Sept. 10, 2026
The Growth You Buy vs. the Growth You Earn: Measuring Patient Trust
Most healthcare organizations can tell you exactly how much they spend acquiring a patient. Far fewer can tell you how many patients arrive because someone already trusts them.
That difference may reveal more about the strength of a healthcare business than another marketing dashboard ever will.
In this episode of The Operator, Jimmy McKay and Larry Benz examine a deceptively simple metric: the percentage of new patients who come from friends, family, or former patients.
Larry explains why digital attribution often gives credit to the final click instead of the relationship that caused it, why he views 35–40% referral-driven patient acquisition as an important benchmark, and why organizations can appear to be growing while quietly becoming more dependent on paid acquisition.
They also introduce the idea of relationship density, the number and strength of trust-carrying connections surrounding a patient, and explore how those relationships eventually show up in the P&L.
Key ideas from the episode:
- Why most healthcare systems measure transactions better than relationships
- The difference between growth you purchase and growth you earn
- Why referral share may reveal the durability of your growth
- How a practice can increase production while weakening relationally
- What Larry means by “relationship density”
- Why hygienists may be an underestimated growth engine in dentistry
- How trust affects acquisition cost, case acceptance, lifetime value, and payer mix
- Why patient reactivation campaigns cannot replace genuine relationships
- The one question front-desk teams can begin asking immediately: “Who can we thank for sending you in?”
A growth number tells you that the business grew.
This metric may tell you why.
Subscribe to The Operator on Substack for more ideas on healthcare leadership, operations, and building better healthcare organizations.
WEBVTT
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Most healthcare companies can tell you
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what they spend on marketing,
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cost per lead, cost per patient,
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conversion rate.
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The latest article on The Operator asks
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about a number most organizations can't
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answer, but should.
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What percentage of your new patients came
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from friends, family, or former patients?
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Because that number might tell you
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something much more important than whether
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your marketing is working.
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It'll tell you whether people actually
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trust you
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So let's start here.
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Larry,
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you say this may be one of the
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most strategically important numbers in
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your business,
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yet most groups can't answer it.
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Why has it been so invisible?
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When I say it like that in the
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intro, it seems obvious.
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Why is it so invisible?
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Yeah, I mean,
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you got to look at the fundamentals of
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what you're measuring.
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There's the old adage,
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you manage what you measure,
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and practice management systems, EMRs,
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they were built to measure billing,
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not built to measure relationships.
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Referral source is a free text field or
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a flip down field,
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or if it gets filled in at all
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in some things like dentistry,
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for example.
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And so digital sort of attribution
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launders the truth.
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Grandma tells her bridge club about you
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three or the Marjan club.
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That's the greatest game right now.
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So everybody's playing that one.
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Three of them Google your address and the
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marketing report says Google earned the
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three patients.
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Right.
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The last click gets the credit.
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The relationship did the work.
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And so I've come up with that term
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relationship density,
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which maybe we can talk about.
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But as any operator in the chair,
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You'll get an answer to two decimals.
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Ask what share of new patients arrived on
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trust and you get a shrug.
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A lot probably.
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A lot probably is not a number, right?
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So, yes,
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this is a big flip for practices who
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are more used to straight relationship or
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straight numbers,
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not relationship driven numbers.
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Right.
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Yeah.
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You draw this line between these two
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phrases, right?
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transactional practice and relational
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practice.
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If you walked into each one tomorrow,
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what's the difference in terms of feel?
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How do they feel differently?
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You know, it's interesting,
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and I wonder if physical therapy is going
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the same way, Jimmy,
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because traditionally I would view PT as a
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very relationship-oriented business.
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But dentistry, I've viewed,
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is a lot more transactional, oddly enough.
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And maybe with higher volumes,
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other things in healthcare are that as
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well.
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But let's face it,
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you could tell within the first thirty
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seconds and probably the last thirty
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seconds, right?
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In a transactional relationship,
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nobody looks up.
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Insurance card and ID, you know,
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everybody's eyes are, you know,
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in the system.
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And what happens at the end?
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You end with checkout, reach the desk,
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do you want a receipt, you know?
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Relational,
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someone greets you by name before you
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reach the desk.
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In dental,
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the hygienist picks up the conversation
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from six months ago, mid-sentence.
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The kid's braces,
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a trip that they went on.
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And the visit ends with a plan and
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a relationship affirmed,
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and you're coming in for your next visit.
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A big data point in dentistry is how
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many percentage of patients when they left
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were scheduled within six months.
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Same chair, completely different business.
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Now,
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from my own conversation, you know,
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the day I understood,
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I still will get is in two thousand
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two in my physical therapy practice.
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And I use this term I coined.
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It's not about treatment anymore.
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Treatment is table stakes.
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Everyone in the market is clinically
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competent.
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The experience around the treatment
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decides whether the patient comes back and
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who they tell.
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It's just that that way.
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I've been running that play for twenty
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four years and
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Dentistry is just the latest here.
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I'm running it from now,
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but it is the same.
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And in fact,
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I think it's going to be easier in
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dentistry because it's easier to shift
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from transactional to relationship and to
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really create a culture around it rather
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than traditional DSOs always think about
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lead generation and marketing and all the
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leaky bucket of spending.
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And now you've got social media and AI
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and all of these different factors.
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Which are important.
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Those can generate leads.
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I'm not saying they can't.
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And you need some effort there.
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But you could spend silly there without
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having a direct understanding of a
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relationship.
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If you spend directly on
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relationship-driven positive psychology,
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high-quality communications,
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peak end effect, empathy,
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exquisite empathy, boundary empathy,
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all of those kind of things,
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what you're really investing in
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is the ability to turn them into
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relationships.
00:05:02.139 --> 00:05:04.303
And we know the lifetime value of a
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customer in healthcare and in dental is
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extremely valuable because of the direct
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benefit and the indirect benefit of the
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people they refer like friends and family.
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all right well we should get more people
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to refer friends and family and former
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patients is nice but you actually have a
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number you have a number that you're
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aiming for right now it's thirty five
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percent of new patients to come from those
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things friends family or former patients
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why thirty five what does that number tell
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you about a normal that a normal growth
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metric might not yeah so let me give
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you some context first you know um where
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the number came from years ago
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we demonstrated in our clinic model,
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our physical therapy clinic model,
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particularly in de novos,
00:05:46.468 --> 00:05:48.069
which take a while to ramp up.
00:05:49.149 --> 00:05:51.170
We found that if you can get to
00:05:51.230 --> 00:05:52.290
forty percent,
00:05:53.509 --> 00:05:55.151
you could be in the hardest hitting
00:05:55.211 --> 00:05:57.372
referral for profit POPs areas
00:05:58.170 --> 00:05:58.350
you know,
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physician owned practice areas and it
00:06:00.151 --> 00:06:02.312
wouldn't matter if forty percent of your
00:06:02.353 --> 00:06:05.235
patients were former friends and family.
00:06:05.574 --> 00:06:05.774
Right.
00:06:06.435 --> 00:06:08.317
So in PT business,
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we thought it was forty.
00:06:10.158 --> 00:06:11.838
What I'm saying in dental right now,
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our number right now is thirty five
00:06:13.499 --> 00:06:13.879
percent.
00:06:13.939 --> 00:06:15.620
That's sort of the actual I want to
00:06:15.641 --> 00:06:17.922
get it higher because the higher it gets
00:06:17.961 --> 00:06:19.882
it, the cheaper my marketing costs are.
00:06:21.043 --> 00:06:22.805
They arrive, as I said,
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more than a third of our new patients.
00:06:24.444 --> 00:06:26.567
That's the growth engine running on trust.
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you know that we didn't have to purchase
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a lead from um what it tells me
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is that a growth metric doesn't you know
00:06:36.271 --> 00:06:38.211
a growth number tells you that you grew
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the number tells this number tells you why
00:06:40.552 --> 00:06:42.713
you grew you follow me like i can
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tell you my same store organic sales are
00:06:44.535 --> 00:06:46.134
three to five to seven percent that
00:06:46.154 --> 00:06:48.216
doesn't tell me why though this number
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tells you why and whether the patient
00:06:49.857 --> 00:06:51.757
growth survives you turning off any ad
00:06:51.798 --> 00:06:53.838
spend um i can tell you
00:06:55.720 --> 00:06:57.622
And I think most retail businesses can
00:06:57.661 --> 00:06:58.502
tell you the same thing.
00:06:58.543 --> 00:06:59.904
If you spend more money on marketing,
00:06:59.925 --> 00:07:01.045
you're going to get more business.
00:07:01.607 --> 00:07:03.889
But the question is the return.
00:07:03.949 --> 00:07:05.891
And in healthcare and in dental,
00:07:05.951 --> 00:07:07.273
it's really whether that patient is
00:07:07.333 --> 00:07:09.095
transactional versus relationship.
00:07:09.915 --> 00:07:11.718
So referred patients come in with a lot
00:07:11.757 --> 00:07:12.879
higher trust.
