Operations Management

Your practice gets an operations department. You keep the practice.

Every practice past a certain size needs one. The question is not whether to hire a consultant, it is what that department would cost to build inside your practice and staff yourself. We run it instead, and you keep 100% of the equity, full clinical autonomy, and day-to-day direction of the team and the schedule.

Operations

The argument

The non-clinical work gets done one of three ways.

It does not go away. Somebody does the books, watches the numbers, manages the vendors, runs the marketing, holds the team accountable, and plans the growth. The only question is who, and what it costs to have them do it.

Option one

The owner does it

Nights, weekends, and the hour between the last patient and dinner. It gets done at whatever standard is achievable when you are already tired and it is already late.

What it costs
Your evenings, and a ceiling on how big the practice can get
Option two

A team member does it

Someone gets promoted into it at a wage. They are learning the job while not doing the one you hired them for, and they have never seen how it works anywhere else.

What it costs
A salary, plus the job they stopped doing
Option three

You subcontract it

It goes to a firm that already has the systems, the reporting, the vendor relationships, and the reps. No hiring, no training, no ramp, and no single point of failure who might quit.

What it costs
A published monthly fee, and this is what we do

The empty seat

Most practices have an owner and a team,
and nothing in between.

In a group practice there is a management company between the doctor and the operation. In a solo or small group practice that position is empty, so every decision that does not belong to the front desk lands on the owner. That is the seat this fills.

The empty position
Above
The owner

Clinical direction, ownership decisions, and where the practice is going

Operations
XpoNential

Reporting, financial oversight, vendor and marketing accountability, capacity planning, roles and standards, and the cadence that holds all of it together

Below
Your team

Patients, the schedule, the day, and the work in front of them

Nobody in the middle position takes a paycheck from the practice,
a seat on anything, or a share of the equity.

What we oversee

Five areas, run on a cadence.

Not advice delivered quarterly. A weekly rhythm, a monthly scorecard, and a named person accountable for each of these.

Financial management and reporting

  • Monthly financial packages, KPI dashboards, and owner-level reporting
  • Budgeting, forecasting, cash flow review, and procurement savings

Marketing and growth

  • Marketing strategy, vendor selection, and accountability across every channel
  • Growth planning built around the owner's goals

Schedule and patient flow

  • Block scheduling discipline and capacity planning
  • Production per day targets and utilization
  • Hygiene, recall, and reactivation systems

Team and operating systems

  • Defined roles, meeting cadence, and clear accountability
  • Associate integration, training structure, and workflow improvement

Owner and leadership support

  • Growth planned around the owner's desired schedule, travel, and teaching commitments
  • Someone accountable for the decisions that reach your desk, who already knows your numbers

The operating rhythm

A schedule, not a phone call when something breaks.

The work runs on a schedule whether anything is wrong or not. That is how a problem gets caught while it is still small, rather than after it has already cost something.

Weekly

The huddle

We review the numbers against target, surface what is blocked, and set this week's priorities with the people who have to execute them.

DeliverableA short list of decisions and the owner of each one
Monthly

The scorecard

We deliver the financial package, the KPI dashboard, and owner-level reporting, and we walk you through all of it instead of emailing it.

DeliverableWhat moved, what did not, and the reason for both
Quarterly

The plan

We reset goals against the trend, review vendors, challenge spend, and scope the next ninety days.

DeliverableA ninety day plan with dates attached to it
Annually

The reset

We build the budget, re-measure the valuation, review compensation and staffing, and plan the year ahead around your schedule.

DeliverableA budget and a current valuation
The rhythm, drawn

It closes back on itself. Every cycle produces something, and the next one starts from what the last one showed.

WEEKLY The huddle MONTHLY The scorecard QUARTERLY The plan ANNUALLY The reset DELIVERABLES A short list of decisions and owners What moved, what did not, and why A ninety day plan with dates on it A budget and a current valuation

What changes on your desk

What we can take off your desk.

A great deal of what reaches an owner is not an ownership decision. It arrives there because no one else is positioned to take it. We can carry as much or as little of this as you want.

We can handle these
  • Vendor calls, renewals, and contract terms
  • Chasing the marketing company for last month's numbers
  • Reconciling why collections and production disagree
  • Building the schedule template again
  • Figuring out what a report is actually telling you
  • Deciding whether a price increase is reasonable
These stay yours, with the work already done
  • Whether to add an operatory, a provider, or a location
  • What the practice is worth and where it is heading
  • Who joins the team and who does not
  • How much you want to work and when
  • Clinical direction and standard of care
  • Anything that changes the ownership of the business

Decisions that are genuinely yours still arrive at your desk, with the analysis attached and a recommendation on the front.

