The next $2 million should not be a guess.

Management’s explanation

Sales teams need more coaching and more leads to restore full-arch conversion.

UnsupportedUnsupported in the sample reviewed.

What the field work found

At several lower-performing practices, CRM tasks were marked complete even though call records and appointment histories showed missed handoffs. Stronger practices quietly corrected the same issues through experienced managers’ manual tracking. The dashboard measured task completion; it did not reliably measure whether patients reached the next step.

Behavioral connection

Staff described repeated unresolved issues and stopped escalating them. Leaders saw green activity metrics and concluded effort was the problem. This is a causal hypothesis supported by cross-source evidence, not proof, and it is tested by the pilot below.

Verified: confirmed across independent sources in the sample. Plausible: supported but not yet confirmed. Unsupported: not supported by the evidence reviewed. Evidence IDs refer to the register in the appendix.

Assume 80 incremental funded cases per year could be recovered after workflow repair, at a $20,000 average collected case value and a 30% incremental contribution margin. That equals $1.6M in annual incremental collections and $480K in annual incremental contribution, before pilot cost and any added fixed costs. At an illustrative 8× multiple, $480K of sustainable EBITDA-equivalent improvement implies $3.84M of enterprise-value sensitivity.

$1.6M

Annual incremental collections

$480K

Annual incremental contribution

$3.84M

Enterprise-value sensitivity at an illustrative 8×

Pilot break-even: the $150K pilot pays back at roughly 25 recovered cases (25 × $20,000 × 30% = $150K), less than a third of the scenario. All figures require verification against real cohort, capacity, cost and cash data before they are treated as recoverable value.

1. 01Reconcile CRM task status with call, appointment and PMS records in a defined sample.
2. 02Reduce verified missed handoffs against a pre-registered baseline.
3. 03Show improvement in attended consultations and collected contribution, adjusted for patient mix and timing.
4. 04Confirm performance holds without manager-maintained shadow spreadsheets or extraordinary coaching.
5. 05Stop or redesign if improvement does not exceed the fully loaded pilot cost.

If broader records show the sample was atypical, if financing denials or market demand explain most of the decline, or if coaching proves to have a durable incremental effect, capital priorities should change. The conclusion stays open to contradictory evidence by design.

Approve

Up to $150K of the proposed CRM allocation for a controlled verification-and-repair pilot.

Defer

$1.85M.

Require

Independent 30/60/90-day reporting and a second authorization vote once the gates are assessed.

Select sites independently across strong, middle and weak performers, including mature and newer locations. Review 12 to 24 months of site-level results, then trace a purposive sample of patient journeys. Observe authorized routine workflows, interview frontline and executive staff separately, and challenge preliminary findings with management. Record the source, timestamp, alternative causes and confidence level for every material claim.

A manager’s workaround can conceal a system defect. A quiet escalation channel can conceal how long it persists. An activity dashboard can record compliance without successful handoffs. None of these observations proves causality on its own. Their value is that they generate testable predictions: after a targeted fix, handoff reliability should improve, manager rescue work should fall, and collected contribution should rise without constant intervention.

A concise decision memo, an evidence register with traceable sources, an operational dependency map, an assumption-based financial model, and a capital-release recommendation with explicit uncertainty and stop criteria.