The Imminent Disruption in Allied Health Clinics
Why invisible administrative effort — not clinical demand — has become the primary driver of cashflow, cost, and burnout in allied health clinics. The next phase of allied health will not be decided by effort alone — but by visibility, integration, and system design.
Author: Joshua Iaquinto
CoFounder of AskLuci.io and Director of PhysioCall.com.au
January 2026
Key Findings
• Allied health clinics can have full diaries and strong demand while still suffering from cashflow uncertainty, margin erosion, and burnout.
• The primary driver is increasingly invisible administrative effort — repeated work created by fragmented systems and unclear ownership.
• Administrative work is rarely measured end-to-end, so delays and leakage are discovered after money stalls (invoicing, claiming, reconciliation).
• AMCA (Administrative Minutes per Completed Appointment) is introduced as a unifying metric to quantify the hidden admin load behind each appointment.
• The paper proposes The One Best Way as an operating framework to restore visibility, reduce friction, and standardise pathways.
• The next phase of allied health will be decided less by effort and more by visibility, integration, and system design.
Summary
This whitepaper examines why allied health clinics — despite skilled clinicians, full diaries, and strong patient demand — continue to struggle with financial clarity, administrative overload, and burnout.
It argues that the core problem is not people, motivation, or effort, but structure: fragmented systems, poorly integrated institutional rails, and invisible administrative work that silently erodes margins and morale.
By introducing Administrative Minutes per Completed Appointment (AMCA) as a unifying operational metric, and proposing The One Best Way as a shared operating framework, the paper outlines a practical path to restoring visibility, reducing friction, and rebuilding clinics as sustainable, scalable, and human-centred businesses.
The disruption facing allied health is already underway; this paper is a call to lead it deliberately - rather than absorb it passively.
Abstract
Reimagining Healthcare Systems for a Sustainable Future
Rebuilding Australian outpatient care through connection, efficiency, and fair exchange
Allied health clinics in Australia operate downstream of a fragmented institutional stack comprising government programs, private health insurance, banking and payment rails, and practice management systems that were never designed to function as an integrated whole. While demand for care remains strong and clinical capability is high, the administrative effort required to deliver, reconcile, and report services has increased steadily over time.
This institutional fragmentation creates a structural drag on clinic operations. Administrative work is dispersed across multiple systems, rulesets, and portals, resulting in duplicated effort, delayed cashflow, limited financial visibility, and rising operating expenses. These costs are absorbed locally by clinics as reduced margins, staff burnout, and diminished patient experience — despite sustained effort and goodwill from clinicians and administrative teams.
This paper introduces Administrative Minutes per Completed Appointment (AMCA) as a unifying operational and governance lens for making this invisible work visible. AMCA represents the total administrative effort required to progress a completed appointment from booking through to final cash receipt and reconciliation. While rarely measured, this effort materially shapes clinic sustainability, staffing requirements, and financial outcomes.
The core argument of this paper is that the primary constraint facing allied health is not motivation, professionalism, or clinical quality — but system design.
Clinics are constrained by a structural CAP: the combined effect of government policy requirements, banking and payment rails, private health claiming systems, and legacy software platforms. Together, these forces determine administrative effort, cashflow timing, and financial visibility regardless of clinical excellence. As complexity increases, administrative minutes per appointment rise, operating expenses grow, and viable margins compress.
At the same time, the conditions for reform have converged.
Modern cloud-based systems, integrated payment rails, digital claiming pathways, and AI-assisted workflows now make it possible to materially reduce administrative effort without removing human value. When applied deliberately, technology does not replace people — it removes repetition, error, and opacity. Clinics regain visibility. Teams regain time. Owners regain governance.
This paper sets out:
How administrative effort has expanded quietly and unevenly across allied health
Why AMCA is the pivotal operational and governance metric for clinics
Where the current system fails, through a “Three Boxes” model of legacy, transitional, and institutional systems
Why technology can act as a structural equaliser when systems are aligned
A shared operating framework — The One Best Way — for standardising core administrative processes without standardising care
A realistic, staged pathway for transformation over five years
Evidence from real clinics showing reduced AMCA, improved margins, lower error rates, higher retention, and improved scalability
The core claim is straightforward:
Clinics that deliberately reduce administrative effort and align systems around a shared operating framework can restore financial sustainability, fund better wages, improve patient experience, and reduce burnout — even as regulatory complexity and patient expectations increase.
Allied health is uniquely positioned to act as a proving ground for this transformation. The sector is diverse enough to stress-test reform, operationally complex enough to make improvement measurable, and sufficiently contained to allow innovation without undue risk. If successful, the same principles can extend to general practice, specialist care, and hospital systems.
This paper does not argue for deregulation or reduced oversight. It argues for visibility, integration, and structural coherence — so that effort can reliably translate into outcomes.
Better systems do not weaken governance.
They make accountability possible.
TABLE OF CONTENTS
1. Author’s Message
2. Executive Summary
3. Understanding the Crisis: A Hierarchy of Disorder
4. What It Feels Like on the Ground: The Pain Points
5. Structural Readiness: Who Is Prepared for Disruption
6. AMCA & the Three Boxes: How the System Currently Fails
7. Technology as the Great Equaliser
8. A New Framework: The One Best Way
9. The Seasons of Transformation: A Five Year View
10. The Future State: A Universal Semantic System
11. What This Looks Like in Practice: Real-World Case Studies & KPIs
12. The Human Impact: More Time Being Human
13. The Leadership Imperative: What Owners Must Do Now
14. Final Message: Leading the Transformation
15. From Practice, Not Theory
16. References
17. Invitiation for Institiutional and Industry Collaboration
1. AUTHOR’S MESSAGE
— Joshua Iaquinto
On a personal level, there are a few truths I hold about myself.
I often feel in life, I have more questions than answers.
And I struggle with trust.
Trust in myself — to follow through on what I commit to.
Trust in others — who don’t always do the same.
And trust in systems — that promise to work, yet fail to meet any clear, shared, or objectively verifiable standard.
My mind and body seek mutual exchange; I want win–win outcomes for myself and others. However, in a polarised world, mutual exchange does not always occur easily, and it is not always a high value for other people.
I experience my lack of trust as distress — emotional feedback that shows up as one-sided perceptions, such as frustration, anger, anxiety, depression, or overwhelm — signalling that I am missing information.