00:07:12.959 --> 00:07:13.500
And in dental,
00:07:13.519 --> 00:07:15.101
they come in with a lot less anxiety,
00:07:15.562 --> 00:07:17.024
better treatment case acceptance,
00:07:17.084 --> 00:07:18.425
and again, a better, you know,
00:07:18.485 --> 00:07:19.245
lifetime value.
00:07:19.286 --> 00:07:21.689
It's a compounding readout of how the
00:07:21.709 --> 00:07:23.670
relationship practices actually are.
00:07:23.711 --> 00:07:25.353
And so one number, you know,
00:07:25.492 --> 00:07:27.295
on the dashboard that you can't be faked
00:07:27.314 --> 00:07:28.175
with a budget, right?
00:07:28.196 --> 00:07:28.415
Yeah.
00:07:28.596 --> 00:07:29.656
Yep.
00:07:29.817 --> 00:07:31.517
And so could a practice be growing
00:07:31.557 --> 00:07:31.939
quickly?
00:07:31.978 --> 00:07:33.360
I think you sort of alluded to this.
00:07:34.000 --> 00:07:35.240
Could a practice be growing quickly
00:07:35.300 --> 00:07:38.384
hitting production targets and still be
00:07:38.463 --> 00:07:41.886
actually getting weaker relationally under
00:07:41.925 --> 00:07:42.586
the surface?
00:07:44.112 --> 00:07:44.353
Yeah,
00:07:44.372 --> 00:07:46.653
I've got a phrase we have now at
00:07:46.694 --> 00:07:49.696
DCA called earn it because you have,
00:07:49.776 --> 00:07:52.177
this is something that is intentional and
00:07:52.317 --> 00:07:54.398
systematic and has to be baked and
00:07:54.418 --> 00:07:56.098
embedded into your organization
00:07:56.158 --> 00:07:56.839
culturally.
00:07:58.300 --> 00:07:59.141
Because if not,
00:07:59.440 --> 00:08:01.182
you're going to have failure underneath it
00:08:01.822 --> 00:08:03.343
and it's going to be inconsistent,
00:08:03.523 --> 00:08:04.543
you know, from month to month,
00:08:04.603 --> 00:08:06.204
production up, new patients up,
00:08:06.245 --> 00:08:08.024
referral share quietly sliding.
00:08:08.105 --> 00:08:08.925
That's not growth.
00:08:09.526 --> 00:08:10.447
And so, yeah,
00:08:11.627 --> 00:08:12.867
You don't want to be on a treadmill
00:08:12.908 --> 00:08:13.108
here.
00:08:13.127 --> 00:08:15.069
And so the day the ad budget blinks,
00:08:15.110 --> 00:08:16.329
the growth blinks with it.
00:08:16.370 --> 00:08:17.831
You can gain weight and lose muscle at
00:08:17.870 --> 00:08:18.632
the same time.
00:08:18.651 --> 00:08:20.992
And most dashboards only have the scale.
00:08:21.153 --> 00:08:22.814
That's a great analogy.
00:08:23.714 --> 00:08:24.355
Yeah.
00:08:24.375 --> 00:08:25.435
So let's get back to that phrase you
00:08:25.475 --> 00:08:26.137
mentioned before.
00:08:26.197 --> 00:08:27.778
And let's sort of define it so people
00:08:27.798 --> 00:08:29.019
can maybe use it themselves.
00:08:29.158 --> 00:08:30.920
Relationship density.
00:08:32.140 --> 00:08:33.542
What exactly are you trying to measure
00:08:33.581 --> 00:08:34.142
with that?
00:08:35.062 --> 00:08:35.263
Yeah.
00:08:35.283 --> 00:08:37.624
So this is just an evolving concept,
00:08:37.724 --> 00:08:38.024
Jimmy.
00:08:38.043 --> 00:08:39.644
And where I would say we're going with
00:08:39.684 --> 00:08:40.326
it is that
00:08:41.559 --> 00:08:43.211
it's really the number and strength of
00:08:43.331 --> 00:08:43.815
trust
00:08:45.030 --> 00:08:47.312
which carries connections per patient,
00:08:47.971 --> 00:08:49.432
not visits, connections.
00:08:50.072 --> 00:08:52.293
Does the patient see the same hygienist
00:08:52.332 --> 00:08:56.693
year over year or a stranger every recall
00:08:57.094 --> 00:08:57.894
patient, right?
00:08:58.355 --> 00:09:00.754
How consistent do they carry through in
00:09:00.774 --> 00:09:02.495
that lifetime value of a customer?
00:09:03.855 --> 00:09:05.096
Do we know the household,
00:09:05.157 --> 00:09:06.157
not just the chart?
00:09:06.557 --> 00:09:07.996
Do you know the spouse, the kids,
00:09:08.038 --> 00:09:09.717
the sister who moved just into town?
00:09:10.077 --> 00:09:12.339
Did anything in the visit create a moment
00:09:12.379 --> 00:09:13.298
worth retelling?
00:09:14.106 --> 00:09:15.687
The proxies are all measurable,
00:09:16.168 --> 00:09:17.828
referral share of new patients,
00:09:17.908 --> 00:09:19.409
hygiene reappointment rate,
00:09:19.509 --> 00:09:20.630
patients per household,
00:09:20.671 --> 00:09:22.451
reactivation of former patients.
00:09:23.892 --> 00:09:26.073
All of those things are metrics and kind
00:09:26.094 --> 00:09:27.413
of operating flow things.
00:09:27.433 --> 00:09:29.836
But this relationship density kind of goes
00:09:30.456 --> 00:09:32.197
a bit further.
00:09:32.236 --> 00:09:34.418
There's some science behind this trust
00:09:34.498 --> 00:09:35.219
issue, by the way.
00:09:36.038 --> 00:09:36.839
So Jane Dutton,
00:09:36.879 --> 00:09:39.301
who developed the concept of high-quality
00:09:39.341 --> 00:09:40.801
connections, and Kahneman,
00:09:40.821 --> 00:09:43.302
who put the concept of peak-end rule.
00:09:44.062 --> 00:09:45.903
Kahneman proved that endings dominate
00:09:45.984 --> 00:09:47.043
memory of all things.
00:09:47.984 --> 00:09:49.884
He started with a colonoscopy study,
00:09:49.924 --> 00:09:50.164
right?
00:09:50.625 --> 00:09:52.726
If an ending can redeem a colonoscopy
00:09:52.907 --> 00:09:53.366
patient,
00:09:54.195 --> 00:09:55.855
It can redeem a crown.
00:09:56.216 --> 00:09:57.696
It can redeem a filling.
00:09:57.735 --> 00:09:57.956
Right.
00:09:58.255 --> 00:10:00.277
The last two minutes of a dental visit
00:10:00.777 --> 00:10:03.638
are a growth strategy for a clinic,
00:10:03.937 --> 00:10:05.798
not just a good way to end the
00:10:05.878 --> 00:10:06.457
treatment.
00:10:06.477 --> 00:10:07.298
Does that make sense?
00:10:07.318 --> 00:10:09.578
So you're you're investing again in these
00:10:09.619 --> 00:10:12.100
growth strategies around connections that
00:10:12.159 --> 00:10:13.840
lead to other connections and other
00:10:13.879 --> 00:10:16.000
patients, not just a gimmicky.
00:10:16.942 --> 00:10:18.683
There's a difference between good customer
00:10:18.724 --> 00:10:20.706
service and good human connection.
00:10:21.307 --> 00:10:22.369
Sometimes it's subtle,
00:10:22.869 --> 00:10:25.913
but both can be growth strategies if they
00:10:25.953 --> 00:10:29.719
are completely attended to, emphasized,
00:10:29.778 --> 00:10:31.019
and really become embedded in your
00:10:31.059 --> 00:10:31.400
culture.
00:10:31.856 --> 00:10:32.256
Yeah, well,
00:10:32.277 --> 00:10:35.717
then one concept should flip some value
00:10:35.778 --> 00:10:36.677
sort of on its head.
00:10:37.677 --> 00:10:38.839
One of the things you mentioned in the
00:10:39.158 --> 00:10:41.578
article is that hygienists might be the
00:10:41.678 --> 00:10:44.720
actual real owner of the relationship,
00:10:44.759 --> 00:10:46.519
the real relationship engine of a
00:10:46.580 --> 00:10:48.801
practice, the face, the vibe.
00:10:49.280 --> 00:10:50.821
Why have many operators historically
00:10:50.921 --> 00:10:51.961
undervalued that one?
00:10:51.981 --> 00:10:53.662
And there's parallel roles with a
00:10:53.701 --> 00:10:56.302
hygienist or a PT or PTA in other
00:10:56.342 --> 00:10:57.202
practices as well.
00:10:57.923 --> 00:10:58.203
Yeah,
00:10:58.224 --> 00:11:00.865
so as best I've learned in dentistry,
00:11:00.905 --> 00:11:01.866
it's this idea, well,
00:11:01.907 --> 00:11:03.427
we started with this hygiene model.
