Dental CBCT has enormous diagnostic benefits that we have detailed in many places. However, we see some dental practice owners making the assumption that a positive business case will automatically flow from their investment. For many dental offices, a dental CBCT will be the largest single investment they ever make for the dental office. Creating a positive ROI for this large capex investment requires benefits that outweigh the cost. Therefore, without a plan, a good return is far from automatic.
Based on our experience implementing dental imaging solutions for thousands of dental offices over 30 years, we have found four common mistakes.
1. Ignoring the business case. The business case does not need to be an elaborate set of spreadsheets. It may be nothing more than a back of the envelope calculation. In addition, as with many business plans, assumptions will inevitably be required. We have heard many doctors make the point that because assumptions are required, it makes the whole exercise pointless. “How can I create a business plan if I’m just guessing at certain numbers?” Our view is that getting all the assumptions exactly right is less important. Rather, what’s more important is understanding all the benefits that can be generated, and then putting a plan in place to realize those benefits.
The most obvious benefit is the ability to perform new services, like implants. In this case, you might estimate how many new cases you could do in a month. However, a common error is not accounting for possible opportunity cost of the procedures you are not doing when you perform these new services. In other words, if your office is operating at a healthy utilization, then the true benefit is the difference in income between the new service and the service that was displaced.
Alternatively, perhaps you are already doing implants, and are just looking at the cost savings from sending patients out for 3rd party scans. In a similar fashion, while there are clearly savings if that scan could be done in-house, don’t forget to account for the added labor that’s now required to perform the activities that were being outsourced (including operating the unit). If your practice is not fully utilized, then this is likely a good tradeoff (because your staff has the bandwidth without adding headcount). However, if your staff is fully utilized, will this stretch your staff to the point where you will need to add headcount, which would then hurt your original business case?
2. Ignoring Cash Flow Requirements. Even if the eventual business case for dental CBCT seems clear, for a new practice that’s just starting, there is the added challenge of managing cash flow during the start up period. Investing too early in a dental CBCT system can put the business case for the entire practice at risk if it means a higher probability of running out of cash during the start up phase.
Typically, for a new office, most of the initial capex will be financed, which means that every month is going to have a breakeven revenue that will need to not only cover your fixed expenses, but also the monthly loan payment. Sometimes it’s useful to think about how many more patients you will need to see every month to pay for that dental CBCT. Conversely, how many fewer patients will you be required to see each month to break even if you didn’t have the dental CBCT (because your monthly loan payment is less)?
Another scenario to consider with a start up office is: what happens if the ramp up is slower than expected? How much cash “buffer” do you have with the added expense of the dental CBCT vs if you didn’t have that incremental monthly payment? One feature to consider is if the dental CBCT capability can be added to a previously installed panoramic x-ray unit one or two years after the initial installation. This could be another very effective way to improve the cash flow for a start up that needs a panoramic on day one, but can wait to get cash flow positive before investing in a dental CBCT.
3. Failing to budget time for training. Dental CBCTs are becoming easier to use and (for better or for worse) the software is doing more of the work. However, it still requires a knowledgeable master to fully tap into its capabilities. Given this, it’s important for the doctor and the staff to commit to investing the time to hone their skills on 3D dentistry. While clearly there are a lot of similarities between 2D imaging and 3D imaging, there are a number of fundamental differences. The good news is there are abundant resources available everywhere.
4. Ignoring the benefits in patient perception. While the main driver for most dental professionals in implementing dental CBCT in their office is for the diagnostic capabilities, it would be foolish to overlook the value it can have with patient confidence and retention.
One of the most underestimated values of dental CBCT that we constantly hear from dentists is the increase in case acceptance. When it comes to helping a patient visualize the recommendation of the dental professional, there are few tools more effective than the three-dimensional cross section of the patient’s anatomy that can be rotated and viewed from any angle. Using this tool, the dental professional can clearly explain the recommended plan, which makes the patient dramatically more comfortable and confident.
In addition, we have seen dental practices realize additional benefits in patient perception through different forms of marketing. There are many that reference their dental CBCT as part of their normal marketing activities. Some display an array of sample 3D volume slices (anonymized, obviously) on monitors in the dental office. We have even seen an office place the dental CBCT in full view of the waiting room through a glass window that can be clouded for patient privacy. All of these steps help differentiate the dentist, which equates to more patient references and higher case acceptance.
Dental CBCT has very clear diagnostic benefits for certain offices, but may not be right for everyone. To help you evaluate if it’s right for you, reach out to us to chat with one of our specialists.