I now understand that “missing information,” and any emotional response to it, is not necessarily a bad thing. Instead, I frame it as an opportunity to do the work required to balance my perception and understanding.
By “work,” I mean:
further learning and education
expansion through asking better questions and communicating with others
practising and training new knowledge into the skill of gaining greater insight and wisdom
There are many areas of life where I lack trust, however the greatest progress I have made in overcoming these feelings has been in my professional career.
University Training
I remember working in my first private practice job as a new graduate physiotherapist, carrying a degree that had prepared me for hospital work — and almost not at all for the reality of working in a private clinic.
That missing information showed up as imposter syndrome and a lack of professional confidence in the clinic for many years.
Work Life
My private practice employers were too busy working — earning their own salaries with their own clients — to mentor me, or anyone else in the clinic.
It took me a long time to truly understand why that was the case.
Understanding the System
Working in hospitals, I watched and listened as physiotherapists, nurses, and doctors complained about how hospitals were run — protesting, striking, and advocating for better pay and conditions.
In private practice, I watched clinic owners and practice managers stay back late at night — not because they loved being in the clinic, but because the administrative work never stopped.
I saw therapists feeling lost and jaded in their day-to-day work — not from a lack of care, but from a lack of structure, communication, and transparency.
Over time, I learned to accept this as “just how healthcare works”: an entire industry of well-intentioned, disillusioned professionals trying to help people within a chaotic system.
Many years later, after becoming an allied health clinic business owner myself, and experiencing the highs and lows of living with more questions than answers, I came to realise that missing information was not just a personal issue — it was systemic in nature.
At every step of setting up and running the business, a significant amount of time and energy was required simply to understand how to operate it. From choosing an internet and phone provider, to selecting a practice management system (PMS), navigating government claiming and private health processing, choosing an accountant, accounting software, and a bookkeeper, to hiring an admin, engaging a clinic cleaner, selecting the right products and equipment suppliers, and understanding regulatory bodies such as ASIC, the ATO, Fair Work, and WorkCover.
And that list barely scratches the surface.
It was at this point that I realised:
“This isn’t a people problem; it’s a systems and process problem.”
On my journey to find answers, I sought out mentors across different areas of life. Professionally and in business, I was fortunate to travel the country with business coach Nick Schuster (from Ultimate Physio).
During this time, I filmed and spoke with physiotherapy clinic owners who openly shared their fears, beliefs, experiences, and limitations within healthcare. These were trained health professionals and business owners — people who, despite their qualifications and responsibilities, felt just as lost or overwhelmed as I did, often carrying more questions than answers.
Both professionally and personally, it was deeply reassuring to realise I wasn’t alone in how I felt — and that many others were experiencing the same challenges and emotions in their careers and businesses.
It took time to process everything I learned through listening and asking questions. But over time, one theme stood out clearly above all the rest.
What became clear was that, collectively, we were struggling with the same gap: missing information.
As healthcare business owners, this showed up across several critical areas:
mentoring and managing teams
balancing identity — being a therapist, an employer, a colleague or friend, and ultimately the boss responsible for others
financial understanding, including company and government obligations, profit and loss, break-even points, invoicing and reconciliation, income, salaries, taxes, and commissions
The same story repeated itself over and over again.
The questions that define clinic ownership
Smart, caring, hard-working clinic owners — often clinically brilliant — consistently struggle to answer a small set of fundamental business questions. Not because they lack intelligence or effort, but because the systems they operate within obscure reality.
Where is the money?
(What is the clinic’s true net profit — after admin load, write-offs, and unpaid work?)
Why does the clinic feel perpetually busy, yet constantly behind?
(High activity without corresponding progress or margin.)
Why does dissatisfaction seem universal — across therapists and admin alike?
(Despite good intentions and hard work.)
How is it possible to keep up with clinical demand while simultaneously managing technology, administration, HR, accounting, marketing, and compliance?
Was it actually worth taking on the responsibility, liability, and personal risk of owning a clinic and being accountable for others?
Why does a clinic often remain a weak or low-value asset — even after decades of operation?
These questions are rarely answered clearly. But they are almost always rooted in the same underlying issue:
A lack of structural visibility into how time, money, and administrative effort actually flow through the clinic.
More specifically, they centred on the relationship between money and effort: how much work was required, how many tasks needed to be completed, and whether the effort being expended was proportional to the financial outcome.
Before being part of Ultimate Physio and listening to other clinic owner stories, I had placed a great deal of emphasis on my own clinical skills. I believed my feelings of incompetence and being lost stemmed from my treatment styles, assessment ability, or diagnostic skills.
But if I was truly honest with myself, my greatest challenge was not clinical at all — it was financial.
I struggled financially as a business owner, and that struggle affected every part of my life far more than any perceived gap in my clinical skills. My lack of financial understanding created constant stress, mentally and emotionally.
I remember taking a trip to Europe to see family members I hadn’t seen in over fifteen years, and I couldn’t stop thinking about the business back home in Australia the entire time. I found it difficult to stay present or fully enjoy the trip because my mind was constantly occupied with work-related thoughts and the inability to check on it or manage it, was stressing me out.
Since becoming a business owner, almost every conversation and decision I’ve had with myself has come down to the same questions:
Can I afford this? And how will I pay for that?
I have limited many life experiences with friends and family because I simply don’t have the confidence to know whether I can make things work financially. I know this feeling isn’t unique to business owners — many people experience it — but after investing so much time, energy, and identity into building the clinic, the idea of having to close it because I couldn’t make it work financially feels like a profound loss.
What I struggled to explain was why I couldn’t find the missing information needed to bring balance back to my mind and body re: my business.
Something critical was missing — something I hadn’t seen before.
And it wasn’t a missing clinical tool or skill (although those can always improve). It wasn’t the latest gadget, nor was it adopting the newest health trend or training method. It wasn’t even something that came naturally to me.
What was the missing information?
After spending years alongside clinic owners from different suburbs, serving different patient demographics, and practising different clinical styles — yet sharing similar values around allied health care — one thing became impossible to ignore.
No two clinics operated in the same way.
Pricing differed for the same billable items
Consultation times varied widely
Team structures were fundamentally different
Administrative processes ranged from loosely defined to wildly inconsistent
Even when clinics used the same practice management systems, they used them in completely different ways
Interpretations of Medicare, WorkCover, insurance claims, and invoicing rules were inconsistent, unaligned, and effectively unregulated
Along the way, I learned about countless issues inside clinics — clinical debates around treatment philosophies, challenges in human behaviour, leadership, and team culture.
