The Real Cost of Losing Patients

ARTICLE | August 12, 2025

Authored by Aprio, LLP

This article was originally published by Aprio on August 06, 2025.

Successful dental practice owners utilize specific metrics to measure practice performance. The recognized metrics include production (revenue), overhead (expenses), and net income (profit). However, there are lesser-known metrics that often go overlooked because they are more difficult to track, but they provide powerful insight and information. One such measurement, the loss of active patients, can have a significant impact on a practice’s financial success, resulting in millions of dollars in lost revenue throughout a career.

Key reasons for losing patients

It is not uncommon for practices to lose up to 15% of their patients annually. While some causes are inevitable, such as death, illness, or relocation, others stem from interactions with the practice team. Let’s examine the more detailed reasons:

1. Fees

Most dental practices charge two types of fees: one for patients with insurance and another for those without.

Patients without insurance or whose insurance is not accepted by the practice are commonly referred to as “fee-for-service” patients. They pay the full amount listed in the practice’s fee schedule. For example, a $1,500 crown is billed in full amount to the patient. These patients are usually aware of the costs because they are paying them in full. Approximately 11% of dental practices operate on a fee-for-service basis; however, many of these practices have patients who don’t utilize insurance to pay for their treatments.

The second fee level is for patients who have an insurance plan that is accepted by the practice. They pay for their treatments significantly less than the practice’s full fee, known as copayment. Although the amount is lower than the full amount, some patients can still feel unhappy about what they owe.

As I have often joked in seminars, no patient has ever gotten up in the morning and said, “I have too much money. I think I’ll get a root canal today.” Most patients recognize that dental care is necessary and accept that it comes with costs, but many feel dental services are expensive.

If treatment costs are not clearly explained or don’t seem valuable, patients may seek other practices with lower fees.

2. Dental insurance

There are two main reasons a dental practice might lose patients due to insurance issues. First, if a practice does not accept specific insurance plans, patients may decide not to join the practice or seek out practices that do take their insurance. Second, if a practice decides to stop accepting a specific plan. When dental practices exit a plan without analyzing the best approach, it guarantees losing a percentage of patients—sometimes up to 50%, potentially leading to financial challenges.

3. Delays in patient scheduling capabilities

Patients may leave a practice if they can’t get timely appointments, especially in emergencies. Sometimes, front desk staff are not equipped to handle emergencies, or the schedule simply cannot accommodate it. If patients have to go to another practice for emergency care, they’re unlikely to come back. To rule this out, it’s essential to create a schedule that meets daily goals and utilize morning meetings to identify ways to accommodate emergencies. Properly managing emergency patients is one way to retain them.

4. Patients owe money to the practice

This is one that most dentists and staff members should focus on more. In cases where patients end up owing money to a dental practice, they may refrain from coming back to address the debt. It’s important to handle overdue accounts properly.

Levin Group data indicates that after 60 days, there’s only a 10% chance of collecting money owed to a practice. The best way to manage an overdue account is to follow a concept known as the “One Day Rule,” which states that any patient who owes money to the practice will be called within one day of the bill’s due date. Staff should dedicate time each day to make these calls.

Remember, patients with unpaid balances often leave, which can also affect family members who are also patients.

How to retain patients

• Systems: The best way to retain patients is to have well-designed systems that everyone follows consistently. Practices that lack clear policies and protocols for handling emergency patients or front desk staff who get overwhelmed with daily tasks are two examples of potentially losing patients.

• Customer service: Ideally, your customer service should be somewhere between good and great to maintain a strong patient base, which will become increasingly important during times of economic uncertainty. Every team member (including the doctors) must receive specific training in customer service.

• Case presentation: Many treatment plans can be costly and overwhelming for patients, so it’s important for dentists and their teams to learn effective case presentation skills. A positive, motivating, and persuasive presentation increases the likelihood that patients will accept recommended treatment by building trust. Simply presenting a case isn’t enough; dental practices need specific systems and scripts to foster trust and confidence. This will keep patients from seeking a second opinion and opening the door for them to leave your practice.

• Patient convenience: Convenience is a significant aspect of customer service, as most patients suffer more today from time-poverty than financial poverty. If patients feel they cannot schedule appointments in a reasonable timeframe, they may look for another dentist. In the past, patients were more loyal to their dental practices, but now it’s easy to find a new dentist online and read reviews. It is no longer difficult to find another dentist!

The bottom line

Practice teams should focus on reducing the number of lost patients each year, as this can result in significant financial loss for the practice over time. Retaining even half of the patients who leave can significantly improve the practice’s revenue and the doctor’s income. Additionally, the strategies and systems designed to help retain patients can make the practice more efficient, attracting new patients and garnering positive reviews, which contribute to overall success.

Unless a patient formally notifies the practice when they leave, most practices do not measure (and therefore are unaware) when they lose patients. A simple way to estimate that number is to compare the number of active patients at the beginning of the year with that number at the end, subtracting any new patients who have joined during that period.

Please connect with your advisor if you have any questions about this article.