Where the money goes, who sees it, and what to do next.

The same KPI set tells three different stories.

Plano is operating near the ceiling of what a 6-chair multispecialty practice can do. The 90-day move at Plano is not to push utilization higher (it's already 91%) but to capture more value per chair-hour by shifting mix toward the high-margin specialty and cosmetic lines.

Frisco has the demand (the biggest new-patient inflow in the group) but is choking on the operational capacity to convert it. The diagnosis is concrete: a single overloaded treatment coordinator, a lab supplier with an above-average remake rate, and complex cases taking longer to turn around than at Plano. All three are fixable. See Tabs 06, 08.

Southlake needs urgent intervention. The site is two years old, the clinicians are good, but every single connected KPI is below target — call answer, case acceptance, schedule utilization, recall compliance, production per hour. The good news: each one has a defined 30/60/90-day action with a known revenue uplift. See Tab 12, P1 column.

Six pillars, ten steps, one patient.

The journey above is colour-coded by which pillar owns each step. The handoffs are where things go wrong:

Step 2 → 3 (Ops → Growth): a call gets answered but the coordinator doesn't book a first visit. 384 enquiries vanish here.
Step 5 → 6 (Clinical → Growth): findings are recorded but a treatment plan never goes back to the patient. 125 vanish here.
Step 7 → 8 (Growth → Finance): patient says yes but the deposit or financing doesn't land. 39 vanish here.
Step 10 → 11 (Clinical → Patients): treatment completed but no recall booked. 85 patients exit unprotected.

Each of these handoffs is between two pillars. Each one is invisible if you only look at one pillar's dashboard. This is the case for DentOps.

The cost number that nobody computes — until it's too late.

Fully-loaded cost per chair hour = base salary or day rate + payroll taxes + benefits + allocated overhead (assistant cost, room cost, sterilization, supplies, software) + employer's portion of insurance · divided by actually-billed chair hours.

This is the true denominator for provider profitability. A provider on a $250K package, with full overhead allocation of $180K (typical for a multispecialty group), needs to deliver $430K of production just to break even. At 1,500 billed chair hours/yr that is $287/hr break-even. At 900 hours (53% util), break-even jumps to $478/hr.

Every line traces to a named patient list. Nothing is theoretical.

The $96K of unbilled procedures is a specific list of completed treatments — clinical notes show the procedure done; the clearinghouse has no matching claim. The billing team at all three sites can be handed that list tomorrow morning and run it through the claim flow. Roughly one week of work for cash already earned.

The $420K of stalled and unscheduled treatment is specific patients who sat in front of a provider, said they were interested, and went home to think about it — or accepted but never got booked. Each comes with the case value, the days since plan presentation, and the reason they hesitated (where captured). Call list ready to print.

Multispecialty practices live or die on the recall book.

The patient who attends their 6-month hygiene recall is the closest thing a dental practice has to a subscription business. The patient is high-trust, high-engagement, very unlikely to switch providers, and refers an average of 1.4 new patients over their next five years. They also represent the practice's clinical liability tail: a patient not under recall is a patient whose decay and perio surface as emergencies — often in someone else's clinic.

Plano's 86% compliance is the result of one specific workflow: the next recall appointment is booked at the same checkout where today's visit ends. The patient does not leave the building without the next appointment in the schedule. Frisco has the workflow on paper but enforcement is patchy. Southlake doesn't have the workflow at all.

This is a free 90-day fix. No new staff. No new system. Just a workflow rollout.

The mix shift is the highest-leverage move in the practice.

Hiring a coordinator costs $42K/yr. Switching a lab supplier saves $58K/yr. Reactivating 304 lapsed patients earns $73K/yr recurring. These are good moves — but they are all operational levers.

Mix shift is a strategic lever, not an operational one. Lifting Southlake's specialty + cosmetic share toward Plano's delivers +$80K of incremental gross margin per quarter with no new payroll, no new chairs, no new marketing spend. Just better case selection by the treatment coordinators and case-acceptance training that surfaces the right treatment for each patient's clinical situation (and for the practice's economics).