Healthcare and clinics
A clinic has the economics of a service business with the complications of healthcare billing. Revenue arrives through provincial billing, private insurers and patients directly, each on a different timeline. Practitioners are paid on splits that were agreed years ago. Rooms sit empty on some days and overbooked on others. We bring practice-level finance to medical, dental, physiotherapy, chiropractic, veterinary and other clinics across British Columbia, working alongside their CPA and within the rules of their college and the province.
How the money works
- Revenue per room, per practitioner and per hour decides profit, and most clinics track visits without tracking the revenue and cost behind them
- Public, insurer and private billing each pay on their own schedule, so cash timing is set by payer mix rather than by the appointment book
- Practitioner compensation is usually a percentage split, which leaves the clinic a thin margin to cover rent, staff and equipment
- No-shows, cancellations and unfilled slots are lost revenue that never appears as a cost
The moves we make
- Revenue and contribution by practitioner, by room and by service, with capacity utilisation alongside
- A payer-mix cash forecast that models each billing stream on its real timeline
- A practitioner compensation review that prices the clinic's cost to support each practitioner honestly
- A fee and service mix review within the rules that apply to the practice
Where cash and margin leak
Margin leaks in splits that do not cover the real cost of a room, a receptionist, supplies and software per practitioner. It leaks in unfilled slots, in no-shows without a policy, in supplies ordered without a budget and in equipment leased at rates nobody re-quoted.
Cash leaks in billing. Claims rejected and not resubmitted, insurer payments reconciled late, patient balances left to drift. A clinic with mixed payers needs a billing process run like collections in any other business, with a person who owns it weekly.
The numbers to watch every week
Revenue per practitioner per day. Revenue per room per hour available. Utilisation of rooms and of practitioner hours. No-show and cancellation rate. Claims outstanding by payer and by age. New patients and recall rate. Contribution per practitioner after split and direct cost.
These numbers tell a clinic owner whether to add a room, add a practitioner, change hours or change the recall process, and they do it months before the year-end statement would.
How pricing works in a clinic
Where fees are set by a public schedule, pricing is about service mix, capacity and the share of private or uninsured services the practice offers within its professional rules. Where fees are set by the clinic, as in many dental, physiotherapy, cosmetic and veterinary practices, the fee should be rebuilt from the cost of the practitioner's time, the room, the supplies and the overhead, plus a margin.
Practitioner splits are pricing in reverse. A split set without knowing the cost to support the practitioner is a margin decision made blind. We model it so the clinic and the practitioner can both see what is fair and sustainable.
Questions from healthcare and clinics owners
Do you understand the billing rules for our type of practice?
We work within the rules your college and the province set, and we do not advise on them. Your CPA and your professional adviser own compliance. Our work is the economics: what each stream earns, when it pays and what the clinic keeps.
How do we decide whether to add a practitioner or a room?
From utilisation and contribution. If existing rooms are full and practitioner hours are not, add hours. If both are full, model the contribution of a new practitioner after split and direct cost against the cost of the room, the staff and the equipment. The model decides, not the waiting list alone.
Our practitioners are on splits agreed years ago. Can that change?
It can, with the numbers and with care. We model the cost to support each practitioner and what the current split leaves the clinic, then design an arrangement that is fair to both. The contractual change is for your lawyer.
Start with a finance review.
Ninety minutes with Ali on your cash, margin and pricing. You leave with the four numbers to watch and the two or three moves that change them, whether or not we work together.