The Southwest Grew Its ATC. So Why Is Revenue Struggling?
When Strong Numbers Aren’t Enough
If you looked only at Average Transaction Charge, the Southwest had a solid 2025. ATC growth of 8.2%, the second highest of any region in the country. Practices were charging more per visit, delivering higher-value care, running a tighter clinical operation.
And yet the Southwest posted the slowest revenue growth of any region. Just 1.5%.
How does that happen?
Volume Is the Variable Nobody’s Watching Closely Enough
New client acquisition in the Southwest fell 10.5% year over year; roughly double the national average. Transaction volume dropped 6.2%, the steepest decline in the country.
Even strong ATC can’t compensate for a client base that’s shrinking that fast. The math simply doesn’t work. Every dollar of per-visit improvement is offset by fewer visits to multiply it against.
ATC Is Not a Strategy. It’s a Metric.
This is a pattern worth paying attention to beyond the Southwest. ATC growth is valuable when it reflects more comprehensive care delivery. But when it becomes the primary lever for revenue growth while volume quietly erodes, it masks a problem that’s getting harder to solve over time.
Bringing in new clients costs more than retaining existing ones. Winning back a lapsed client is easier than finding a new one. But neither happens without intention, without marketing that reaches the right people, systems that track who’s overdue, and a client experience worth returning to.
The Question for Every Region
What does your new client trend look like over the last 12 months? And more importantly, do you know why it looks that way?