#181 4 Types of Leverage That Let Your Practice Make Money Without You

If you stepped away from your practice for 30 days, what would happen to your revenue? 

If the honest answer is "it would fall apart" — you don't have a scalable practice. You have a high-paying job with employees. 

In this episode, Dr. Heather Signorelli breaks down the four forms of leverage that separate practices that grow on their own from the ones that only move when you show up. 

The Leverage Framework: 

• Form 1 — Capital Leverage: why it's the highest-risk, lowest-compounding form 
• Form 2 — Labor Leverage: why 10x headcount creates 10x management complexity 
• Form 3 — Code/AI Leverage: what $15K–$25K/month in avoidable billing losses actually looks like 
• Form 4 — Media Leverage: the one asset that compounds while you sleep 
• The Lion Sprint Framework: why sprinting beats grinding — and what your three sprints are this week 

Episode breakdown: 

00:00 Opening question: what happens if you step away? 

02:30 Leveraged vs. un-leveraged — the real 2026 divide 

05:00 Form 1: Capital Leverage 

08:00 Form 2: Labor Leverage 

11:00 Form 3: Code/AI Leverage 

14:30 Form 4: Media Leverage 

18:00 The Lion Sprint Framework 

20:30 Sprint 1: Policy Sprint (Media Leverage) 

22:30 Sprint 2: Chart Closure Sprint (Code + Labor Leverage) 

24:30 Sprint 3: Eligibility Training Sprint (Labor + Media Leverage) 

27:00 Free resource + payer rule change tease

Resources Mentioned 

Payment Posting Audit Checklist (free): 

eligibility.natrevmd.com/payment-posting-checklist 

Practice Revenue Leak Scorecard (free): 

eligibility.natrevmd.com/nrm-revenue-scorecard-v3 

Book a free 30-minute audit call: 

calendly.com/heather-natrevmd 

RECOVER Diagnostic Quiz: 

natrevmd.com/quiz 

Transcript

Opening question: What Happens if you step away?

