Multi-location healthcare groups lose an average of $1.2 million annually to missed calls. Here’s the math for a typical 10-location group:

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That’s revenue you already paid to acquire through marketing—walking out the door because no one answered the phone. The solution lies in implementing systems that ensure you never miss an appointment opportunity again.

For PE-backed DSOs and growing optometry groups, this isn’t a phone problem. It’s a financial blind spot that’s silently eroding your EBITDA and dragging down your valuation.

This guide breaks down the math behind the revenue leak, explains why multi-location groups are uniquely vulnerable, and shows you exactly how to calculate what missed calls cost your specific organization.

The Math Behind the $1.2M Leak

Let’s start with the numbers that matter to your board.

According to Invoca’s healthcare call tracking data, the average healthcare practice misses 29% of inbound calls. For dental practices specifically, Peerlogic’s 2024 analysis found even worse results: 68% of calls go unanswered during peak hours, and only 42% of answered calls result in booked appointments. The discrepancy reflects dental’s higher call volume and the industry’s reliance on multi-line phone systems that overwhelm front desk staff.

Here’s how missed calls translate to lost revenue for a 10-location healthcare group:

The Basic Calculation (Conservative First-Visit Model)

Factor Value

Average calls per location/day 50-80

Missed call rate 29-35%

Missed calls per location/day 15-25

New patient inquiries (% of missed) 35-40%

New patient opportunities lost/day/location 2-3

Average new patient first-visit value $230-$400

Daily revenue at risk per location $460-$1,200

Note: This uses first-visit value only. When you factor in lifetime value ($800-$2,500 per patient), the revenue at risk multiplies 3-5x.

By Location Count

Locations Daily Missed Calls Annual Revenue at Risk (Conservative)

5 100 $600,000

10 200 $1,200,000

25 500 $3,000,000

50 1,000 $6,000,000

The $1.2M figure assumes a 10-location group with moderate call volume and conservative lifetime values. Your actual number could be significantly higher.

Why Multi-Location Groups Miss More Calls Than Solo Practices

Single-location practices have phone problems. Multi-location groups have phone crises. Here’s why:

1. Peak Volume Spikes Hit Everywhere Simultaneously

When your 10 locations all experience Monday morning rush hour at the same time, you need 10 front desks performing perfectly in parallel. One location having a bad day means lost patients. Five locations having staff call-outs means a revenue hemorrhage.

2. Staffing Math Doesn’t Scale Linearly

A solo practice can cross-train the optician to grab overflow calls. A 25-location DSO can’t maintain that flexibility without standardized systems. The complexity of coordinating coverage across locations creates gaps that don’t exist in single-site operations.

3. No Centralized Visibility

Most multi-location groups can tell you revenue per location but can’t tell you:

Without this data, you’re optimizing blind.

4. Acquired Practices Create Integration Chaos

For DSOs and PE-backed groups, every acquisition brings a different phone system, different PM software, and different call handling culture. Integration takes 12-18 months. Revenue leaks the entire time.

The Hidden Costs Beyond Lost Patients

The $1.2M calculation only accounts for direct revenue loss. The real damage goes deeper.

Marketing Waste

If you’re spending $50,000 per month on marketing and missing 29% of the calls that marketing generates, you’re throwing away $14,500 monthly—$174,000 annually—on leads you never even spoke to.

According to Invoca’s analysis of large healthcare systems, providers are wasting up to $383,827 in marketing spend each month due to unanswered calls. Even at smaller scale, a 10-location group spending $50K/month on marketing and missing 29% of resulting calls wastes over $170,000 annually on leads that never get a callback.

Staff Burnout and Turnover

Front desk staff forced to choose between the ringing phone and the patient standing in front of them experience constant stress. According to MGMA data, this contributes to the 30-40% annual turnover rates common in healthcare front desk positions. Each turnover costs $15,000-$25,000 in recruiting, training, and lost productivity.

Patient Experience Degradation

Research from BIA/Kelsey shows 85% of callers won’t try calling back if their first attempt goes unanswered. And according to a 2023 Podium survey, 67% of healthcare consumers will call a competitor if their primary practice doesn’t answer quickly.

