A fully booked solo practice on the Gulf Coast was producing $2.2M and keeping $1.5M. Here is how we started closing that gap.
This case study is different from the other two. This doctor did not come to me with a struggling practice. He came with the opposite problem. Fully booked. High demand. A team that patients love. And a structural financial leak that had been running silently for years. It addresses four problems I see constantly in high-demand practices: a busy practice producing more than it keeps, fees systematically underpriced across the board, write-offs normalized as the cost of doing business, and no KPI tracking despite strong patient demand.
If any of that sounds like your practice, keep reading.
When this doctor first reached out in early 2025, I was looking at something I do not see as often as you might think: a genuinely thriving practice with a structural financial problem hiding inside its success. On paper, everything looked fine. A solo general dentist in a high-demand Gulf Coast market with a loyal patient base, long-tenured team members, and more demand than he could accommodate. Hygiene booked six to seven months out. New patients calling daily with nowhere to put them.
But inside those numbers was a quiet financial drain that had been running for years. The practice was producing around $2.2M at UCR fees and collecting only $1.4 to $1.5M. The gap, roughly $300,000 every year, was going straight to insurance companies in the form of write-offs. In my words to this doctor: that $300K was pure net profit walking out the door.
A fee analysis made it worse. Nearly every procedure fee was sitting below the 40th percentile for the zip code. The crown fee was $1,495 when the 80th percentile for the area was $1,769. Comprehensive exams, perio probing, periapical x-rays. All systematically underpriced across the board for years.
There was no formal KPI tracking. The Google review system had been quietly abandoned after COVID and never restarted. And the doctor himself was physically running out of capacity, checking hygiene for three different hygienists simultaneously, managing two doctor columns, and fielding emergencies on top of it.
Producing $2.2M. Keeping $1.5M. A $300K gap that had become invisible. When a practice is busy and profitable, the write-offs stop feeling like a problem and start feeling like overhead. They are not. They are money the practice earned and handed back. Most doctors I work with in this situation have never seen the gap laid out in a single number. That number changes the conversation immediately.
The primary focus from session one was designing a methodical exit from the plans costing the most. My approach is never to resign all at once. I rank plans by financial loss, patient volume, and fee flexibility, then exit in sequence while managing patient retention at every step.
The first plan we targeted had low fees and a long pattern of denying legitimate claims that had been frustrating the team for years. The office manager had personally been pushing for this move for a long time. The team was briefed, the patient communication script was trained, and the first resignation was executed. The result was extraordinary. Not a single patient was confirmed lost. The practice’s relationship with its patients held completely.
The next plan has a target effective date of early 2026. Two further plans are on the horizon after that. Each exit is designed the same way. Start heads-up conversations with patients weeks before the formal letter. Make the message warm, honest, and focused on continuity of care. Book their next hygiene appointment before they leave the chair. Track who books and who hesitates.
The team had been waiting for years to drop the first plan. They just needed a system to do it safely. This is one of the most common dynamics I encounter. The clinical team knows the insurance relationship is costing the practice money. They want to act. What they are missing is a structured process for doing it without losing patients. Once that process is in place, the team does not just comply. They lead.
I used zip-code-based fee analysis software to map every fee against the percentile distribution in this specific market. The analysis showed fees scattered below the 40th percentile with no logical pattern. The target is the 80th percentile, the same standard I set for my own practice in 2007. Fees are being raised across the top 30 most-used procedures.
Nine KPIs are now tracked quarterly. Total office production, doctor production, hygiene production, hygiene occupancy, collections, AR ratio, new patient flow, Google reviews, and whitening. My team pulls and prepares the data. Each review session covers what is working and what needs attention, with specific accountability back to one of my 24 systems for any metric below goal.
One of the most powerful conversations in this coaching relationship has been framing every decision against practice valuation. I showed this doctor that a $2M practice sells at roughly 90 percent of average collections. A $4M practice is worth dramatically more. Every dollar recovered from write-offs, every fee raised, every system that improves collections is not just income today. It is compounding valuation for a practice he intends to sell.
| Metric | Before coaching (early 2025) | In progress / after |
|---|---|---|
| Annual collections | ~$1.4M to $1.5M | $1.69M (2025 best year on record) |
| Annual production | ~$2.02M | Growth continuing as capacity opens |
| Insurance write-offs | ~$300K per year | Decreasing as plans exit |
| First plan targeted | In-network (low fees + denials) | Exited. Zero patients lost. |
| Crown fee | Below 40th percentile ($1,495) | Raised toward 80th percentile ($1,769+) |
| KPI tracking | None | 9 KPIs reviewed quarterly |
| Hygiene occupancy | Not tracked | 95%+ consistently (goal: 92%) |
| AR ratio | Unknown baseline | 0.47, well below the 1.0 goal |
| Google reviews | System abandoned post-COVID | New system in production |
Full financial impact will be quantifiable by end of 2026. Coaching ongoing.
“For every dollar you collect, you are writing off nearly 15 cents to insurance companies. That is not a fee problem. That is a system problem. And it is fixable.”
Gary Takacs
