starting point.

Make sure you are dealing with a problem and not just a symptom. It would probably be an error to think that just working on a symptom would ever fix the real problem. It would be like trying to get rid of a fire by eliminating the smoke rather than actually fighting the fire. Result: A lot of wasted effort while the real problem consumes your business.

There seems to be a challenge in understanding the relationships that various practice management areas have with one another. For every action there is a reaction or “ripple” effect on the process you are trying to perfect. The three deadly sins are prime examples of how this works. They are thinking that Collections, Reactivation, and Cancellations and No-Shows are “problems” instead of “symptoms”. Think about it. Every day I receive calls asking for help fixing one of these three “symptoms” when the problem is clearly somewhere else.

The root of the problem is in allowing each of these to occur. You’ve seen this from me before: What you allow you encourage.

  1. Allowing Collection Problems: It isn’t a problem but a symptom of poor financial arrangements with a willing patient to help them fit what they need into their budget. Generally your accounts receivable is divided into current, 30 days, 60 days, and 90 and over. 70% should be in the current, maybe 12% or so in the 30 days, another 8-10% in the 60 days column, and about 6% or less in the over 90 days. The ACT here is for you, the doctor, to take a look at the accounts receivable summary and make sure these benchmarks are in place. If not, go back to the protocol for financial arrangement and the person that is responsible for carrying it out and modify what they are doing/not doing. Do it this week. Final note: Most practice management software will give you a “net” account receivable total (debit and credit balances). The trouble is that if you do it this way, you are not seeing the true accounts receivable. Every negative number “hides” a positive number.


  1. Allowing Cancellations and No-Shows: The creeping death for your schedules and often the reason for missing your goals and watching your overhead climb. You will always have some cancellations and no-shows but with the right strategies you can lower it below 10% and even that percentage can be replaced with another patient. The national average for CA/NS hovers around 15%-20%. You can do better than that. So your ACT for this week means determining the why of this system. Here are the reasons people cancel.
    1. Confirming too soon. It is best to do it the 24 hours before the appointment
    2. Scheduling a patient that is past due on their account. People that owe you money will not show up, will not refer, and are the most likely to sue when you try to collect what they said they would pay.
    3. Scheduling too far in advance. You must be able to get people in within 4-10 days (that is not working days, it is calendar days). Fail in this and the CA/NS rate will soar
    4. Not confirming unless you actually speak with the patient. No messages.
    5. You have not addressed the patients concerns.
    6. Time: Inconvenient hours for the patients appointment.
    7. Fear: Pain
    8. Money: If you are not able to fit the cost into their budget, they will cancel or no-show.
    9. Apathy or a lack of trust: This may be the number one reason. If you do not inspire your patients as you help them want what they need, you will find yourself with a lot of holes in your schedule.


  1. Needing to spend too much time on Reactivation: If you find that you are not getting a 70%+ recall or find that more and more patients just don’t come back you are a donor practice. Reactivation is a symptom of not inspiring the patient. In other words, they don’t like something about your staff or office protocols. Something was missing, and this is one of the more crucial areas to attack. Your ACT is to look at the management report for your practice and share the statistic of the number of active patients without an appointment vs. the number of active patients with an appointment. Take the number and sit down with your staff and find out why patients are voting with their feet and leaving your practice. This is a sucking chest wound that needs immediate attention.

In closing, ask the right questions, work on the problems and not the symptoms, and avoid the three deadly sins. This is how you Summit.

Michael Abernathy, DDS
[email protected]
972-523-4660 cell

Summit Practice Solutions