SPEAKER_00 0:04

There's a question I want you to sit with before we get into any tactics for today. If you stopped working tomorrow, not for a week, but actually generally stepped out of the day-to-day operations of your practice for 30 days, what would happen to your revenue? Welcome to Nat RevMD, a podcast where we share tips on optimizing medical billing and improving practice efficiency so you can have the business of your dreams. I'm your host, Dr. Heather Signorelli, founder of Nat RevMD. Let's get started. Obviously, the answer to this question is it would fall apart in 24 hours, or that you would have no idea because you've never been gone long enough to find out. Then you may have set up this high-paying job with a lot of employees, but not a true scalable practice. And the difference between those two things is not how hard you work, it's whether or not your income is attached to your hours or detached from your hours. And that is defined as leverage. And that's what we're going to be talking today. So we're going to be talking about how to build leverage in your practice. We're not going to talk really about billing systems or payer contracts. And this is part two of our framework that really separates the practices that scale from the ones that plateau. And we're using the strategies that we have seen are successful practices be able to implement within their framework so that you can take these and three you can take these ideas and build three different sprints, which we'll talk about at the end, so that you can start building that scalable practice. Now, I recognize many of you guys are seeing patients every week, and that is a big source of your revenue. And so stepping away obviously is going to impact your revenue. What we want to build though is where I see our more successful, where I where I see our very successful scaling of practices is that they have developed kind of two modes of revenue, right? The revenue by which when they see patients, but the revenue by which the other physicians and providers in their practice see patients and how to separate out the time which they have to do in order to generate revenue versus what their team does in order to generate revenue. And that is the essence of being able to build that scalable practice. So this all kind of comes from uh Naval Ravacant, which is one of these incredible thinkers really around wealth creation. He's built companies, he's invested early in companies that changed industries and has spent years distilling what he actually learned into something that's transferable even to medical practices. And so one of the ideas that he comes back to a time and time again is the idea that it's it's not about being rich versus poor, white collar versus blue collar. It's actually about being able to build leverage versus having a bit business that is unleveraged, meaning it requires your time and effort to create any revenue. And so you want to build systems that allow your practice to run and generate revenue without you spending that specific time in order to get that outcome. Now, leverage versus unleveraged is the real divide that I think we're seeing in in many different industries. This isn't about what specialty you're in. It isn't about whether you're a solo practitioner or a group practice. It's really about leverage. So in a traditional medical practice, right, revenue is almost entirely unleveraged if you're a singled physician. One hour of a physician's time equals a fixed number of dollars related to the number of patients that they see, right? To grow, you have to add more hours, you have to add more patients to see, et cetera. Now the ceiling is always at the capacity of the people in the building. And the moment that those people stop showing up, the revenue stops with them. So leverage is that mechanism that breaks that ceiling. It is the detachment of your earnings from your hours. And the practices that are growing in ways that feel disproportionate to their headcount are the ones that have truly figured this out. And we're going to talk through the framework of where we're seeing some of those really successful practices who've built this framework and how you can take those lessons and apply them to your own practice. All right, so we're going to talk about a couple different types of leverage because I think it's important to understand this. And again, these concepts are all around in business, but I think talking about them in the sense of your medical practice is where I want to frame. And again, using some of the examples of some of the practices that we work with and that we see and how they have been able to do this. So the first type of leverage that we're going to talk about is called capital leverage. And capital leverage is really the oldest form of scaling, I would say, that medical practices have used, right? So it means using money to mop and uh multiply capacity. So you buy equipment, you buy buildings, you buy other practices, and every hospital system in the country was built on this model. Obviously, it works. The problem is that capital leverage requires permission. You have to have banks, investors, lenders. It carries the highest structural risk of the four forms that we're going to talk about today. But it and it does scale linearly, right? The more money you put in, proportionally more output, but it doesn't have quite the compounding that you see with the other types of leverage we'll talk today. So a practice that doubles its square footage, right, does not automatically double its margin. It doubles its overhead, it doubles its management, it's got more complexity, it's got exposure to the decisions that got made during the build-out, right? But the mistake that most owners make is that it that treating capital is that primary growth lever before the operational systems that are underneath it are solid. A second location that's built on broken workflows, right, does not scale the practice. It scales the problem and the expenses, but you're not scaling the revenue. So you want to make sure as you're expanding your office, whether that's with other providers or a second location, that you have the framework that allows for revenue generation to multiply before you do that. So that then the uh business scales more easily. All right. So before we get to the next form of leverage, I do want to share if you're doing over $250,000 a month in net receipts and you're realizing that your workflow has some leverage gaps, you've got claims falling through eligibility missed before visits, or staff just making decisions without a documented protocol when it comes to write-offs and your AR is ballooning, please check out our payment posting audit checklist. It is the