Your revenue problem isn’t at the top of the funnel.
Your revenue problem isn’t at the top of the funnel.
BLOCKERS Podcast, Episode 8 — with Natasha Saavedra, who built three medically integrated practices and now coaches practice owners through the same terrain.
I asked Natasha Saavedra to unpack a question I hear from practitioners more than any other. It usually sounds like this:
“My clinical outcomes are good. My patients are happy. But my revenue growth is flat. Where do I start?”
You might think the solution is to seek more patients. Natasha’s answer had nothing to do with marketing to attract new patients and I couldn’t wait to share this wisdom with you.
There are three funnels, and you’re only watching one
She’s not talking about a marketing funnel. She means the revenue funnel — what happens to money once people are already in your building.
The top is new patients who start care. That’s the part everybody watches, and the part everybody spends money on.
The middle is whether you actually deliver everything those people already said yes to.
Natasha: The middle of the funnel, this is where the funnel starts leaking, and it starts leaking a ton.
The bottom is reactivation — the people who already know, like and trust you and never got called again — and moving patients onto maintenance or wellness care once the correction is made.
Her point is blunt. Practices obsess over the top third and ignore the other two, and then go buy leads to replace the people quietly leaving out the bottom.
What leaking in the middle actually looks like
This is the part I’d want every practice owner to sit with, because it’s specific and it’s checkable this week.
People aren’t pre-scheduled for the visits they already agreed to. They said yes to a course of care. They booked the next one, maybe. And then there’s a gap, and the gap becomes a month, and they’re gone — not because they decided to quit, but because nothing was on the calendar.
Natasha: If people are not pre-scheduled out for every single visit that they agree to do, they’re falling off of care.
Your staff isn’t prepared to deliver what’s supposed to happen that day. The patient arrives. Nobody has looked ahead at what this visit is supposed to include. They get the adjustment and leave, without the thing that was part of the plan they paid for.
And then the sentence that should genuinely alarm you:
Natasha: People start leaving without decompression or interferential or a shockwave therapy. And guess what? At the end of it saying, hey, you guys were supposed to be delivering these things. I want my money back.
That isn’t a marketing problem, a messaging problem, or a market problem. That’s revenue you already earned, walking back out the door, with a bad taste attached to it.
Her fix is a morning routine, not a project:
Natasha: We train all front desk in the beginning of the day to look at who’s coming in. Are they pre-scheduled out? Do they owe anything? When’s the last time they had additional services? That keeps your middle of the funnel very, very strong.
The sentence that’s costing you patients on the phone
Before any of that, there’s an earlier leak, and this was the most useful thirty seconds of the conversation.
A patient calls to cancel or reschedule. And they say some version of: I’m feeling better today, so I probably don’t need it.
And your front desk says:
Natasha: Okay, well, call us if you do. Bye.
That’s it. That’s where the patient is lost. Not at the top of the funnel, not in your marketing — in one unchallenged objection on a phone call you never heard.
Natasha’s point is that most owners assume that because they handed a new front desk person a script, that person read it, understood it, and understands the why underneath it. So the first time someone pushes back, there’s no second question. Just a polite goodbye and a patient who doesn’t come back.
Natasha: If they can’t even make it in for an appointment, that’s your first blocker right there.
Her advice: record your phone calls and actually listen to them. Most phone systems already do the recording. Almost nobody plays them back.
If you want a genuinely uncomfortable afternoon, go listen to five cancellation calls from last month.
Onboarding is not training, and training is not apprenticeship
She drew a distinction here I hadn’t heard put this cleanly, and it explains why scripts don’t stick.
Onboarding is paperwork and a tour of the office.
Training is teaching someone the hard skills of how to do the thing.
Apprenticeship is drilling, role-playing, auditing, and listening to how they actually do it when a real patient pushes back.
Most practices do the first, call it the second, and never do the third. Then they’re surprised that the person is ad-libbing.
Natasha: You’re like, why are you saying this? Well, that’s what it says. Well, no, let’s see what it says.
“I don’t have time” doesn’t survive her schedule
I pushed on this, because every owner says it.