00:11:03.447 --> 00:11:04.830
We're going to have the hygienist do
00:11:04.889 --> 00:11:06.471
hygiene, clean teeth,
00:11:06.510 --> 00:11:08.331
then put them on a maintenance program,
00:11:08.351 --> 00:11:09.774
get them in every six months,
00:11:10.274 --> 00:11:11.754
and the doctor will do the production.
00:11:12.355 --> 00:11:14.256
And so all of the metrics around
00:11:14.317 --> 00:11:15.878
production follow the doctor.
00:11:16.458 --> 00:11:18.841
And hygiene got reduced to a schedule and
00:11:18.921 --> 00:11:20.881
a perio percentage.
00:11:20.902 --> 00:11:23.124
We measure what hygienists produce today
00:11:23.144 --> 00:11:25.066
and almost never what they actually are.
00:11:25.566 --> 00:11:27.495
Right, so now we're on the FaceTime math,
00:11:27.576 --> 00:11:28.902
same chair twice a year,
00:11:30.059 --> 00:11:32.041
oftentimes for a decade or more,
00:11:32.682 --> 00:11:34.663
most patients see their hygienist more
00:11:34.702 --> 00:11:37.184
reliably than they see any other clinician
00:11:37.225 --> 00:11:37.884
in their life.
00:11:39.285 --> 00:11:41.106
More visits, more conversations,
00:11:41.227 --> 00:11:41.927
less drama.
00:11:42.107 --> 00:11:43.349
They spend time with them.
00:11:43.408 --> 00:11:45.269
And so more trust is built in that
00:11:45.389 --> 00:11:47.572
earning there, including myself.
00:11:49.072 --> 00:11:50.693
The doctor's name might be on the door,
00:11:50.714 --> 00:11:52.174
but the hygienist is in the room.
00:11:52.514 --> 00:11:53.755
Read your own Google reviews.
00:11:53.836 --> 00:11:56.136
Notice how often the five stars named the
00:11:56.177 --> 00:11:58.499
doctor for trust that the hygienist
00:11:58.698 --> 00:11:59.559
actually built.
00:12:00.360 --> 00:12:02.881
And so one of the major chapters I
00:12:02.902 --> 00:12:04.341
wrote in my dental call to care book
00:12:04.402 --> 00:12:04.822
upcoming,
00:12:05.123 --> 00:12:06.624
it was a lot of research on that
00:12:06.683 --> 00:12:07.443
relationship.
00:12:07.984 --> 00:12:09.164
And it's like everything else,
00:12:09.205 --> 00:12:10.826
when people leave an organization,
00:12:10.846 --> 00:12:12.147
they don't leave the organization,
00:12:12.167 --> 00:12:14.347
they leave the case of a dental practice,
00:12:14.368 --> 00:12:16.528
they may leave a doctor who's obstinate,
00:12:16.729 --> 00:12:17.950
you know, who's hard to work with.
00:12:18.570 --> 00:12:21.631
Hygienists are one of the most valuable
00:12:21.932 --> 00:12:23.974
clinicians in all of healthcare,
00:12:24.073 --> 00:12:26.475
and their salaries are now starting to get
00:12:26.535 --> 00:12:27.376
reward for it.
00:12:27.756 --> 00:12:29.619
A starting salary in dental hygiene,
00:12:30.318 --> 00:12:32.201
which can oftentimes be a two-year degree,
00:12:32.240 --> 00:12:33.601
makes more than a physical therapist
00:12:33.642 --> 00:12:34.383
starting salary.
00:12:35.222 --> 00:12:36.342
Um, so think of what,
00:12:36.383 --> 00:12:38.183
think of what that has evolved to over
00:12:38.224 --> 00:12:39.364
the past, uh, uh,
00:12:39.663 --> 00:12:40.764
half a dozen or so years.
00:12:41.124 --> 00:12:41.803
Yeah.
00:12:41.844 --> 00:12:43.364
Someone started paying attention to what
00:12:43.705 --> 00:12:44.945
that result is.
00:12:45.625 --> 00:12:47.284
Um, you argue that it's not,
00:12:47.804 --> 00:12:48.644
it's not soft.
00:12:48.684 --> 00:12:50.706
So make, make the CFO case for me,
00:12:50.745 --> 00:12:51.926
make it, make it tangible.
00:12:52.466 --> 00:12:54.385
When does the stronger relationship
00:12:54.505 --> 00:12:57.147
density start to show up in real hard
00:12:57.187 --> 00:12:58.527
numbers?
00:12:58.846 --> 00:12:59.106
Yeah.
00:12:59.187 --> 00:13:00.246
So three lines,
00:13:00.287 --> 00:13:02.187
the CFO stares at every month.
00:13:02.248 --> 00:13:03.388
The first one is, um,
00:13:04.703 --> 00:13:06.686
the marketing cost per new patient.
00:13:07.126 --> 00:13:09.549
So every referred patient is a marketing
00:13:09.590 --> 00:13:11.331
patient you didn't have to buy in this
00:13:11.351 --> 00:13:12.332
particular case, right?
00:13:12.352 --> 00:13:15.395
And like I said, in dentistry,
00:13:15.436 --> 00:13:16.496
that could be a hundred and fifty to
00:13:16.538 --> 00:13:18.500
two hundred bucks per case in these
00:13:18.580 --> 00:13:19.961
services that we talked about.
00:13:20.581 --> 00:13:22.904
Second is case acceptance and lifetime
00:13:22.924 --> 00:13:23.365
value.
00:13:23.706 --> 00:13:25.067
So referred patients,
00:13:25.827 --> 00:13:28.109
Treatment case acceptance is more in the
00:13:28.249 --> 00:13:30.029
eighty percent rate than the fifty to
00:13:30.070 --> 00:13:31.150
seventy five percent.
00:13:31.691 --> 00:13:32.692
And they stay longer.
00:13:33.231 --> 00:13:35.253
That's not just revenue quality.
00:13:35.293 --> 00:13:37.374
That's that's that is revenue quality,
00:13:37.433 --> 00:13:38.875
not just not just quantity.
00:13:39.456 --> 00:13:40.456
And then the third, I would say,
00:13:40.475 --> 00:13:42.317
is payer mix relationships.
00:13:42.417 --> 00:13:43.697
Patients choose you,
00:13:43.758 --> 00:13:44.958
not a network or a grid.
00:13:44.979 --> 00:13:45.219
Right.
00:13:46.479 --> 00:13:48.139
And the payer mix reflexes.
00:13:48.681 --> 00:13:50.422
This isn't a culture slide.
00:13:50.461 --> 00:13:52.503
It's a P&L strategy, you know,
00:13:52.582 --> 00:13:53.923
wearing a culture costume.
00:13:55.004 --> 00:13:56.326
so all right talk to everybody out there
00:13:56.346 --> 00:13:58.730
who's might run a pt organization medical
00:13:58.750 --> 00:14:01.054
group other multi-site healthcare platform
00:14:01.836 --> 00:14:03.679
what is the equivalent of that thirty five
00:14:03.720 --> 00:14:05.624
percent number for them that they should
00:14:05.644 --> 00:14:06.706
be trying to understand
00:14:08.038 --> 00:14:10.080
Yeah, again, the exact same number,
00:14:10.120 --> 00:14:12.802
the percentage of new patients who arrive
00:14:12.861 --> 00:14:15.504
as friends, family, or former patients.
00:14:16.024 --> 00:14:18.285
Former patients meaning separate diagnosis
00:14:18.346 --> 00:14:21.188
effectively or a separate episode of care,
00:14:21.229 --> 00:14:21.428
yeah.
00:14:22.269 --> 00:14:23.711
And I'd argue it's even more,
00:14:24.912 --> 00:14:26.232
I think it's actually more revealing
00:14:26.293 --> 00:14:28.053
outside dentistry because you don't have
00:14:28.073 --> 00:14:30.596
this kind of hygienist concept in most
00:14:30.635 --> 00:14:31.116
healthcare.
00:14:32.977 --> 00:14:35.500
In PT where a physician referrals dominate
00:14:35.539 --> 00:14:36.000
the funnel,
00:14:36.942 --> 00:14:38.923
The patient's source share is only part of
00:14:38.964 --> 00:14:40.283
the funnel you actually own.
00:14:40.364 --> 00:14:42.345
The physician relationship can be lost to
00:14:42.365 --> 00:14:44.485
a hospital, acquisition tomorrow, right?
00:14:44.525 --> 00:14:46.586
They can go into a POPs relationship,
00:14:47.106 --> 00:14:49.008
but the patient who sends their sister
00:14:49.028 --> 00:14:50.989
can't be bought out from under you.
00:14:51.269 --> 00:14:52.549
Medical groups, same thing,
00:14:52.590 --> 00:14:55.350
plus track households and former patient
00:14:55.451 --> 00:14:56.370
reactivation.
00:14:56.410 --> 00:14:57.192
You know, what we do
00:14:58.011 --> 00:15:00.754
is we have this reactivation that started
00:15:00.774 --> 00:15:02.235
about ten years ago where all of a
00:15:02.254 --> 00:15:04.056
sudden you'd go through your CRM,
00:15:04.076 --> 00:15:05.876
you'd go through your email,
00:15:05.897 --> 00:15:07.557
you'd go through your EMR database,
00:15:07.597 --> 00:15:08.958
and you'd send them a reminder.
