Running the clinic
Cost & feasibility
The capital is large and one-off. The operating cost is what eats first-year budgets — service contracts, consumables, and the half-FTE you forgot to count.
A starter vertigo clinic embedded in an ENT or neurology department typically needs moderate capital (one room, a booth, a Frenzel system) and half-time staff on top of an existing service. A standalone build with VNG, vHIT and VEMP needs an order of magnitude more.
Whichever scale, the rule of thumb is the same: capital is a one-off, operating cost is forever. Plan for at least two years of operating cost before the clinic is expected to break even.
Demand is not a constraint — vertigo is common (≈30% lifetime prevalence; ~35% of US adults over 40 have measurable vestibular dysfunction).1,2 The real constraint is conversion: how many patients with dizziness actually reach the clinic. The business case lives or dies on the referral pathway from primary care, ED and stroke teams.
The financial story is also a clinical story. Structured vertigo services reduce unnecessary imaging, ED revisits and inpatient stays.3 Frame the business case in terms of system-level savings — not just departmental revenue — and the conversation with administrators gets easier.
Three quiet budget killers: service contracts (8–12% of capital cost per year, so easy to under-budget), year-2 staff growth (the audiologist gets busier than expected; the physio waiting list needs a half-FTE), and under-coding (procedures performed without the right tariff code leak revenue silently for months).
Three quiet revenue uplifts: same-visit diagnosis (fewer return visits per case), group rehab classes (CPG-grade evidence, lower per-patient cost than 1:1), and downstream procedures(intratympanic injections, surgical referrals from a service the surgeons trust).
Cost breakdown
Bands rather than absolute figures — costs vary too much across jurisdictions for a single number to be useful. Hover a segment for the underlying assumption.
Percentages are illustrative bands derived from published service-setup reports and are not prescriptions; actual costs vary by jurisdiction, procurement scale and host-institution shared-services arrangements.
Feasibility checklist
- Catchment: ≥3,000 ENT and ≥2,000 neurology referrals/year in the host catchment makes a standalone clinic viable.
- Payer mix: Identify dominant payers (public, private, out-of-pocket); model two scenarios for first-year volume.
- Procurement scale: Bundle VNG + vHIT + VEMP with one vendor for a service-contract discount and a single integration story.
- Host-institution shared services: Reception, rent, utilities and IT often shared at modest internal-transfer cost — capture these in the business case.
- Reserve: 10% capital contingency and 20% year-1 OpEx contingency are reasonable starting positions.