Cash-based healthcare practices have seen an exponential growth of over 1000% in the past 6 years in the United States.
From concierge medicine and direct primary care, to cash-based physical therapy, mental health, and specialty clinics, more providers are choosing to step away from insurance-driven models in favor of transparency, flexibility, and deeper patient relationships.
Unfortunately, most cash-based practice founders quickly learn that very few software solutions were designed with their needs in mind. As a result, they often find themselves frustrated by big or bulky Electronic Health Record (EHR) or Electronic Medical Record (EMR) software that simply does not meet their needs.
“We were using only 20% of the functionality of our EHR because it was so difficult to use,” said Jody Layne, Chief Operating Officer of Florida Center for Hormones and Wellness. “We were looking for a company who would innovate with us.”
The right system supports growth, automation, and patient satisfaction. The wrong one introduces friction, inefficiencies, and limitations that can stall your growth.
In this guide, we’ll explore what truly matters when choosing an EMR for a cash-based practice, review some of the leading platforms on the market, and explain why Cerbo continues to stand out as a preferred solution for practices that want flexibility without compromise.
Cerbo is widely recognized as a flexible, clinician-friendly platform that aligns naturally with the needs of cash-based and concierge practices.
Cerbo offers customizable charting, a modern patient portal, integrated medical billing tools, and flexible workflows that support non-insurance care models. The platform is designed to adapt to how providers actually practice, rather than forcing standardized insurance-driven processes.
Its patient portal supports secure messaging, appointment management, document sharing, and lab result access. Cerbo also integrates with a wide range of labs and third-party tools, making it suitable for wellness-focused and specialty practices.
“I came from the hospital world and had used multiple EHRs. I knew how important it was to have ePrescribe functionality, a patient portal, fax line, the ability for patients to add their credit cards, patient charts, integrated billing, and telemedicine features. Cerbo has it all,” said Dr. Andrea Wadley from 127 Pediatrics.
“Cerbo has worked very well for me and my patients,” says Dr. Wadley.
SmartClinix is positioned as an EMR solution for independent practices, including some cash-based providers.
The platform includes scheduling, billing, charting, and reporting tools. It also offers telehealth capabilities and basic patient engagement features.
Kareo has long been associated with small to mid-sized medical practices and insurance-based billing.
Kareo includes practice management, EHR, billing services, and patient communication tools. It is often used by practices transitioning away from traditional insurance models.
NextGen Healthcare is a large, enterprise-grade platform commonly used by multi-provider practices and health systems.
The platform offers comprehensive EHR and practice management functionality, advanced reporting, and population health tools.
DrChrono is a cloud-based EMR known for its clean interface and mobile-friendly design.
DrChrono provides scheduling, charting, billing, telehealth, and patient portal capabilities, with a strong emphasis on usability.
Athenahealth is a widely used platform known for its revenue cycle management and payer connectivity.
The system includes EHR, practice management, patient engagement, and billing services with a strong insurance focus.
Spry positions itself as a modern EMR solution, particularly within physical therapy and wellness spaces.
Spry offers cloud-based scheduling, documentation, billing, and patient engagement tools, with a modern interface and growing feature set.
Cash-based practices allow clinicians to:
Patients benefit from predictable costs, faster access, and a more personalized experience. However, while the business model may be simpler on the surface, cash-based practices face a unique set of operational challenges that make technology selection critically important.
Unlike insurance-heavy practices, cash-based providers rely on seamless patient experiences, efficient workflows, and clear financial reporting to remain profitable and scalable. This is where choosing the best EMR for a cash-based practice becomes a make-or-break decision.
Not all EMRs are built with your workflows in mind. Many legacy platforms were designed primarily for insurance billing, claims management, and large health systems. Cash-based practices require something different, software that enhances patient experience while supporting streamlined operations.
Here are the most important criteria to consider when evaluating the best EMR for cash-based practice success.
A strong patient portal is essential. Patients expect convenience, transparency, and digital-first interactions. The portal should allow patients to complete intake forms, schedule appointments, communicate securely with providers, access lab results, and manage payment processing without unnecessary friction.
For cash-based practices, the patient portal often becomes the primary touchpoint between visits. A poorly designed portal can undermine an otherwise excellent clinical experience.
Efficient charting tools save time and reduce burnout. Cash-based providers often offer longer visits, personalized treatment plans, and ongoing patient care relationships. Charting should be customizable, intuitive, and fast, allowing providers to document care without rigid templates designed for insurance coding.
The best EMRs allow clinicians to chart the way they practice, not force them into predefined workflows.
“Cerbo is amazing. It decreased my charting time by 50%," said Dr. Jamie Kyei-Frimpong, DNP, FNP-BC, IFMCP
“I have really enjoyed using Cerbo, particularly the ChartParts. It is so easy to write notes, leverage the patient portal and the ease of integration with other products I use. I highly recommend Cerbo.”
Lab integration is another critical component. Cash-based practices frequently order specialty labs, wellness panels, and diagnostic tests outside of traditional insurance networks. An ideal EMR supports flexible lab ordering, result tracking, and patient-facing lab access without excessive administrative steps.
No EMR operates in isolation. Integrations with payment processors, telehealth platforms, labs, and third-party tools help practices create a cohesive ecosystem. Cash-based practices especially benefit from seamless payment and scheduling integrations that reduce manual work.
Many cash-based practices start small but grow quickly. Whether expanding services, adding providers, or opening new locations, the EMR should scale without forcing a platform change. Scalability ensures that the software grows alongside the practice.
Clear, actionable reporting supports smarter business decisions. Cash-based practices rely heavily on financial visibility, patient engagement metrics, and operational insights. Robust reporting tools help owners understand revenue trends, visit utilization, and growth opportunities.
“We very quickly realized we needed a better platform because we were trying to build something that was going to be longer lasting,” said Dr. Jeff Hunter of Upstream Functional Medicine.
“We want to be able to pull data and just do it correctly.”
Choosing the best EMR for cash-based practice success isn’t about finding the most features. It’s about finding the right fit. Cash-based practices thrive on flexibility, efficiency, and patient-centered care.
While many platforms can accommodate cash-based workflows to some degree, Cerbo consistently stands apart. Its customizable architecture, clinician-first design, and deep support for non-insurance models make it a natural choice for practices that want control, scalability, and a better patient experience.
For providers committed to building a sustainable, patient-focused cash-based practice, Cerbo offers a balance of power and simplicity that few platforms can match. At the same time, Cerbo was named the 2025 Battle of the EHRs Champion by My DPC Story, based on a survey of almost 300 people in the DPC space, including physicians and clinic teams.
“There has not been a time I have wished I had picked a different EHR. I tell my colleagues to look at Cerbo because the product works great and they have excellent customer service. I have been very happy with Cerbo.” - Dr. Shauna Guthrie, MD, MPH, FAAFP. Sunflower DPC.