But despite all this variation, one deeper pattern was forming.
A single, recurring, and uncomfortable perspective emerged — one that affected every clinic.
Owners were routinely delegating financial management to whoever was willing to take on the role: admin staff, practice managers, bookkeepers, accountants, and sometimes even family or friends. In doing so, they were allowing their businesses to be run by other people — people who are not as invested as the clinic owner, with different values, priorities, incentives, and goals to their own.
This one seemingly normal act — abdicating responsibility for the business, particularly financial responsibility — was quietly creating distress across every clinic, and for everyone within it.
By understanding the necessity for clinic owners — who are university-trained therapists, not business majors or accountants — to delegate so many operational and leadership requirements simply to keep a business running, a deeper issue became visible.
It revealed not personal failure, but widespread incompetence and chaos occurring at the highest levels of the clinic structure itself — among clinic owners and practice managers alike.
And if intelligent, capable people could not figure out how to “successfully” run a private practice, then perhaps the reasons why ran much deeper than individual ability.
The same recurring theme appeared in every clinic:
"Where's the money?"
As I looked more closely at how clinics were trying to keep up with the seemingly endless administrative load, a pattern emerged. Practice managers, administrators, and sometimes even therapists were working late into the night — not out of choice, but out of necessity.
Administrative work never truly stopped. Even after rostered hours had finished, there was still work being processed — often from home as technology evolved to allow it.
I listened as administrators, therapists, and clinic owners alike began to question whether working in healthcare was even worth it.
Through personal investigation and years of searching for answers, I discovered that there is enormous redundancy built into many allied health businesses: too many steps, too many tasks, just to process a single appointment.
Complexity had been layered on top of complexity — created by government requirements, banks, private health funds and other third-party payers, poorly designed practice management systems, business tools, accounting software, and professional services that often delivered superficial or misaligned advice to people in our profession.
And at the end of that chain sat clinic owners — underprepared, unsupported, and expected to hold it all together.
By following the stress, I eventually found the source of the problem.
The system itself.
A top-down failure.
This wasn’t just a people issue — it was a systemic process failure. Yet no one was asking the deeper questions: Why were systems designed this way? And why do we continue to accept them, even when they are clearly stressing everyone out?
Across Australia — and increasingly around the world — research points to the same conclusions:
too many administration required to process tasks
too little integration
too much manual handling and redundant work
too few business owners truly in the know and in control
Business inefficiency has quietly become an epidemic, not a minor inconvenience.
If those delivering healthcare are exhausted and disillusioned, we risk creating an industry where the sick are treating the sick.
What began as frustration for me is now an unprecedented opportunity — for reinvention, trust, transparency, and industry cohesion — if together we are willing to name the problem and fix it.
The Flow of Energy (Money) Is Impacting All of Us
In a simple service-based business, if one therapist sees one patient who pays on the spot, the journey of that money should be obvious, trackable, and transparent. Yet in many clinics, tracking revenue from appointment booking to bank account feels more like following smoke in the dark.
Once third-party billing is added — Medicare, WorkCover, DVA, NDIS, private health funds, GP management plans — the problem compounds. Administrative work explodes with additional tasks. Cash flow slows.
That slowdown directly impacts how clinic owners feel, which then negatively shapes their conversations, decisions, and perceptions about:
building a business in healthcare
cash flow, break-even, and net profit
the ability to pay salaries, service business loans, hire new staff, and pay commissions
At its core, this has always been a story about trust — trust in ourselves, trust in others, and trust in the systems we rely on to do meaningful work. When information is missing, trust erodes. That erosion shows up as stress, confusion, emotional fatigue, and ultimately burnout — not because people don’t care, but because they are being asked to operate inside systems they cannot clearly see, control, or understand.
This white paper exists to surface that missing information. By making systems visible, flows transparent, and responsibilities clear, we can restore trust where it has been quietly lost.
Burnout in healthcare is not inevitable — it is preventable. And by understanding the systems we work within, rather than blaming ourselves for struggling inside them, we create the opportunity to do this work sustainably, together.
2. EXECUTIVE SUMMARY
— Why This Matters Now
Every profession reaches a point where it must decide what it truly stands for.
For allied health, that point has arrived.
The assumptions that once sustained the sector no longer hold. Staff effort and goodwill can no longer compensate for broken systems. “Good people doing their best” is not a business model. Adding more administrators, more clinicians, or more patients does not resolve the structural complexity constraining clinic sustainability. And legacy practice management systems — combined with fragmented government, banking, and insurer rails — are no longer fit for purpose.
While many examples in this paper draw from physiotherapy, the structural issues described apply across allied health disciplines operating within similar funding, regulatory, and payment frameworks.
The result is an industry under pressure from all sides.
According to the Nous Group’s Physiotherapy Sustainable Rate Report (2025), the sustainable hourly rate for physiotherapy in Australia is $261 AUD. Yet most clinics operate well below this once administrative load, write-offs, no-shows, and unpaid time are accounted for. At the same time, administrative effort across healthcare continues to grow faster than clinical capacity, increasing operating expenses without improving care delivery.
This paper argues that the crisis facing allied health is not primarily about people, motivation, or capability.
It is structural.
Administrative work has expanded quietly, invisibly, and unevenly — driven by fragmented systems, inconsistent rules, and poorly integrated technology. Clinics absorb this complexity locally as higher Admin Minutes per Completed Appointment (AMCA), higher operating expenses (OPEX), and rising burnout. Owners lose visibility. Teams lose clarity. Patients inherit friction.
Disruption, in this context, is not a future event.
It is already embedded in day-to-day operations.
At the same time, the conditions for reform have finally converged.
Automation, integrated digital rails, and AI-assisted workflows now make it possible to dramatically reduce administrative effort without removing human value. Clinics that align systems, standardise core processes, and measure what matters can restore financial sustainability while improving the human experience of care.
This paper sets out:
1. Why the crisis is structural, not individual
Allied health is constrained by a “structural CAP” — the combined effect of government rules, banking rails, private health claiming systems, and legacy software — which shapes cost, cashflow, and visibility regardless of clinical quality.
