How to Measure Marketing Success After You Go Fee-for-Service
Has your practice gone fee-for-service? Here’s how to assess the success of your dental marketing.
New-patient count was built for in-network practices, where volume drives the math. After you go fee-for-service, that count can fall while the business gets better — fewer patients at whole fees, more production per day. Grade net production, production per day (increasingly per hour), active patient count, and referral share instead. A campaign that generates calls you can’t convert hasn’t worked, whatever the top line says.
A practice we have worked with for years came to us doing around 43 new patients a month. Today it produces meaningfully more, on fewer doctor days, with fewer new patients.
Put that on a standard marketing report and one line stands out: new patients, down. Every agency dashboard in dentistry would render that in red. In reality, it was the best year the practice ever had.
The metric was built for a different kind of business
For an in-network practice, the new patient number is close to the right number, because the write-offs mean volume is what makes the arithmetic work. A full-time doctor in network needs somewhere around 25 to 30 new patients a month.
Out of network, the requirement drops to roughly 15 to 20, because each patient is worth substantially more. The entire strategic point of leaving insurance is to need fewer people and treat them better.
So a practice that executes the transition well should expect its new-patient count to fall. Reading that shift alone as failure is not a measurement problem, it’s grading the new business on the old business’s exam.
Three ways the headline number lies
- It hides whether you are actually growing.
New patients is a gross figure. It says nothing about how many left.
One owner we spoke with was seeing about seven new patients a month and, on reflection, put his net new patients for the year at almost zero with gains and losses roughly cancelling. Nothing on a marketing report would have shown that.
Practice management systems are less forgiving: most classify a patient as lost after eighteen months without a visit, which is why practices with respectable new-patient numbers sometimes discover their net growth is negative. The bucket was filling, but it was also draining.
- It has an arbitrary clock on it.
We once asked a prospective client how he defined marketing success. The answer was production from a patient who found the practice on Google, within the first ninety days.
Any window you draw is arbitrary, and the shorter it is the more it favors cheap, fast, low-value patients over the ones worth having. This is not a hypothetical disadvantage. It is roughly why DSOs can outspend private practices, because they understand the economics of lifetime patient value, where a normal dentist tends to think in a year.
A high-value case does not arrive on a convenient schedule. Grade on a quarter and you will systematically underrate the marketing that produces the patients you actually want.
- It changes what your agency does.
This is the one that matters most. If you judge success this way, all your marketing agency’s energy is going to be to get more people to say ‘Google’ on the form. That’s different from energy going towards growing the active patient base, because on the second one, yes, maybe it is Google. But maybe it’s finding referral opportunities from other businesses, maybe it’s internal referral programs and collateral and scripts, or anything that helps grow that goal.
Tell an agency it will be judged on patients who credit Google and you have told it what to optimize, and it’s not your practice. It is your intake form. Everything that grows the practice without being attributable becomes work the agency is paid not to do.
What dental marketing metrics agencies report vs what to grade
There is a hierarchy in the data dental marketing agencies report on, and each succeeds the last, is harder to measure, and closer to the truth.
Impressions > Clicks > Phone calls > New patients > Production > Net production per day.
Agencies tend to report from where they look strongest, which tends to be a thousand website visitors and healthy social engagement. It’s a real number, but it doesn’t answer any questions you care about. New patients is a considerably better metric, but it’s not the top one, and for a fee-for-service practice it is the wrong place to stop.
What should fee-for-service practices grade instead?
Net production, not collections. When we pull a practice’s history we use net production month over month and year over year, because collections are distorted by write-offs and cannot be compared across practices or across a transition.
Production per day, and increasingly per hour. This is the number that survives the change of business model. Fewer patients at whole fees can beat more patients at a discount, and only a per-hour figure shows it.
Active patient count. The measure that captures both directions at once. If it is rising, you are growing regardless of which channel gets the credit.
The share of new patients who were referred. Covered elsewhere in this series, and the best single indicator of whether the practice is worth what you are charging.
What happens on the phone. The first thing we measure is whether we can identify every new-patient call, say whether it scheduled, and explain why when it did not. A campaign that generates calls a practice cannot convert has not worked, whatever the top line says.
Three things this argument is not
We are aware of how this reads coming from a marketing agency, so we want to be clear by the limitations of these numbers.
New patient count is not useless. It is a fast leading indicator, it is the first thing to move when something breaks, and it belongs on the report. The argument is about what you grade on, not about what you look at.
For some practices it is exactly the right number. A startup filling a new schedule, or a practice genuinely short of volume, has a new patient problem and should be measured on new patients. One owner described his situation to us as plainly as it can be put: he had a volume problem. Nothing in this article applies to him yet.
It is not permission to under-deliver. The alternative measures above are harder to hit than a patient count, not easier. Net production and production per day are the practice’s actual results, which is a considerably more exposed place for an agency to stand than a number counted at the front desk. If an agency proposes softer metrics rather than harder ones, that is a different conversation and you should have it.
What it looks like when it’s working
Go back to the practice at 43 new patients a month. Today: fewer new patients, more production, fewer days worked, and an owner who chose all three.
That is the version worth wanting. You get fewer, better-fitting patients. More production per chair. A schedule the owner actually wants to work. But none of that shows up as growth on a dashboard built to count arrivals, which is a good reason to change the dashboard rather than the plan.
Do you know how your success is measured?
Ask your agency how it defines success before you ask what the numbers are. If the answer is new patients, ask what happens to that answer when your business model changes, and whether they would still call it a good year if new patients fell and production rose.
You will learn more from that conversation than from a quarter of reports.
And, if you don’t have an agency on your side to ask, we’re happy to discuss if we’re the right fit for your needs.
Frequently asked questions
How should a fee-for-service practice measure marketing success?
Grade net production (not collections, which write-offs distort), production per day and increasingly per hour, active patient count, and the share of new patients who were referred. Plus, whether every new-patient call can be identified, scored as booked or not, and explained. New-patient count is a useful leading indicator, but the wrong place to stop.
Why can new-patient count fall after going fee-for-service?
Because the whole point of leaving insurance is to need fewer patients and treat them better. A full-time in-network doctor needs about 25-30 new patients a month; out of network, 15-20 is enough because each is worth more. A count that drops while production rises is a successful transition, not a failure.
What’s wrong with judging marketing on new-patient count alone?
Three things: it’s gross, so it hides how many patients left; it usually carries an arbitrary short window that favors cheap, fast, low-value patients; and it tells the agency to optimize your intake form rather than grow the practice. Anything that grows the base without being attributable becomes work the agency is paid not to do.
Is new-patient count ever the right metric?
Yes. For a startup filling a new schedule or a practice genuinely short of volume, it’s exactly right. It’s a fast leading indicator that belongs on the report; the point is what you grade on. And the alternatives here are harder to hit, not softer.