In-house or outsourced: what it actually costs.
Most comparisons put a salary next to a monthly fee and stop. This one includes payroll burden, vacancy, ramp and recruiting — the costs that are real, recurring, and almost never in the spreadsheet.
Your in-house cost
Turnover — the part usually left out
The alternative
Annual comparison
Outsourcing costs less by
$77,731
Turnover alone — vacancy, ramp and recruiting — accounts for 9% of your in-house cost. That is the number practices leave out.
About this comparison
Why does this include turnover?
Because leaving it out is the single biggest reason the comparison usually comes out wrong. Front-office turnover is high across the industry, and every departure creates a gap where calls go unanswered, verification slips and A/R ages — then you pay recruitment and ramp costs again. It is a real recurring cost, not an edge case.
Can this conclude that in-house is cheaper?
Yes, and on plenty of realistic inputs it does. A calculator built by a vendor that always favours the vendor is a sales device. If your turnover is genuinely low and your team is stable, keeping it in-house may well be the right answer — and you should have that answer rather than a rigged one.
What isn't captured here?
Revenue effects. A front desk that answers more calls books more patients, and recovered A/R is money you already earned. Those move the picture further than cost alone, but they depend on your specific conversion rate and payer mix, so putting invented numbers in would be worse than leaving them out.
What should we do with the result?
Use it to decide whether to have the conversation at all. If the gap is small, stay in-house and fix retention. If it is large, the next step is scoping one workstream rather than switching everything.