Why Your “Slow Month” Might Be Lying to You: A Clinic CFO’s View

Every practice has that month. The month where the reports hit the inbox, the room goes quiet, and someone finally says what everyone is thinking:

“Something’s wrong.”

Production is down. Collections are down. The schedule felt busy, but the numbers don’t agree. Suddenly the conversation jumps straight to fear. Are patients going somewhere else? Is the market slowing down? Do we need to change our entire strategy?

Before you overhaul marketing, cut expenses, or question the future of the practice, take a breath and do something much less dramatic. Count the days.

A Real-Life Example: The “Terrible” November at a Podiatry Clinic

Recently, we reviewed the financials of a podiatry clinic that was convinced they had a bad November. On paper, they weren’t wrong. Production was down compared to October. Production was also down compared to November of the prior year. Collections softened right along with it.

It looked like patient demand had dropped. But when we moved beyond the P&L and into the operational data, the story changed. The podiatrist had only been in clinic for about three weeks that month. Holidays, travel, and a few half-days chopped the schedule into pieces. Several clinic days had just one or two patients scheduled.

Here’s the key insight most practices miss:

"A one-patient day is not a production day."

In a podiatry clinic, the overhead—staff, rooms, equipment, rent—doesn’t scale down just because the schedule is light. If half the calendar is made up of half-days or barely booked days, the month will look bad no matter how strong demand actually is.

Lesson one: a slow month is often a capacity problem, not a demand problem.

The Quiet Killer: Average Per Case (APC)

Next, we looked at Average Per Case, or collections per visit. Historically, this podiatry clinic averaged in the low $200s per visit. Recently, APC had slipped into the high $100s.

There was no sudden drop and no dramatic warning sign, just a quiet slide of 10–15 percent.

In podiatry, APC can decline due to a shift away from procedures toward lower-acuity visits, under-coding routine care or procedures, pricing that hasn’t kept up with costs, or increased discounts or write-offs.

Office managers and providers should treat APC like a vital sign. If clinic days and visit counts are steady but APC is drifting down, the issue isn’t volume. It’s value capture.

“Our Collections Are Fine”… Until They Aren’t

Then we examined adjustment percentages. On the surface, everything looked healthy. The collection ratio was still strong, and adjustments were only a few points higher than prior years.

But in a podiatry clinic producing six or seven figures annually, a few percentage points can represent tens of thousands of dollars.

More importantly, small changes in adjustments often point to deeper issues like missed procedure charges, inconsistent use of modifiers, weak follow-up on claims, or documentation that doesn’t fully support billed services.

Small leaks don’t sink the ship overnight, but they absolutely erode profitability over time.

The Growth Lever Most Podiatry Clinics Underestimate: New Patients

Finally, we looked at new patient volume. For a typical podiatry practice, around 25 percent of visits should come from new patients, and roughly half of unique patients in a given year should be new.

This clinic had actually improved new-patient numbers year over year, which was encouraging. But to hit an aggressive growth target, the math showed they needed one additional new patient per clinic day.

One patient per day doesn’t sound like much. Over a year, it changes everything.

The Simple CFO Framework Any Podiatry Office Can Use

When you put it all together, most bad months in a podiatry clinic come down to three levers.

Capacity. How many true production days did you actually run? Not half-days. Not holiday-shortened schedules. Not one-patient days.

Average per case. Are you maintaining or improving your collections per visit? If APC is sliding, review coding accuracy, pricing and fee schedules, visit mix, and consistency in presenting and performing higher-value services.

New patients. Are you consistently feeding the top of the funnel? Even small daily improvements compound into meaningful annual growth.

Before You Panic, Do the Math

The next time your podiatry practice has a slow month, don’t start with blame.

Start with math. If vacations, holidays, or light schedules reduced capacity, fix the calendar first. If APC is drifting, look at coding, pricing, and operational consistency. If new-patient numbers are soft, that’s a marketing and access issue, not a clinical one.

The month isn’t lying to you. But without context, it’s easy to misunderstand what it’s really saying and make decisions that solve the wrong problem. That’s where a modern, strategic CFO earns their seat at the table.