How to read outreach ROI without fooling yourself

Outreach ROI is the production your outreach caused. Not the production that happened near it. Most groups measure the second thing, and I understand why: it's easier, and the number looks great right up until somebody on the board asks a hard question and it falls apart in the room.

What is outreach ROI in a dental practice?

I'd define it as three links in a chain, because every shortcut I've seen drops one of them. Somebody on your team contacted a patient who was on a list you were actually working. That contact turned into an appointment. The patient showed up and the dentistry got done. Outreach ROI is the completed production at the end of that chain, set against what it cost you to run the outreach.

Count contacts and you're measuring effort. Count bookings and you're measuring intent, which is nicer, but still isn't money. Only the group that follows the chain all the way through to produced value is measuring a return. Everyone else is measuring activity and calling it ROI.

What is the difference between booked value and produced value?

Booked value is what your outreach put on the calendar, at fee-schedule value. Produced value is what actually happened in the chair after the no-shows, the cancellations, the patient who downgraded from a crown to a filling, and the one who rebooked three times and then moved to Austin.

Both numbers are useful. They're just useful for different things. Booked value belongs in the morning huddle, because it tells you whether this week's calls are working. Produced value is the only one I'd put in a board deck, because it's the only one that ever reaches the bank. And the gap between them is a diagnosis on its own: when booked and produced drift apart and stay apart, that's usually a confirmation problem or a scheduling problem, not an outreach problem. Different fix.

• Booked value: steers the week
• Produced value: settles the argument
• The spread between them: its own diagnosis

Why do outreach programs overstate their ROI?

Almost never on purpose. The usual culprit is generous attribution. A patient gets a reactivation call on Monday, ignores it, and walks in Thursday with a toothache. Loose attribution gives the call the credit. Do that for a year and the outreach program has quietly absorbed credit for production that was coming anyway, which makes it look wonderful and makes it impossible to improve, because you can no longer tell what's working.

The fix that has held up for us is boring: a written attribution rule, applied by the system, not by whoever is building the slide deck that quarter. Ours is strict on purpose. The appointment has to be created from the outreach workflow itself, for a patient who was on the list when the contact happened. If giving credit would take a judgment call, it doesn't get credit. We lose some real wins that way. I'd rather lose those than keep the fake ones.

A generous attribution rule makes every outreach program look successful and none of them improvable.

What should a multi-office group review each week?

Four numbers, per office, in this order, and the order matters. Was the list worked, meaning contacts made against the list that was ranked for that office. Appointments created from those contacts. Booked value of those appointments. Produced value once the visits happen. The first is a discipline check on the office. The last is the return. Reading them in sequence shows you where the chain breaks in each office, instead of averaging nine different problems into one blended percentage that tells you nothing.

The reason it's worth the effort is the size of the pool. On average we find $590,000+ in unscheduled treatment per office already sitting in the practice management system: patients who said yes to treatment and never got scheduled. Against a pool that size, the interesting question was never whether outreach pays for itself. It's which offices are converting the pool and which are sitting on it, and you can't answer that with a blended number.

This is what our Outreach ROI screen holds a group to: the same chain from list to contact to booked to produced, computed the same way in every office, with no slide deck in between.