00:15:09.239 --> 00:15:09.679
And you know what?
00:15:09.740 --> 00:15:11.620
Statistically, you can't argue.
00:15:11.801 --> 00:15:13.062
There are a certain number of patients
00:15:13.081 --> 00:15:13.822
that come back.
00:15:14.442 --> 00:15:16.784
But I would argue that if you're relying
00:15:16.845 --> 00:15:18.846
on reactivation campaigns,
00:15:19.365 --> 00:15:20.486
that reactivation,
00:15:20.527 --> 00:15:21.927
that former patient percentage,
00:15:21.947 --> 00:15:23.509
is never going to get to that thirty-five
00:15:23.528 --> 00:15:25.309
to forty percent because you're reacting
00:15:25.890 --> 00:15:27.912
on a transaction, not a relationship.
00:15:28.972 --> 00:15:29.153
All right.
00:15:29.173 --> 00:15:29.613
So right now,
00:15:29.653 --> 00:15:31.335
if an operator listening could add one
00:15:31.394 --> 00:15:33.355
metric to their dashboard tomorrow,
00:15:33.836 --> 00:15:35.158
what would you be in their ear telling
00:15:35.197 --> 00:15:38.139
them to start tracking first?
00:15:38.320 --> 00:15:40.642
You know, I would probably start simple,
00:15:40.802 --> 00:15:42.003
embarrassingly simple.
00:15:42.102 --> 00:15:42.322
You know,
00:15:42.342 --> 00:15:44.504
have the front desk ask every new patient
00:15:45.125 --> 00:15:47.226
one question asked, you know, really well.
00:15:48.587 --> 00:15:51.690
Who could we thank you for sending you
00:15:51.809 --> 00:15:51.931
in?
00:15:52.934 --> 00:15:53.916
Not a form field,
00:15:54.236 --> 00:15:57.561
a warm question recorded in, you know,
00:15:57.660 --> 00:15:59.043
not some type of pick list,
00:15:59.123 --> 00:16:00.585
not a free text.
00:16:01.066 --> 00:16:01.986
Put it in a free text.
00:16:02.006 --> 00:16:02.768
Thirty days later,
00:16:02.788 --> 00:16:04.269
you have a number most of your competitors
00:16:04.309 --> 00:16:05.030
will never have.
00:16:05.652 --> 00:16:07.934
Put it on the dashboard next to production
00:16:08.434 --> 00:16:10.258
and trend it monthly.
00:16:10.850 --> 00:16:12.111
You manage what you measure.
00:16:12.131 --> 00:16:13.813
And this is the one number that measures
00:16:14.214 --> 00:16:15.895
where all the other numbers will still be
00:16:15.936 --> 00:16:16.956
there in five years.
00:16:18.638 --> 00:16:23.142
And that's not anything difficult to do.
00:16:23.322 --> 00:16:23.802
And yes,
00:16:23.822 --> 00:16:25.845
you can automate it and all of those
00:16:25.865 --> 00:16:26.365
kind of things.
00:16:26.404 --> 00:16:28.966
But what you can't automate and what AI
00:16:28.986 --> 00:16:31.229
cannot automate is the humanness behind
00:16:31.269 --> 00:16:31.509
this.
00:16:32.090 --> 00:16:34.652
Who can we thank for sending you in?
00:16:35.352 --> 00:16:36.374
Oh, I've been here before.
00:16:36.793 --> 00:16:37.634
Oh, my sister.
00:16:38.135 --> 00:16:38.696
Oh, whatever.
00:16:39.176 --> 00:16:40.157
Most people are saying,
00:16:40.216 --> 00:16:40.878
how did you get here?
00:16:40.957 --> 00:16:41.177
Again,
00:16:41.197 --> 00:16:42.438
that goes back to how they got here
00:16:42.479 --> 00:16:43.039
by Google.
00:16:43.080 --> 00:16:43.759
They Googled you.
00:16:44.140 --> 00:16:45.241
That's not who sent you.
00:16:45.322 --> 00:16:45.841
That's a who.
00:16:46.101 --> 00:16:47.322
You're asking for a who question.
00:16:47.683 --> 00:16:48.163
Exactly.
00:16:48.625 --> 00:16:49.445
Yeah, that's the magic.
00:16:50.145 --> 00:16:51.346
All right.
00:16:51.366 --> 00:16:51.586
Yeah.
00:16:52.028 --> 00:16:53.889
Most growth dashboards tell you how many
00:16:53.928 --> 00:16:54.990
patients walk through the door.
00:16:55.009 --> 00:16:56.130
But Larry, again,
00:16:56.191 --> 00:16:57.832
wants you to ask the different question.
00:16:58.552 --> 00:16:59.453
Why'd they walk the door?
00:16:59.894 --> 00:17:02.154
Or more accurately, who can they thank?
00:17:02.455 --> 00:17:03.875
Who can you thank for sending them your
00:17:03.916 --> 00:17:04.175
way?
00:17:04.596 --> 00:17:06.057
Because if more than a third of your
00:17:06.096 --> 00:17:07.817
growth comes from people who already trust
00:17:07.856 --> 00:17:08.998
someone you cared for,
00:17:09.018 --> 00:17:11.159
it's not just marketing efficiency.
00:17:11.179 --> 00:17:12.799
That's evidence that the relationship
00:17:12.900 --> 00:17:14.740
itself is working.
00:17:15.280 --> 00:17:17.582
Check out this and more articles now on
00:17:17.821 --> 00:17:19.462
the operator on Substack.
00:17:19.502 --> 00:17:21.584
And until next time, keep operating.
00:00:05.599 --> 00:00:07.702
Most healthcare companies can tell you
00:00:07.822 --> 00:00:09.202
what they spend on marketing,
00:00:09.343 --> 00:00:10.843
cost per lead, cost per patient,
00:00:10.923 --> 00:00:11.663
conversion rate.
00:00:12.324 --> 00:00:14.846
The latest article on The Operator asks
00:00:14.926 --> 00:00:17.367
about a number most organizations can't
00:00:17.489 --> 00:00:18.289
answer, but should.
00:00:18.629 --> 00:00:21.390
What percentage of your new patients came
00:00:21.431 --> 00:00:24.734
from friends, family, or former patients?
00:00:25.094 --> 00:00:27.035
Because that number might tell you
00:00:27.074 --> 00:00:29.036
something much more important than whether
00:00:29.056 --> 00:00:30.137
your marketing is working.
00:00:30.478 --> 00:00:32.598
It'll tell you whether people actually
00:00:32.798 --> 00:00:33.420
trust you
00:00:34.707 --> 00:00:35.387
So let's start here.
00:00:36.027 --> 00:00:36.347
Larry,
00:00:36.427 --> 00:00:37.628
you say this may be one of the
00:00:37.707 --> 00:00:40.670
most strategically important numbers in
00:00:41.009 --> 00:00:41.789
your business,
00:00:41.869 --> 00:00:44.371
yet most groups can't answer it.
00:00:44.930 --> 00:00:46.451
Why has it been so invisible?
00:00:47.131 --> 00:00:48.093
When I say it like that in the
00:00:48.133 --> 00:00:49.093
intro, it seems obvious.
00:00:49.152 --> 00:00:50.173
Why is it so invisible?
00:00:50.414 --> 00:00:51.374
Yeah, I mean,
00:00:51.393 --> 00:00:52.975
you got to look at the fundamentals of
00:00:53.054 --> 00:00:53.854
what you're measuring.
00:00:55.454 --> 00:00:56.835
There's the old adage,
00:00:57.055 --> 00:00:58.296
you manage what you measure,
00:00:58.317 --> 00:01:00.878
and practice management systems, EMRs,
00:01:00.898 --> 00:01:02.459
they were built to measure billing,
00:01:02.658 --> 00:01:05.240
not built to measure relationships.
00:01:05.340 --> 00:01:07.543
Referral source is a free text field or
00:01:07.563 --> 00:01:08.802
a flip down field,
00:01:09.504 --> 00:01:10.864
or if it gets filled in at all
00:01:11.344 --> 00:01:13.465
in some things like dentistry,
00:01:13.486 --> 00:01:14.066
for example.
00:01:16.073 --> 00:01:18.954
And so digital sort of attribution
00:01:19.454 --> 00:01:20.516
launders the truth.
00:01:21.096 --> 00:01:23.177
Grandma tells her bridge club about you
00:01:23.216 --> 00:01:25.878
three or the Marjan club.
00:01:26.317 --> 00:01:27.697
That's the greatest game right now.
00:01:27.718 --> 00:01:28.778
So everybody's playing that one.
00:01:29.179 --> 00:01:30.899
Three of them Google your address and the
00:01:30.938 --> 00:01:33.019
marketing report says Google earned the
00:01:33.040 --> 00:01:33.719
three patients.
00:01:33.760 --> 00:01:34.099
Right.
