Fixed and Variable Costs of an HOF Clinic: How to Map Them

Most orofacial harmonization (HOF) clinics know how much they billed in the month, and almost none know precisely how much it costs to keep the doors open. The result is prices set by looking at a colleague, discounts given without knowing the margin, and a constant feeling that "money comes in, but nothing is left over." Mapping your costs is the first step to changing that.

This guide shows how to separate fixed and variable costs, how to organize the list, and how to arrive at the cost per chair hour and the break-even point. The figures in the examples are hypothetical: they don't represent any real clinic or market range. For taxes, payroll and tax regime in Brazil, talk to your accountant.

What is the difference between a fixed cost and a variable cost?

• Fixed cost is what you pay even if you see no patients that month. Rent, staff salaries, software, accountant, insurance, subscriptions.
• Variable cost is what changes with how many patients you see. Injectable product, disposable supplies, commission, card fees, tax on revenue.

There are also semi-fixed (or semi-variable) costs: costs with a fixed part and a part that varies, such as electricity, phone and internet, or outsourced cleaning with a minimum charge. For the calculation, classify each item by its dominant behavior and review the classification every quarter.

This separation matters because the price of a visit has to cover what is variable in it and still contribute toward what is fixed. Without it, it is easy to think a consultation "makes a profit" because it covered the product, when in fact it did not contribute to the rent.

Which items go on the fixed cost list?

Use the table as a guide. The right-hand column is a question, not a value:

And variable costs?

For injectable products, also record loss: what is left in the vial or syringe and goes unused, expiry before use, disposal due to contamination. Loss raises the effective cost. See injectables inventory in the HOF clinic.

How do you calculate the cost per chair hour?

The chair hour is one of the most useful figures for pricing procedures of different lengths. In steps:

1. Add up your monthly fixed costs (including your own owner's draw).
2. Estimate the hours actually worked with patients in the month, not the hours available on your schedule.
3. Divide: monthly fixed cost ÷ hours worked.

Hypothetical example: fictional values.

If the schedule has low occupancy, the 80 hours become 60 and the cost per hour rises to R$ 550.00. The same structure, left empty, makes each visit cost more. This also explains why no-shows and empty slots weigh so heavily: see no-shows in the HOF clinic and the HOF clinic schedule.

How do you arrive at the minimum price of a visit?

With costs mapped, the price of a visit is the sum of what it consumes plus margin, adjusted for taxes and fees:

Direct cost of the visit = product including loss + supplies + fixed cost per hour × hours spent + reserve. Minimum price = direct cost ÷ (1 − taxes − fees − desired margin).

Hypothetical example: a visit with R$ 500.00 of product including loss, R$ 40.00 of supplies, 1 hour at R$ 412.50 and R$ 20.00 of reserve has a direct cost of R$ 972.50. With taxes of 10%, fees of 4% and a desired margin of 25% (all hypothetical), the divisor is 1 − 0,39 = 0,61. The minimum price would be R$ 972.50 ÷ 0,61 ≈ R$ 1,594.26.

To test it with your own numbers, use the price per ml and margin calculator and read pricing per ml. A caveat: market price and positioning also matter, but the floor is your own math.

What is the break-even point and how do you use it?

It is the monthly revenue that covers all fixed and variable costs, with neither profit nor loss. The logic in plain language:

Break-even point = fixed costs ÷ contribution margin (the percentage of the price left after variable costs).

Hypothetical example: with fixed costs of R$ 33,000.00 and variable costs (product, supplies, fees and taxes) equal to 55% of revenue, the contribution margin is 45%. The break-even point would be R$ 33,000.00 ÷ 0,45 ≈ R$ 73,333.33 per month. Below that revenue, the clinic operates at a loss; above it, money starts to be left over.

With the break-even point, you can turn the goal into visits: if the average ticket is R$ 1,600.00, that is about 46 visits a month just to break even (R$ 73,333.33 ÷ R$ 1,600.00). Use the break-even point and average ticket and monthly goal calculators to redo the math with your own data. See also average ticket in HOF and profit margin in HOF.

What about the initial investment?

Anyone opening a clinic needs three blocks of money, and they are different:

The typical mistake is to calculate only the first block. New clinics often take a while to fill the schedule, and without working capital the professional is squeezed before the clinic matures. See opening an orofacial harmonization clinic and cash flow in the HOF clinic.

Where can you cut costs without cutting quality?

Before cutting, understand what each expense delivers. A few questions help:

• Does this expense improve safety, patient care or patient acquisition?
• Can it be renegotiated (rent, contract, supplier)?
• Are there duplicate or unused subscriptions?
• Is the setup larger than current demand requires? See renting a room or running your own clinic.
• Is there a recurring product loss that better scheduling could reduce?

Don't cut what protects the patient and the clinic: biosafety, lot records, emergency supplies, insurance and licenses. The wrong cut costs more than the savings.

Mapping checklist

• Did I list all fixed costs, including the owner's draw and annual provisions?
• Did I separate variable costs per visit, with product loss?
• Did I classify the semi-fixed costs?
• Did I calculate the cost per chair hour using real hours?
• Do I know my break-even point and how many visits it represents?
• Does my minimum price cover cost, taxes, fees and margin?
• Do I have working capital for the slower months?
• Do I review the spreadsheet every month?

Knowing your costs won't make the clinic bill more, but it changes the quality of your decisions: pricing, discounts, hiring, investment. And from there, growth stops being a bet.