Squeezing More Growth from Your Practice: KPIs and Systems That Actually Move the Needle

For many dentists, the instinct to grow a practice begins with marketing — bring in more new patients, boost top-line revenue, and let the numbers take care of themselves. But as consultant Kelly Schwarz of Schwarz Consulting has seen firsthand, the biggest growth opportunities are often hiding in plain sight. They’re not about spending more to attract strangers; they’re about re-engaging the patients you already have, tightening systems, and holding your team accountable to key performance indicators (KPIs) that drive results.

With 30 years of experience working inside more than 800 practices, Schwarz has a simple but powerful message: focus on what you can measure, improve, and prove. His perspective is a reminder that intentional ownership, not just marketing, creates long-term growth.

Rethinking KPIs: From Numbers to Opportunities

Dentists often hear about KPIs but rarely know which ones matter most. Schwarz narrows it down to a handful that consistently predict success:

Hygiene capacity: A practice claiming 2,400 “active” patients but employing only one hygienist doesn’t truly have 2,400 active patients. One hygienist can handle about 768 one-hour appointments every six months. The rest are overdue and likely slipping away. Capacity — not just patient count — is the real measure of growth potential.
Case acceptance: The “80/50 Rule.” At least 80% of patients should schedule the first phase of their recommended treatment, and at least 50% of presented dollars should get scheduled. If you’re presenting $100,000 a month in treatment and only $20,000 moves forward, you don’t have a new patient problem — you have a system problem.
Net patient growth: It’s not enough to count how many new patients arrive. Practices must also measure how many are leaving. Schwarz recommends aiming for a “positive 16” each month — 16 more patients staying than leaving.

Each of these metrics shines a light on missed opportunities. And unlike external factors such as reimbursement rates or macroeconomics, these are within an owner’s control.

The Entire Team is a Treatment Coordinator

One of Schwarz’s strongest messages is that case acceptance isn’t the doctor’s job alone. In fact, hygienists and assistants often influence the decision more than the dentist.

When a hygienist uses an intraoral camera to show a cracked tooth, explains potential consequences, and sets up the doctor’s recommendation, patients walk into the exam already primed to accept treatment. That’s why effective handoffs matter — passing along the patient’s concerns, summarizing what’s been discussed, and framing the doctor’s exam as confirmation rather than a surprise.

This team-driven approach not only improves acceptance rates, it builds trust. Patients don’t feel “sold to”; they feel guided by a consistent, caring team.

Follow-Up Isn’t About Money — It’s About Care

Dentists and office managers often feel squeamish about follow-up calls, as if they’re pestering patients for money. Schwarz reframes it: follow-up is about showing patients you care.

He points to a Stanford study finding that 68% of patients leave practices due to perceived indifference — not price, not quality of care, but the feeling that no one followed up.

That’s why his system emphasizes personal letters — not just emails. Two weeks after a patient declines treatment, they receive a short letter with a photo of their tooth and a handwritten note from the doctor in red ink: “I’m concerned about this crack” or “Please call before your vacation.” It’s simple, personal, and powerful.

Emails, Schwarz notes, are easily ignored. A letter on real paper lands differently. Practices that adopt this system see average returns of over $250 per follow-up attempt.

Hygiene as the Engine of Growth

While treatment drives revenue, hygiene fuels long-term growth. Schwarz recommends practices measure hygiene by “0.85 patients per hour” — in other words, seven out of eight hygiene slots should be filled daily. If that isn’t happening, either recall systems are failing or capacity doesn’t match the patient base.

But here’s the nuance: not every patient should be reappointed automatically. Mature practices that pre-appoint every six months risk filling the schedule with patients who need little or no treatment, while patients with urgent needs wait. Startups, on the other hand, should aggressively reappoint to build their recall base.

The common denominator? Intentionality. Decide what your practice needs most at its stage of growth, then build systems to support that.

Human Terrain Over Clinical Terrain

Dentistry isn’t just about teeth — it’s about people. Schwarz calls this the “human terrain,” and it’s where many practices stumble. Phone skills, empathetic communication, and follow-up scripts that emphasize concern rather than salesmanship all make the difference between a patient who stays and one who drifts away.

When a front desk call begins with “Dr. Smith asked me to reach out because he’s concerned,” the patient hears care, not pressure. When hygienists hand off patients to doctors with context and empathy, acceptance rises. When follow-up letters arrive with handwritten notes, patients feel remembered, not marketed to.

These details don’t just polish a practice’s image — they directly impact collections, retention, and referrals.

The Big Picture: Sustainable, Intentional Growth

The real lesson in Schwarz’s playbook isn’t just which KPIs to track. It’s about being intentional in every decision:

Be intentional about who fills your hygiene chairs.
Be intentional about how you present and follow up on treatment.
Be intentional about whether you’re chasing growth for growth’s sake, or building a system that matches your goals.

Dentists can run successful practices in wildly different ways — boutique fee-for-service or high-volume insurance-driven, startup or multi-location group. What separates thriving practices from struggling ones is that the former know their numbers, apply systems consistently, and make patient care feel personal.

As Schwarz put it, growth isn’t about chasing more — it’s about doing better with what you already have. For many practices, the path to an extra $300,000–$1M in revenue isn’t more marketing; it’s maximizing hygiene, improving case acceptance, and showing patients you care enough to follow up.

Final Thought: If you’re a dentist chasing growth, the first place to look isn’t at your advertising budget — it’s at your systems. Your patients are already telling you what they need. The question is, are you listening?

Key Takeaways for Dental Leaders

EBITDA isn’t just for Wall Street — your hygiene and treatment systems directly drive profitability, not just revenue.
Hygiene capacity sets the ceiling — one hygienist equals ~768 appointments per six months. If you claim more “active patients” than you can serve, you’ve already lost ground.
The 80/50 Rule matters — 80% of patients should schedule at least phase one of treatment; 50% of presented dollars should get scheduled.
The whole team sells care — hygienists, assistants, and front desk all play critical roles in treatment acceptance.
Follow-up shows you care — letters with photos and handwritten notes outperform impersonal emails or voicemails.
Measure net patient growth — don’t just count new patients in, track how many leave each month. Aim for a “positive 16.”
Intentional scheduling beats autopilot — startups may pre-appoint aggressively, while established practices should prioritize patients with higher treatment needs.
Patient perception is everything — indifference (or lack of follow-up) is the #1 reason patients leave a practice.

Listen to the Original Podcast HERE.

View the Episode on YouTube HERE.