Every missed call isn’t just lost revenue—it’s a patient telling five friends about their frustrating experience with your practice.

Data Blind Spots

You can’t improve what you don’t measure. Groups without call analytics are making operational decisions—staffing levels, marketing spend, expansion plans—without fundamental data about how patients are actually reaching (or failing to reach) their practices.

Missed Calls by Specialty: Dental vs. Optometry vs. Veterinary

Not all missed calls cost the same. Patient lifetime values vary dramatically by specialty.

Dental Practices

Metric Value

Average new patient LTV $2,100-$10,000

Annual patient value $400-$800

Cost per missed new patient call $735-$3,500 (35% conversion × LTV)

Dental has the widest range because LTV depends heavily on whether patients accept treatment plans. A patient who comes for cleanings only is worth $2,000 over 5 years. A patient who accepts a full-mouth restoration is worth $25,000+.

DSO-Specific Impact: With EBITDA multiples of 6-12x for dental practices, every $100,000 in annual revenue you recover from missed calls adds $600,000-$1,200,000 to your enterprise value.

Optometry Practices

Metric Value

Average new patient LTV $4,000-$8,000 (10-20 year relationship)

Annual patient value $400-$500

Family multiplier 3.15x (patients bring families)

Cost per missed new patient call $1,400-$2,800

Optometry’s advantage is the family effect. One missed call from a parent looking for a kids’ eye exam often represents three or more potential long-term patients.

Capture Rate Connection: Optometry groups tracking capture rate (percentage of exam patients who buy glasses) should also track phone conversion. If your capture rate is 65% but your call answer rate is 70%, you’re losing patients before they even walk in the door.

PE-Readiness Impact: For optometry groups considering private equity partnership, phone metrics are increasingly part of operational due diligence. Groups with documented 90%+ answer rates and clear intake processes command premium valuations.

Veterinary Practices

Metric Value

Average client LTV $5,000-$10,000

Annual client value $500-$1,600

Emergency premium 2-3x regular visit value

Cost per missed call $1,750-$3,500

Veterinary has the highest per-call value because of the emergency component. Pet owners calling about a potential emergency represent immediate, high-value revenue. Miss that call and they’re driving to your competitor’s emergency clinic.

40% After-Hours Challenge: Unlike dental and optometry, veterinary practices receive approximately 40% of calls outside business hours. Groups without after-hours answering solutions are automatically missing nearly half their opportunities.

The solution isn’t hiring more staff—it’s implementing systematic intake operations. For a complete framework on evaluating intake solutions, see our Multi-Location Healthcare Intake Guide.

How Top-Performing Groups Achieve 95%+ Answer Rates

The benchmark for elite multi-location healthcare groups is a 95%+ answer rate with under 20-second average speed to answer. Here’s what they do differently:

1. Centralized Overflow Handling

Rather than expecting each location to handle peak volume independently, top performers route overflow calls to a centralized team (internal or outsourced) that can handle scheduling across all locations.

2. Real-Time Visibility Dashboards

Leaders can see, at any moment:

3. After-Hours Coverage

Instead of sending evening and weekend calls to voicemail, they connect callers with trained representatives who can schedule appointments, answer common questions, and triage urgent situations.

4. Staff Ratios Aligned to Call Volume

Top performers staff to call patterns, not just patient schedules. If Monday 9-11am generates 3x the call volume of Thursday afternoon, staffing reflects that reality.

5. Technology Integration

Phone systems integrated with practice management software enable:

The EBITDA Impact: What Missed Calls Cost Your Valuation

For PE-backed groups and practices considering a transaction, missed call revenue has a multiplied impact on enterprise value.

The Valuation Math

Current DSO valuations range from 6-12x EBITDA for platform acquisitions, with exceptional practices commanding up to 15x. Here’s how missed call recovery affects valuation:

Recovered Annual Revenue EBITDA Flow-Through (25%) Value at 6x Multiple Value at 10x Multiple

$500,000 $125,000 $750,000 $1,250,000

$1,000,000 $250,000 $1,500,000 $2,500,000

$2,000,000 $500,000 $3,000,000 $5,000,000

A 10-location dental group recovering $1.2M in annual revenue from missed calls—at a 25% EBITDA flow-through and 8x multiple—adds $2.4 million to their enterprise value.

