Why the deal looked good and the month did not
Deals get put together on the price and the feel. A party offer, a membership credit, a new-patient special: each sounds fine next to the menu price, and none was checked against what the treatment costs to deliver. When margin is not tracked to the dollar, a discount that goes past it looks like a busy day until the bank statement. The fix is one honest cost list per treatment, from your own invoices and schedule, reread every quarter.
The cost lines each treatment hides
- IV therapy: the bag, the tubing set, the catheter or needle, gloves, prep and dressing. Add the additive (a vitamin or glutathione) costed by the dose drawn, not by the vial it came from. Then the nurse's time for the full drip plus setup and removal, the chair for that time, and sharps disposal.
- Neurotoxin: units purchased per vial from the invoice, against units drawn and charted. Add the units lost when a vial is opened for one patient and the rest is not used inside the window your medical director sets. Then the diluent, the syringes, the provider's time for consult, mapping and injection, and the room.
- Filler: the syringe, the cannula or needle, topical numbing, gloves and gauze, the provider's time including the consult and the result check, and the room. Whether opened product may be kept is your medical director's call; if not, a half-used syringe is a full syringe on the cost line.
- Laser and energy devices: the tip or consumable per session, gel and eyewear, and the service contract divided by a year's sessions with a handpiece reserve. Then the provider's time with setup and cleanup, and the room.
One table, and the line each treatment forgets
| Treatment | Direct materials to list | Time to cost | The line everyone forgets |
|---|---|---|---|
| IV therapy | Bag, tubing set, catheter, gloves, prep, additive by the dose drawn, disposal | Nurse for the drip plus setup and removal; the chair for that time | The drip holds the chair for the hour; the glutathione was the small part |
| Neurotoxin | Units drawn, diluent, syringes, gloves | Provider for consult, mapping and injection; the room | Units left in an opened vial, unused inside the window your medical director sets |
| Filler | Syringe, cannula or needle, numbing, gauze | Provider for consult, injection and result check; the room | The consult that did not convert still cost the provider's hour |
| Laser session | Tip or consumable, gel, eyewear | Provider for setup, treatment and cleanup; the room | The service contract and handpiece reserve, divided across the year's sessions |
A worked example, labeled illustrative
Say your IV menu price is the number on the board; the illustrative cost sits beneath it. Say the bag and tubing set come to $6 from the supply invoice, and the catheter and prep to $3. Say the additive by the dose drawn is $9 and disposal $1, for $19 of materials in this illustrative example. Say the nurse's loaded hourly cost is $45 and the drip plus setup and removal fills the hour, so time is $45. Say the chair costs $12 an hour from rent and utilities over open chair hours. The illustrative contribution margin is the price minus $76, and the glutathione was the smallest line on the page. Replace every figure with your own.
Where each input lives
- Materials: the last three supply invoices. Divide each line by the units it contains (bags per case, units per vial) for a per-use cost, and date it.
- Dose drawn: the chart. Export one month of treatment notes, read the units or milliliters per visit, and cost the additive by that.
- Time: the schedule. Export one month of completed appointments with the booked length and the provider, paired with each provider's loaded hourly cost from payroll.
- Room and chair: rent, utilities and equipment leases for the month, divided by the hours the rooms were open and bookable.
- Waste: the opened-vial log. If there is none, Dana starts it this week: the date a vial is opened, the units drawn per patient, and what was discarded under the window the medical director set.
What contribution margin per treatment tells you
Price minus the direct cost list is the contribution margin for one treatment, and it answers three questions the menu price cannot. Which treatments carry the practice: the ones with the margin and the volume, not always the ones on Instagram. Whether a party can afford a discount: only an offer inside the margin of the treatment being discounted, after waste. How much membership credit is safe: credit a member will spend on a treatment whose margin covers the bonus you added. The margin column beside the volume column changes what gets promoted.
How to do this on Monday
- Pick the four treatments that make up most of your revenue; cost those first.
- Hand the supply invoices to Priya and the schedule export to whoever runs payroll; the sheets meet on Friday.
- Ask Dana to start the opened-vial log the same day. One week of it says more about waste than a year of guessing.
What to do next
NorthCore's Know your numbers solution builds the margin by treatment and the waste line into one dashboard from the cost list you keep, on top of the record system you already run. Scoped in writing and covered by the promise on this site: results in 90 days, or we keep working until you have them.