framework that you we use with practices, and you can check it out in the show notes below. So if you are looking for some help around this, it's a great, easy uh audit checklist. So please go check it out. All right. So labor leverage is the second type of leverage. And obviously a model that many practices run on. And so as you're trying to scale, having a leverage around labor is going to be very important because you can't see all the patients, right? Hiring PAs, MPs, MAs, administrators, really, it's the team around you, other physicians, to do the work you use to do yourself, right? So if you were to say, if you have three physicians in the office and you list out all the things that you're doing and the things that are on your plate, then identifying the things that can be pushed to somebody else, right? So as your margin increases or your profit increases off of three physicians, then having two more and handing off, you know, more of your patient load to them or another PA is going to allow you to delegate that specific task, right? That task of time equals money, right? Because time equals money is really related to that patient activity. And obviously, you know, may decide you want to see patients three days a week. That's great. It's necessary, but it is going to be something that you want to eventually delegate as you scale the practice, if that's the piece of the practice that you enjoy. Now, obviously, hiring additional labor is the most expensive and slowest scaling form of leverage available to you. Um, 10 times the revenue in a labor-only model almost always means 10 times the management complexity and maybe even the expense, right? Because the margin is low. So every new hire is a new variable. And managing people, right, their performance, their schedules, their training gaps, making sure that their schedules are full, their conflict with, you know, somebody else is just can be messy. Obviously, it's a it's a necessary part of the business, but it can be messy. And so the gap most practices cannot see is that labor, labor leverage without the other forms underneath it, um, really creates uh a ceiling that uh it feels like a staffing problem, but it's actually a structural one, right? So you can hire your way to $250,000, $500,000 a month and still be working every weekend because no decision in the practice happens without you. So that's the piece that when it comes to people leverage, that you have to sort through, right? So how is bringing on three additional providers impacting your personal workflows, right? Your personal work within the practice. And what are you then doing as the practice owner that then can also be listed out and then delegated to the right people, or like we've talked about the last couple of weeks, put into a policy and procedure where somebody else is accountable for it, where somebody else is making those decisions, where there are guardrails of allowing them to make the decision so that it is not you, the owner of the practice. All right. So the third form of leverage is code leverage, right? And this is the form of leverage that I think is the biggest opportunity right now, and that is reshaping independent practices. So if you think about the different parts of your practice, right? So you've got patient acquisition, right? How are you acquiring patients? And then you've got the workflow in the front office, you've got the workflow in the back office, all the way through, you know, kind of closing the loop or really understanding the patient life cycle. And I think in other businesses, this often becomes a big focus, right? So customer acquisition, customer retention, all of that becomes a very large focus. In smaller medical practices, this is not as big of a focus. And I think it's just because of the training that we're given and the time that we have. And so the practices that I see really scaling and doing an excellent job is really leveraging and understanding the customer acquisition and the customer retention piece of this, and then using AI as an example to help build those frameworks. And obviously, you can use AI, and we're trialing some AI on our end on the billing side. There's AI you can be using for eligibility tools. There's AI you can use for prior authors. There's also AI for building a referral network, right? And so, how can you use the tools of AI, whether it's Claude or Claude plus N8N or different types of automation tools? And again, there's vendors out there that do this. So if you're like, I'm not techie, I don't like any of this stuff, that's okay. But I think really understanding this idea of code leverage and using software and AI to do the work of multiple people with less of marginal uh cost, right? Obviously, people are not replaceable. This is not meant to say go replace everybody with AI, but be but there are entire categories of work that should never require a person or require a person very uh at a low at low levels. And so for revenue cycle, for example, we are evaluating tools, actually, and we're even already using automated clean scrubbing tools. Those have been around for a while. There are things that you can do to also leverage referrals for your patients, right? And so if you can use AI to give you a full list of practices within 100 miles that may be referral networks for you, and then using AI to be able to set up reach out campaigns so that you could have, you know, maybe someone in your front office or a virtual assistant help identify, okay, here are the here's what my ideal patient looks like. Here's my ideal referral practice. And how can I leverage AI in order to manage reaching out to those referral networks, sharing them, sharing with those referral practices your practice and then being able to get a feedback loop or with your current patients? How can you set up an automated tool that reminds them when their next appointment is? They haven't scheduled their annual yet. They've uh canceled and now need to reschedule. Like all of these things are ways that don't require you as the owner to constantly be babysitting. You have to build the system, use the AI tool, but then be able to use those to capture patients. The other thing is, okay, well, what about patient retention, right? So if you're supposed to see these patients on an annual basis, how many of your patients do you actually see on an annual basis? Is it 35%, 75%? Um, you know, the practices that we see that are most successful are actually starting to use these tools in eligibility, in patient retention, getting feedback from their patients after a visit and then using that to improve, or using that to say, hey, you like you gave us five stars. We'd love for you to share us with, you know, share our practice