2. Why AMCA is the pivotal operational metric
Administrative Minutes per Completed Appointment provides a clear, measurable way to understand where time, money, and energy are actually going — and why effort so often fails to translate into margin or sustainability.
3. How the current system fails — and where
Through the “Three Boxes” model, the paper explains how legacy clinic systems, transitional platforms, and underdeveloped institutional integration interact to inflate administrative burden.
4. Why technology is the great equaliser — if used deliberately
Automation does not replace people; it removes repetition. When systems connect, clinics regain visibility, teams regain time, and owners regain governance.
5. A new operating framework: The One Best Way
A shared, practical standard for how clinics run, integrate systems, and govern administration — without standardising clinical care or culture.
6. How transformation realistically unfolds
Through a five-year, staged model — from escaping legacy systems, to integration, to institutional reform — grounded in what is already happening in practice.
7. What this looks like in real clinics
Case studies and KPIs demonstrate consistent outcomes: AMCA reduced below five minutes per completed appointment, improved margins, lower error rates, higher retention, and clinics that become scalable and sellable.
The core claim is simple:
Clinics that deliberately reduce AMCA and align systems around The One Best Way can fund better wages, retain talent, restore margins, and deliver better care — even as regulatory complexity and patient expectations increase.
If allied health acts now, it can become the national testbed for a more coherent, transparent, and humane model of healthcare administration — one that later extends to general practice, specialists, and hospitals.
If it does not, the sector will continue to exhaust its people while invisible systems quietly erode its economics.
The disruption is already underway.
The only remaining question is who chooses to lead it.
What This Paper Is - and What It Is Not
This paper is not an attack on government, regulators, financial institutions, or insurers.
It does not argue for deregulation, reduced oversight, or cost-cutting at the expense of care.
It argues for visibility, integration, and structural coherence.
The core issue facing allied health is not a lack of compassion, professionalism, or effort. It is the absence of systems that allow effort to translate reliably into outcomes — for patients, clinicians, clinics, and the institutions that support them.
Better systems do not weaken governance. They strengthen it.
They reduce ambiguity, improve compliance, and make accountability possible without burnout.
This paper exists to surface what has been invisible — so that responsibility can be shared, improvement can be measured, and reform can occur with clarity rather than blame.
3. UNDERSTANDING THE CRISIS AT HAND:
A HIERARCHY OF DISORDER
“We have a level of division inside allied health clinics that has persisted for decades—a hierarchy of disorder that leaves a few in power and the many powerless.”
Unlike many industries, healthcare cannot operate independently of government and institutional systems. At every level, clinics are bound to:
Medicare
DVA and veterans’ schemes
WorkCover and Comcare
NDIS and mental health plans
Private Health Insurance (PHI)
Banks and payment gateways
We do not simply interact with these systems — we absorb their complexity as overhead and operating expense (OPEX).
The result is a power imbalance: those who control data, rules, and payment rails shape the operating reality of every clinic, without ever seeing a waiting room.
Inside the average clinic, this imbalance shows up as:
Front desk staff re-keying item numbers and patient details into multiple portals
Claims bouncing or being rejected with opaque error codes
Payments delayed by weeks or months
Increasing administrative headcount just to keep up
Owners feeling compelled to hire more people instead of implementing better systems
As system complexity increases, so do Administrative Minutes per Completed Appointment (AMCA) — a metric that measures the total administrative time associated with each completed appointment (see AskLuci AMCA definition: https://www.askluci.io/administration-minutes-per-completed-appointment):
More minutes entering data
More minutes correcting errors
More minutes chasing missing payments
More minutes reconciling fragmented reports
This additional administrative load is ultimately paid for through:
Lower therapist wages
Increased reliance on additional admin staff
Reduced clinic profitability
Higher stress and burnout
Less time, attention, and care for patients
The Structural CAP
At the top of this hierarchy sits what I call THE CAP:
Government agencies and regulators
Private Health Insurers
Major banks and payment rails
Every additional form, opaque rule, and fragmented portal introduces friction that clinics must absorb as:
Higher AMCA
Higher Operating Expenses (OPEX)
Lower sustainable hourly rates for therapists
As complexity increases, viable clinic margins inevitably shrink.
“We need to demand more from the top, not settle for less.”
A functional system would ensure that:
Every health professional has equal opportunity to operate within the system and access core data
Operational clarity is not a privilege—it’s baseline infrastructure
Right now, that’s not our reality.
4. WHAT IT FEELS LIKE ON THE GROUND:
THE PAIN POINTS
Let’s name the pain as it actually shows up in clinics.
Administrative hires continue to outpace clinical roles. This pattern has been documented internationally for decades, most starkly in the United States, where administrative staffing growth has vastly exceeded clinical growth since the 1970s, without reducing documentation burden or burnout for clinicians.¹ While Australia and the United Kingdom have avoided the most extreme ratios, the underlying trend of rising administrative friction remains evident across all developed healthcare systems.
Clinic survival is increasingly threatened by operating expenses (OPEX), not just competition. Rising rent, wages, and software costs are compounded by bloated administrative workload that quietly expands year after year.
Most clinics remain stuck on legacy systems. Outdated practice management software, siloed CRMs, and manual spreadsheets make meaningful integration slow, fragile, or impossible.
The cost of “staying put” is hidden but enormous. Doing nothing feels safer, yet every month spent on outdated systems quietly erodes margins, morale, and momentum.
Practice managers and senior administrators often become single points of failure. When long-serving staff retire or move on, undocumented SOPs — the unwritten “how things really work” — leave with them.
Technology tools do not talk to each other. Payment terminals, PMS platforms, referral systems, and government portals exist as separate islands. Tools stack up, complexity rises, and Administrative Minutes per Completed Appointment (AMCA) increases.
Most clinics are not ready for AI or automation. They are buried under manual processes and poor-quality data. You cannot automate chaos — you can only accelerate it.
Deeply held financial beliefs undermine sustainability. Many health professionals were trained to “help, not profit.” That value is admirable, but when it prevents clinics from remaining viable, it harms staff, patients, and owners alike.
Advertising and marketing are constrained by regulation. Unlike other sectors, health businesses operate under tighter rules around testimonials, claims, and language. This limits differentiation and slows growth.
Weak business systems create passive clinics. Many rely almost entirely on referrals rather than building clear, intentional go-to-market strategies.
Owners are burning out. They carry financial risk, debt, and responsibility — often for low return on investment. That stress filters down into teams, increases wait times, reduces consult quality, and erodes public trust.