When Natasha was running her practices, she blocked 45 minutes every day for her team to drill and role-play. An hour every Wednesday with the whole office. An hour every Friday for the staff meeting.
Her office was open all day Monday, Tuesday and Thursday, and half days Wednesday and Friday with training after.
They were seeing close to 400 patient visits a week.
Natasha: It’s not how much time you have, but what do you do with the time that you have?
The bottom of the bucket
Then there’s everyone who already came through and left.
Most of the practices she works with have been open twenty years or more. Thousands of patient files. People who already know, like and trust them, who nobody has contacted in years.
Natasha: All these people are just wanting to hear — hey, it’s me. I’ve been thinking about you. How the heck are you? I call it tickling the files. My team says that’s the voodoo hoodoo. I’m like, no, it’s not — because I have a love for these people.
Picture it in the analog version. Somebody tells you they don’t have enough business. You say: take me to your file room. You open the door and there are six thousand folders in there.
There’s all your business. Right there.
And the second half of the bottom is patients who finished their correction and were never told what comes next. Nobody educated them about maintenance. So they drift, they regress, and eventually they turn up somewhere else.
Natasha: If you don’t tell people about that and educate them to move on to wellness care, you put a huge hole in your bucket and you’re constantly trying to fill the top with leads from Facebook.
This is the same thing I keep running into
A few weeks ago I wrote about what happens to a patient between visits — how 40 to 80 percent of what you say in the room is forgotten before they reach their car, and how nothing in your day ever flags that the transfer didn’t happen.
Last week I sat with a practitioner who had spent a hundred thousand dollars filling the top of her funnel while something she’d already built sat quietly producing revenue she never counted.
Now Natasha, from a completely different direction, describing a practice bleeding money in the middle and the bottom while the owner stares at the top.
It’s the same finding three times. The expensive problems are the invisible ones — the visit that never got scheduled, the service that never got delivered, the patient who was never called, the person who finished care and was never told what comes next.
None of those generate a complaint. None of them show up on a report. Nothing in your week says this didn’t happen.
Which is exactly why they run for years.
What to actually do this week
I asked her for one number, and one action.
The number: patient visit average. Collections divided by visits. It tells you what each person is worth each time they walk in, and once you know it you can work backwards from a revenue target to a number of visits.
The action she framed as a question back at me. What’s the first thing they do when you walk into the ER?
They take your vitals.
Natasha: Look at the vitals of your office. Is it healthy? Are you about to go into cardiac arrest?
Concretely, for one day:
How many patient visits did you have? How many of those were pre-scheduled? How many actually showed? That gives you a fall-off ratio. Then: how many of the ones who fell off got rescheduled?
Four numbers. One day. You could have them by Friday.
And if nobody in your office can answer them — that’s not a failure of your staff. That’s the thing you’ve been looking past.
One more, because it’s the honest part
I asked Natasha about something in her own history that almost didn’t work. She deflected once, then came back with this.
Natasha: Many of the providers that I work with — naturopaths, MDs, DCs, NPs — they have a high care factor. They really want to help people. And when you operate from your heart, when you need to make business decisions … I have held on to people for too long.
She had someone miss twenty days of work. There was always a reason, and she kept extending compassion, because that’s who she is. What it cost wasn’t that person’s output. It was what the rest of her team concluded while they watched her not act.
Two days before our call, she ended a job interview fifteen minutes in. The candidate mentioned that talking about numbers and KPIs stressed her out. Natasha told her that’s what they do here, and asked if she’d rather end the call.
Two days. Not two years.
Which is what it looks like when someone has actually learned the thing they’re describing to you.
Natasha Saavedra runs Medical Professional Dojo and Regen Revenue. If you want help figuring out where your practice actually is and what’s standing in the way: schedule a Practice Growth Strategy Session.
And if you’re stuck on something and you’d be willing to work through it on camera with me — you don’t have to have it figured out, that’s the point. Email me and say blocked.
John Cummings
Founder, BodySite.com
Catch up on the series: Episode 7 — One webinar beat $100,000 in ad spend · Episode 6 — Someone is blocking your success. Who is it? · Episode 4 — Your patient forgot in the parking lot