A century-old solo practice in the Midwest was handing $340,000 a year to insurance companies. Here is how we changed that.
This case study documents how I helped transform a 100-year legacy practice from one quietly handing away $340,000 a year to one on track to keep $560,000 in pre-tax income. It addresses five of the most common problems I see in established practices: write-offs normalized and unaddressed, fees kept artificially low, no succession or exit plan, a legacy practice underselling itself, and insurance dependency eroding margins silently.
If any of that sounds like your practice, keep reading.
When this doctor first connected with me in early 2022, I was looking at something I rarely see: a genuinely strong practice being systematically undersold. Not a practice in crisis. A practice with a century of community trust, long-tenured staff, and a doctor who genuinely cares, being quietly drained by a financial structure that had never been examined closely enough.
Around 70 percent of production came from insurance-dependent patients. A fee analysis confirmed why that mattered: the doctor had deliberately kept his fees at the 50th percentile for his zip code for years. His reasoning was sound on the surface. Insurance companies would never challenge UCR fees sitting at average. The cost of that logic was enormous.
At the time coaching started, the practice was writing off an estimated $340,000 annually. That is not a collection problem. It is not a production problem. It is the direct, ongoing cost of being contracted with plans that pay far below what the dentistry is worth.
Nearly $340,000 a year in write-offs had become so familiar they felt normal. This is one of the most expensive blind spots I see in established practices. Write-offs that have existed for years stop feeling like losses and start feeling like the cost of doing business. They are not. They are money the practice earned and chose to give away.
This is the longest active coaching relationship in this case study series. The arc moves from foundation-building through one of the most complex insurance exits I have navigated with any client, into a breakthrough financial year and now succession planning.
The first year established the operating framework. I introduced nine KPIs and set monthly goals for each. The membership plan was developed. DISC personality training ran with the full team. The digital patient photo system was implemented to drive case acceptance.
My guidance from the start was clear: do not invest in the in-office milling machine while still heavily insurance-dependent. Fix the financial foundation first. The milling machine is a reward, not a starting point.
No KPI tracking, no membership plan, no formal system for Google reviews. When there is nothing to measure, there is nothing to improve. Installing a nine-KPI dashboard is not about bureaucracy. It is about creating a clear line of sight from problem to system to solution.
The insurance exit here was one of the most complex navigations in my coaching practice. The plans were heavily interconnected through umbrella arrangements. Two plans with the worst fee-to-patient ratios were the first targets. What followed was months of navigating umbrella plan interconnections, resignation letters being ignored, fax confirmations going to wrong desks, and insurance companies hoping the practice would simply give up.
I coached through each step. The State Insurance Commission leverage tactic. The importance of faxing with confirmation. Starting with the smallest patient counts to build confidence before tackling the large ones.
The verbal skills training was equally critical. My heads-up conversation script was trained with the office manager and team so patients heard about changes directly and personally before any formal letter arrived. This is what separates a practice that loses 30 percent of its patients from one that loses 5 percent.
Fees deliberately kept at the 50th percentile to avoid UCR letters. The logic is understandable. The cost is not. The 50th percentile means average. Years of CE investment, clinical quality, and decades of experience place this doctor well above average. Undercharging for the quality you deliver is not a defensive strategy. It is a subsidy at your own expense.
The first half of 2025 produced results the practice had never seen. Monthly production averaging $107K against a $94K goal. Doctor production at $64K against a $51K goal. Collections averaging $83K per month, on track for the first $1M collection year in the practice’s hundred-year history.
A fee analysis in mid-2025 revealed the full opportunity still ahead. Every fee had been indexed to the 50th percentile. My recommendation was the 80th percentile, the same standard I used at my own practice for nearly two decades. By late 2025, the conversation had expanded into associate planning, practice expansion, call conversion training, and a formal succession timeline.
| Metric | Before coaching (2022) | Current status (2025) |
|---|---|---|
| Annual collections | ~$663K | ~$957K (approaching $1M) |
| Annual production | ~$877K | ~$1.24M |
| Insurance write-offs | ~$340K per year | Decreasing as final plan exit approaches |
| Insurance dependence | ~70% dependent | One plan remaining |
| Fee structure | 50th percentile | Raising to 80th percentile |
| Pre-tax income (est.) | ~$220K per year | Projected ~$560K post-exit |
| KPI tracking | None | 9 KPIs reviewed quarterly |
| Membership plan | Not launched | Developed and in use |
| Succession planning | Not considered | Formal planning underway |
Full financial impact of final plan exit and fee raise to be documented in a 2026 update.
“You deserve better. And there is nothing wrong with $220K, but you could be keeping $560K.”
Gary Takacs, February 2024
Same practice. Same doctor. Same team. The only thing that changes is what the practice keeps.
~$750K collections
$340K in write-offs
Fees at 50th percentile
~$220K pre-tax income
$1.4M to $1.5M collections
Write-offs close to zero
Fees at 80th percentile
~$560K pre-tax income