00:01:34.460 --> 00:01:36.120
The last click gets the credit.
00:01:36.141 --> 00:01:37.861
The relationship did the work.
00:01:38.561 --> 00:01:40.623
And so I've come up with that term
00:01:40.664 --> 00:01:41.944
relationship density,
00:01:42.385 --> 00:01:43.865
which maybe we can talk about.
00:01:43.906 --> 00:01:46.388
But as any operator in the chair,
00:01:47.498 --> 00:01:49.319
You'll get an answer to two decimals.
00:01:50.159 --> 00:01:52.341
Ask what share of new patients arrived on
00:01:52.382 --> 00:01:53.822
trust and you get a shrug.
00:01:54.024 --> 00:01:54.784
A lot probably.
00:01:55.465 --> 00:01:57.746
A lot probably is not a number, right?
00:01:58.227 --> 00:01:59.268
So, yes,
00:01:59.308 --> 00:02:04.492
this is a big flip for practices who
00:02:04.531 --> 00:02:08.596
are more used to straight relationship or
00:02:08.635 --> 00:02:09.437
straight numbers,
00:02:09.516 --> 00:02:11.277
not relationship driven numbers.
00:02:11.318 --> 00:02:11.959
Right.
00:02:11.998 --> 00:02:12.139
Yeah.
00:02:12.179 --> 00:02:13.639
You draw this line between these two
00:02:13.680 --> 00:02:14.661
phrases, right?
00:02:14.800 --> 00:02:17.365
transactional practice and relational
00:02:17.746 --> 00:02:18.326
practice.
00:02:18.888 --> 00:02:21.251
If you walked into each one tomorrow,
00:02:21.752 --> 00:02:23.915
what's the difference in terms of feel?
00:02:23.975 --> 00:02:25.298
How do they feel differently?
00:02:25.830 --> 00:02:27.572
You know, it's interesting,
00:02:27.611 --> 00:02:29.231
and I wonder if physical therapy is going
00:02:29.252 --> 00:02:30.133
the same way, Jimmy,
00:02:30.173 --> 00:02:32.894
because traditionally I would view PT as a
00:02:32.933 --> 00:02:35.594
very relationship-oriented business.
00:02:36.215 --> 00:02:37.756
But dentistry, I've viewed,
00:02:37.816 --> 00:02:40.056
is a lot more transactional, oddly enough.
00:02:41.097 --> 00:02:42.798
And maybe with higher volumes,
00:02:43.157 --> 00:02:44.979
other things in healthcare are that as
00:02:45.038 --> 00:02:45.299
well.
00:02:45.979 --> 00:02:46.838
But let's face it,
00:02:46.878 --> 00:02:48.439
you could tell within the first thirty
00:02:48.500 --> 00:02:50.659
seconds and probably the last thirty
00:02:50.699 --> 00:02:51.280
seconds, right?
00:02:51.300 --> 00:02:52.840
In a transactional relationship,
00:02:53.320 --> 00:02:54.300
nobody looks up.
00:02:54.841 --> 00:02:56.501
Insurance card and ID, you know,
00:02:56.540 --> 00:02:58.701
everybody's eyes are, you know,
00:02:58.782 --> 00:02:59.421
in the system.
00:02:59.461 --> 00:03:00.782
And what happens at the end?
00:03:00.801 --> 00:03:03.223
You end with checkout, reach the desk,
00:03:03.242 --> 00:03:05.603
do you want a receipt, you know?
00:03:05.682 --> 00:03:06.423
Relational,
00:03:06.622 --> 00:03:08.584
someone greets you by name before you
00:03:08.623 --> 00:03:09.403
reach the desk.
00:03:10.324 --> 00:03:10.784
In dental,
00:03:10.805 --> 00:03:12.765
the hygienist picks up the conversation
00:03:12.786 --> 00:03:14.926
from six months ago, mid-sentence.
00:03:15.548 --> 00:03:16.487
The kid's braces,
00:03:17.248 --> 00:03:19.330
a trip that they went on.
00:03:19.389 --> 00:03:21.431
And the visit ends with a plan and
00:03:21.450 --> 00:03:23.132
a relationship affirmed,
00:03:23.771 --> 00:03:25.913
and you're coming in for your next visit.
00:03:26.112 --> 00:03:29.715
A big data point in dentistry is how
00:03:29.735 --> 00:03:31.376
many percentage of patients when they left
00:03:31.415 --> 00:03:33.516
were scheduled within six months.
00:03:34.097 --> 00:03:36.298
Same chair, completely different business.
00:03:37.218 --> 00:03:37.438
Now,
00:03:39.209 --> 00:03:41.211
from my own conversation, you know,
00:03:41.251 --> 00:03:42.592
the day I understood,
00:03:42.671 --> 00:03:44.413
I still will get is in two thousand
00:03:44.453 --> 00:03:47.235
two in my physical therapy practice.
00:03:47.275 --> 00:03:48.756
And I use this term I coined.
00:03:48.795 --> 00:03:50.337
It's not about treatment anymore.
00:03:50.858 --> 00:03:52.318
Treatment is table stakes.
00:03:52.498 --> 00:03:53.980
Everyone in the market is clinically
00:03:54.040 --> 00:03:54.540
competent.
00:03:54.901 --> 00:03:56.923
The experience around the treatment
00:03:56.983 --> 00:03:59.384
decides whether the patient comes back and
00:03:59.425 --> 00:04:00.044
who they tell.
00:04:00.445 --> 00:04:02.026
It's just that that way.
00:04:02.167 --> 00:04:03.587
I've been running that play for twenty
00:04:03.627 --> 00:04:04.288
four years and
00:04:05.669 --> 00:04:07.370
Dentistry is just the latest here.
00:04:07.389 --> 00:04:08.570
I'm running it from now,
00:04:08.971 --> 00:04:10.072
but it is the same.
00:04:10.092 --> 00:04:10.972
And in fact,
00:04:11.072 --> 00:04:12.372
I think it's going to be easier in
00:04:12.432 --> 00:04:14.774
dentistry because it's easier to shift
00:04:14.813 --> 00:04:19.216
from transactional to relationship and to
00:04:19.276 --> 00:04:21.577
really create a culture around it rather
00:04:21.617 --> 00:04:24.879
than traditional DSOs always think about
00:04:24.959 --> 00:04:27.601
lead generation and marketing and all the
00:04:27.641 --> 00:04:29.141
leaky bucket of spending.
00:04:29.201 --> 00:04:31.444
And now you've got social media and AI
00:04:31.483 --> 00:04:33.144
and all of these different factors.
00:04:34.004 --> 00:04:34.865
Which are important.
00:04:34.944 --> 00:04:36.505
Those can generate leads.
00:04:36.565 --> 00:04:37.786
I'm not saying they can't.
00:04:37.846 --> 00:04:39.346
And you need some effort there.
00:04:39.766 --> 00:04:41.548
But you could spend silly there without
00:04:41.567 --> 00:04:43.848
having a direct understanding of a
00:04:43.889 --> 00:04:44.649
relationship.
00:04:44.968 --> 00:04:46.490
If you spend directly on
00:04:46.550 --> 00:04:49.490
relationship-driven positive psychology,
00:04:49.531 --> 00:04:50.872
high-quality communications,
00:04:50.932 --> 00:04:53.093
peak end effect, empathy,
00:04:53.153 --> 00:04:55.312
exquisite empathy, boundary empathy,
00:04:55.452 --> 00:04:56.694
all of those kind of things,
00:04:57.113 --> 00:04:58.555
what you're really investing in
00:04:59.475 --> 00:05:00.918
is the ability to turn them into
00:05:00.978 --> 00:05:01.699
relationships.
00:05:02.139 --> 00:05:04.303
And we know the lifetime value of a
00:05:04.384 --> 00:05:06.608
customer in healthcare and in dental is
00:05:06.668 --> 00:05:08.690
extremely valuable because of the direct
00:05:08.730 --> 00:05:10.553
benefit and the indirect benefit of the
00:05:10.593 --> 00:05:12.497
people they refer like friends and family.
00:05:13.694 --> 00:05:15.175
all right well we should get more people
00:05:15.216 --> 00:05:16.797
to refer friends and family and former
00:05:16.836 --> 00:05:19.379
patients is nice but you actually have a
00:05:19.480 --> 00:05:20.920
number you have a number that you're
00:05:21.021 --> 00:05:22.601
aiming for right now it's thirty five
00:05:22.641 --> 00:05:25.084
percent of new patients to come from those
00:05:25.103 --> 00:05:26.665
things friends family or former patients
00:05:27.264 --> 00:05:29.307
why thirty five what does that number tell
00:05:29.326 --> 00:05:31.869
you about a normal that a normal growth
00:05:31.928 --> 00:05:34.350
metric might not yeah so let me give
00:05:34.370 --> 00:05:37.312
you some context first you know um where
00:05:37.333 --> 00:05:39.214
the number came from years ago
00:05:40.706 --> 00:05:43.826
we demonstrated in our clinic model,
00:05:43.867 --> 00:05:45.307
our physical therapy clinic model,
00:05:45.348 --> 00:05:46.447
particularly in de novos,
00:05:46.468 --> 00:05:48.069
which take a while to ramp up.
