Why we never charge per patient

Our parent company, Peak Engine, works with contractors and is paid partly on results. Practice owners sometimes ask why we don't offer the same thing here. It's a fair question, and the answer is the reason this company exists as a separate brand.

The pitch that sounds fair

"Pay only for patients who actually book." "We take a small percentage of what new patients spend." On the surface, that puts the risk on the agency. In most industries it's a perfectly good way to pay for marketing.

Healthcare is different, because the law has long been wary of anyone being paid for sending patients to a provider.

The federal Anti-Kickback Statute

The federal Anti-Kickback Statute makes it a crime to knowingly and willfully offer, pay, ask for or receive anything of value to induce or reward referrals of business paid for by federal health care programs such as Medicare and Medicaid. The HHS Office of Inspector General describes "remuneration" as anything of value, and the law reaches both the one who pays and the one who is paid.

A marketer paid for each patient who shows up can look a lot like someone being paid for referrals. There are regulatory safe harbors, and one feature that runs through them is compensation set in advance at fair market value, not tied to the volume or value of referrals. A per-patient fee is tied to volume by design.

"But we don't take Medicare"

Many of the practices we work with, such as med spas and cash-pay wellness clinics, don't bill federal programs. That narrows the federal statute's reach, but it doesn't end the question.

• State fee-splitting rules. Many states restrict licensed professionals from splitting their professional fees with people who aren't licensed. A marketer taking a percentage of what a patient pays for treatment can fall into that.
• State kickback and patient brokering laws. Some states have their own versions that apply regardless of who pays, including private insurance and cash.
• Federal law beyond Medicare. Congress passed a separate law in 2018, known as EKRA, covering referrals to laboratories, recovery homes and clinical treatment facilities, and it applies to private insurance as well.
• Licensing boards. A clinician's own board may treat paying for referrals as unprofessional conduct.

These rules differ from state to state and by license type. That's exactly why a structure that might be fine in one place is a problem in another.

What we do instead

We charge a flat monthly fee for a defined scope of work: managing your Google profile, running your ads, building pages, setting up follow-up and reporting. The fee is agreed in advance. It doesn't change with how many patients you see, which treatments they choose or what they spend.

• No fee per patient, per booking or per inquiry.
• No percentage of collections or of any treatment.
• Ad spend paid by you, directly to Google and Meta, with no markup.
• Everything in accounts you own.

How we stay accountable without it

The obvious worry with a flat fee is that the agency gets paid whether or not anything happens. We deal with that in the open:

• A monthly report in plain English on what we did and what came of it, by channel.
• A minimum term followed by month to month, so you can leave if it isn't working.
• No guarantees. Nobody can honestly promise patient volume, and healthcare advertising rules discourage promises like that.

If someone offers you per-patient pricing

It isn't our place to say another agency's arrangement is illegal. Structure and state both matter, and that judgment belongs to a healthcare attorney. But before you sign, ask your counsel to review how the fee is calculated. If a vendor has never heard the question before, that tells you something about how much healthcare work they've done.