Why Your Conversion Rate Is Probably Lying to You
Dr. Andrew Oteo thought his conversion rate was great. Then he split it into gross and net and found out how much of it was insurance carrying him. He runs Stonebridge in Dallas with chiros, PTs, an NP and MDs under one roof, and he's the president of the Texas Chiropractic Association.
Episode Details
Andrew Oteo thought his conversion rate was strong. Then he actually measured it properly and it upset him enough that he kept re-checking the math because he didn't want it to be true.
Here's the split he built, and I haven't heard anyone else on the show describe it this way. Gross conversion is every new patient who says yes to care. PI, cash, VA, professional courtesy, Blue Cross, Cigna, all of it. Net conversion is only the people who had to reach into their own wallet. Copay, coinsurance, self-pay. Same split on retention: did they continue on maintenance, and did they pay out of pocket to do it. Most owners are looking at the gross number, feeling good, and never seeing how much of that yes was insurance carrying them.
Andrew runs Stonebridge in Dallas with chiropractors, physical therapists, a nurse practitioner, and medical doctors under one roof. Ten years in. Before that were six years he calls failure and now calls tuition: a practice he opened inside an MD's office on the eleventh floor of a Dallas high rise and closed within a year, an independent-contractor gig with a doc whose systems were worse than his own, and a $250K-funded cash clinic with Taj Mahal floors where the investor wanted eight locations in three years and neither founder knew how to run one.
The thing that broke his bottleneck wasn't a book. His daughter started having seizures and he was out of the practice for almost a month sitting in a hospital. He'd always been the "I have to be the guy" type. The practice grew while he was gone. He says it was the most eye-opening month of his career, and he's been hungry to scale ever since.
His systems stack is worth stealing: Monday team meeting with everybody in the building, 90-day rocks (he's an EOS guy and calls Traction required reading), grand rounds every Wednesday where all the practitioners talk through cases, and quarterly alignment meetings that trickle from him to his leaders to their teams and get compiled into start / stop / continue. The grand rounds idea came from a retired Navy SEAL patient who has an AK-47 round still lodged in his back. When the teams guys get treated, they don't get one doctor. They get a room of people building a plan together. Andrew wanted that.
He's also refreshingly blunt about tooling. His words: all EHRs suck, all dashboards suck, pick the one you're willing to embrace the suck with. He ended up building his own scorecard in Power BI with manual data entry and eventually paid a guy in the Netherlands to build a custom one, because nothing off the shelf would give him the numbers that actually mattered to him. On AI he's bought Claude seats for the whole team, trained it on Stonebridge branding so his PT can generate a flyer without asking anyone, and is working through the BAA and HIPAA side before going further. His framing on tools in general: most of us drive a Ferrari like it's a Pinto.
Then he closes on the Texas Chiropractic Association, where he's president, and it gets serious. (Kris Arnold (Ep 49) made the same case from the Pennsylvania side a few weeks back, and the two of them land on the exact same membership number without talking to each other.) A few years ago two bills came through Texas. One stripped chiropractors of the ability to diagnose. The other nearly pulled the nervous system out of scope, which would have meant no headaches, no sciatica, no radiculopathy. The diagnosis piece actually got taken away for a period before the Third Court of Appeals restored it. Andrew's read: Texas is the Alamo. If it had fallen there it was rolling to the next state and the next. TCA membership sits at 18-19%. The Texas Medical Association is north of 90%.
Key Takeaways
- Gross Conversion vs Net Conversion. Gross is anyone who says yes to care. Net is only the people who had to pay out of their own pocket. Andrew split his and found his real number was well below what he thought. Same split on retention. If you're only tracking gross, you don't know how much of your yes is insurance doing the work.
- His Practice Grew While He Was Gone a Month. His daughter started having seizures and he was in a hospital for nearly four weeks. He'd always been the "nobody cares about this as much as I do" guy. The team stepped up and the numbers went up. That month is what convinced him to actually scale instead of white-knuckle it.
- All EHRs Suck. Pick Your Suck. Same for dashboards. Andrew tried the popular ones and none of them would report the numbers he actually cared about. He built his own in Power BI with manual entry and later paid a developer overseas for a custom build. Use the tool because it's relevant, not because it came bundled with something else.
- Grand Rounds, Borrowed from the SEALs. A retired Navy SEAL patient (AK-47 round still in his back) told Andrew that when teams guys get treated, a room of practitioners builds the plan together. Now Stonebridge does grand rounds every Wednesday across chiro, PT, and medical. He also standardized intake and re-exam forms so cases flag consistently across departments.
- The Bridge Questionnaire. Bolted onto intake under the pain scale and functional questions. Have you gained weight recently? Are you concerned about it? Lower energy? Is your progress slower than expected, on par, or faster? Cheap way to surface whether somebody needs a different game plan or a different department.
- Teach Patients to Be Sneezers. Straight out of Seth Godin. Make the ask (Stonebridge runs "four card days" where everyone hands out four VIP passes), but more importantly remind the patient where they started. "You came in at a 10 and were thinking about the hospital. You're at a zero now." That's the story they retell at work and at church.
- Your State Association Is Not a Netflix Subscription. Texas nearly lost the ability to diagnose and nearly lost the nervous system from scope. Third Court of Appeals gave diagnosis back. TCA membership is 18-19%. The Texas Medical Association is over 90%. Andrew's point: if TCA hit 50%, the funding problem disappears entirely.
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