Your revenue per visit is set by a fee schedule or an insurer. Your cost per visit is not. When inputs move and fees do not, the entire increase lands on the clinic.
In force since 8 September · what hit clinics
- Plastics articles — 50% — a great deal of single-use clinical consumable
- Electronics — diagnostic, imaging, monitoring, therapy devices
- Appliances — refrigeration, sterilizers, lab units
- Pulp and paper — drapes, couch roll, packaging
- Furniture — treatment and waiting room fit-out
There is no general medical exemption in either measure. The US carve-outs are energy, potash, fish, critical minerals and Section 232 goods, and nothing else. This is being charged on your orders now, not something arriving later in the year.
What we do about it: we work out where your supply list is exposed, build you a private AI knowledge base on your own distributor and service data, and scope what to build next. The review also covers who else in the world would buy what your clinic knows how to do. See what you receive →
What this actually does to a clinic
Talks between Ottawa and Washington have broken down, so plan on this lasting rather than lifting.
- Consumables creep past you. Gloves, gowns, syringes, dressings and single-use plastics rise a few percent each. Individually negligible, collectively enough to erase the margin on your highest-volume appointments.
- Capital gets deferred. Imaging, laser and diagnostic equipment becomes materially more expensive, pushing purchases out and limiting the services you can offer.
- The fee schedule does not care. Publicly funded and insurer-set fees do not adjust for input inflation on any relevant timeline, so the gap has to be closed operationally.
Three things to do this week
- Cost your top ten appointment types at current consumable prices. Most clinics have never done this, and are surprised by which visits are actually unprofitable.
- Ask your distributor for origin and equivalents on your top twenty items. Clinically equivalent alternatives at lower landed cost frequently exist and are almost never offered unprompted.
- Review private-pay and package pricing. Where you set your own prices, that is the lever you control — and multi-session packages priced pre-tariff are the first place money leaks.
What it looks like in practice
Worked example · a two-site physiotherapy and rehabilitation clinic
Six therapists and four support staff across two locations, about 11,000 visits a year, a standard session at $95. Roughly 60% of billing goes through insurers and public plans at set rates; the other 40% is private pay. No revenue comes from the United States and none ever will, because you cannot put a treatment in a box.
The textiles are the biggest mover, and nobody calls them medical supplies. Clothing, textiles and protective garments are at 50%, which is gowns, strapping, bracing sleeves and laundry stock. At 11,000 visits that is a per-visit number, not a supply-cupboard number.
Ask for the entry date before you pay the increase. Goods already in transit on 8 September were not caught. A distributor that raised its whole catalogue on one date was also charging more for stock that had landed in August. The washroom line moved too: toilet paper and facial tissue at 25%.
Two worries to drop, one we could not settle. Section 338 taxes Canadian goods entering the US; this clinic ships nothing, so none of its 554 subheadings apply. Remission covers inputs that cannot be sourced outside the US, and gloves and couch roll can. The therapy units we could not price, because the distributor will not state origin.
Then the other half. A clinic cannot export care, and we are not going to pretend otherwise. What can leave the country is what the clinic has already written down: the return-to-work protocol, the therapist training, and the intake and exercise-prescription tool built in-house — software and services cross borders with no freight, no duty and no customs paperwork, and CETA opens EU public procurement worth about $3.3 trillion a year with health systems inside it. That is a two-year build, not a fix for this year’s glove invoice, and it should be planned as one.
What we would build:
- A per-visit cost model tying each appointment type to its actual consumable list at today’s prices, so the sessions that have gone negative are visible by name.
- A reorder screen showing origin and two clinically equivalent alternatives beside every item before the order is confirmed, because textiles at 50% are where substitution pays best.
- An invoice check that flags blanket distributor increases and asks for the entry date, so stock that cleared before 8 September is not paid at the new price.
- A private-pay package re-pricer that rebuilds multi-session pricing from live delivery cost, since that is the only price the clinic actually sets.
None of it moves the fee schedule. It stops the clinic losing money it never decided to lose.
What you receive
Six things, built for your clinic, starting within 48 hours of checkout.
The core is a written review: deep research across your supplies, equipment and sector, with a human checking every finding against the actual schedules and discarding what is wrong. You also get a private AI knowledge base trained on your website, distributor price lists, supply catalogues and service menu — yours to keep, and able to answer “what does a standard consult actually cost us now?” with a source you can check. Running through both is a scoped plan of what we would build, with real hour estimates.
Alongside those: a slide deck for the partners, a one-page infographic, and video and audio overviews.
See a complete worked example →
What we would build for your clinic
- A per-appointment margin calculator tying each service to its real consumable and staff cost, flagging what has gone negative.
- A supply and reorder dashboard that surfaces equivalent products at lower cost before the order is placed.
- An equipment lifecycle planner modelling replacement timing against rising acquisition costs.
- A private-pay pricing tool keeping packages aligned with actual delivery cost as inputs move.
And beyond tariffs: the booking, intake or records system you have been putting off. See our case studies.
And the other half — who else would buy this?
You cannot put a consultation in a container, so a clinic is not an exporter in the ordinary sense and we will not pretend otherwise. What does cross a border is everything built around the care — the protocols and training material another country’s clinics would pay to licence, the intake or scheduling tool you had written for yourselves and could sell to fifty clinics like you, and the patients who already travel for treatment and are choosing between Vancouver, Bangkok and Warsaw — and software and services move with no freight, no duty and no customs paperwork at all.
CETA opens EU public procurement worth about $3.3 trillion a year, health systems included.
Japan
An ageing population, and services and software that arrive with no duty at all.
Australia & NZ
Same language and much the same clinical vocabulary, so training and software need no translation.
Getting found
How an overseas patient or a licensing clinic finds you in the first place.
Two things worth knowing
There is money for this
Ottawa has $7.5 billion behind tariff-hit businesses, including non-repayable contributions up to $3 million and BDC working capital from $250,000. The full list →
Support for keeping staff
The Workforce Retention and Retraining Program covers training costs up to $1,000 per participant and consolidates work-sharing. Worth reading before any staffing decision.
Questions we get asked
Are medical devices exempt on humanitarian grounds?
No. The exclusions are energy, potash, fish, critical minerals and goods already under Section 232 measures. There is no general medical exemption. Whether a specific device is captured depends on its classification, which your supplier or a licensed customs broker can confirm.
We are publicly funded. Can we raise fees?
Generally not on any useful timeline, which is precisely why the response has to be operational — procurement, substitution and utilization — rather than pricing.
Should we buy equipment now or wait?
If the purchase is budgeted and clinically needed, moving earlier can beat further increases. If it needs new financing, borrowing cost may exceed the saving. Model it against your actual replacement schedule.
Do I have to hire you for software afterwards?
No. The plan is written to be useful whether or not you ever work with us.
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Related
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- The full rules, in plain English
- Where else in the world would buy this?
The worked example above is an illustration, not a client, and every tariff fact in it is real. Operational and strategic guidance from a software studio, not legal, customs, medical, or tax advice. Confirm classification and duty liability with a licensed customs broker. Last reviewed 11 September 2026.