with three other friends, those sorts of marketing tools that other businesses use all the time, or referral bonus, all of those things, you know, you can leverage within your medical practice as well. You just need to sit down and understand again again, it comes back down to what are your goals and how can we sit down and look at those goals and then apply these different points of leverage, right? So is it a is it a capital need? Is it a labor need, or is it a codingslash AI automation tool need that then again builds leverage? So it's all about what do you have on your plate as the owner or as the COO of the practice that then you can leverage other people to do oftentimes better, faster, and allow you to do higher, more strategic things that help drive growth and uh profit within the practice so that then you can leverage other people's time, money, energy. Obviously, the cost of not doing this and not leveraging AI or other types of tools that help make your practice more sustainable long term means that, you know, maybe you're doing uh a manual process where you're paying somebody a full-time FTE and maybe you're paying them $50,000 a year for doing things that an AI team can be doing for you in an automated fashion. Or it's things that, you know, maybe you could be increasing your patient visits every month that you wouldn't be able to do if you weren't leveraging AI in order to get those referrals. All right. And so the last form of leverage is media leverage. So this is the highest leverage form available to an independent practice that is probably the easiest. And I would say that I we see practices leverage this and some that don't. And that's really around building, taking your knowledge and what you know, and then building that out into a podcast, a training video, a written protocol, policy document, really all of these different things that once they're written and recorded once, then can be leveraged to train employees, to market for your practice, to train your patients, even on, you know, patient AR, making sure they're paying their patient bills, leverage a building with regards to making sure that patients understand your financial uh policy. Like those sort of things, if they're done once, they then become assets and something that you can provide out to your patients, to your staff. And that allows your time to not be spent again on that task, right? You have recorded it, you've memorized, you've put it into a policy so that people can use that information without taking up that hour of a time again. And so this is for us in our company, we are big about policies and procedures, not just for the practices, but for how to run the business. But then also videos for those complex things that we need somebody to uh watch and then understand. So then instead of having to train that staff member, which may take an hour, we have them watch a 10-minute video and then make sure that they understand. And so that takes that task of going over one thing for an hour into maybe 10 or 15 minutes that we record. And then maybe we spend 10 minutes going over that plus many other things. And so using media leverage, again, leverage is all about I am not expecting a one-for-one return in my time and the result. It is multiples, right? So I spend that one hour, but now I've got, you know, 10 employees listening to that one hour of training, or, you know, I've got a podcast that shares my knowledge so that I can get patients. You know, some of the most successful physicians, Dr. Una being one of them, who's built a pediatrician or pediatrics practice and then also an entire business school of how to teach physicians how to do the business side of medicine. She's amazing if you haven't checked her out, is really about media leverage, right? So building a podcast. What I'm trying to explain here is not just the marketing side of things, but also training your billing staff, training your office manager, training your front desk staff. It's all of the things that you can do to leverage, again, not having to repeat yourself. And same with your office manager. If your office manager is the one doing all of that, have her or him do the training videos, the policies and procedures, the protocols, the expectations, and then pushing that to the staff, that means they're not always trading their time one for one with the result, right? So again, leverage is not just about the physician owner, but is about the different types of ways that you can uh leverage your team. So here's what it looks like in practice, right? And so instead of an answering the same post-op question 50 times a week, you record one high-quality video. That one hour of work answers the question perfectly for the next 5,000 patients, right? So this podcast episode is gonna take some time for us to prepare, right, and record and edit, but then it will get listened to hundreds of times. And so maybe more than that. But so that is a point of leverage for our own company. And this compounding effect, right? Whether that's a billing protocol or training video for your front desk, a policy for handling insurance appeals, right? Every single one of those is media asset. It is a point of leverage. And so every one of these that you build reduces the number of times that you personally have to present and solve a problem. And so that reduction is leverage. And unlike every other form on this list, right, media compounds, the highest ever. And so the asset that you build today is more valuable next year because it has been working every day in between. So very, very important that you understand these points of leverage because I'm telling you, the practices that we see most successful are using these leverage, points of leverage, right? We've got in one of our urgent cures, they are trialing um an eligibility AI tool. Um, we're happy to share as that you know comes out. We are leveraging different AI tools to help build the policies and the frameworks and the checklists within our own company. All of these things are points of leverage. Um it there's an interesting uh story that correlates this with like the animal world, right? So lions sleep 60 to 70% of the time. And that's not because they're lazy, right? It's because their survival actually depends on being completely recovered so that the moment that they were required full capacity, right? When a lion hunts, it does not jog after a prey, it does not grind steadily across the savannah. It waits, positions, and then explodes with everything in its might with this very short, precise maximum effort. And then obviously it then eats and then goes back to bed. And so the lion is not grinding day after day after day, right? It is sleeping and then it goes and