Beneath all of this lies a core reality:
Too much of every appointment is consumed by redundant administrative work — work that future modern systems can reduce or eliminate.
Clinics do not have a staffing problem.
They have an internal systems problem — one created and reinforced by institutional design.
5. STRUCTURAL READINESS:
WHO IS PREPARED FOR DISRUPTION?
Right now, allied health operates across three distinct structural positions.
1. Government / Private Health / Banks
Role:
Set the rules and enable the systems that govern healthcare delivery and payment.
Status:
Ready in theory to push digital change
Slow-moving in practice due to bureaucracy, risk aversion, and legacy infrastructure
Capable of change, but constrained by policy cycles and institutional inertia
2. Future‑Ready Clinics
Role:
Early adopters and emerging industry leaders.
Status:
Operating on modern, integrated technology stacks
Capable of rapid adoption of new digital rails, standards, and workflows
Positioned to scale, franchise, or expand to multi-site operations without losing operational control
3. Legacy‑Based Clinics
Role:
The majority of clinics operating today.
Status:
Dependent on outdated systems and manual processes
Carrying rising administrative load and operational fragility
Increasingly vulnerable to staff turnover, regulatory shifts, and margin compression
At high risk of irrelevance if structural change is delayed
The clinics that will survive — and thrive — are not the largest or the busiest.
They are the ones that act early to move out of the legacy tier and into structural readiness.
6. AMCA & THE THREE BOXES:
HOW THE SYSTEM CURRENTLY FAILS
Let’s visualise the current landscape of administrative burden across three structural “boxes.”
Administrative Minutes per Completed Appointment (AMCA) provides a practical way to understand how much invisible work is required to process care — from booking through to final payment and reconciliation.
Every complex system eventually discovers a constraint metric. In manufacturing, it was throughput. In logistics, it was dwell time. In allied health, it is administrative minutes per completed appointment.
Administrative Minutes per Completed Appointment (AMCA) is an original operational metric developed through applied practice. While no clinic can yet measure administrative effort with absolute precision, the goal of the framework — and of AskLuci — is to progressively improve data integration and system visibility until AMCA can be calculated with near-complete accuracy.
AMCA is not a measure of clinical quality, therapeutic outcomes, or human connection — nor should it be. Its role is narrower and more precise: to make visible the administrative effort required to deliver care. By isolating this variable, clinics can reduce waste, improve sustainability, and protect the time and attention that high-quality care actually depends on.
BOX 1 — The Legacy Small Business Systems
The Danger Zone
This includes allied health clinics operating on outdated practice management systems, manual forms, and fragmented software tools.
Administrative load is heavy. Processes are redundant, manual, and highly prone to human error.
Data is re-keyed multiple times across different portals and systems. There is no single source of truth, and reports frequently fail to reconcile.
Operational knowledge is often concentrated in one or two key administrative staff — “the person who knows how it works.”
Impact on AMCA:
AMCA per appointment is high and unpredictable
Each additional patient creates disproportionate administrative workload
Growth amplifies inefficiency rather than revenue
BOX 2 — Evolved Clinic System
The Transitional Zone
Clinics have moved to cloud-based systems and digital tools.
Workflows are partially standardised, with early automation in place. Systems are selected with future integration in mind rather than short-term fixes.
Teams are trained and using digital tools as part of everyday operations, not as workarounds.
Impact on AMCA:
AMCA becomes measurable and begins to decline
Performance improves, but ceilings remain
Clinics are structurally ready for deeper integration
BOX 3 — Evolved Government & Institutional
The Future Zone
Government and private health systems provide direct, end-to-end digital integration.
GP referrals, Medicare, DVA, NDIS, WorkCover, and mental health plans are digitally tracked from referral to reconciliation.
Clinics can submit, reconcile, and report with minimal manual handling. Banks and payment gateways support transparent, item-level tracking and reporting.
Impact on AMCA:
AMCA drops dramatically across the ecosystem
Manual rework is largely eliminated
Clinics focus on care delivery and strategic growth rather than firefighting administration
Today’s Reality
Most clinics are attempting to solve problems within Box 1 or Box 2, while operating inside a broader macro-system (Box 3) that remains fragmented, slow-moving, and under-integrated.
As a result, clinics absorb institutional inefficiency locally — through higher AMCA, higher operating expenses (OPEX), and increased burnout — rather than benefiting from system-wide optimisation.
Why this matters
AMCA makes invisible administrative effort visible. Once visible, it can be governed, reduced, and designed out of the system — rather than silently eroding margins, morale, and care quality.
7. TECHNOLOGY AS THE GREAT EQUALISER
The conversation around automation in healthcare is often framed in fear.
Will automation replace administrative jobs?
Will AI make clinicians obsolete?
That is not what plays out in real clinics.
Evidence consistently shows that automation reduces administrative burden rather than eliminating human roles. According to McKinsey (2023), automation has the potential to reduce administrative workload in healthcare by 30–40%, effectively reclaiming the equivalent capacity of one full-time clinician per small practice. In the clinics I have worked with, this impact shows up in practical, observable ways.
Automation does not replace human value — it replaces repetition.
It does not remove jobs — it removes the tasks that quietly exhaust people.
And it does not reduce care — it gives clinicians back the time and cognitive space that quality care depends on.
As systems begin to connect, the nature of work inside clinics changes. Billing, reporting, and compliance stop dominating the day. Front-desk roles shift away from constant data entry toward patient experience and coordination. Owners begin to see their businesses clearly — often for the first time — and in real time.
Technology, then, is not the villain.
It is the groundwork for a fairer, more sustainable industry.
The tools already exist. Integrated payment rails now span EFTPOS, private health insurance, Medicare, and online payments. Cloud-based practice management systems and CRMs are widely available. AI-assisted tools support triage, documentation, and pattern recognition. Digital forms and portals reduce paper handling and re-entry.
Structurally, clinics are ready to connect into future government and institutional systems.
What is missing is no longer the technology.
What is missing is alignment — a shared, deliberate way of using it.
8. A NEW FRAMEWORK:
THE ONE BEST WAY
— The future of allied health will not be rebuilt through competition between clinics—but through alignment across them.
The One Best Way is not a slogan.
It is a blueprint.
