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. Examples reported by specialty trade bodies: ADA Health Policy Institute data shows PPO dominance in private dental (roughly 40–50% of revenue in most group practices), APMA surveys place Medicare above one-third of podiatry revenue, and med spa industry surveys report self-pay typically above 60% of revenue. Track your own mix monthly so you catch shifts before they hit the bottom line.
From Sorso
In the multi-location dental and dermatology groups we work with, we routinely see payer mix drift 5–10 percentage points year over year without the owner noticing — which is why we trend it monthly, not annually.
Founder of Sorso. 18 years in corporate finance. Managed a $450M loan portfolio before building a fractional CFO firm exclusively for healthcare clinics.
Want to see how your practice measures up?
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