Bonus structures that do not distort behaviour
Pay someone on a number and you will get the number. That is the entire promise of incentive pay, and also the entire problem with it.
Most practices bonus treatment coordinators on case acceptance percentage or on collected production. Both are reasonable-sounding. Both produce specific, predictable distortions, and the distortions are usually invisible for about a year.
What each one does to behaviour
Acceptance percentage creates an incentive to present smaller plans. If you are measured on the proportion accepted, the safest strategy is to only present what you are confident will be said yes to. Phase everything. Drop the borderline tooth. Your percentage climbs beautifully while the practice diagnoses more than it treats.
It also punishes coordinators who take on hard cases. Whoever gets the difficult families ends up looking worse than whoever gets the easy ones, which is a good way to make the person you worked hardest to hire quit.
Collected production pushes the other way. Now the incentive is bigger plans and larger totals, and the borderline tooth is definitely in. That is worse, because now the pressure runs toward over-treatment, and a parent who feels sold to does not come back.
It also makes the coordinator's pay dependent on things they do not control — whether the schedule has capacity, whether the doctor diagnoses aggressively, whether a family's insurance renewed in January.
Any metric a coordinator can move without doing their job better is a metric that will eventually be moved without the job being done better. Not because people are dishonest — because incentives are quiet, and everyone drifts toward what pays.
What to measure instead
The honest answer is that the outcome you care about is not any single number. It is diagnosed treatment getting completed, at a rate that stays high across easy and hard families alike. That is hard to reduce to one figure, which is why most practices reach for the easy ones.
A structure that holds up better in practice has three parts.
1. A base that is genuinely liveable
If the bonus is the difference between paying rent and not, you have built desperation into every treatment conversation. Parents can feel it. Make the base the salary and the bonus the upside.
2. Completion, not acceptance
Bonus on treatment that actually happened, not treatment that was agreed to. This closes the gap where a coordinator books a case, it goes to the unscheduled list, and it never happens — but it counted.
It also aligns them with the schedulers, because now they care whether the appointment holds.
3. A quality gate that can veto
This is the part most structures lack. Something that says the number alone does not earn the bonus.
It can be simple: a monthly review of a few recorded or observed presentations, or a same-week patient sentiment check. The mechanism matters less than its existence. The moment there is a quality gate, presenting a plan badly and getting a yes stops being a winning strategy.
The team question
Individual bonuses in a multi-coordinator practice create competition over the schedule — who gets the new patient exam with the good insurance, who gets stuck with the walk-in. That fight is not worth the incremental motivation.
In a practice with more than two coordinators, an office-level pool usually behaves better. It costs you some individual sharpness and buys you a team that shares what works instead of hoarding it.
How to know yours is distorting
Three things to look at, and you can check them this week:
- Average plan size over time. Drifting down suggests the acceptance metric is shaping what gets presented.
- Unscheduled treatment as a share of accepted. Growing means cases are being closed but not completed — the gap between yes and done.
- Variation between coordinators on similar patient mixes. If one is far ahead, find out whether they are better at the conversation or better at the metric. Those look identical on a report and are completely different things.
The uncomfortable bit
Bonus structures are also a statement about what the practice values, and staff read them accurately.
If the only thing measured is dollars, you have said dollars are the thing — and then you cannot be surprised when a coordinator pushes a family who should have been let go gently. They did what you paid them to do.
If you want coordinators who occasionally tell a parent “honestly, let's watch that one and look again in six months,” the structure has to make room for it. That sentence costs money today and earns it back over a decade, and no percentage-of-acceptance formula will ever reward it.