Profit per hour

Profit per hour is the number Ryan builds most of the PPO and scheduling arguments around, because it is the one that finally separates a full schedule from a profitable one. Every hour the practice is open costs a certain amount to cover (the break-even production per hour), and anything a patient produces above that line in that chair is profit; anything below it is the practice working for free or close to it.

The reframe matters most with insurance. A PPO patient whose plan allows exactly the break-even rate for that hour is not a bad patient, but that hour is not building the practice. It is only covering the lights. An out-of-network or higher-fee patient in the same chair, producing meaningfully above break-even, is the hour that actually pays the owner. Two practices can look equally busy on a schedule and have completely different profit-per-hour numbers depending on the plan mix filling the chairs.

Calculate it by dividing break-even production by clinical hours per day, then compare it against what different patient types and procedures actually produce per hour. It is the clearest lens for deciding which plans, which procedures and which schedule blocks are worth protecting.