Why I don't take a commission on clinic revenue

Last week I deleted a number from two pages on my own site. A two per cent success commission on revenue, which had sat in the offer for dental practices and aesthetic clinics since the beginning. The commission went, the calculator formula that used it went, the small print under the calculator went. In its place I added a new entry to the FAQ: Do you earn from my treatment revenue? — No.

I kept the same two per cent for the home & living and landscaping work. Same services, same person doing them, different pricing model depending on the industry. That asymmetry is deliberate, and it's the whole subject of this post.

Why the industry changes the model

A percentage of revenue means my income rises when the client sells more. In furniture that is clean alignment. More sofas is unambiguously good for everyone involved, and the person buying a sofa is making a decision about their living room with nobody's professional authority leaning on them.

In a clinic, the thing that produces revenue is a treatment decision. The person making it is a health professional advising a patient who has walked in precisely because they don't have the expertise to decide alone. I do not want a line in my contract that gets larger when a borderline case gets treated.

Not, to be clear, because I think I'd be tempted. Because the clinic shouldn't have to think about whether I am. The moment a practice owner has to run that calculation about their marketing partner, I've added a cost to the relationship that no amount of performance can pay back.

What the rules actually say, and what they don't

I went looking for a provision that would make the decision for me, and there isn't a tidy one. The Swiss dental profession's code of conduct doesn't name referral commissions at all. What it does defend is independence: Article 2 requires that the dentist decides freely whether to accept or refuse a patient, and that the patient's choice of dentist remains free. Article 21 limits advertising claims to what is useful to the public, and Article 24 forbids promoting free services for advertising purposes. The code is plainly built around keeping commercial pressure out of the consulting room, even though my particular fee structure never comes up in it.

The American case law is more explicit, which makes it useful even from Switzerland. In Advisory Opinion 98-4, the US Office of Inspector General looked at a practice management company paid partly through a percentage of a physician corporation's net revenue, and because part of that payment covered marketing, found "at least a potential technical violation of the anti-kickback statute". The arrangement also failed the relevant safe harbour, which requires compensation to be set in advance — in other words, a fixed fee.

The honest counterpoint arrived this April. In United States v. Sorensen, the Seventh Circuit held that payments to marketers aren't illegal referrals when the recipients have no influence over patients' health care decisions, and said plainly that percentage-based compensation is not automatically unlawful. A marketer who can't override a physician's judgement isn't buying referrals.

So the law would quite possibly have let me keep the two per cent. I'm not a lawyer, none of this is legal advice, and a Swiss clinic's own counsel would be the one to ask. I removed it anyway, which means this was never really a compliance decision.

Pricing is a value you can't argue with

The old version of that page said I was aligned with the clinic's growth. The old contract said my income tracked their treatment revenue. One of those is a claim and the other is a mechanism, and only one of them survives contact with a sceptical reader.

Ben Horowitz puts the test well in What You Do Is Who You Are: "a culture is not a set of beliefs, but a set of actions." And the question that follows it — "If you are tested on this virtue, will you pass the test?"

Every stated value in marketing has a mechanism somewhere that either backs it or quietly contradicts it. I've argued before that putting every hour in the quote is worth more than the margin it costs, and that the website is a tool rather than the offer. This is the same argument applied to the contract: the pricing model is the part a client can't talk themselves out of believing.

What replaced it

A fixed monthly fee, three published tiers, a three-month minimum. Nothing clever. The commission wasn't swapped for a bigger retainer — I simply gave up the upside in a good quarter in exchange for nobody ever having to audit my motives.

The published tiers do a different job, and it isn't persuasion. Clinics plan in budgets and financial years, and a practice manager who can see an entry point works out in thirty seconds whether a conversation is worth anyone's time. That saves them an awkward call and saves me three. Openness about what a thing costs is a courtesy, not a pitch.

The new FAQ matters more than I expected. Answering the uncomfortable question directly, on the page, in one word, is the cheapest trust you will ever buy — and it's the same instinct as counting patients rather than bookings: say the thing the client would otherwise have to find out for themselves.

If you sell into regulated work

The transferable rule is this: your pricing model has to survive the ethics of your buyer's profession, not just your own. Marketing for clinics is full of these edges — I've written about how health claims creep into ad copy for products that aren't medical devices, and about a clinic chain advertising its empty appointment slots. In every case the constraint turned out to be a better brief than the freedom would have been.

Twenty years of running marketing teaches you that most incentive problems are invisible until someone acts on them. The cheapest fix is to not install the incentive.

Sources & further reading

External
Swiss Dental Association (SSO) — Standesordnung, 2016 edition (PDF, German)
OIG Advisory Opinion 98-4 on percentage fee arrangements with practice management companies
Foley — the Seventh Circuit on "referrals" under the Anti-Kickback Statute (US v. Sorensen, 2025)