sprints. And so I want you guys to think about sprinting in your practice so that you can have this amazing burst of productivity and revenue and support for your practice for the rest of the year. And so obviously it can be exhausting every day to be grinding and grinding and working long hours every single day. And, but it, you know, if the practice isn't accumulating these new ways to leverage, you know, whether that's capital people, AI tools, then that there isn't the same level of compound. And so the answer isn't always doing more hours. It's just understanding the different kinds of effort that you need, right? So short, focused, maximum intensity sprints to build these systems and then stepping back and then letting the systems run. And so here are three sprints that you can run this week. I love sprints. We do sprints within my day job world. And I think having sprints right now in our own company, we're doing a policy sprint and an audit sprint where we're really focused on policy creation for our practices and updating those with AI now because it's, you know, we've manually written them over the years. And now we can actually take those and put them into more intuitive structures and checklists, and then be able to build additional videos with those. So the first sprint I want you to focus on is the policy sprint. So think of this as media. So identify the single question your staff asks you or your office manager most often. The one that interrupts your day, your focus, your composure because you've answered it 40 times and somehow it keeps coming back. So I want you to take that time back, write that protocol. And if writers writing is slower than talking, record the video and either hand it to your office manager, put it into AI. There's even a tool called ScribeHow that will watch you do it on your desktop and then create a policy for you and hand it to your team with the instruction of this is now the answer. And I'm not, I'm not gonna answer that question anymore. This is the answer. And you guys read and listen to this. This is the answer. So then that one asset then stops the interruption permanently, right? And so I want you to start building the training library that eventually means new staff can onboard without consuming your time. And obviously, if you skip this. Sprint, the question's just going to come back over and over again. So that would be sprint number one. Sprint number two, we talked about this in part one of this episode, which is the chart closure sprint. So I want you to really understand what is impacting unsigned encounters across your provider schedule. And you really have to configure your EMRs to flag those, or if you're your billing team, um, sending you those. But after 48 hours, you need to have those signed out. And so if that means you need to do a catch-up sprint with your, you know, your current staff, sit down and do that sprint where they pull their charts, they sit down, they get them out and sign them out. And then from moving forward, once everybody's caught up and you define what caught up timeline looks like, right? So if it's 400 charts, you sit down and go, okay, we're gonna do 100 charts a week. And at the end of four weeks, we're gonna catch up. And it may be a painful four weeks, but you're gonna get through it. And then moving forward, you can set up reminders. Typically, most EMRs that flag when a chart hasn't been signed out for 48 hours and you get those done. Or you're using leverage and you're having a scribe in the room, virtual scribe or whatever, who is then being able to help and clear the bottleneck of what's causing that physician to not be able to sign out. So then you are tracking those numbers on a weekly basis, again, delegating that to somebody else so that then they're presenting those numbers, even the provider themselves. Hey, when we do our weekly Huddle, we're gonna talk about unsigned charts. Everybody's gonna go around the room and we're gonna talk about the number of unsigned charts we have. And if you, as the practice owner, are part of that, then you present your numbers as well. And so unsigned charts, I know I've sound like a broken record, really, really critical to get these done. So this is not a staffing problem, it's a systems problem. So add this sprint if this is an issue in your practice. And then the last sprint is really the eligibility training sprint, which is really all about both labor and media. And so charges that enter the billing queue but have unverified coverage is one of the most avoidable revenue leaks in a medical practice. And so for this week, identify one pre-recorded eligibility verification training module, have your superstar on the front desk create it themselves. It could go along with a policy that hopefully you already have, and then make sure that your entire staff team has read and understood that. If you keep having this like a specific issue with eligibility that hits as a denial, maybe it's a certain payer, maybe it's a certain insurance card, then that is the training video you create next. And so the guy, the the goal here is that you have a policy and procedure, you have a general training module that your staff go through. And then when issues come up, instead of just fixing it live, make it a recording video and make that be the understanding for all staff. So that if you get that question again, that's the video that they're gonna go listen to. And then just make these standing onboarding requirements. So every future hire goes through the same policy procedure videos, et cetera. So this is another sprint that it can be a huge training asset and it stops the AR from inflating or the denials from building up before the patient even walks in the door. All right. So we want to make sure that you guys understand that these are things that we see our most successful practices doing day in and day out. And again, 1% better every single day. And really, really important to make sure that you understand that these types of leverage can really help you scale and also create a business to where it's not completely dependent on you, the physician owner. As I said before, we do have a payment posting audit checklist. Check out the link in the show notes below. As always, if you are a practice and you are struggling with billing, you don't have transparency around your metrics, you don't know what your team is actually doing when it comes to managing AR and you feel frustrated with the lack of communication. We would love to hear from you. Head on over to netrevmd.com. Check out the free revenue metric audit that we offer for practices if you qualify. We'd love to be able to see if we're the right fit for you. All right. Have a great rest of your day.