At its core, it recognises that many of the most critical processes inside clinics do not benefit from being reinvented repeatedly. There is one best way to book, confirm, and complete an appointment. One best way to handle Medicare claims and receipts. One best way to capture key clinical and financial data. And one best way to measure Administrative Minutes per Completed Appointment (AMCA) and accountability across teams.
This does not mean imposing a rigid script that strips clinics of individuality. It means establishing a shared operating system beneath the surface — one that reduces waste, increases clarity, protects margins, and enables scale without chaos.
In practice, The One Best Way creates consistency where it matters most, while still allowing clinics to express their values, culture, and clinical philosophy where it actually counts.
The Three Pillars of The One Best Way
At the centre of The One Best Way are three pillars: operational clarity, financial transparency, and cultural alignment. Together, they form a shared operating system that allows clinics to scale without losing control — or compassion.
1. Operational Clarity - Automate and measure every key process.
Operational clarity starts with the recognition that every key process inside a clinic should be both automated and measurable. Booking, billing, claims, and follow-up work best when they are defined end-to-end, rather than handled ad hoc.
Digital tools are used deliberately to remove manual duplication, and Admin Minutes per Completed Appointment (AMCA) is tracked for each critical workflow and reduced over time, intentionally rather than accidentally.
2. Financial Transparency - Track every dollar in real time.
Financial transparency follows naturally when bookings, invoices, payments, and remittances are connected into a single visibility layer. Owners can see what is happening as it happens.
Questions such as What did we bill today? What was collected? What’s outstanding — and why? stop being mysteries answered days or weeks later. Financial understanding no longer depends on one person who “knows how things work,” and single points of failure are removed from the system entirely.
3. Cultural Alignment - Empower every team through open governance and shared accountability.
Cultural alignment is what turns structure into trust. Open governance and shared accountability empower teams rather than constrain them.
Incentives are aligned across owners, managers, therapists, and administrative staff. Performance is made visible through transparent dashboards rather than private spreadsheets. Success is measured in ways that feel fair, collective, and anchored to shared goals.
Cultural alignment is what turns structure into trust. Open governance and shared accountability empower teams rather than constrain them.
Incentives are aligned across owners, managers, therapists, and administrative staff. Performance is made visible through transparent dashboards rather than private spreadsheets. Success is measured in ways that feel fair, collective, and anchored to shared goals.
“Leadership will belong to those who can standardise excellence without standardising compassion.”
The One Best Way is not about turning clinics into machines.
It is about giving humans the structural support they have never had.
When systems are integrated and guesswork gives way to governance, profit and purpose are no longer in tension — they begin to converge.
9. THE SEASONS OF TRANSFORMATION:
A FIVE YEAR VIEW
A realistic view of how change unfolds across allied health over the next five years.
Transformation in allied health will not happen all at once. It will unfold in stages, as clinics, systems, and institutions move at different speeds. What follows is a pragmatic view of how this change is likely to occur over time.
Season One — Escape Legacy
Goal: Move clinics off legacy systems and into the cloud.
Season One is about getting clinics out of survival mode. Many remain constrained by outdated, on-premise systems that fragment data, slow teams down, and trap critical operational knowledge in individuals rather than systems.
Key changes:
Clinics replace legacy practice management software with modern, cloud-based platforms. Core processes — scheduling, billing, and clinical notes — are standardised. Clear, accessible SOPs are documented so knowledge is no longer tribal or dependent on a single person. Digital literacy becomes embedded into onboarding and role expectations, creating consistency as teams evolve.
Result:
Clinics stop reacting to demand and begin regaining the ability to direct operations deliberately.
Season Two — Build a Proactive Commercial Engine
Goal · Align services, pricing, payments, and marketing to reality
Once clinics are operationally stable, the next constraint is commercial misalignment. Many offerings, pricing models, and marketing approaches no longer reflect how patients actually decide, book, and commit to care.
Key changes:
Clinics redesign service offerings around real patient decision-making. Pricing, packages, memberships, and rebates are communicated in clear, plain language. Systems connect marketing directly to bookings and payments, replacing disconnected funnels with measurable pathways. Clinics shift from passive reliance on referrals toward intentional, repeatable go-to-market strategies.
Result:
Clinics move from waiting for demand to actively creating and directing it.
Season Three — Integration & The One Best Way
Goal · Achieve deep integration across payments, PHI, and practice systems
Season Three is where systems stop co-existing and begin operating as one.
Key changes:
The focus shifts from individual tools to true integration across practice management systems, payment rails, banking, and accounting platforms. Administrative effort is treated as a measurable variable — tracked through Administrative Minutes per Completed Appointment (AMCA) — and deliberately reduced by removing non-value-adding work.
Clinics adopt a unified One Best Way playbook governing operations and finance. Processes are standardised end-to-end. Patients access their data digitally through portals. Paper is eliminated wherever regulation allows. The organisation moves from patchwork workflows to a shared operating system that is visible, repeatable, and auditable.
Result:
AMCA drops below five minutes per completed appointment. Clinics are no longer constrained by internal chaos, but only by genuine external system limits.
This is where AskLuci operates today — linking operational, financial, and governance layers into a single, coherent, and scalable system.
Season Four — Government Sandbox: Allied Health as Testbed
Goal · Trial a universal, semantic digital system at the institutional level—starting with allied health
Why allied health:
Allied health is well-suited as a proving ground for large-scale digital reform. Errors, while inconvenient, are rarely life-threatening. The ecosystem is diverse enough to stress-test systems. And administrative burden is high enough that improvements are measurable and meaningful, while risks remain manageable.
What is trialled:
A universal semantic digital categorisation for allied health services is developed and trialled, creating a shared language for services, funding, referrals, and payments.
This framework is applied across major pathways including Medicare, GP referrals, DVA, mental health care plans, WorkCover and Comcare, and the NDIS.
What is tracked:
Core operational flows are tracked digitally end-to-end — including referrals, allocation, rebates, digital payments, EFTPOS transactions, and PHI claims. The emphasis is on consistency, ensuring the same data carries the same meaning across systems.
Institutional integration:
Integration extends into banking and private health systems, enabling transparent rebate tracking, accurate allocation of digital payments, and auditable claims processing across clinical, financial, and regulatory layers.
Result:
Proof that a unified digital framework can simultaneously reduce AMCA, improve financial transparency, and strengthen government oversight — without compromising patient outcomes.
