Payer mix
The percentage breakdown of your revenue by insurance type: commercial PPO, HMO, Medicare, Medicaid, self-pay, workers compensation, and any other payer category. It tells you who is paying your bills and how much they pay per visit.
Why this matters for your clinic
A practice with 40% Medicare gets paid differently than one with 40% commercial PPO. Payer mix determines your effective reimbursement rate, your denial patterns, and your collection speed. Two clinics with identical patient volume can have dramatically different revenue because their payer mix is different.
Payer mix also drives your operational complexity. High Medicare means more compliance requirements. High self-pay means more patient collections work. High Medicaid means lower reimbursement but often steadier volume. There is no universally good payer mix, but you need to know yours and plan around it.
What good looks like
Payer mix benchmarks are specialty-specific. MGMA DataDive reports payer mix distributions by specialty each year. Payer mix varies a lot by specialty. Private dental practices typically lean heavily on PPO plans, podiatry carries meaningful Medicare exposure given its older patient base, and med spas are overwhelmingly self-pay since most aesthetic procedures aren't insurance-covered at all. Track your own mix monthly so you catch shifts before they hit the bottom line.
From Sorso
Payer mix can drift several points in a single year as contracts renew and your patient mix shifts, and most practice management systems won't flag it on their own. Pull the report monthly, not at tax time.
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Founder of Sorso and a CFA charterholder. Before Sorso, Stan spent 19 years in corporate finance at institutions including UniCredit and Société Générale — managing a $450M loan portfolio and making senior partner at a major mezzanine lender by 29 — then built a fractional CFO firm exclusively for outpatient healthcare clinics.
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