00:05:49.149 --> 00:05:51.170
We found that if you can get to
00:05:51.230 --> 00:05:52.290
forty percent,
00:05:53.509 --> 00:05:55.151
you could be in the hardest hitting
00:05:55.211 --> 00:05:57.372
referral for profit POPs areas
00:05:58.170 --> 00:05:58.350
you know,
00:05:58.370 --> 00:06:00.112
physician owned practice areas and it
00:06:00.151 --> 00:06:02.312
wouldn't matter if forty percent of your
00:06:02.353 --> 00:06:05.235
patients were former friends and family.
00:06:05.574 --> 00:06:05.774
Right.
00:06:06.435 --> 00:06:08.317
So in PT business,
00:06:08.336 --> 00:06:09.237
we thought it was forty.
00:06:10.158 --> 00:06:11.838
What I'm saying in dental right now,
00:06:11.879 --> 00:06:13.459
our number right now is thirty five
00:06:13.499 --> 00:06:13.879
percent.
00:06:13.939 --> 00:06:15.620
That's sort of the actual I want to
00:06:15.641 --> 00:06:17.922
get it higher because the higher it gets
00:06:17.961 --> 00:06:19.882
it, the cheaper my marketing costs are.
00:06:21.043 --> 00:06:22.805
They arrive, as I said,
00:06:22.865 --> 00:06:24.404
more than a third of our new patients.
00:06:24.444 --> 00:06:26.567
That's the growth engine running on trust.
00:06:27.326 --> 00:06:29.007
you know that we didn't have to purchase
00:06:29.067 --> 00:06:31.788
a lead from um what it tells me
00:06:31.949 --> 00:06:36.190
is that a growth metric doesn't you know
00:06:36.271 --> 00:06:38.211
a growth number tells you that you grew
00:06:38.531 --> 00:06:40.512
the number tells this number tells you why
00:06:40.552 --> 00:06:42.713
you grew you follow me like i can
00:06:42.754 --> 00:06:44.495
tell you my same store organic sales are
00:06:44.535 --> 00:06:46.134
three to five to seven percent that
00:06:46.154 --> 00:06:48.216
doesn't tell me why though this number
00:06:48.255 --> 00:06:49.836
tells you why and whether the patient
00:06:49.857 --> 00:06:51.757
growth survives you turning off any ad
00:06:51.798 --> 00:06:53.838
spend um i can tell you
00:06:55.720 --> 00:06:57.622
And I think most retail businesses can
00:06:57.661 --> 00:06:58.502
tell you the same thing.
00:06:58.543 --> 00:06:59.904
If you spend more money on marketing,
00:06:59.925 --> 00:07:01.045
you're going to get more business.
00:07:01.607 --> 00:07:03.889
But the question is the return.
00:07:03.949 --> 00:07:05.891
And in healthcare and in dental,
00:07:05.951 --> 00:07:07.273
it's really whether that patient is
00:07:07.333 --> 00:07:09.095
transactional versus relationship.
00:07:09.915 --> 00:07:11.718
So referred patients come in with a lot
00:07:11.757 --> 00:07:12.879
higher trust.
00:07:12.959 --> 00:07:13.500
And in dental,
00:07:13.519 --> 00:07:15.101
they come in with a lot less anxiety,
00:07:15.562 --> 00:07:17.024
better treatment case acceptance,
00:07:17.084 --> 00:07:18.425
and again, a better, you know,
00:07:18.485 --> 00:07:19.245
lifetime value.
00:07:19.286 --> 00:07:21.689
It's a compounding readout of how the
00:07:21.709 --> 00:07:23.670
relationship practices actually are.
00:07:23.711 --> 00:07:25.353
And so one number, you know,
00:07:25.492 --> 00:07:27.295
on the dashboard that you can't be faked
00:07:27.314 --> 00:07:28.175
with a budget, right?
00:07:28.196 --> 00:07:28.415
Yeah.
00:07:28.596 --> 00:07:29.656
Yep.
00:07:29.817 --> 00:07:31.517
And so could a practice be growing
00:07:31.557 --> 00:07:31.939
quickly?
00:07:31.978 --> 00:07:33.360
I think you sort of alluded to this.
00:07:34.000 --> 00:07:35.240
Could a practice be growing quickly
00:07:35.300 --> 00:07:38.384
hitting production targets and still be
00:07:38.463 --> 00:07:41.886
actually getting weaker relationally under
00:07:41.925 --> 00:07:42.586
the surface?
00:07:44.112 --> 00:07:44.353
Yeah,
00:07:44.372 --> 00:07:46.653
I've got a phrase we have now at
00:07:46.694 --> 00:07:49.696
DCA called earn it because you have,
00:07:49.776 --> 00:07:52.177
this is something that is intentional and
00:07:52.317 --> 00:07:54.398
systematic and has to be baked and
00:07:54.418 --> 00:07:56.098
embedded into your organization
00:07:56.158 --> 00:07:56.839
culturally.
00:07:58.300 --> 00:07:59.141
Because if not,
00:07:59.440 --> 00:08:01.182
you're going to have failure underneath it
00:08:01.822 --> 00:08:03.343
and it's going to be inconsistent,
00:08:03.523 --> 00:08:04.543
you know, from month to month,
00:08:04.603 --> 00:08:06.204
production up, new patients up,
00:08:06.245 --> 00:08:08.024
referral share quietly sliding.
00:08:08.105 --> 00:08:08.925
That's not growth.
00:08:09.526 --> 00:08:10.447
And so, yeah,
00:08:11.627 --> 00:08:12.867
You don't want to be on a treadmill
00:08:12.908 --> 00:08:13.108
here.
00:08:13.127 --> 00:08:15.069
And so the day the ad budget blinks,
00:08:15.110 --> 00:08:16.329
the growth blinks with it.
00:08:16.370 --> 00:08:17.831
You can gain weight and lose muscle at
00:08:17.870 --> 00:08:18.632
the same time.
00:08:18.651 --> 00:08:20.992
And most dashboards only have the scale.
00:08:21.153 --> 00:08:22.814
That's a great analogy.
00:08:23.714 --> 00:08:24.355
Yeah.
00:08:24.375 --> 00:08:25.435
So let's get back to that phrase you
00:08:25.475 --> 00:08:26.137
mentioned before.
00:08:26.197 --> 00:08:27.778
And let's sort of define it so people
00:08:27.798 --> 00:08:29.019
can maybe use it themselves.
00:08:29.158 --> 00:08:30.920
Relationship density.
00:08:32.140 --> 00:08:33.542
What exactly are you trying to measure
00:08:33.581 --> 00:08:34.142
with that?
00:08:35.062 --> 00:08:35.263
Yeah.
00:08:35.283 --> 00:08:37.624
So this is just an evolving concept,
00:08:37.724 --> 00:08:38.024
Jimmy.
00:08:38.043 --> 00:08:39.644
And where I would say we're going with
00:08:39.684 --> 00:08:40.326
it is that
00:08:41.559 --> 00:08:43.211
it's really the number and strength of
00:08:43.331 --> 00:08:43.815
trust
00:08:45.030 --> 00:08:47.312
which carries connections per patient,
00:08:47.971 --> 00:08:49.432
not visits, connections.
00:08:50.072 --> 00:08:52.293
Does the patient see the same hygienist
00:08:52.332 --> 00:08:56.693
year over year or a stranger every recall
00:08:57.094 --> 00:08:57.894
patient, right?
00:08:58.355 --> 00:09:00.754
How consistent do they carry through in
00:09:00.774 --> 00:09:02.495
that lifetime value of a customer?
00:09:03.855 --> 00:09:05.096
Do we know the household,
00:09:05.157 --> 00:09:06.157
not just the chart?
00:09:06.557 --> 00:09:07.996
Do you know the spouse, the kids,
00:09:08.038 --> 00:09:09.717
the sister who moved just into town?
00:09:10.077 --> 00:09:12.339
Did anything in the visit create a moment
00:09:12.379 --> 00:09:13.298
worth retelling?
00:09:14.106 --> 00:09:15.687
The proxies are all measurable,
00:09:16.168 --> 00:09:17.828
referral share of new patients,
00:09:17.908 --> 00:09:19.409
hygiene reappointment rate,
00:09:19.509 --> 00:09:20.630
patients per household,
00:09:20.671 --> 00:09:22.451
reactivation of former patients.
00:09:23.892 --> 00:09:26.073
All of those things are metrics and kind
00:09:26.094 --> 00:09:27.413
of operating flow things.
00:09:27.433 --> 00:09:29.836
But this relationship density kind of goes
00:09:30.456 --> 00:09:32.197
a bit further.
00:09:32.236 --> 00:09:34.418
There's some science behind this trust
00:09:34.498 --> 00:09:35.219
issue, by the way.