Season Five — Sector-Wide Rollout
Goal · Extend the proven framework beyond allied health
Once validated, the framework expands to general practice, specialists, and eventually hospitals — not as a replacement for clinical care, but as a way to make administration coherent and interoperable across the health system.
System effect:
As systems align, communication improves and patient information flows cleanly between providers. Decisions by clinicians, administrators, and patients are informed by clear, shared data rather than fragmented records.
Intent:
This is not transformation for its own sake. The intent is practical: reduce friction between institutions, simplify how information moves, and make it easier for patients to understand and participate in their care.
Result:
Administrative workload falls across the system. Operating costs decline as duplication is removed. Most importantly, clinicians and patients gain back time — time that can be spent on care rather than navigating systems never designed to work together.
10. THE FUTURE STATE:
A UNIVERSAL SEMANTIC SYSTEM
Picture this.
No paper.
Minimal note-taking.
A shared, universal semantic digital categorisation for allied health services.
Patient portals that integrate cleanly with government and small-business systems.
Not as a future ideal — but as a baseline for how care is delivered.
In the future:
Patients can see their plans, entitlements, and usage across Medicare, private health insurance, and other funding schemes in one place.
Clinicians document care within a structured, interoperable framework — reducing duplication while improving data quality.
Clinics no longer need to interpret dozens of slightly different versions of the same rules across multiple systems.
Government gains clearer visibility into spending, utilisation, and outcomes, with significantly less administrative friction.
The clinic becomes something different.
Not a silo drowning in administrative chaos, but a node in a connected health network — interoperable, auditable, and transparent.
This is not a distant fantasy.
It is the logical next step once we agree to standardise how work is structured, not how care is delivered.
11. WHAT THIS LOOKS LIKE IN PRACTICE:
REAL WORLD CASE STUDIES & KPIs
— This isn’t theory developed in isolation. It reflects what happens when clinics apply The One Best Way in real operating environments.
Case Study 1 — PhysioCall: From Fragmented Admin to High-Performance Team
PhysioCall is where many of these ideas were first pressure-tested.
When we examined front-desk operations honestly, the issue was not capability — it was structure. Administrative staff were not ineffective; they were confined to narrow roles focused on answering calls, processing payments, and ticking boxes. At the same time, clinicians were carrying avoidable administrative load that diluted their clinical focus.
A small number of deliberate decisions changed that dynamic.
What changed
Administrative roles were redesigned to support the full patient journey, not isolated tasks.
Therapists were enabled to manage rebooking and payments at the point of care.
Administrative KPIs were aligned to outcomes — including rebooking rates, Patient Visit Average (PVA), and collections — rather than activity alone.
Every administrative process was mapped end-to-end and simplified.
Redundant steps were removed and core workflows automated.
Bookings, payments, and records were integrated into a single operational flow.
Clinician workflows were rebuilt around a unified patient journey, from first contact through to reporting.
What happened
Within months:
AMCA dropped below five minutes per completed appointment.
Clinic margins stabilised and consistently improved.
PVA increased as patients committed more fully to structured care plans.
Lifetime Value (LTV) rose as engagement deepened.
Clinician utilisation improved as time shifted toward high-value activity.
Customer acquisition costs fell as systems aligned with real patient behaviour.
Most importantly, the invisible boundary between “admin” and “clinical” work dissolved. The clinic stopped running on personalities and workarounds and began operating on systems.
Case Study 2 — Clinics Adopting The One Best Way
Across other clinics implementing the same framework, similar patterns emerged.
What managers reported
Regaining evenings and weekends previously lost to reconciliation and spreadsheet updates.
Increased visibility into issues previously masked by informal processes.
Faster identification of performance gaps once dashboards replaced anecdotes.
For owners, the shift was more confronting — and more valuable.
What changed
Numbers replaced narratives.
Weekly scorecards replaced reactive decision-making.
Accountability shifted from individuals to systems.
Practice managers operated against defined standards rather than improvisation.
Owners moved from firefighting to governance.
What showed up in the data
Higher collection rates.
Fewer write-offs and unclaimed rebates.
Double-digit margin improvements over time.
Consistent reductions in AMCA and staff stress.
Clinics that became scalable — and, critically, sellable.
The Pattern
The pattern is consistent across settings.
When clinics install The One Best Way, they do not merely improve efficiency — they remove ambiguity. Weak leadership becomes visible. Strong systems compound. Performance stops being accidental.
That clarity is not always comfortable. But it is necessary.
The message is simple:
The One Best Way does not impose control — it reveals reality.
And once reality is visible, clinics can finally improve it.
12. THE HUMAN IMPACT:
MORE TIME BEING HUMAN
After all the discussion about systems, AMCA, and KPIs, it is worth asking a simpler question:
What does this actually change for real people?
When structure improves, the human experience changes with it.
For clinic owners:
Less time firefighting. More time setting direction. A business that can operate without constant manual intervention — and confidence that the numbers reflect reality, not guesswork.
For practice managers and administrators:
Fewer repetitive, draining tasks. Clear expectations. Work that feels meaningful, visible, and fairly accountable.
For therapists:
Fewer unpaid administrative hours outside clinic time. Greater presence in sessions. A professional environment that supports care instead of quietly burning people out.
For patients:
Fewer surprises and less confusion. Easier access to information, plans, and entitlements. A sense that the clinic is navigating the system with them — not pushing the burden onto them.
For government and institutions:
Clearer visibility into where money is going. Less leakage and duplication. Data that can genuinely inform policy, rather than lag behind reality.
Across all of it, the same outcome emerges:
More time being human.
Less time processing systems.
More time connecting with people.
Less bureaucratic friction.
More genuine care.
13. THE LEADERSHIP IMPERATIVE:
WHAT OWNERS MUST DO NOW
This paper is not meant to be comfortable.
If reading it makes you feel exposed, that is intentional.
Because if your clinic:
Relies on one or two key administrators to “keep the wheels on”
Lacks a clear, real-time view of financial performance
Remains dependent on paper, manual forms, and double-entry
Operates in fear of key people leaving
Cannot clearly state break-even, AMCA, outstanding invoices, net profit, cost per acquisition, or team utilisation
Then the risk is not coming.
It is already here.
Disruption is not a future event — it is embedded in day-to-day operations.
Your Next Steps as a Leader
1. Audit your AMCA
Map the true Administrative Minutes per Completed Appointment. Be honest. Include follow-ups, error correction, reconciliation, and rework. What is not measured cannot be reduced.