What PE Buyers Look For

During operational due diligence, sophisticated buyers evaluate:

Groups with documented answer rates above 90% and clear phone conversion data command premium multiples. Those with no call analytics represent integration risk—and get priced accordingly.

Calculating Your Group’s Specific Revenue Leak

Ready to calculate your actual number? Here’s the framework:

Step 1: Gather Your Data

Data Point Where to Find It

Total monthly calls (all locations) Phone system reports

Missed/abandoned calls Phone system reports

New patient inquiries (% of total) Estimate 30-40% if unknown

New patient conversion rate PM system or estimate 65-75%

Average new patient lifetime value PM system or use benchmarks above

Step 2: Run the Calculation

Monthly Missed Calls × New Patient % × Conversion Rate × Value = Monthly Revenue Leak

Example (Conservative, First-Visit): 2,000 missed calls × 35% new patient × 30% would convert × $230 first-visit = $48,300/month

Example (Lifetime Value): 2,000 missed calls × 35% new patient × 30% would convert × $1,500 LTV = $315,000/month

Step 3: Annualize and Add EBITDA Impact

Monthly Revenue Leak × 12 = Annual Revenue Leak Annual Revenue Leak × 25% = EBITDA Impact EBITDA Impact × Your Multiple = Valuation Impact

Stop the Leak: Next Steps

The $1.2M leak isn’t inevitable. Multi-location healthcare groups that implement systematic intake operations typically begin recovering this revenue within the first 30-60 days of implementation.

Immediate Actions

Strategic Solutions

For groups serious about closing the revenue leak:

Our Never Miss an Appointment solution is specifically designed for multi-location healthcare groups facing this challenge, combining trained healthcare specialists with technology that integrates directly into your practice management systems.

Stop the Revenue Leak

Schedule a consultation to see how much revenue your multi-location group is leaving on the table—and how to capture it within 90 days.

Schedule a Consultation Today

Key Takeaways

Frequently Asked Questions

How much revenue do multi-location healthcare groups lose to missed calls?

Multi-location healthcare groups lose an average of $1.2 million annually to missed calls (for a typical 10-location group). This calculation assumes 20 missed calls per location per day, 35% being new patient inquiries, 30% conversion rate, and $230 average first-visit value. Groups with 25+ locations can lose $3-6 million annually.

What percentage of healthcare calls go unanswered?

According to Invoca’s healthcare call tracking data, the average healthcare practice misses 29% of inbound calls. For dental practices specifically, up to 68% of calls go unanswered during peak hours, and only 42% of answered calls result in booked appointments.

Will patients call back if they don’t reach someone?

No. Research shows 85% of callers won’t try calling back if their first attempt goes unanswered. Additionally, 67% of healthcare consumers will call a competitor if their primary practice doesn’t answer quickly. Every missed call represents permanent lost revenue.

What answer rate should healthcare groups target?

Top-performing multi-location healthcare groups achieve 95%+ answer rates with under 20-second average speed to answer. The minimum acceptable threshold is 85%. Every percentage point below 95% represents lost revenue and patients going to competitors.

How do missed calls affect practice valuation?

For PE-backed groups, recovered missed call revenue adds 6-12x to enterprise value through EBITDA multiples. A 10-location dental group recovering $1.2M in annual revenue—at 25% EBITDA flow-through and 8x multiple—adds $2.4 million to their enterprise value.

What’s the best solution for reducing missed calls?

The solution isn’t hiring more staff—it’s implementing systematic intake operations including centralized overflow handling, after-hours coverage, real-time visibility dashboards, and technology integration with practice management systems. See our complete Multi-Location Healthcare Intake Guide for detailed evaluation frameworks.

Last Updated: December 2025

Sources: Invoca Healthcare Call Tracking, Peerlogic Dental Call Analysis 2024, BIA/Kelsey Consumer Calling Behavior Study, Podium Healthcare Consumer Survey 2023, MGMA Staff Turnover Data, AVMA Veterinary Industry Statistics, Review of Optometric Business, Dental Economics Valuation Trends 2024

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