Preoperative Assessment Clinic Break-Even: About $103K/Month

Fixed costs $75.6K/mo Base monthly burn

Contribution margin 81.5% After variable costs

Break-even revenue $92.8K/mo Monthly target

Break-even timing Month 1 Launch month

Break-even calculator

Test monthly revenue, variable expenses, and fixed costs against break-even for a preoperative assessment clinic.

Lean Base Full

Monthly revenue Revenue drives the margin left to cover fixed costs. $ Low sales High sales Variable expenses Use direct costs that rise with clinic volume, like supplies, lab fees, commissions, and transaction fees. $ Low direct High direct

Money available to cover fixed costs $1,128,190 $1,343,083 revenue - $214,893 variable expenses

Margin ratio

84%

Covers fixed costs

Yes

Fixed monthly costs This is the monthly overhead the clinic must cover before profit starts. $ Lean overhead High overhead

Break-even chart Revenue Total costs

Which expenses are fixed, and which move with sales in a preoperative assessment clinic?

Cost classification

This clinic breaks even in Month 1, but that result only holds if fixed lease and payroll are separated from visit-linked supplies, labs, commissions, and EHR fees. Treat payroll carefully; salaried roles don’t rise one-for-one with visits.

Expense	Cost	Break-Even Treatment	Common Mistake
Clinic Facility Lease	Fixed	Include $12,500 per month in fixed overhead from Month 1 through Month 60.	Spreading rent across visits and making low-volume months look too profitable.
IT Maintenance and Cybersecurity	Fixed	Include $2,200 per month as fixed overhead before calculating required visit volume.	Treating the monthly system spend as if it drops when patient volume dips.
Disposable Clinical Supplies	Variable	Deduct as a revenue-linked charge; first-year model rate is 4.5% of revenue.	Budgeting supplies as flat overhead instead of tying them to completed assessments.
Diagnostic Lab Processing Fees	Variable	Deduct as a revenue-linked charge; first-year model rate is 6.5% of revenue.	Leaving lab fees below gross margin and overstating contribution per visit.
Business Development Commissions	Variable	Deduct as a sales-linked charge; first-year model rate is 5.0% of revenue.	Counting referral growth without charging the related commission expense.
EHR Transactional Fees	Variable	Deduct as a usage-linked charge; first-year model rate is 2.5% of revenue.	Modeling electronic health record fees as only a fixed software subscription.
Patient Coordinator	Semi-fixed	Model as salary blocks that step up from 2.0 FTE in Year 1 to 6.0 FTE in Year 5.	Treating coordinators as visit-driven when Year 1 total fixed payroll is about $59.9K per month.
Billing and Coding Specialist	Semi-fixed	Model as capacity-linked staffing that rises from 1.0 FTE in Year 1 to 3.0 FTE in Year 5.	Assuming billing labor flexes per claim instead of stepping up as the clinic scales.

How do break-even costs change from a lean launch case to a full referral build?

Scenario table

Lean is already above the first-year break-even line, and base and full cases add cushion fast. The real risk is not the math; it’s whether referrals, payer setup, and staffing can keep up.

Planning figures only; actual results will move with referral flow, payer readiness, and staffing execution.

Scenario	Monthly Revenue	Variable Costs	Fixed Costs	CM Ratio	Operating Profit	Break-Even Signal
Lean launch case	$371K	$69K	$69K	81.5%	$233K	Break-even is reached in Month 1, but cushion is thin.
Base referral case	$759K	$130K	$77K	82.9%	$552K	Month 1 break-even with a much wider cushion.
Full referral case	$1.34M	$215K	$104K	84.0%	$1.02M	Strong cushion, but throughput becomes the limit.

What breaks the break-even cushion for this clinic?

Stress test

The clinic still clears break-even in the first-year run rate, but referral slippage, payer delays, and staffing hired ahead of volume are the main pressure points. A 15% revenue drop still stays above break-even, yet the cushion gets noticeably thinner.

Stress Case	Changed Assumption	Break-Even Revenue	Revenue Gap	Risk Signal
Current plan	No change from the first-year run rate.	$103K	$268K cushion	Break-even is covered, but opening cash is still tight.
Revenue shortfall	Revenue falls 15% from plan.	$103K	$213K cushion	A volume miss still leaves room.
Fixed-cost increase	Fixed overhead rises 10%.	$113K	$258K cushion	Hiring ahead of volume cuts the cushion.
Margin pressure	Variable expenses rise 3 points.	$107K	$264K cushion	Fee pressure lifts break-even, but the plan still clears it.
Combined pressure	Revenue falls 15%, fixed overhead rises 10%, and variable expenses rise 3 points.	$117K	$199K cushion	Still above break-even, but slack shrinks fast.

Can this clinic clear break-even before you sign the lease and hire the team?

Founder checklist

Don't sign the lease yet unless referral flow, staffing, and setup cash all clear the Year 1 break-even math. This clinic needs at least 462 visits a month, and the model only feels safe if it can build toward 1,672 monthly visits.

1Referral flow462/mo floor

Verify surgeon and hospital referrals can hold at least 462 visits a month, with a path toward the modeled 1,672 monthly visits.

2Fixed load$79.5K/mo

Check that Year 1 wages and clinic overhead really fit about $79.5K a month before owner income, debt service, or reserves.

3Contribution81.5% CM

Make sure each visit keeps about 81.5% after supplies, lab fees, commissions, and EHR fees, because that margin pays the fixed load.

4Year 1 staff2-3-2-4-4

Open with the modeled staffing mix: 2 perioperative physicians, 3 nurse practitioners, 2 physician assistants, 4 registered nurses, and 4 medical assistants.

5Cash reserve$886K

Keep at least the modeled $886K minimum cash, since Month 1 is the cash low point and capex starts before volume stabilizes.

6Build spend$287K capex

Stage the $75K exam equipment, $45K EHR setup, and $60K waiting area renovation so launch spend matches demand, not hope.