00:09:36.038 --> 00:09:36.839
So Jane Dutton,
00:09:36.879 --> 00:09:39.301
who developed the concept of high-quality
00:09:39.341 --> 00:09:40.801
connections, and Kahneman,
00:09:40.821 --> 00:09:43.302
who put the concept of peak-end rule.
00:09:44.062 --> 00:09:45.903
Kahneman proved that endings dominate
00:09:45.984 --> 00:09:47.043
memory of all things.
00:09:47.984 --> 00:09:49.884
He started with a colonoscopy study,
00:09:49.924 --> 00:09:50.164
right?
00:09:50.625 --> 00:09:52.726
If an ending can redeem a colonoscopy
00:09:52.907 --> 00:09:53.366
patient,
00:09:54.195 --> 00:09:55.855
It can redeem a crown.
00:09:56.216 --> 00:09:57.696
It can redeem a filling.
00:09:57.735 --> 00:09:57.956
Right.
00:09:58.255 --> 00:10:00.277
The last two minutes of a dental visit
00:10:00.777 --> 00:10:03.638
are a growth strategy for a clinic,
00:10:03.937 --> 00:10:05.798
not just a good way to end the
00:10:05.878 --> 00:10:06.457
treatment.
00:10:06.477 --> 00:10:07.298
Does that make sense?
00:10:07.318 --> 00:10:09.578
So you're you're investing again in these
00:10:09.619 --> 00:10:12.100
growth strategies around connections that
00:10:12.159 --> 00:10:13.840
lead to other connections and other
00:10:13.879 --> 00:10:16.000
patients, not just a gimmicky.
00:10:16.942 --> 00:10:18.683
There's a difference between good customer
00:10:18.724 --> 00:10:20.706
service and good human connection.
00:10:21.307 --> 00:10:22.369
Sometimes it's subtle,
00:10:22.869 --> 00:10:25.913
but both can be growth strategies if they
00:10:25.953 --> 00:10:29.719
are completely attended to, emphasized,
00:10:29.778 --> 00:10:31.019
and really become embedded in your
00:10:31.059 --> 00:10:31.400
culture.
00:10:31.856 --> 00:10:32.256
Yeah, well,
00:10:32.277 --> 00:10:35.717
then one concept should flip some value
00:10:35.778 --> 00:10:36.677
sort of on its head.
00:10:37.677 --> 00:10:38.839
One of the things you mentioned in the
00:10:39.158 --> 00:10:41.578
article is that hygienists might be the
00:10:41.678 --> 00:10:44.720
actual real owner of the relationship,
00:10:44.759 --> 00:10:46.519
the real relationship engine of a
00:10:46.580 --> 00:10:48.801
practice, the face, the vibe.
00:10:49.280 --> 00:10:50.821
Why have many operators historically
00:10:50.921 --> 00:10:51.961
undervalued that one?
00:10:51.981 --> 00:10:53.662
And there's parallel roles with a
00:10:53.701 --> 00:10:56.302
hygienist or a PT or PTA in other
00:10:56.342 --> 00:10:57.202
practices as well.
00:10:57.923 --> 00:10:58.203
Yeah,
00:10:58.224 --> 00:11:00.865
so as best I've learned in dentistry,
00:11:00.905 --> 00:11:01.866
it's this idea, well,
00:11:01.907 --> 00:11:03.427
we started with this hygiene model.
00:11:03.447 --> 00:11:04.830
We're going to have the hygienist do
00:11:04.889 --> 00:11:06.471
hygiene, clean teeth,
00:11:06.510 --> 00:11:08.331
then put them on a maintenance program,
00:11:08.351 --> 00:11:09.774
get them in every six months,
00:11:10.274 --> 00:11:11.754
and the doctor will do the production.
00:11:12.355 --> 00:11:14.256
And so all of the metrics around
00:11:14.317 --> 00:11:15.878
production follow the doctor.
00:11:16.458 --> 00:11:18.841
And hygiene got reduced to a schedule and
00:11:18.921 --> 00:11:20.881
a perio percentage.
00:11:20.902 --> 00:11:23.124
We measure what hygienists produce today
00:11:23.144 --> 00:11:25.066
and almost never what they actually are.
00:11:25.566 --> 00:11:27.495
Right, so now we're on the FaceTime math,
00:11:27.576 --> 00:11:28.902
same chair twice a year,
00:11:30.059 --> 00:11:32.041
oftentimes for a decade or more,
00:11:32.682 --> 00:11:34.663
most patients see their hygienist more
00:11:34.702 --> 00:11:37.184
reliably than they see any other clinician
00:11:37.225 --> 00:11:37.884
in their life.
00:11:39.285 --> 00:11:41.106
More visits, more conversations,
00:11:41.227 --> 00:11:41.927
less drama.
00:11:42.107 --> 00:11:43.349
They spend time with them.
00:11:43.408 --> 00:11:45.269
And so more trust is built in that
00:11:45.389 --> 00:11:47.572
earning there, including myself.
00:11:49.072 --> 00:11:50.693
The doctor's name might be on the door,
00:11:50.714 --> 00:11:52.174
but the hygienist is in the room.
00:11:52.514 --> 00:11:53.755
Read your own Google reviews.
00:11:53.836 --> 00:11:56.136
Notice how often the five stars named the
00:11:56.177 --> 00:11:58.499
doctor for trust that the hygienist
00:11:58.698 --> 00:11:59.559
actually built.
00:12:00.360 --> 00:12:02.881
And so one of the major chapters I
00:12:02.902 --> 00:12:04.341
wrote in my dental call to care book
00:12:04.402 --> 00:12:04.822
upcoming,
00:12:05.123 --> 00:12:06.624
it was a lot of research on that
00:12:06.683 --> 00:12:07.443
relationship.
00:12:07.984 --> 00:12:09.164
And it's like everything else,
00:12:09.205 --> 00:12:10.826
when people leave an organization,
00:12:10.846 --> 00:12:12.147
they don't leave the organization,
00:12:12.167 --> 00:12:14.347
they leave the case of a dental practice,
00:12:14.368 --> 00:12:16.528
they may leave a doctor who's obstinate,
00:12:16.729 --> 00:12:17.950
you know, who's hard to work with.
00:12:18.570 --> 00:12:21.631
Hygienists are one of the most valuable
00:12:21.932 --> 00:12:23.974
clinicians in all of healthcare,
00:12:24.073 --> 00:12:26.475
and their salaries are now starting to get
00:12:26.535 --> 00:12:27.376
reward for it.
00:12:27.756 --> 00:12:29.619
A starting salary in dental hygiene,
00:12:30.318 --> 00:12:32.201
which can oftentimes be a two-year degree,
00:12:32.240 --> 00:12:33.601
makes more than a physical therapist
00:12:33.642 --> 00:12:34.383
starting salary.
00:12:35.222 --> 00:12:36.342
Um, so think of what,
00:12:36.383 --> 00:12:38.183
think of what that has evolved to over
00:12:38.224 --> 00:12:39.364
the past, uh, uh,
00:12:39.663 --> 00:12:40.764
half a dozen or so years.
00:12:41.124 --> 00:12:41.803
Yeah.
00:12:41.844 --> 00:12:43.364
Someone started paying attention to what
00:12:43.705 --> 00:12:44.945
that result is.
00:12:45.625 --> 00:12:47.284
Um, you argue that it's not,
00:12:47.804 --> 00:12:48.644
it's not soft.
00:12:48.684 --> 00:12:50.706
So make, make the CFO case for me,
00:12:50.745 --> 00:12:51.926
make it, make it tangible.
00:12:52.466 --> 00:12:54.385
When does the stronger relationship
00:12:54.505 --> 00:12:57.147
density start to show up in real hard
00:12:57.187 --> 00:12:58.527
numbers?
00:12:58.846 --> 00:12:59.106
Yeah.
00:12:59.187 --> 00:13:00.246
So three lines,
00:13:00.287 --> 00:13:02.187
the CFO stares at every month.
00:13:02.248 --> 00:13:03.388
The first one is, um,
00:13:04.703 --> 00:13:06.686
the marketing cost per new patient.
00:13:07.126 --> 00:13:09.549
So every referred patient is a marketing
00:13:09.590 --> 00:13:11.331
patient you didn't have to buy in this
00:13:11.351 --> 00:13:12.332
particular case, right?
00:13:12.352 --> 00:13:15.395
And like I said, in dentistry,
00:13:15.436 --> 00:13:16.496
that could be a hundred and fifty to
00:13:16.538 --> 00:13:18.500
two hundred bucks per case in these
00:13:18.580 --> 00:13:19.961
services that we talked about.
00:13:20.581 --> 00:13:22.904
Second is case acceptance and lifetime
00:13:22.924 --> 00:13:23.365
value.
00:13:23.706 --> 00:13:25.067
So referred patients,
00:13:25.827 --> 00:13:28.109
Treatment case acceptance is more in the
00:13:28.249 --> 00:13:30.029
eighty percent rate than the fifty to
00:13:30.070 --> 00:13:31.150
seventy five percent.
00:13:31.691 --> 00:13:32.692
And they stay longer.