2. Classify your clinic realistically
Identify where you actually sit — by box and by season — not where you wish you were. Are you in Season One, Two, or approaching Three? Clarity always beats optimism.
3. Break dependency on individuals
Document key processes. Move away from “ask Sarah, she knows how to do that.” Shift practice management from control to governance.
4. Commit to The One Best Way
Stop allowing each clinician and administrative function to run its own micro-system. Choose standard operating procedures — and use them consistently.
5. Invest in systems, not band-aids
Replace fragmented tools and outdated platforms. Integrate payments, claims, and reporting so information flows end-to-end.
6. Prepare for future integration rails
Choose platforms that can connect to banks, private health insurers, and government systems. Do not lock your clinic into software that cannot evolve.
This work will feel confronting.
Some people on your team may resist.
Some may even need to leave.
But the cost of avoiding this work is far higher:
Ongoing burnout
Financial fragility
Missed opportunities as the broader economy modernises
Leadership now is not about comfort.
It is about choosing structure early — before chaos chooses for you.
14. FINAL MESSAGE:
LEADING THE TRANSFORMATION
“Disruption isn’t coming — it’s already here.
The only question left is who will lead it.”
When I began my career, I believed what many in healthcare still believe today:
that compassion alone could carry the system forward.
Now I know this isn’t true.
Compassion, without systems, breaks people.
We’ve built an industry on good hearts and heroic effort.
We’ve kept it running with unpaid overtime, emotional resilience, and quiet sacrifice.
We normalised chaos and called it “busy.”
That era is over.
Today, we have what we didn’t before:
• The technology to integrate and automate
• The economics that increasingly demand we do so
• And the opportunity — if we choose it — to rebuild from within
Not by tearing the system down, but by reforming it around clarity, transparency, and trust.
Allied health is not the endpoint of this transformation — it is the proving ground.
By 2030, the clinics that once struggled under inefficiency will be the ones leading the sector — not because they worked harder, but because they worked differently:
• Through automation
• Through open governance
• Through aligned teams
• Through a shared One Best Way
AskLuci is already proving what’s possible:
• Reducing AMCA to under five minutes
• Restoring clinic profit margins
• Giving clinicians back the time and energy to focus on real care
The leaders who step into this now won’t just survive disruption.
They’ll define what comes next.
Disruption has already begun.
Leadership starts now.
— Joshua Iaquinto
Founder & Director, AskLuci.io & PhysioCall.com.au
15. FROM PRACTICE, NOT THEORY
The principles outlined in this paper are not theoretical.
They are drawn from direct implementation across clinics of different sizes, locations, and funding mixes — and refined through real operational use.
Across these environments, consistent patterns emerged.
Observed patterns include:
Structural issues repeatedly presenting as “people problems”
Administrative effort increasing faster than clinical capacity
Financial uncertainty driven by fragmentation rather than volume
Burnout caused by invisible work, not workload alone
When these issues were addressed systemically, the same interventions produced measurable outcomes.
Observed outcomes include:
Reduced Administrative Minutes per Completed Appointment (AMCA)
Improved operating margins and cash flow predictability
Lower error rates across billing, claims, and reconciliation
Higher staff retention and engagement
Clearer visibility for owners, managers, and funders
CORE METRICS USED IN PRACTICE
Clinics adopting a shared One Best Way do not track everything.
They track what matters.
Primary indicators
AMCA (Administrative Minutes per Completed Appointment)
Operating margin (per site)
Patient Visit Average (PVA)
Utilisation rate (clinician hours booked vs available)
Lifetime Value per patient (LTV)
Customer Acquisition Cost (CAC)
Supporting indicators
Claim rejection rate
Time to payment (service → cash)
Outstanding invoice totals
No-show and cancellation rates
Staff retention and engagement
They measures are used to make reality visible — so improvement becomes possible.
16. REFERENCES
Australian Institute of Health and Welfare (AIHW). (2023). Health Workforce Data Series: Allied Health in Australia 2023. Canberra: AIHW.
AskLuci.io. (2024). Administration Minutes per Completed Appointment (AMCA): Measuring Administrative Load in Allied Health Clinics. Retrieved from https://www.askluci.io/administration-minutes-per-completed-appointment
Harvard University Press. (2019). Administrative Growth and Clinical Productivity in Advanced Healthcare Economies, 1990–2019. Cambridge, MA: Harvard University Press.
McKinsey Global Institute. (2023). The Productivity Potential of Automation in Healthcare: Reclaiming Clinical Time. New York: McKinsey & Company.
Nous Group. (2025). Physiotherapy Sustainable Rate Report. Melbourne: Nous Group.
Organisation for Economic Co-operation and Development (OECD). (2024). Health at a Glance 2024: OECD Indicators. Paris: OECD.
17. INVITATION FOR INSTITUTIONAL AND INDUSTRY COLLABORATION
If you are from the Australian Government — particularly departments responsible for healthcare policy, digital health, payments, or technology infrastructure — this paper is intended as a constructive contribution to the national conversation.
The same invitation extends to organisations that sit at critical points in the healthcare and payments ecosystem, including:
Banks and financial institutions supporting healthcare businesses (e.g. NAB Health, Commonwealth Bank)
Healthcare payment and claiming platforms (e.g. HICAPS, Tyro Health)
Private Health Insurance organisations operating in Australia
Technology providers building infrastructure for clinical, financial, and administrative workflows
The frameworks described in this paper are not speculative. They are grounded in real operational environments, informed by lived experience inside allied health clinics, and tested against measurable outcomes.
Allied health represents a uniquely suitable proving ground for system-level reform: complex enough to reveal inefficiencies, regulated enough to matter, and contained enough to innovate safely.
If your organisation is involved in:
enabling or governing healthcare payments and claiming
designing digital health or financial infrastructure
reducing administrative burden and reconciliation friction
improving transparency, compliance, and system interoperability
or exploring scalable, human-centred technology adoption
this paper is an open invitation for engagement.
The intention is not to criticise existing institutions or platforms, but to support them — by making invisible work visible, aligning incentives across systems, and identifying practical, collaborative pathways to reduce administrative effort while strengthening governance.
Engagement may take the form of exploratory discussions, shared research, pilot programs, or structured collaboration.
For discussion, collaboration, or institutional engagement, please contact:
Our Thingking