Where the line sits

Your practice. Your authority.

We do not take decisions that belong to the owner, and we do not put ourselves between you and your patients or your team. That is the arrangement, and it is written into the agreement before you sign it.

  • Patients talk to your practice. We do not make patient calls or present treatment. Your team owns every patient relationship.
  • You hire and you fire. We build the roles, the standards, and the accountability. Employment decisions are yours alone.
  • Clinical is clinical. Treatment, materials, labs, and standard of care are never ours to have an opinion about.
  • Scope is written down. Defined before the engagement starts, and anything outside it gets a statement of work before anyone begins.
  • We run on a cadence. A weekly huddle and a monthly review, not a queue of whatever came up today.
  • Licensed work goes to licensed people. Legal, tax, investment, and brokerage go to your professionals, and we say so in writing.

Your investment

One monthly fee for the whole platform.

The full operations department. Financial, operational, and marketing oversight, procurement savings, KPI reporting, and growth planning.

$7,450
Per month
First practice
$5,500
Per month, each additional location
Same platform, same access

Earned Incentives for Performance. A meaningful share of what we make on a management relationship is earned rather than billed. We set fixed dollar amounts against operating benchmarks at scoping, we write them into the engagement agreement, and the calculation is settled before the work starts.

If the benchmark is not reached, nothing additional is owed. When it is reached, the amount is nominal against the growth that produced it and you keep the substantial majority of every dollar. That structure puts our economics on the same side of the table as yours.

Every management relationship is documented separately with a defined scope, term, economics, responsibilities, and performance expectations.

Elective add-ons

Add-ons, priced separately.

None of the services below are included in the monthly fee and none are required. Each carries its own price, quoted when we scope it against your volume.

  • You elect each add-on in writing and release it with sixty days notice
  • We price it at scoping and state that price in the engagement agreement
  • Anything outside a defined scope receives a written statement of work before any work begins
  • Every add-on reports into the same weekly huddle and the same monthly scorecard as the core program

Revenue cycle management

  • Billing, claims, and collections management
  • AR cleanup and recovery, patient payment processing, financial policy enforcement

AP, payroll, and credentialing

  • Accounts payable, and full service payroll with tax registrations and filings
  • Provider credentialing and fee schedule negotiation

Marketing execution

  • Fractional CMO at three levels of engagement
  • Media operations by channel with ad spend at cost, and projects scoped separately

Real estate and facilities

  • Lease abstraction and critical date tracking
  • CAM review, landlord negotiation support, and refinance coordination

On-site and special projects

  • In-office team training and custom on-site work
  • Hiring support, additional practice evaluations, and coordination with counsel engaged by the client

For practices with substantial federal healthcare program revenue, revenue cycle management converts to a monthly fee at fair market value. Brokerage, legal, tax, and investment work is delivered through our own licensed professionals or through vetted partners we bring to the engagement, so you are not left to assemble that bench yourself.

The questions everybody asks

Fair questions. Straight answers.

Are you buying part of my practice?

No. There is no equity component, no option, no buy-in, and no structure where we end up owning any part of it. This is a management agreement with a defined scope and a defined term. You own 100% of the practice on the first day and 100% on the last.

Do I have to do a Practice Review first?

Yes. We do not propose an ongoing relationship until both parties can see what they would be agreeing to. If the Review says it does not make sense, we say that, and nothing obligates either side to continue.

What are performance incentives, really?

Fixed dollar amounts tied to specific operating benchmarks, agreed in writing before the work starts. Not a percentage, not open ended, and not a share of your growth, so the number cannot run away from you. If the benchmark is not hit, nothing additional is owed.

What if it is not working?

The term, the notice period, and the exit are written into the agreement before you sign it. Add-ons release with sixty days notice. Nothing is designed to be hard to leave, and everything we build stays with the practice.

How much of my time does this take?

Less than the work takes now. A weekly huddle and a monthly review is the standing rhythm. The point of the arrangement is that decisions arrive at your desk already worked, with a recommendation attached.

I have more than one location. How does the fee work?

The first practice is $7,450 per month and each additional location is $5,500 per month, covering the same platform and the same access. Add-ons are elected per practice or across the group depending on which makes sense.

Start here

You built the practice.
Now let it run without you in every decision.

Book a call to walk through what this would look like for your practice. Thirty minutes, no obligation.

Thirty minutes, no obligation. Nothing you share goes anywhere else.