00:13:33.231 --> 00:13:35.253
That's not just revenue quality.
00:13:35.293 --> 00:13:37.374
That's that's that is revenue quality,
00:13:37.433 --> 00:13:38.875
not just not just quantity.
00:13:39.456 --> 00:13:40.456
And then the third, I would say,
00:13:40.475 --> 00:13:42.317
is payer mix relationships.
00:13:42.417 --> 00:13:43.697
Patients choose you,
00:13:43.758 --> 00:13:44.958
not a network or a grid.
00:13:44.979 --> 00:13:45.219
Right.
00:13:46.479 --> 00:13:48.139
And the payer mix reflexes.
00:13:48.681 --> 00:13:50.422
This isn't a culture slide.
00:13:50.461 --> 00:13:52.503
It's a P&L strategy, you know,
00:13:52.582 --> 00:13:53.923
wearing a culture costume.
00:13:55.004 --> 00:13:56.326
so all right talk to everybody out there
00:13:56.346 --> 00:13:58.730
who's might run a pt organization medical
00:13:58.750 --> 00:14:01.054
group other multi-site healthcare platform
00:14:01.836 --> 00:14:03.679
what is the equivalent of that thirty five
00:14:03.720 --> 00:14:05.624
percent number for them that they should
00:14:05.644 --> 00:14:06.706
be trying to understand
00:14:08.038 --> 00:14:10.080
Yeah, again, the exact same number,
00:14:10.120 --> 00:14:12.802
the percentage of new patients who arrive
00:14:12.861 --> 00:14:15.504
as friends, family, or former patients.
00:14:16.024 --> 00:14:18.285
Former patients meaning separate diagnosis
00:14:18.346 --> 00:14:21.188
effectively or a separate episode of care,
00:14:21.229 --> 00:14:21.428
yeah.
00:14:22.269 --> 00:14:23.711
And I'd argue it's even more,
00:14:24.912 --> 00:14:26.232
I think it's actually more revealing
00:14:26.293 --> 00:14:28.053
outside dentistry because you don't have
00:14:28.073 --> 00:14:30.596
this kind of hygienist concept in most
00:14:30.635 --> 00:14:31.116
healthcare.
00:14:32.977 --> 00:14:35.500
In PT where a physician referrals dominate
00:14:35.539 --> 00:14:36.000
the funnel,
00:14:36.942 --> 00:14:38.923
The patient's source share is only part of
00:14:38.964 --> 00:14:40.283
the funnel you actually own.
00:14:40.364 --> 00:14:42.345
The physician relationship can be lost to
00:14:42.365 --> 00:14:44.485
a hospital, acquisition tomorrow, right?
00:14:44.525 --> 00:14:46.586
They can go into a POPs relationship,
00:14:47.106 --> 00:14:49.008
but the patient who sends their sister
00:14:49.028 --> 00:14:50.989
can't be bought out from under you.
00:14:51.269 --> 00:14:52.549
Medical groups, same thing,
00:14:52.590 --> 00:14:55.350
plus track households and former patient
00:14:55.451 --> 00:14:56.370
reactivation.
00:14:56.410 --> 00:14:57.192
You know, what we do
00:14:58.011 --> 00:15:00.754
is we have this reactivation that started
00:15:00.774 --> 00:15:02.235
about ten years ago where all of a
00:15:02.254 --> 00:15:04.056
sudden you'd go through your CRM,
00:15:04.076 --> 00:15:05.876
you'd go through your email,
00:15:05.897 --> 00:15:07.557
you'd go through your EMR database,
00:15:07.597 --> 00:15:08.958
and you'd send them a reminder.
00:15:09.239 --> 00:15:09.679
And you know what?
00:15:09.740 --> 00:15:11.620
Statistically, you can't argue.
00:15:11.801 --> 00:15:13.062
There are a certain number of patients
00:15:13.081 --> 00:15:13.822
that come back.
00:15:14.442 --> 00:15:16.784
But I would argue that if you're relying
00:15:16.845 --> 00:15:18.846
on reactivation campaigns,
00:15:19.365 --> 00:15:20.486
that reactivation,
00:15:20.527 --> 00:15:21.927
that former patient percentage,
00:15:21.947 --> 00:15:23.509
is never going to get to that thirty-five
00:15:23.528 --> 00:15:25.309
to forty percent because you're reacting
00:15:25.890 --> 00:15:27.912
on a transaction, not a relationship.
00:15:28.972 --> 00:15:29.153
All right.
00:15:29.173 --> 00:15:29.613
So right now,
00:15:29.653 --> 00:15:31.335
if an operator listening could add one
00:15:31.394 --> 00:15:33.355
metric to their dashboard tomorrow,
00:15:33.836 --> 00:15:35.158
what would you be in their ear telling
00:15:35.197 --> 00:15:38.139
them to start tracking first?
00:15:38.320 --> 00:15:40.642
You know, I would probably start simple,
00:15:40.802 --> 00:15:42.003
embarrassingly simple.
00:15:42.102 --> 00:15:42.322
You know,
00:15:42.342 --> 00:15:44.504
have the front desk ask every new patient
00:15:45.125 --> 00:15:47.226
one question asked, you know, really well.
00:15:48.587 --> 00:15:51.690
Who could we thank you for sending you
00:15:51.809 --> 00:15:51.931
in?
00:15:52.934 --> 00:15:53.916
Not a form field,
00:15:54.236 --> 00:15:57.561
a warm question recorded in, you know,
00:15:57.660 --> 00:15:59.043
not some type of pick list,
00:15:59.123 --> 00:16:00.585
not a free text.
00:16:01.066 --> 00:16:01.986
Put it in a free text.
00:16:02.006 --> 00:16:02.768
Thirty days later,
00:16:02.788 --> 00:16:04.269
you have a number most of your competitors
00:16:04.309 --> 00:16:05.030
will never have.
00:16:05.652 --> 00:16:07.934
Put it on the dashboard next to production
00:16:08.434 --> 00:16:10.258
and trend it monthly.
00:16:10.850 --> 00:16:12.111
You manage what you measure.
00:16:12.131 --> 00:16:13.813
And this is the one number that measures
00:16:14.214 --> 00:16:15.895
where all the other numbers will still be
00:16:15.936 --> 00:16:16.956
there in five years.
00:16:18.638 --> 00:16:23.142
And that's not anything difficult to do.
00:16:23.322 --> 00:16:23.802
And yes,
00:16:23.822 --> 00:16:25.845
you can automate it and all of those
00:16:25.865 --> 00:16:26.365
kind of things.
00:16:26.404 --> 00:16:28.966
But what you can't automate and what AI
00:16:28.986 --> 00:16:31.229
cannot automate is the humanness behind
00:16:31.269 --> 00:16:31.509
this.
00:16:32.090 --> 00:16:34.652
Who can we thank for sending you in?
00:16:35.352 --> 00:16:36.374
Oh, I've been here before.
00:16:36.793 --> 00:16:37.634
Oh, my sister.
00:16:38.135 --> 00:16:38.696
Oh, whatever.
00:16:39.176 --> 00:16:40.157
Most people are saying,
00:16:40.216 --> 00:16:40.878
how did you get here?
00:16:40.957 --> 00:16:41.177
Again,
00:16:41.197 --> 00:16:42.438
that goes back to how they got here
00:16:42.479 --> 00:16:43.039
by Google.
00:16:43.080 --> 00:16:43.759
They Googled you.
00:16:44.140 --> 00:16:45.241
That's not who sent you.
00:16:45.322 --> 00:16:45.841
That's a who.
00:16:46.101 --> 00:16:47.322
You're asking for a who question.
00:16:47.683 --> 00:16:48.163
Exactly.
00:16:48.625 --> 00:16:49.445
Yeah, that's the magic.
00:16:50.145 --> 00:16:51.346
All right.
00:16:51.366 --> 00:16:51.586
Yeah.
00:16:52.028 --> 00:16:53.889
Most growth dashboards tell you how many
00:16:53.928 --> 00:16:54.990
patients walk through the door.
00:16:55.009 --> 00:16:56.130
But Larry, again,
00:16:56.191 --> 00:16:57.832
wants you to ask the different question.
00:16:58.552 --> 00:16:59.453
Why'd they walk the door?
00:16:59.894 --> 00:17:02.154
Or more accurately, who can they thank?
00:17:02.455 --> 00:17:03.875
Who can you thank for sending them your
00:17:03.916 --> 00:17:04.175
way?
00:17:04.596 --> 00:17:06.057
Because if more than a third of your
00:17:06.096 --> 00:17:07.817
growth comes from people who already trust
00:17:07.856 --> 00:17:08.998
someone you cared for,
00:17:09.018 --> 00:17:11.159
it's not just marketing efficiency.
00:17:11.179 --> 00:17:12.799
That's evidence that the relationship
00:17:12.900 --> 00:17:14.740
itself is working.
00:17:15.280 --> 00:17:17.582
Check out this and more articles now on
00:17:17.821 --> 00:17:19.462
the operator on Substack.
00:17:19.502 --> 00:17:21.584
And until next time, keep operating.